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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 31 out of 8,753

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VAERS ID: 1846475 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 RA / IM

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

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

Write-up: 0.5mL given instead of 0.25mL.


VAERS ID: 1846477 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 RA / IM

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

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

Write-up: 0.5mL given instead of 0.25mL.


VAERS ID: 1846481 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, 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), 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: fainting
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no known allergies
Diagnostic Lab Data: Blood pressure taken by EMT
CDC Split Type:

Write-up: Patient began to feel dizzy about 5 minutes after vaccination. Patient then passed out. Patient regained consciousness about 2 minutes after passing out. Emergency EMT were called and reported to the scene. Vitals were taken and patient denied further medical care.


VAERS ID: 1846485 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

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

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

Write-up: 0.5mL given instead of 0.25mL.


VAERS ID: 1846487 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-11-04
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Tested NAAT positive for COVID 11/4/21 after being fully vaccinated.


VAERS ID: 1846492 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-02
Onset:2021-11-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

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

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

Write-up: Hospitalization for COVID-19; received booster dose 11/2/2021; admitted 11/4/2021 to ICU; currently requiring HFNC.


VAERS ID: 1846495 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

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

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

Write-up: 0.5mL given instead of 0.25mL.


VAERS ID: 1846497 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-20
Onset:2021-11-04
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -

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

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

Write-up: Tested positive for Covid on 11/4/21. mild cold symptoms, mostly very tired


VAERS ID: 1846499 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

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

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

Write-up: 0.5mL given instead of 0.25mL.


VAERS ID: 1846505 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

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

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

Write-up: 0.5mL given instead of 0.25mL.


VAERS ID: 1846510 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 RA / IM

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

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

Write-up: 0.5mL given instead of 0.25mL.


VAERS ID: 1846520 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

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

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

Write-up: 0.5mL given instead of 0.25mL.


VAERS ID: 1846525 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 RA / IM

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

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

Write-up: 0.5mL given instead of 0.25mL.


VAERS ID: 1846527 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

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

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

Write-up: 0.5mL given instead of 0.25mL.


VAERS ID: 1846542 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-04
Onset:2021-11-04
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK - / -

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

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

Write-up: tested positive for Covid on 11/4/2021 reported congestion


VAERS ID: 1846547 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-11-04
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid+ on 11/04/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1846549 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-23
Onset:2021-11-04
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chest pain, Headache, Injection site reaction, Limb discomfort
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: I develop thick rushes on the injection site like a map and I feel my right arm is a bit heavy. I also feel some pinching inside my head and a knife stab feeling from my left chest going to my stomach the other day.


VAERS ID: 1846558 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-29
Onset:2021-11-04
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 11/04/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1846568 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-11-04
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 11/04/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1846573 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Unknown  
Location: Massachusetts  
Vaccinated:2021-03-03
Onset:2021-11-04
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -

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

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

Write-up: Tested positive on 11/04/21. Feels "fine" tested because we had two residents test positive. All residents had to be tested.


VAERS ID: 1846593 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-04
Onset:2021-11-04
   Days after vaccination:304
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

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

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

Write-up: Hospitalized


VAERS ID: 1846595 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-02-20
Onset:2021-11-04
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -

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

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

Write-up: Tested positive for Covid on 11/4 while conducting testing for all residents after two residents tested positive. Patient claims he is just feeling tired.


VAERS ID: 1846601 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-11-04
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hospitalized for syncope and found to have COVID positive diagnosis


VAERS ID: 1846603 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Feeling hot, Flushing, Hypersensitivity, Interchange of vaccine products, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen, imitrix
Current Illness: migraines
Preexisting Conditions:
Allergies: latex, demerol (past anaphylactic reaction), amoxicillin, sulfa drugs, onions
Diagnostic Lab Data: No tests or lab results
CDC Split Type:

Write-up: I had an allergic reaction. Doses 1 and 2 were Pfizer. The reaction started 4 minutes into the observation period and resolved 26 minutes into the observation period. My throat felt like it was closing and the pharmacist said I looked red/flushed. I got extremely warm. They had 2 pharmacists observing for worsening and ready with an epipen but epipen wasn''t needed and it resolved on its own. If this happens with other mix and match boosters then it might be worth advising people with a history of severe allergies to boost with the same vaccine as the original dose?


VAERS ID: 1846604 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 3 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Extra dose administered, Headache, Hyperhidrosis, Hypotension, Nausea
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Tessalon Perles, Oxybutynin, Montelukast, Bupropion, Rosuvastatin, Lisinopril, Levothyroxine, Duloxetine
Current Illness: N/A
Preexisting Conditions: Obesity, Hypertension, Obstructive sleep apnea, Irritable bowel syndrome, Dyslipidemia, Major Depression, Stress Incontinence,
Allergies: Carboplatin, Pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red hands, headache, nausea, low blood pressure and sweating


