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From the 9/17/2021 release of VAERS data:

Found 711,579 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 318 out of 7,116

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VAERS ID: 1524511 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-02-16
Onset:2021-07-31
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Nasal congestion, Rhinorrhoea, 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? No
Previous Vaccinations:
Other Medications: IUD, vitamin-C, loratadine, Sudafed, biotin, multivitamin
Current Illness: none
Preexisting Conditions: OSA, external hemorrhoid
Allergies: shellfish
Diagnostic Lab Data: COVID positive PCR on 08/02/2021
CDC Split Type:

Write-up: nasal congestion, runny nose. COVID positive PCR on 08/02/2021


VAERS ID: 1524514 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-25
Onset:2021-07-31
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: COVID positive PCR on 08/02/2021
CDC Split Type:

Write-up: cough, sore throat. COVID positive PCR on 08/02/2021


VAERS ID: 1524531 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-31
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Condition aggravated, Epistaxis, Fear, Impaired work ability, Mobility decreased, Muscle spasms, Somnolence, Vaccination complication
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta, Lexapro, Livalo, Xanax, Lyrica
Current Illness: None
Preexisting Conditions: Depression, Anxiety, High Cholesterol, IBS, Neuropathic Pain
Allergies: doxycycline
Diagnostic Lab Data: Didn''t complete any at this point in time.
CDC Split Type:

Write-up: On 7/31/21 around 8pm that evening, I had a spontaneous bloody nose. The worst one I have ever had in my life. It took a whole roll of toilet paper to shove in my nose, apply pressure and stop the bleed. It was bleeding so bad, I couldn''t keep up with the flow and thus got blood all over my new leather chair. When it was done after about 45 minutes, it looked like a murder scene that I had to clean up. On 8/3/21 around 8am, I woke up in the morning with an extremely painful back spasm. I immediately laid on a heating/massaging pad and took 2 Advil for 3 hours. When I tried to move the pain was still there. I took more Advil and continued the heating/massage pad. I fell asleep until 4pm. My back was still in tremendous pain. It was my my lower back, just to the left of my spine. At this time, I took 250mg of Soma and rested more on the heating/massage pad. Around 8pm, I tried to get up and walk a little. the Soma (muscle relaxant worked on the paid about 50% bringing the pain level down from a 9 to about a 6. I took another Soma and got back on the heating/massage pad. Around 10pm, I took another 250mg Soma as my back was still spasming and still in pain. Needless to say, I couldn''t go to work today, it was too painful to move. I was unable to eat because the pain was too much. I was able to drink a small amount of cold water. I have never had any back pain, problems or spasms in my entire life. This pain was highly unusual and very scary. I have determined by talking with other health care professionals that my nose bleed and back spasms were directly related to the 1st dose of the Covid vaccine, Moderna that was administered on 7.30.21.


VAERS ID: 1524791 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-31
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Emotional distress, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210800603

Write-up: BLURRY RIGHT EYE; DISTRESSED MOOD; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 30-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 31-JUL-2021, the subject experienced blurry right eye. On 31-JUL-2021, the subject experienced distressed mood. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from blurry right eye, and the outcome of distressed mood was not reported. This report was non-serious.; Sender''s Comments: V0: Medical Assessment Comment not required as per standard procedure as case assessed as non-serious.


VAERS ID: 1524801 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-07-31
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202AZIA / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Body temperature, Menstruation irregular, Muscle spasms, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient had no known medical history.
Allergies:
Diagnostic Lab Data: Test Date: 20210731; Test Name: Body temperature; Result Unstructured Data: 99 F
CDC Split Type: USJNJFOC20210801065

Write-up: CRAMPS IN BODY; PERIODS STARTED ONE WEEK EARLY THAN USUAL; CRAMPS IN STOMACH; FEVER; This spontaneous report received from a parent concerned a 19 year old female. The patient''s weight was 60 kilograms, and height was 164 centimeters. The patient''s pre-existing medical conditions included patient had no known medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A and expiry: UNKNOWN) dose was not reported, administered on 30-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 31-JUL-2021, the subject experienced cramps in body. On 31-JUL-2021, the subject experienced periods started one week early than usual. On 31-JUL-2021, the subject experienced cramps in stomach. On 31-JUL-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 99 F. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from fever, and the outcome of cramps in body, periods started one week early than usual and cramps in stomach was not reported. This report was non-serious.


VAERS ID: 1524805 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-07-31
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Nausea, Pain, Pyrexia, Vision blurred
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: USJNJFOC20210801244

Write-up: LOT OF BODY PAIN (LEGS, BACK, ARMS, NECK); BLURRY SPOTS IN VISION; NAUSEA; FEVER; This spontaneous report received from a consumer concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 30-JUL-2021 for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch number. No concomitant medications were reported. On 31-JUL-2021, the subject experienced lot of body pain (legs, back, arms, neck). On 31-JUL-2021, the subject experienced blurry spots in vision. On 31-JUL-2021, the subject experienced nausea. On 31-JUL-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from blurry spots in vision, and had not recovered from lot of body pain (legs, back, arms, neck), nausea, and fever. This report was non-serious.