VAERS ID: 1846605 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-25
Onset:2021-11-04
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Injection site erythema, Injection site induration, Injection site inflammation, Injection site swelling, Injection site warmth, Pain, Pain in extremity, Vaccination site pain
SMQs:, Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: 2ND MODERNA DOSE EXPERIENCED 24 HOURS OF FEVER AND BODY ACHES
Other Medications: multivitamin, calcium, vitamin D
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: ARM SORE AND PAINFUL TO LIFT ON FIRST DAY AFTER VACCINATION. THEN BETTER. ON 11/04/21 CLIENT WOKE UP IN MIDDLE OF THE NIGHT TO BURNING SENSATION AT VACCINE SITE AND ARM. LOOKED AT ARM - ARM WAS RED, INFLAMED, HOT TO TOUCH, SLIGHTLY SWOLLEN AND FELT HARD AT INJECTION SITE. 12 HOURS LATER STILL WARM TO TOUCH, SLIGHTLY LESS RED AND LESS BURNING SENSATION. HAS IMPROVED


VAERS ID: 1846611 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 LA / IM

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

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

Write-up: Not an adverse event. The patient had her initial series completed with Pfizer on 5/21/2021. The patient was accidentally given a Moderna booster which is on EUA approved as of yet. Also time frame too short.


VAERS ID: 1846631 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F63527 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Hyperhidrosis, Immunodeficiency, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: 2nd Dose of Phizer 04/2021 ( fever, chills, nausea, excessive sweating lasting 72hrs)
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt.''s Wife states that after receiving the 3rd Booster Phizer 11/04/2021, started experiencing symptoms that evening of fever (103.3), fatigue, excessive sweating, and nausea. No noted Primary visit/communications. (Covid + Mid-April) 2nd Dose of Phizer 04/2021 similar reaction to above (Emergency Room visit, treated with IV Fluids for dehydration and nausea).


VAERS ID: 1846632 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-02
Onset:2021-11-04
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Tested positive for Covid after conducting testing for all residents. Patient claims to feel "fine".


VAERS ID: 1846660 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-13
Onset:2021-11-04
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / UNK - / -

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

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

Write-up: Tested positive on 11/04/21 while conducting testing for all of the residents. Patient claims to feel tired.


VAERS ID: 1846666 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN 500MG, FERROUS SULFATE 325MG, FLUTICASONE NASAL, GERI-LANTA 200-200-20 MG/5ML, LEVOTHYROXINE 50MCG, LOPERAMIDE 2MG, MILK OF MAGNESIA 400MG/5ML, PRESERVISION AREDS 2, VITAMIN B COMPLEX
Current Illness:
Preexisting Conditions: ATHEROSCHLEROSIS, HYPERLIPIDEMIA, COGNITIVE IMPAIRMENT, DECREASED VISION BILATERALLY, AORTIC ECTASIA, HYPERTENSION
Allergies: ASPIRIN, PENICILLIN, SULFA, NAPROSYN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was mistakenly given a dose of 0.5 mL instead of the protocol 0.25 mL dose for the Moderna booster dose.


VAERS ID: 1846670 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-20
Onset:2021-11-04
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Fatigue
SMQs:, Anaphylactic reaction (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: Tested positive on 11/04/2021. symptoms are tired and dry cough


VAERS ID: 1846677 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Flushing, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topical only: Bacitracin, emollients
Current Illness: Atopic Dermatitis
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None - VS stable
CDC Split Type:

Write-up: Patient received second COVID-19 vaccine around 1445 on NOV 4, 2021 and about 4 minutes later reported feeling flushed , hot and tightness in her throat and lightheaded. Vaccine was administered at an outlying clinic. Administrators on scene gave her half a milligram of epinephrine IM in the right thigh.. She was then transported b to ED and arrived at about 1516 where she reported she had a similar reaction after her first COVID19 vaccine, but she also received a penicillin injection at the same time and the allergy was determined at that time to probably be related to the penicillin injection. Patient monitored for 3 hours after epinephrine (0.5 mg IM) administered. At no time (on arrival, throughout stay, at discharge) did she exhibit hives, uvular swelling, stridor, wheezes or any other acute anaphylactic reaction. She was given acet325Tab, 975 mg, Oral; diphSol, 25 mg, IV Push (Intravenous); famotidine, 20 mg, IV Push (Intravenous); mecl25Tab - Shared, 25 mg, Oral; methylPREDNISolone sod succinate 125 mg vial, 125 mg, IV Push (Intravenous) ; NS1000bolus_IP, 1000 mL, IV Bolus (Intravenous). She was discharged with 5 day supply of prednisone and 10 days of Zyrtec.


VAERS ID: 1846683 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058FZ1A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sildenafil 20mg/oxybutyin 5mg/euthyrox 88mcg/ fish oil/ multi vit./-------flu shot-----oct
Current Illness:
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: headach musille pain fagtive


VAERS ID: 1846696 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

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

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

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


VAERS ID: 1846698 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Chills, Dehydration, Dizziness, Feeling cold, Gait disturbance, Influenza virus test, Pyrexia, Retching, SARS-CoV-2 test, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singular 10mg, nexium 40mg, Prozac 20mg, albuertol 90mg,Breo 200, zrytec, baby aspirin,
Current Illness: None
Preexisting Conditions: Asthma,
Allergies: None
Diagnostic Lab Data: COVID tests, flu tests, chest X-ray, IV fluids, pulse ox
CDC Split Type:

Write-up: Chills, fever, dry heaves, weak, throwing up, shaking, cold feeling, dehydration, vomiting, dizziness, went to the hospital in an ambulance, had trouble walking and they gave me IV fluids


VAERS ID: 1846707 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CALCIUM + VIT D3 600MG - 200 UNIT, DOCUSATE 100MG, FISH OIL 1000 MG, FUROSEMIDE 20MG, GABAPENTIN 300MG, HYDROCODONE + APAP 10-325 MG, LISINOPRIL 10MG, MULTIVITAMIN, OMEPRAZOLE 20MG, POLYETH GLYCOLE 3350 17 GRAMS/DOSE, TRIMETHOPRIM 100MG, VI
Current Illness:
Preexisting Conditions:
Allergies: SULFA, ANTI-INFLAMMATORY, CEFDINIR
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was mistakenly given a dose of 0.5 mL instead of the protocol dose of 0.25 mL for the Moderna booster. The patient''s family has been informed. The Long-Term Care facility at which the patient is residing has been notified and is monitoring the patient for adverse reactions. We have contacted Moderna as well, who have instructed us that the only risk we should expect is a slight increased chance in the normally observed vaccine-related side-effects.


VAERS ID: 1846708 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-20
Onset:2021-11-04
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -

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

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

Write-up: Tested positive for Covid on 11/4 while conducting testing for all associates and residents


VAERS ID: 1846711 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Site: Pain at Injection Site-Mild, Systemic: Fever-Severe


VAERS ID: 1846714 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER FE3592- / UNK LA / SYR
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / UNK AR / SYR
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK AR / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Headache, Inappropriate schedule of product administration, Insomnia, Nasopharyngitis, Pain, Pyrexia, Tremor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Vitamin D, Omega 3, Tramadol, Tylenol. Novolin, Atorvastatin,, ibuprofen, , oxybubutyn, proglitazone,prednisolone, ozempic, oxubutynin, pioglitazone,acemaminophen, vitamin c, Tylenol ,tumaric.
Current Illness: Back pain, numbness at r foot, light headache, low blood sugar.
Preexisting Conditions: Diabetic , cholesterol, high blood pressure
Allergies: No
Diagnostic Lab Data: N/A . Off work, sleep a lot to recover. Eat in small amounts of food to avoid nausea and vomiting and diarrhea. Drink a lot of water.
CDC Split Type:

Write-up: Fever, cold, can not sleep, diarrhea, shaking trembling , light headache, body ache, sharp pain in left shoulder, blurry vision on 2nd day. Take Tylenol, aspirin. Stop all other medicine. Blurry vision, on 2nd day.


VAERS ID: 1846716 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered
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: None
Current Illness: None
Preexisting Conditions: Enlarged tonsils.
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient was given an adult dose of the vaccine instead of the pediatric dose.


VAERS ID: 1846722 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Rash, Rash pruritic, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient received the Pfizer booster vaccine on 11-4-21, patient called on 11-5-2021 at 1030 and reported she developed a rash 1700 on her body except her face, stated rash was itchy and felt warm, patient denied any respiratory distress. Patient states went to the Urgent Care, but was taking long to be seen, she went home and took a benadryl at 1830, patient states rash, itching and and warmth was relieved with the benadryl, patient states the itchy and warmth returned at 0830, took benadryl at 0930 and was relieved again. At 1330 Called patient, patient states going to the Urgent Care now to be seen, patient states does not have the rash.


VAERS ID: 1846724 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALPHA LIPOIC ACID 200MG, BUPROPION SR 100MG, CETIRIZINE HCL 10MG, CLONAZEPAM 1MG, CRANBERRY 300MG, ESCITALOPRAM 20MG, LANSOPRAZOLE 30MG, MECLIZINE 12.5MG, MELOXICAM 7.5MG, NYSTATIN 100,000 UNIT/GRAM TOPICAL, OMEPRAZOLE 20MG, VITAMIN B COMPL
Current Illness:
Preexisting Conditions: MS, GENERALIZED WEAKNESS
Allergies: PEN G, AMOXICILLIN, ADHESIVE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was mistakenly given a dose of 0.5 mL instead of the protocol dose of 0.25 mL for the Moderna booster. The patient''s family has been informed. The Long-Term Care facility at which the patient is residing has been notified and is monitoring the patient for adverse reactions. We have contacted Moderna as well, who have instructed us that the only risk we should expect is a slight increased chance in the normally observed vaccine-related side-effects.


VAERS ID: 1846727 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-27
Onset:2021-11-04
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Nasal congestion, Pain, Productive cough, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

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

Write-up: productive cough, fever 101 yesterday, chills, body aches, nasal congestion. starting 11/4/21


VAERS ID: 1846735 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 - / IM

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

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

Write-up: Received 100mcg dose as her 3rd dose booster rather than 50mcg.


VAERS ID: 1846737 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ANXIETY, BUNION, CORONARY ARTERY DISEASE, HYPERLIPIDEMIA, HYPERTENSION, OSTEOARTHRITIS
Allergies: LISINOPRIL
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was mistakenly given a dose of 0.5 mL instead of the protocol dose of 0.25 mL for the Moderna booster. The patient''s family has been informed. The Long-Term Care facility at which the patient is residing has been notified and is monitoring the patient for adverse reactions. We have contacted Moderna as well, who have instructed us that the only risk we should expect is a slight increased chance in the normally observed vaccine-related side-effects.