VAERS ID: 1524806 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-07-31
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Food allergy; Osteoporosis (Patient took meds for osteoporosis); Shellfish allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Gastric bypass; Hysterectomy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210801423

Write-up: RASH TO UNDERARM AND STILL PAINFUL TO THE SITE; This spontaneous report received from a patient concerned a 65 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included gastric bypass, and hysterectomy, and concurrent conditions included osteoporosis, shellfish allergy, and coconut allergy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207a21a,and expiry: 21-SEP-2021) dose was not reported, administered on 20-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 31-JUL-2021, the subject experienced rash to underarm and still painful to the site. Treatment medications (dates unspecified) included: cortisone. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rash to underarm and still painful to the site. This report was non-serious.


VAERS ID: 1525370 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1525610 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

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

Write-up: Symptoms started a little less than 24 hours later. Some stiffness in left arm started in the morning after the shot. Other symptoms were mild fatigue and persistent headache. I got the shot Friday evening, all side effects were gone by early Sunday. I took ibuprofen and Tylenol as advised by pharmacist.


VAERS ID: 1525635 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-04-27
Onset:2021-07-31
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pravastatin, Allopurinol, Verapamil and aspirin
Current Illness: A.fib, HTN
Preexisting Conditions: A.fib, HTN
Allergies: NKDA
Diagnostic Lab Data: SARS-COV-2, QUALITATIVE, NAA (COVID-19) Order: 196015024 Status: Final result Visible to patient: Yes (kp.org) Next appt: 11/15/2021 at 02:30 PM in Optometry Dx: CORONAVIRUS COVID-19 DISEASE Specimen Information: NASOPHARYNGEAL SWAB 1 Result Note Ref Range & Units 8/3/21 9:23 AM SARS-COV-2 NAA (COVID-19) Detected Abnormal Comment: Test performed by polymerase chain reaction (PCR). This is a Nucleic Acid Amplification Test (NAAT) which is a molecular assay also known as PCR, RT-PCR, or TMA. Disclaimer: This test has not been FDA cleared or approved. This test has been authorized by FDA under an Emergency Use Authorization (EUA) for use by authorized laboratories. Please see fact sheet for healthcare providers & fact sheet for patients posted on the Lab Services intranet website.
CDC Split Type:

Write-up: Pt received 2 doses of COVID Pfizer vaccines - contracted COVID-19 mild symptoms on 8/3/21 Immunizations COVID-19 Vaccine, PFIZER, External administration 4/27/2021, 4/4/2021 Dose Site Route Manufacturer Lot # Product 4/27/2021 Given 0.3 mL EW0171 Delete History 4/4/2021 Given 0.3 mL ER8732


VAERS ID: 1525642 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-29
Onset:2021-07-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Diarrhoea, Fatigue, Headache, Myalgia, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Anxiety, Depression
Allergies: Unknown
Diagnostic Lab Data: Covid 19 Rapid Antigen
CDC Split Type:

Write-up: Case symptom onset was 7/31/2021. Symptoms included muscle aches, runny nose, sore throat, loss of taste and smell, headache, fatigue, cough, abdominal pain and diarrhea. Case was still symptomatic upon Case Investigation completed on 8/4/21.


VAERS ID: 1525657 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: swollen, tender to touch, and lump at injection site


VAERS ID: 1525762 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Pain in extremity
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: HR 87 (self-tested and reported from home during event).
CDC Split Type:

Write-up: Extreme pain in arm and left side of chest for 2 days (Saturday and Sunday; July 31st and August 1st). Patient drank water and took Tylenol and symptoms/event has since resolved. Advised patient that she can consult her physician prior to receiving second dose.


VAERS ID: 1525809 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-11
Onset:2021-07-31
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Dehydration, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ? acetaminophen ? buPROPion ? celecoxib ? cetirizine ? Collagen Crea ? DULoxetine ? fludrocortisone ? losartan ? melatonin ? omeprazole ? oxybutynin
Current Illness: 1. COVID-19 Virus 2. Gastroenteritis 2/2 COVID -19 3. Sepsis 4. AKI 5. Chronic diastolic heart failure 6. Depression 7. Hypertension 8. GERD 9. Overactive bladder
Preexisting Conditions: Hypertension and depression
Allergies: Lisinopril Penicillin
Diagnostic Lab Data: COVID-19 PCR, Rapid Order: 332854019 Collected: 7/31/2021 14:22 Status: Final result Visible to patient: Yes Specimen Information: Nasopharynx; Swabbed Collection
CDC Split Type:

Write-up: Patient was dx''d with covid on 7/31/2021. She was short of breathe, weak, dehydrated, developed a cough.