VAERS ID: 1846745 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

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

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: 1st dose Moderna at age 69, she had a similar reaction to the reaction described above. She recieved 1st dose in January of 2021
Other Medications: Atorvastatin, Tylenol
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin, sulfa antibiotics
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: A couple hours after vaccine, redness occurred under band-aid. Hours later, injection site became raised and hot to the touch, itchy, red, and swollen.


VAERS ID: 1846755 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 LA / IM

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

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

Write-up: Received 100mcg Moderna COVID-19 3rd dose rather than approved 50mcg dose.


VAERS ID: 1846756 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Dyspnoea, Fatigue, Heart rate abnormal, Hypoaesthesia, Injection site pain, Nausea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Fever, fatigue, nausea, chills, tiredness, joint pain, body aches, numbness distal to injection site, rapid heart rate, difficulty breathing, abnormal heart rate, pain in injection site, soreness at injection sight.


VAERS ID: 1846759 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DISPLACED RIGHT FEMUR, SEPSIS, TOXIC ENCEPHALOPATHY, MAJOR DEPRESSIVE DISORDER
Allergies: SHELLFISH, STRAWBERRIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was mistakenly given a dose of 0.5 mL instead of the protocol dose of 0.25 mL for the Moderna booster. The patient''s family has been informed. The Long-Term Care facility at which the patient is residing has been notified and is monitoring the patient for adverse reactions. We have contacted Moderna as well, who have instructed us that the only risk we should expect is a slight increased chance in the normally observed vaccine-related side-effects.


VAERS ID: 1846761 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330268D / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular 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: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: na
CDC Split Type:

Write-up: pt was accompanied by her grandmother. Pt felt a little dizzy after the vaccine, but she said she always feels a little dizzy like this after any vaccine she has gotten in the past. We provided bottled water. Pt said she didn''t need ice pack. Pt sat in place for about 5 minutes, accompanied by her grandmother, and closely observed by me. Pt said she felt much better and felt normal. I asked the pt and grandmother to stay for extra 30 minutes just in case, even though pt was feeling normal now. Pt felt normal after 3 minutes, and had no other adverse effects at all after that. Pt and grandmother left after 30 minutes without incidence.


VAERS ID: 1846762 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Fatigue, Feeling abnormal, Indifference, Pallor, Piloerection, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Dyskinesia (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received his first dose of the Pfizer vaccine, roughly 3 seconds following administration, this patient''s upper body fell to the back of the chair he was sitting in, he then preceded to mildly shake, along with jerking movements in the upper limbs. He also appeared very pale in color. His father had supported him until the event was over. This event lasted roughly 5 seconds. Immediately following the event, the patient reported feeling "blurry", but within roughly 2 minutes following the event, the patient was asked his age and name, which he answered correctly -- he was alert by this point, but appeared tired and off-standish. We then offered him a ginger-ale which he accepted and drank. The patient along with his father and younger sister agreed to stay for 15-20 minutes following the event. The patient was not very talkative, but did not experience any other events during this time besides experiencing "goosebumps". After the 20 minutes passed, the patient and his family had left.


VAERS ID: 1846770 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: MILD COGNITIVE IMPAIRMENT, AGE RELATED DEBILITY, HYPERTENSION, ASBESTOS IN LUNGS, MACULAR DEGENERATION
Allergies: NONE KNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was mistakenly given a dose of 0.5 mL instead of the protocol dose of 0.25 mL for the Moderna booster. The patient''s family has been informed. The Long-Term Care facility at which the patient is residing has been notified and is monitoring the patient for adverse reactions. We have contacted Moderna as well, who have instructed us that the only risk we should expect is a slight increased chance in the normally observed vaccine-related side-effects.


VAERS ID: 1846771 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Contusion, Fall, Feeling abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal 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: Latanoprost, trazodone, levothyroxine, lisinopril, alendronate
Current Illness: No
Preexisting Conditions: Hypertension, thyroid disorder, mood disorder
Allergies: No
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: Patient woke up at 2:30 AM after having vaccine the previous morning. She stated she felt thick headed and could not see. Patient stated she fell twice and presented to pharmacy 11/5/21 with bruising on face.


VAERS ID: 1846772 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 RA / IM

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

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

Write-up: Received 100mcg Moderna COVID-19 booster instead of 50mcg approved dose.


VAERS ID: 1846777 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 RA / IM

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

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

Write-up: Patient was mistakenly given a dose of 0.5 mL instead of the protocol dose of 0.25 mL for the Moderna booster. We have attempted to contact the patient''s family, and left a message asking them to contact us that we may inform them. The Long-Term Care facility at which the patient is residing has been notified and is monitoring the patient for adverse reactions. We have contacted Moderna as well, who have instructed us that the only risk we should expect is a slight increased chance in the normally observed vaccine-related side-effects.


VAERS ID: 1846778 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Dizziness, Extra dose administered, Fatigue, Headache, Impaired work ability, Pain, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: In January of 2021, for 2nd shot of covid vaccine series, had a similar reaction. Fever, chills, aches, headache for 2-3 days. I
Other Medications: Baseline medications for lupus- plaquenil. (Recently stopped cellcept on September 15, 2021 after being weaned) Baseline medications for anxiety- zoloft, trazadone
Current Illness: None
Preexisting Conditions: Lupus
Allergies: Penicillins
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA Received vaccine 11/3 at 2:30 pm. On 11/4, around 1;30 am, I woke up out of my sleep due to severe chills, fever, aches, and a headache. Little improvement of fever with both Tylenol and Motrin. T-max was 103.6 on 11/4 at 2:00 pm. As of 11/5 (4:00 pm, time of writing this note), fever improving and chills stopped at 11:00 am. Still feeling achey/tired and lightheaded at times. Had to miss work today at the hospital due to fevers.


VAERS ID: 1846781 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

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

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

Write-up: Patient was mistakenly given a dose of 0.5 mL instead of the protocol dose of 0.25 mL for the Moderna booster. We have attempted to contact the patient''s family, and left a message asking them to contact us that we may inform them. The Long-Term Care facility at which the patient is residing has been notified and is monitoring the patient for adverse reactions. We have contacted Moderna as well, who have instructed us that the only risk we should expect is a slight increased chance in the normally observed vaccine-related side-effects.


VAERS ID: 1846791 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

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

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

Write-up: Patient was mistakenly given a dose of 0.5 mL instead of the protocol dose of 0.25 mL for the Moderna booster. We have attempted to contact the patient''s family, and left a message asking them to contact us that we may inform them. The Long-Term Care facility at which the patient is residing has been notified and is monitoring the patient for adverse reactions. We have contacted Moderna as well, who have instructed us that the only risk we should expect is a slight increased chance in the normally observed vaccine-related side-effects.


VAERS ID: 1846803 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

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

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

Write-up: Patient was mistakenly given a dose of 0.5 mL instead of the protocol dose of 0.25 mL for the Moderna booster. We have attempted to contact the patient''s family, and left a message asking them to contact us that we may inform them. The Long-Term Care facility at which the patient is residing has been notified and is monitoring the patient for adverse reactions. We have contacted Moderna as well, who have instructed us that the only risk we should expect is a slight increased chance in the normally observed vaccine-related side-effects.


VAERS ID: 1846822 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Balance disorder, Blood test normal, Chest discomfort, Cold sweat, Condition aggravated, Crying, Diarrhoea, Disorientation, Electric shock sensation, Eye pain, Eyelid pain, Fatigue, Feeling abnormal, Feeling cold, Gait disturbance, Gastrointestinal sounds abnormal, Headache, Hypotension, Influenza virus test negative, Injection site bruising, Joint stiffness, Limb discomfort, Musculoskeletal stiffness, Nausea, Pain, Pyrexia, SARS-CoV-2 test negative, Somnolence, Spinal pain, Tinnitus, Urine analysis normal
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: COVID Dose 1 and Dose 2 - had about 45 minutes following, I felt kind of off and over the next few hours I felt achy and joints
Other Medications: Concerta
Current Illness: No
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: COVID; flu - negative; bloodwork - no sign of infection or of any illness going on; they said they were symptoms attributed to booster. Urine test - no infection found.
CDC Split Type: vsafe

Write-up: About midnight, 12 hours after getting the shot, I woke up in the middle of night with severe pain; up and down my spine and back of head - like someone had hit me with sledgehammer. I took Tylenol and that dulled the pain but I was still in pain. Joints achy and stiff. I kind of expected the achy joints - happened the first two COVID shots. That morning, I tried to get ready for work - got slower and slower in movement and I had a whooshing sound in my ears. I felt very off. When I had woken up, initially, my eyelids hurt but by the time I got going in the morning, there was an intense throbbing behind my eyes. It felt like I was walking through quicksand. Every thing (all symptoms) got worse throughout the day. The injection site felt very bruised and it still does. That''s completely normal for me compared with the first doses of the COVID vaccine. There was not redness or swelling this time but just bruised. Yesterday, I got random sharp jabbing pains through various parts of my body; kind of like a shock or a pinched nerve feel. I felt queasy; I had three bouts of diarrhea and a lot of gurgling in my stomach after the diarrhea. From 02:30 - 09:00PM I was "dead to the world," and woke up with intense pain from head to toe. I was disoriented and I thought it was 03:00 in the morning. I texted my daughter to bring the thermometer as I felt chilled and clammy. Fever was 103. 6. My chest was very heavy and tight. I didn''t feel like I was wheezing or having trouble breathing but it was concerning to have the heaviness and tightness. I called my primary care doctor. On-call doctor told me to go to ER - since symptoms had worsening it was over 24 hours since vaccine. They tested me for COVID at ER. They gave me Tylenol and IV (Ibuprofen in an IV). And it all dulled the pain but the pain has still persisted. The fever goes down when I take Tylenol but then it goes back up but only up to 101. It was 99 something this morning but it''s 101 around 01:00 or 2:00 today but it''s gone back down again. Last night, not moving, my pain was 7 or 8. That was just sitting completely still. If I tried to move the pain was excruciating - it was hard to walk. Right now, the whooshing noise has decreased in my ears; the pain has decreased in joints - still stiff but I can move them. I don''t feel so disoriented. They said to come back in tonight if I''m not significantly improved. The pain is still definitely there and the fever is there but not as bad. They said about 20% of people will have a reaction to this extent for the booster. Blood pressure was significantly low when they took it at ER - 85/58 (my normal reading is 115-120/90). Treatment - stay in bed; Tylenol every six hours. Just before they discharged me this morning, at ER, my hands and feet felt very compressed; like they being smashed between boards. That was consistent pain for about two hours and when I got home and went to sleep and woke up it wasn''t quite as bad. Still stiff though. There''s a lot of fatigue. It takes a lot of effort just to have energy to get up and go to the bathroom. I don''t feel like I''m passing out but I just feel like I have to walk slowly to keep my balance because my leg joints and my feet are so stiff that trying to get them to move is a challenge; I haven''t felt like I was in danger of collapsing though or that I was going to pass out. The pain was enough to make me cry. I can''t believe I''m feeling this bad and that I''m not sick. Two months prior to this, I got the flu vaccine. I think it was on September 2, 2021. Got that at work: set up a flu vaccine site at one of our buildings for Employees. I got that in my right arm which I have never done before.