VAERS ID: 1525820 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-19
Onset:2021-07-31
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ? acetaminophen (TYLENOL) 500 MG tablet Take 1,000 mg by mouth 2 times daily as needed for Pain. ? alendronate (FOSAMAX) 70 MG tablet Take 70 mg by mouth per week. Take with water 30 min before breakfast on Fridays. ? amLODIPine (NORVASC) 5
Current Illness: ? Scalp laceration ? History of angina ? Dizziness ? Insomnia ? Constipation ? Fall ? UTI (urinary tract infection) ? Lower extremity edema ? SDH (subdural hematoma) ? Syncope, unspecified syncope type
Preexisting Conditions: Hx of intracranial hemorrhage ? GERD (gastroesophageal reflux disease) ? Hypothyroidism ? Hydrocephalus ? HLD (hyperlipidemia) ? OSA (obstructive sleep apnea) 0 ? Coronary artery disease involving native coronary artery of native heart, angina presence unspecified ? HTN (hypertension)
Allergies: Contrast Dye [Ivp Dye, Iodine Containing] Contrast Dye [Ivp Dye, Iodine Containing]HivesMedium8/2/2019Deletion Reason: Gluten GlutenNot Specified8/2/2021Deletion Reason: Oxycodone OxycodoneNot Specified8/2/2019Deletion Reason: Sulfa Drugs
Diagnostic Lab Data: COVID-19 PCR Order: 332838224 Status: Final result Visible to patient: Yes Specimen Information: Nasopharynx; Swabbed Collection
CDC Split Type:

Write-up: Patients family was concerned with her extreme weakness and fatigue. Upon ER arrival she was dx''d with COVID19.


VAERS ID: 1525837 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-07-31
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19/SARS-COV2, PCR 8/3/21 POSITIVE
CDC Split Type:

Write-up: COVID positive $g14 days post vaccine series


VAERS ID: 1525876 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-07-31
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / UNK RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Rhinnitis
Preexisting Conditions: Diabetes, Heart Disease, Asthma, Emphysema, COPD, Pulmonary Fibrosis(2-4 Years to live)
Allergies:
Diagnostic Lab Data: 8/28/21 Antigen
CDC Split Type:

Write-up: Developed Covid 7/31/2021


VAERS ID: 1525932 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood luteinising hormone decreased
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: Folic Acid 800 mcg one by mouth daily
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: 7/28/21 @ 7:28 am LH: 0.24 7/29/21 @ 7:12am LH: 0.25 7/29/21 @ 10:21 am LH: 0.15 7/30/21 @ 7:55am LH: 0.55 7/30/21 @ 12:14pm LH: 0.39 7/30/21 @ 10:08pm LH: 0.33 7/31/21 @ 8:34am LH: 0.66 7/31/21 @ 8:25am LH: 0.66 8/1/21 @ 7:51pm LH: 0.12 8/2/21 @ 9:11am LH: 0.16 8/3/21 @ 11:27am LH: 0.16 8/4/21 @ 10:47am LH: 0.14
CDC Split Type:

Write-up: I have been tracking my ovulation over the past several months by way of LH ovulation test strips as I am actively trying to get pregnant. I have always had a LH peak each month. I have never missed a LH peak. The day after receiving my first dose of the covid-19 moderna vaccine, my LH peak which was on the rise had a sharp decline on 7/31/21. I am not sure if this is due to chance, but I am very upset this means I am likely not going to be able to get pregnant this month. Feel free to reach out and follow along. I am eager to see if getting the second dose at the end of the month will prevent next expected ovulation. My employer is mandating the vaccine in order to remain employed. I was also encouraged to get the vaccine by my healthcare provider. I am pro vaccines, but if this did not occur by chance, I wanted to make sure it was documented.


VAERS ID: 1525948 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: injection site pain/soreness, fatigue, headaches, and muscle aches beginning 4-6 hours after injection; fatigue, headaches, and muscle aches resolved by day 4; mild residual injection site tenderness


VAERS ID: 1525960 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin 40mg losartan 50mg low does asprin fish oil
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: BP of 200/100, HR of 160+ (while sitting down, nothing active at time of symptoms)


VAERS ID: 1525976 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 RA / IM

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

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

Write-up: Nausea, vomiting,diarrhea for 4 days, headache


VAERS ID: 1525979 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-08
Onset:2021-07-31
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fall
SMQs:, Accidents and injuries (narrow)

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

Write-up: A Symptomatic, patient was admitted to hospital due to fall


VAERS ID: 1525996 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fainting in middle school with MMR vaccine
Other Medications: none stated or listed on agency
Current Illness: none stated or listed on agency
Preexisting Conditions: none stated or listed on agency
Allergies: none stated or listed on agency
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Within 10-15 minutes patient fainted and woke up with no other issues. Breathing was normal throughout this time period. Some sweating.


VAERS ID: 1526008 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa drugs
Diagnostic Lab Data: None. will continue to monitor menstrual cycle
CDC Split Type:

Write-up: The morning after taking first injection I started my menstrual cycle which was 9 days early. I never start even a day early. I also had a heavy nose bleed on that day after my first vaccination.


VAERS ID: 1526278 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-09
Onset:2021-07-31
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain lower, Blood triglycerides increased, Diabetic ketoacidosis, Flank pain, Hyperlipidaemia, Laboratory test, Pancreatitis, Plasmapheresis, SARS-CoV-2 test
SMQs:, Acute pancreatitis (narrow), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Home Medications Reviewed on 07/30/21 at 0041 Med Sig Last Dose Dt/Time Biktarvy 50-200-25 MG PO Tab TAKE 1 TABLET BY MOUTH DAILY 7/29/2021 Unknown time Med Note Cobalamin Combinations (B-12) 100-5000 MCG SL SL Tab place 1 E
Current Illness: Past Medical History: Diagnosis Date ? Anal fistula ? Diabetes mellitus, type II ? GERD (gastroesophageal reflux disease) ? HIV (human immunodeficiency virus infection)
Preexisting Conditions: Past Medical History: Diagnosis Date ? Anal fistula ? Diabetes mellitus, type II ? GERD (gastroesophageal reflux disease) ? HIV (human immunodeficiency virus infection)
Allergies: No known allergies
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) Micro Not Detected Detected Abnormal Narrative The SARS-CoV-2 (COVID-19) test is for in vitro diagnostic use This test has not been cleared or approved. Methodology: Nucleic Acid Amplification (NAA)/Polymerase Chain Reaction (PCR). Specimen Collected: 07/30/21 12:20 PM Last Resulted: 07/30/21 1:47 PM
CDC Split Type:

Write-up: This patient is a vaccinated male who travels throughout the country and overseas on business. Due to the travel he is frequently tested for Covid. He indicates having clinical disease with the typical symptoms in December through early January. He was able to manage at home and did not require admission or intensive services. A family member owns a device which he used for respiratory support. He was vaccinated for Covid with his second dose 7/6. He has no known exposures. He currently has no symptoms consistent with Covid He presented yesterday with a complaint of right lower quadrant abdominal and flank pain. Evaluation in the emergency room identified pancreatitis hyperlipidemia and laboratory consistent with DKA. With his triglycerides greater than 7500 a Quinton was placed in the right IJ position and plasmapheresis performed. Insulin drip and support was administered. He feels better today. Intravenous Ancef and Flagyl were administered for support.


VAERS ID: 1526285 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 575HC / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Pain in jaw, Paraesthesia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The patient called with-in 1 hour of receiving these vaccinations to report jaw tingling/pain/swelling that started on the right side of jaw, but spread to both sides of the faces. No itching or hive or difficulty with breathing. Took a Benadryl tablet (not sure what strength) while on the phone with me. There was a family member with the patient at the time.I called back to check around 2:45 PM and the patient said that they were doing ok, a little headache, but the swelling was better. Left v/m on 8-3-21 to follow up as well, no response as yet. Patient called back and said doing fine. Arm never hurt, started with tingling in jaw and both sides of face swollen. Benadryl took care of swelling.


VAERS ID: 1526303 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-16
Onset:2021-07-31
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac tamponade, Cardiogenic shock, Computerised tomogram abdomen, Computerised tomogram pelvis, Computerised tomogram thorax, Echocardiogram, Pericardial drainage, Pericardial effusion
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Haemodynamic oedema, effusions and fluid overload (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? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol 650mg q8hr, carvedilol 25mg BID, cholecalciferol 25mcg qd, hydralazine 100mg TID, glargine 5 units qHS, pravastatin 10mg qHS, Rena-Vite 0.8mg qd, Sevelamer carbonate 2400mg TID,
Current Illness: ESRD on dialysis, 1 episode of dyspnea
Preexisting Conditions: She has a past medical history of A-V fistula, Anemia due to chronic kidney disease, Anemia, iron deficiency, Chronic kidney disease, Congestive heart failure, Depression, Diabetes mellitus, Diabetic nephropathy, Former tobacco use, High blood pressure, History of blood clots, Nephrosclerosis, and Peptic ulceration.
Allergies: Ceftriaxone sodium; Hydromorphone; Aranesp (in albumin) [darbepoetin alfa-albumin]; Ciprofloxacin; Hydrocodone bitartrate; Lidocaine hcl; Macrolide antibiotics; Metronidazole; Mircera [epoetin beta, methoxy peg]; Morphine; Phoslo [calcium acetate(phosphat bind)]; Quinolones; Renvela [sevelamer carbonate]; Retacrit [epoetin alfa-epbx]; Sulfa (sulfonamide antibiotics); and Zithromax [azithromycin]
Diagnostic Lab Data: Pericardiocentesis 7/31, CT angiogram chest/abd/pelvis 7/31, transthoracic echocardiogram x2 7/31 and 8/3
CDC Split Type:

Write-up: Pericardial effusion with tamponade requiring emergent pericardiocentesis, currently still admitted to hospital with s/p cardiogenic shock. Currently receiving colchicine 06mg twice weekly, holding on low dose NSAIDs as patient also has ESRD.


VAERS ID: 1526325 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-07-31
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 - / IM

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

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

Write-up: Patient developed a fever. It got up to 101 F. She went to doctor and tested positive for Covid. Hospitalized.