VAERS ID: 1846826 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH DON''T KNOW / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea, Pruritus, Skin burning sensation, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None with the exception of occasional Aleve and Excedrin.
Current Illness: Allergies + inconsistent diagnoses of bicuspid aortic valve with heart murmur
Preexisting Conditions:
Allergies: No known allergies to medications. Allergic to various outdoor allergens (ragweed, birch, oak) and some food items (e.g., salmon, hazelnuts).
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had a severe allergic anaphylactic reaction that consisted of restricted breathing and large, full body hives, that itched and burned.


VAERS ID: 1846838 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-01
Onset:2021-11-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Lip swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 Amoxicillin Bees
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Itching all over body and lip swelli g


VAERS ID: 1846839 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Deafness, 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: Women?s daily multivitamin
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Minor loss of hearing in right war accompanied by tinnitus. Following day, hearing ok but tinnitus continues. Tinnitus is not typical for me and I?m not sick wit congestion or anything.


VAERS ID: 1846840 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 RA / IM

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

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

Write-up: Received 100mcg Moderna COVID-19 booster rather than 50mcg approved dose.


VAERS ID: 1846844 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-05-23
Onset:2021-11-04
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Diabetes, Hyperlipidemia, Hypertension, Other (palpitations/tachycardia, obesity, migraines, ASD)
Allergies: Demerol, Floxin, penicillins, propantheline bromide, streptomycin, hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization after being fully vaccinated


VAERS ID: 1846848 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 RA / IM

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

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

Write-up: Received 100mcg Moderna COVID-19 booster rather than approved 50mcg dose.


VAERS ID: 1846855 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 RA / IM

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

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

Write-up: Received 100mcg dose of Moderna COVID-19 vaccine instead of approved 50mcg dose.


VAERS ID: 1846860 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-27
Onset:2021-11-04
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Cancer, Coronary Artery Disease, Congestive Heart Failure, CVA, Diabetes (t2), Hyperlipidemia, Hypertension, Myocardial Infarction and Reflux
Allergies: NKDA
Diagnostic Lab Data: positive covid pcr 11/4/21
CDC Split Type:

Write-up: hospitalization after being fully vaccinated


VAERS ID: 1846873 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 RA / IM

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

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

Write-up: Received 100mcg Moderna COVID-19 vaccine instead of approved 50mcg dose.


VAERS ID: 1846879 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, Underdose
SMQs:, Extravasation events (injections, infusions and implants) (broad), 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: Pediatric dose 0.2ml of Pfizer-BioNTech given to 12 year old girl who should have received adolescent/adult dose of 0.3ml Pfizer-BioNTech. Phone call to mom, on 11/05/2021 at 12pm to report error. Mom states patient has a little bit of injection site pain but feels fine otherwise. Mom appreciates the notice and questioned what dose she will get when she returns for second dose. Writer informed mom that patient will received the adolescent/adult 0.3ml dose of Pfizer-BioNTech. No other questions from om and patient is scheduled for second dose administration on 11/23/2021.


VAERS ID: 1846905 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-01
Onset:2021-11-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Retching, Vertigo
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu like symptoms after Moderna #2
Other Medications: Trospium Chloride ER 60m Losartan Potassium 100 mg Amlidipine Besylate 2.5 mg Atorvastatin 40mg (Lipitor) Omeprazole 10mg. ( Bupropion HCl 150x3 (Wellbutrin) Methylphenidate ER 54 mg. (Concerta) Paroxetine HCL 30mg For hot flashes/dep
Current Illness: N/a
Preexisting Conditions: Depression High Blood Pressure high Cholesterol GERD incontinence
Allergies: Codeine makes me nauseated
Diagnostic Lab Data: No labs or tests. Symptoms were clear
CDC Split Type:

Write-up: Acute/severe Vertigo. Started Thursday am at 7:00. World spinning. Nauseous. Dry heaves. Called and went to doctor. Also physical therapist.