VAERS ID: 1526515 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-05-19
Onset:2021-07-31
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: SARS-CoV-2 test, Vaccine breakthrough infection
SMQs:, 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:
Current Illness:
Preexisting Conditions: COPD
Allergies: NKDA
Diagnostic Lab Data: Sofia SARS Antigen FIA
CDC Split Type:

Write-up: Breakthrough COVID19 infection


VAERS ID: 1526524 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-01
Onset:2021-07-31
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: minor. red and sore
Other Medications: NO
Current Illness: NO
Preexisting Conditions: autoimmune disorders
Allergies: penicillin
Diagnostic Lab Data: no. N/A
CDC Split Type:

Write-up: SWOLLEN ARM. A BIG RED SPOT ABOUT 4 ICHES AND PAIN TO THE COLLORBONE AND PAIN IN A LYMPH NOTE. IS GETTING WORSE.


VAERS ID: 1526525 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939893 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Vaccination site induration, Vaccination site pain, Vaccination site warmth
SMQs:, Extravasation events (injections, infusions and implants) (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: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient experienced ''Covid arm.'' It was reported to the pharmacy 5 days after the vaccination. She complained of a warm, hard, painful and itchy arm on the side the vaccine was administered. The redness seemed to spread some, but was overall improving. She did try a muscle rub that helped with the pain. She was going to try Benadryl to see if that improved it.


VAERS ID: 1526534 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939893 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site warmth, Post-acute COVID-19 syndrome
SMQs:, Extravasation events (injections, infusions and implants) (broad), COVID-19 (narrow)

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

Write-up: Patient reported experiencing ''Covid arm'' the day after her Covid vaccine, but the pharmacy was notified 5 days later. She reported a warm, hard, painful, itchy arm on the side the vaccine was administered. The redness seemed to spread, but was overall, it was getting better. She applied a muscle rub to the area that helped with the pain. She was going to try Benadryl.


VAERS ID: 1526543 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Heart rate increased, Sleep disorder, Vaccination site pain
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol Succinate 25mg once daily Losartan 50mg once daily
Current Illness:
Preexisting Conditions: Hypertension. Two-time cancer survivor (cancer-free at time of vaccination)
Allergies:
Diagnostic Lab Data: HR 117 bpm (self-measured at home late night July 31st or early morning August 1st)
CDC Split Type:

Write-up: Patient reported extreme pain in vaccinated arm and in corresponding side of chest over the weekend following vaccination (Saturday July 31st and Sunday August 1st). Patient also reported waking up in the middle of the night in between previously stated days during the weekend with extremely high heart rate. Patient took one of his blood pressure medications to lower heart rate. He only takes these medications on an ''as needed'' basis otherwise. Heart rate returned to normal after taking blood pressure medication. Patient reported normal blood pressure readings during event. Advised patient''s wife to consult physician to determine appropriateness of receving a second dose.


VAERS ID: 1526767 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-28
Onset:2021-07-31
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram ST segment elevation, Fatigue, Myalgia, Myocarditis, Pyrexia, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: buPROPion (WELLBUTRIN XL) 150 MG 24 hr tablet cetirizine (ZYRTEC) 10 MG tablet colchicine (COLCRYS) 0.6 MG tablet methylphenidate ER (CONCERTA) 54 MG controlled release tablet naproxen (NAPROSYN) 500 MG tablet
Current Illness: NA
Preexisting Conditions: Attention deficit hyperactivity disorder (ADHD), predominantly inattentive type Generalized anxiety disorder Current mild episode of major depressive disorder without prior episode (HCC) Acne vulgaris
Allergies: NKDA
Diagnostic Lab Data: Note Discussed with Dr. Troponin lab from today still pending as of 1:15pm. Hospital to call with STAT results as soon as it is processed. In the meantime, to stop Ibuprofen, start Naproxen 500mg BID x 14 days, and start Colchicine 1.2 mg BID for one day then 0.6mg BID x 6 days. OP echocardiogram to be completed on the first business day after they return from vacation. Should patient be experiencing any symptoms of chest pain or shortness of breath, to be direct admitted. Per Mom, patient is denying any shortness of breath, chest pain, or other cardiac symptoms. They return on Thursday, so OP echo to be scheduled for Friday (order placed). Reviewed the medication changes with Mom, who verbalized understanding. Thee prescriptions were sent to pharmacy per her request.
CDC Split Type:

Write-up: Myocarditis Patient is a 14 y.o. male with no past medical history who presented to the ED today due to acute chest pain. He received his second mRNA COVID vaccine on 7/28, that night he developed a fever and over the next two days had some muscle aches, fatigue and continued fevers. This morning he woke up with left sided chest pain, not reproducible and unaffected by his breathing. He denies any palpitations, shortness of breath or syncope. He was seen in urgent care which found ST elevation on EKG and sent him to HDVCH ED. EKG here confirmed ST elevation, troponin found to be elevated at 147. His chest pain improved with ibuprofen. He was admitted to cardiology service for continued monitoring. HOSPITAL COURSE: Patient is a 14 y.o. male with no past medical history who presented after 2nd mRNA COVID vaccine with chest pain, ST changes on EKG and elevated troponin. He was admitted to the cardiology service for ongoing evaluation of myocarditis. He was started on ibuprofen every 6 hours for inflammation with resolution of his pain. His ECHO demonstrated normal cardiac structure and function. EKG at time of discharge showed improvement in ST elevation. Serial troponin levels continue to be elevated, but not rapidly increasing (147, 229, 243, 267), he will get a repeat troponin tomorrow as outpatient. ID was consulted this admission and myocarditis labs are still pending. He will continue 600mg Motrin TID until troponin level improves. He will have scheduled follow up with Dr in 3 weeks.


VAERS ID: 1526938 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came into the pharmacy and requested a Covid vaccine. Pt filled out the form and discussed the screening questions and EUA with the RPh. Pt said this was her 1st covid dose. She was administered the vaccine and reminded to come back in a minimum of 3 weeks for a 2nd dose to complete the series.Pt''s family member called later upset. They said she already completed the series and has memory issues. Apparently she was sent here to request a Covid test but requested and went through with a 3rd Pfizer vaccine instead. She was not scheduled to get a Covid test either at our store. Pt''s family member was urged to come in and fill out a form if pt is not able to manage her prescriptions/healthcare, but no form has been received yet. An internal pharmacy report was also made on the 3rd dose.


VAERS ID: 1527323 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-31
Onset:2021-07-31
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: BK virus infection, Blood culture, Blood test, COVID-19, Chills, Computerised tomogram abdomen, Computerised tomogram thorax, Cytomegalovirus test, Diarrhoea, Full blood count, Pyrexia, Renal failure, Urine analysis, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cellcept, Prograft, Prednisone, Norvasc, Labetalol, Lipitor, Lisinopril
Current Illness: Covid19 infection: onset of symptoms 7/31/2021. Admit to hospital 8/4/2021 for breakthrough infection and renal failure
Preexisting Conditions: renal transplant in 2009, CMV infection 2013, genital HSV-2/staph infection 2020, chronic antibody mediated renal transplant rejection.
Allergies: Penicillin
Diagnostic Lab Data: chem7, cbc, blood culture, urine test, CMV, BK virus. CT chest/abd/pelvis
CDC Split Type:

Write-up: breakthrough covid19 infection - onset of symptoms 7/31/2021 and admitted to hospital for fever/chills, diarrhea and renal failure on 8/4/2021


VAERS ID: 1527347 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Intermenstrual 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: Wellbutrin - 300mg 1x per day Seroquel - 100mg 1x per day Seroquel - 25mg as needed Klonopin - 1mg 2x per day
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: D11S271

Write-up: On 7/31 I experienced painful, heavy period-like cramps and a small amount of spotting, 10 days before the predicted start date of my period. I had no symptoms until mid afternoon 8/4 and my period began one whole week early.


VAERS ID: 1527853 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-21
Onset:2021-07-31
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 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: tested positive for COVID on 7/31/2021.
CDC Split Type:

Write-up: tested positive for COVID on 7/31/2021.


VAERS ID: 1527855 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-03
Onset:2021-07-31
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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: tested positive for COVID on 7/31/2021
CDC Split Type:

Write-up: Patient was exposed to someone with COVID on 7/30/2021, he did not develop symptoms, he tested positive for COVID on 7/31/2021


VAERS ID: 1528141 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-07-31
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Discomfort, Dizziness, Dysarthria, Headache, Influenza, Muscle tightness, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210801647

Write-up: HEAVY ALL OVER; BODY ACHES ALL OVER; MUSCLE TIGHT; SLURRING WORDS; FEEL DIZZY; REAL BAD CASE OF THE FLU; POUNDING HEADACHE; SORE DELTOID FOR A FEW MINUTES/FELT IT IN HIS HANDS AND ARMS; This spontaneous report received from a patient concerned a 41 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included asthma. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and expiry: UNKNOWN) dose was not reported, administered on 31-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 31-JUL-2021, the subject experienced sore deltoid for a few minutes/felt it in his hands and arms. On 01-AUG-2021, the subject experienced heavy all over. On 01-AUG-2021, the subject experienced body aches all over. On 01-AUG-2021, the subject experienced muscle tight. On 01-AUG-2021, the subject experienced slurring words. On 01-AUG-2021, the subject experienced feel dizzy. On 01-AUG-2021, the subject experienced real bad case of the flu. On 01-AUG-2021, the subject experienced pounding headache. Treatment medications included: paracetamol. Additional treatment medications (dates unspecified) included: menthol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from slurring words, feel dizzy, and real bad case of the flu, and sore deltoid for a few minutes on 31-JUL-2021, and had not recovered from heavy all over, pounding headache, body aches all over, and muscle tight. This report was non-serious.