VAERS ID: 1846909 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: severe body rash, 60, 10/13/2021, Pfizer
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, body aches, headache, chills


VAERS ID: 1846913 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Hypersensitivity (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: Lipitor?s 20mg, 600 IU vitamin E, 500mg zinc, vitamin B, 180 mg aspirin, Hair, skin & nails, 20mg Lutein, 1000IU fish oil, MusinexDM, Sudafed, daily multi-vitamin
Current Illness: Sinus infection 2x from day old CPAP water. However, I did not have the lack of energy that I?ve been experiencing all day
Preexisting Conditions: Obesity
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No energy, nose running thin mucas all day, sneezing


VAERS ID: 1846936 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Nausea, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: hydroxyzine, metoprolol, mirtazapine, isosorbide mononitrate, fluticasone, albuterol, nitroglycerin, metformin, aspirin, atorvastatin.
Current Illness: None
Preexisting Conditions: Anaphylaxis, Anxiety, Asthma, CAD(coronary artery disease), Depression, Hypertension, Hyperlipidemia,
Allergies: latex, SINEquan, Sulfa drugs
Diagnostic Lab Data: patient is hospitalized at this time.
CDC Split Type:

Write-up: Patient complained of shortness of breath, nausea and tingling sensation in hands.


VAERS ID: 1846942 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (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: Mirena IUD, Apri oral birth control
Current Illness: None
Preexisting Conditions: Exercise induced asthma, anxiety
Allergies: Nond
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received the Johnson and Johnson vaccine April 6th 2021. I received my moderna booster at 6:45pm. By 2am I was extremely nauseous and vomiting until 8am. My fever of 102 started around 8am, I needed to take Zofran in order to keep my Tylenol down. My fever with Tylenol 1000mg every 6 hours stayed around 101.5 until 48 hours after my vaccine. It is now 48 hours after my vaccine and I still have a 101.5 fever.


VAERS ID: 1846949 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Rash, Skin burning sensation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (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: Shellfish, Duragesic Patch
Diagnostic Lab Data:
CDC Split Type:

Write-up: Burning rash all over body.


VAERS ID: 1846957 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2953 / 3 LA / SYR

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

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

Write-up: Chills and body aches started taround noon on November 4. Chills lasted until around 2::00 am on November 5. Nausea, headache, diarrhea body aches on November 5. Headache still


VAERS ID: 1846970 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Public       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Gluten, shell fish, and peanuts.
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving my second nose of the pfizer vaccine I passed out from it.


VAERS ID: 1846973 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dry mouth, Mouth swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Dehydration (broad)

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

Write-up: Client reported dizziness and dry mouth. Reported having swelling in mouth, but no observable swelling. Taken to treatment area, put in wheelchair. Vital signs taken. Pulse oximetry 97 % on room air.


VAERS ID: 1846988 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Pt says she began menstruating the evening she was vaccinated. Menstruation was heavy. She says she has not menstruated in months, but denies going through menopause. No known hx of contraceptives.


VAERS ID: 1847016 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Extra dose administered, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: coumadin
Current Illness: none
Preexisting Conditions: Hx venous Thromboembolic disease Factor V Leiden Mutation
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vaccine Booster dose given. Pt ambulated to observation chair. While sitting, pt became dizzy and fainted. Placed in Trendelenbug position, immediately responsive to commands, VSS stable. Ice pack applied to head. Patient denies pain, Observed for 30 minutes. discharged home in stable condition.


VAERS ID: 1847159 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-02
Onset:2021-11-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, 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: UNKNOWN
Current Illness: UNKNOWN/ NONE REPORTED
Preexisting Conditions: UNKNOWN
Allergies: NKDA
Diagnostic Lab Data: SO FAR NONE
CDC Split Type:

Write-up: PATIENT CALLED TODAY 11/5/21 TO SAY THAT SHE HAD A RASH ON HER FACE. IT STARTED IN THE MORNING OF 11/4/21 BUT SEEMS TO BE WORSE TODAY. SAID ITS JUST THAT HER FACE IS RED AND BUMPY. NO SWELLING OR TROUBLE BREATHING. THE ONLY ISSUE SHE HAD WITH EITHER OF THE FRIST TWO DOSES WAS A DELAYED RASH ON HER ARM WITH THE SECOND DOSE. SHE SAID IT WAS SMALL AND JUST AROUND THE AREA, MUCH LIKE THE KNOWN REACTION CALLED "MODERNA ARM".


VAERS ID: 1847174 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Flushing, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto, memantine, seroquel, preservision
Current Illness: None
Preexisting Conditions: COPD, atrial fibrillation, Lewy body
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Elevated blood pressure, elevated pulse, serious flushing


VAERS ID: 1847176 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Hyperhidrosis, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Dizzy, light headed, sweating, dry heaving, vomiting, chills, very tired, exhausted. Past 36 hours and is continuing


VAERS ID: 1847185 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061F21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Chills, Fatigue, Headache, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chlorthalidone 25, vitamin D, vitamin B 12, vitamin C, biotin, and Allegra
Current Illness: No
Preexisting Conditions: hypertension
Allergies: heyfever
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Thursday- 11/4/21- Extremely sore arm and underarm, body aches, low grade fever, chills, headache, fatigue, nausea. Friday- 11/5/21 - Symptoms stayed the same, no improvement.