VAERS ID: 1528273 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-07
Onset:2021-07-31
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 - / -

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: tested positive for COVID on 7/31/2021
CDC Split Type:

Write-up: patient was exposed to COVID on 07/24, she is asymptomatic, tested positive for COVID on 7/31/2021


VAERS ID: 1528369 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-07-31
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient does not know where or how he got the virus, but said once masking mandates were lifted, he stopped wearing masks indoors.
Allergies:
Diagnostic Lab Data: Test Date: 20210731; Test Name: COVID-19 virus test; Result Unstructured Data: positive
CDC Split Type: USJNJFOC20210802984

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient via a company representative via social media (news article, KATU 2 ABC) concerned a male of unspecified age. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included patient does not know where or how he got the virus, but said once masking mandates were lifted, he stopped wearing masks indoors. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, 1 total, start therapy date was not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 31-JUL-2021, the patient was tested positive for covid-19 using home testing kit (suspected clinical vaccination failure and suspected covid-19 infection), the patient experienced symptoms of cough, cold, headache and fever. Patient quarantined himself in basement. He believed he had a mild case and he said that his symptoms are still difficult to deal with. He fears that if he would not vaccinated though, he would have to be in the hospital. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected covid-19 infection and suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0 20210802984--Suspected Vaccination Failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1528570 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Muscle tightness
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamins
Current Illness:
Preexisting Conditions: Recent dx of colon ca (4/2021) , treatment for Lymes (6/4/21-6/14/21)
Allergies: Sulfa, pcn
Diagnostic Lab Data: ER
CDC Split Type:

Write-up: I received second vaccine Friday 7/30/21 at 1600. Approximately 24 hours after, I was experiencing SOB. Intense tightening of chest muscles/ rib cage down to lower back. This continued/worsening. Sunday am reached out to primary Md. I was advised to go to ER. Worked up to R/O PE as well as MI. Also COVID neg. DC on Robaxin and ibuprofen. SOB continues. Can not catch my breath.


VAERS ID: 1528720 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (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: Had a strong metal taste in mouth about 5 minutes after vaccine. It went away about 3 hours later.


VAERS ID: 1528754 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Cough, Decreased appetite, Dyspnoea, Fatigue, Gait inability, Nasal inflammation, Oropharyngeal pain, Oxygen saturation decreased, Pneumonia, Respiratory tract congestion, Secretion discharge
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Ampicillin, Penicillin
Diagnostic Lab Data: Chest Xray 8/4/21
CDC Split Type:

Write-up: Extreme difficulty when breathing, consistent coughing, massive mucous production, low oxygen levels, severe congestion, Pneumonia, loss of appetite, sore throat, inflamed nasal passageways, inability to ambulate without overexhaustion and difficulty breathing


VAERS ID: 1528784 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-21
Onset:2021-07-31
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Chills, Cough, Headache, Pain, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: POC/Rapid test completed by facility on 8/2/21
CDC Split Type:

Write-up: Employee reported symptoms began on Saturday, July 31st of headache, coughing, chills and body aches


VAERS ID: 1528793 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 181602H / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: COVID + in October 2020
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 102.4 Fever for 12 hours headache for 20 hours Body aches for 24 hours Tired for 24 hours


VAERS ID: 1528797 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-23
Onset:2021-07-31
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 020B21A / 1 LA / IM

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

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

Write-up: Allergic reaction to it giving a red rash


VAERS ID: 1528822 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-07-31
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

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

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

Write-up: Positive Covid 19


VAERS ID: 1528837 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-08
Onset:2021-07-31
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B208 / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L208 / 2 - / -

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

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

Write-up: Positive for Covid 19


VAERS ID: 1528928 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Unknown  
Location: Missouri  
Vaccinated:2021-01-13
Onset:2021-07-31
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chest X-ray abnormal, Cough, Dyspnoea, Facet joint syndrome, Hypoxia, Injury, Intervertebral disc degeneration, Loss of consciousness, Lung opacity, Neck pain, Pneumonia, Pulmonary contusion, Road traffic accident, Tachycardia, X-ray of pelvis and hip abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Unknown
Preexisting Conditions: unknown
Allergies: Adhesive Bandages. NKMA
Diagnostic Lab Data:
CDC Split Type:

Write-up: History of Present Illness Patient is a 71-year-old male with a history of tobacco use, aortic bypass on antiplatelet agents, and cholecystectomy presenting for concerns of a trauma. Patient was a restrained driver in a car when he had a coughing fit, "blacked out" and hit a tree. Patient was extracted by EMS on scene and was complaining of neck pain, so was placed in a cervical collar. He was also hypoxic on scene, so placed on nonrebreather. He was tachycardic on scene, but was maintaining good pressures. Patient endorses pain in his neck, shortness of breath, and pain in his lower back, which he states is chronic. (07/29/2021 15:39 CDT XR Pelvis) IMPRESSION: 1. No acute fracture of the pelvis. 2. Lower lumbar disc and facet degenerative change, greatest at L5-S1. [1] (07/29/2021 15:39 CDT XR Chest Portable) IMPRESSION: Diffuse bilateral airspace opacities. Differentials include pulmonary contusion, in the setting of trauma versus less likely multifocal pneumonia.


VAERS ID: 1528945 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cyanosis, Dyspnoea, Electrocardiogram, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: Celexa
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: EKG, ultrasound, bloodwork
CDC Split Type:

Write-up: Right arm turned blue and difficulty breathing.