VAERS ID: 1847383 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

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

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

Write-up: On 11/04/2021 the patient was brought to the clinic by her Father to receive a Covid Vaccine. She was checked in and the vaccine information form was filled out, this was reviewed by myself with the father and daughter. We reviewed possible side effects at this time. She was then given 0.3 ml of the Pfizer covid vaccination in the right deltoid IM. They stayed for 15 minutes following the injection. The following day the Father returned with his other daughter to get a covid vaccine. It was at this time that it was realized that there had been an error in vaccinating the patient the previous day. It was at that time that RN discussed with the Father that an error had occurred when vaccinating the patient due to her age. He stated that she had woke this morning with a headache and a sore arm, and he gave her Tylenol at that time, and she went to school.. He also stated that at this time she was doing fine, and would continue to monitor her. He was advised by RN to contact their local provider of abnormal signs or symptoms.


VAERS ID: 1847387 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site discolouration
SMQs:

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

Write-up: Patient returned to pharmacy 11/5/2021 with a nickel-sized, purple mark at injection site.


VAERS ID: 1847621 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Hypoaesthesia, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan Ozempic. Paxil. Vitamins D, B 12, and C. ASA. MegaRed Zinc. Prilosec. Aleve PM. Metamucil.
Current Illness: None.
Preexisting Conditions: Type 2 Diabetes Depression Hypertension Elevated cholesterol Sleep apnea
Allergies: Penicillin
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Had Covid booster around 4 PM. By 10 PM both arms and hands were numb and tingling. Shot given in left arm. Right arm worse than left arm. Both hands tingling and extremely painful. Continues at time of report, just not as painful as last night.


VAERS ID: 1847624 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse event
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 1st dose as Moderna from a different facility on 9/14/2021. Per CDC guidelines pharmacy administered Moderna as second dose.


VAERS ID: 1847751 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT AVAILABLE
Current Illness: NOT AVAILABLE
Preexisting Conditions: NOT AVAILABLE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: NOT REPORTING ANY ADVERSE EFFECT JUST REPORTING THAT PATIENT GOT 3RD 0.25 ML DOSE BEFOR THE 6 MONTH THAT IS RECOMMENDED CALLED PATIENT TODAY DAUGHTER SAID THERE IS NO REACTION WHAT SO EVER DAUGHTER SAID HE IS DOING WELL NO REACTION AT ALL


VAERS ID: 1847754 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039FZIA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Headache, Lymphadenopathy, Myalgia, Night sweats, Pain, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (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: Pneumovax in 2002, swollen arm, redness at injection site and down arm. Resolved over several days
Other Medications: Amlodipine Super B vitamin Vitamin D Calcium tablets
Current Illness:
Preexisting Conditions: Hypertension
Allergies: Hydrocodone
Diagnostic Lab Data: Messaged my primary physician
CDC Split Type:

Write-up: Initially total body myalgia, diffuse headache, joint pain beginning 9 hours after injection. Continued the following day and noticed L neck swelling (ipsilateral side). No fever or pain noted. Second night had night sweats. Finally felt better the next morning but noticed the left neck supraclavicular lymph node swollen. Still no fever or pain at the neck site, just pain when lifting left arm.


VAERS ID: 1847764 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood creatinine increased, Blood thyroid stimulating hormone normal, Chest X-ray normal, Computerised tomogram head normal, Full blood count normal, Mental status changes, Metabolic function test normal, Pyrexia, Troponin normal, Urine analysis normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ, Micardis, ASA, lipitor, mobic, sertraline, nucynta, lyrica
Current Illness:
Preexisting Conditions: HTN, HL, OSA, Obesity, chronic pain
Allergies: none
Diagnostic Lab Data: CBC, CMP, TSH, troponin, urinalysis all within normal limits aside from Cr elevation to 1.5 from a baseline of 1.3. Chest x-ray and head CT with no acute process.
CDC Split Type:

Write-up: Patient developing fever, weakness and AMS after receiving the vaccine requiring admission to the hospital for AMS which resolved shortly after admission


VAERS ID: 1847771 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-18
Onset:2021-11-04
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamin, Labetalol
Current Illness: none
Preexisting Conditions: essential hypertension
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: early menses 10+ days early


VAERS ID: 1848629 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ? / 3 LA / SYR

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

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

Write-up: Red ring around the injection site.


VAERS ID: 1848632 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-03
Onset:2021-11-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (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: Same events; except persistent headache; 31 years old; 4/22/2021; second Pfizer shot.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, muscle pain, fatigue, headache for one day. Headache continues to persist at this time (5:40 am 11/6/2021).


VAERS ID: 1848633 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Hyperhidrosis, Immediate post-injection reaction, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Heavy sweating immediately following injection. Injection side (left) pain and injection side hip pain ensued following day. Fatigue. Nausea. Headache following day.


VAERS ID: 1848646 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-23
Onset:2021-11-04
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: Patient''s injection site developed a tender red rash approximately 5x2 inches in size 12 days after receiveing the vaccine.


VAERS ID: 1848674 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Aphasia, Confusional state, Dyspnoea, Fear, Hypoaesthesia, Loss of personal independence in daily activities
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mmj
Current Illness: Epilepsy, CND, TBI
Preexisting Conditions: Epilepsy, CND, TBI
Allergies: Buspar, tamiflu, MRI Dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Anaphylaxis- was riding bike home and had to stop and jump off bike legs went numb couldn''t breath and I couldn''t ask for help because I was too confused. This came in waves of 5 minutes or so until yesterday. Very scary.


VAERS ID: 1848681 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF 2570 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st covid shot on 10/14/2021
Other Medications: Quercetin, Berberine, multi-vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, fatigue, headache


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