VAERS ID: 1529000 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-10
Onset:2021-07-31
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Atelectasis, Atrioventricular block first degree, COVID-19, Chest X-ray abnormal, Condition aggravated, Diarrhoea, Dyspnoea, Dyspnoea exertional, Electrocardiogram abnormal, Exposure to SARS-CoV-2, Fall, Hyperhidrosis, Lung opacity, Myocardial infarction, Oxygen saturation decreased, Pallor, Productive cough, Pulmonary valve disease, QRS axis abnormal, SARS-CoV-2 test positive, Sinus bradycardia
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Conduction defects (narrow), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: HTN, HLD, OSA on CPAP, prior CVA, and gout, former smoker, who was brought in by EMS s/p fall.
Allergies: hydrochlorothiazide, sulfadiazine
Diagnostic Lab Data: Diagnostic Results (07/30/2021 09:25 CDT XR Chest Portable) IMPRESSION: 1. Left basilar airspace opacities, most likely atelectasis. [1] SINUS BRADYCARDIA WITH FIRST DEGREE AV BLOCK PATTERN CONSISTENT WITH PULMONARY DISEASE LEFT AXIS DEVIATION INFERIOR MYOCARDIAL INFARCTION, OF INDETERMINATE AGE Compared to ECG 11/26/2009 18:04:38 First degree AV block now present Sinus rhythm no longer present Myocardial infarct finding still present
CDC Split Type:

Write-up: Complaint EMS was called for lift assist post fall, upon arrival pt was SOB, pale, diaphoretic. Pt given duoneb en route. Pt reports he was supposed to get a covid test today. Pt on 10L NRB History of Present illness Client is a 74yo M w HTN, HLD, OSA on CPAP, prior CVA, and gout, former smoker, who was brought in by EMS s/p fall. Was found pale, diaphoretic, SOB, found to be covid positive, was experiencing 3 day of progressively worsening SOB and cough, weakness, was transferring from his walker to bed and fell. Did not his his head, did not lose consciousness. Has had three days of SOB with minimal exertion, does have some SOB at baseline as pt is deconditioned due to bad L hip, does not use any home O2. Also w cough productive of brown, frothy sputum. no blood in sputum. Pt also endorses 3d of diarrhea 3x/d, nonbloody, nonpainful. Pt denies any urinary sx, CP, palpitations/, no nausea, vomiting. reports good PO intake. Recent sick contacts include wife and contractor who was working in his house found to be covid positive. Of note pt has been vaccinated several months ago got both doses of Pfizer vaccine. In ED, pt on vapotherm 80% FiO2, 40L, sating low 90s. EKG showing sinus brady, CXR w L basilar atelectasis.


VAERS ID: 1529006 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-07-31
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-05
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
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: positive covid19 PCR result 8/3/21
CDC Split Type:

Write-up: fully vaccinated (pfizer, 2/8/21, 3/1/21); symptom onset 7/31/21


VAERS ID: 1529010 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-27
Onset:2021-07-31
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Menstruation irregular
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad)

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

Write-up: Intense abdominal cramps Wednesday 05/28. Early irregular period 07/31.


VAERS ID: 1529044 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-07-31
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-08-05
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
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: positive covid19 PCR result, 8/4/21
CDC Split Type:

Write-up: fully vaccinated (pfizer, 2/3/21, 3/2/21); onset of symptoms 7/31/21


VAERS ID: 1529137 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 RA / IM

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

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

Write-up: Fever shortly after vaccination, patient with osteosarcoma s/p BKA, sent to EC for evaluation of fever - patient has central


VAERS ID: 1529231 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 - / -

Administered by: School       Purchased by: ?
Symptoms: Burning sensation, Discomfort, Ear discomfort, Headache, Muscle tightness, Paraesthesia, Sluggishness
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: XELJANZ
Current Illness:
Preexisting Conditions: RHEUMATOID ARTHRITIS
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: 30 mins after the injection in left arm, left side of my body became heavy and sluggish. Left ear started popping as if air pressure or elevation changed in a plane. Hearing was affected in left ear and also got a headache. By the evening lower back, upper back and neck felt like it was recovering from a muscle spasm. Next day: Both arms and hands began with tingling and burning sensations back and neck still tight Day 3,4 and 5: Arm and hands seem to be better but its still present and the back and neck still feel tight


VAERS ID: 1529276 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Vaccination error
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 known.
Current Illness: Not known.
Preexisting Conditions: Not known.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: This event was a vaccine error. No known adverse event has been reported by the patient at this point in time.


VAERS ID: 1529290 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 RA / IM

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

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

Write-up: This incident was a vaccine error. A vial of Moderna COVID-19 vaccine was used after the 12-hour window for beyond use date and time had expired. The vial was initially punctured July 30th, 2021 at approximately 4:45pm EST. The patient has not reported any adverse events at this time.


VAERS ID: 1529298 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

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

Write-up: This incident was a vaccine error. A vial of Moderna COVID-19 vaccine was used after the 12-hour window for beyond use date and time had expired. The vial was initially punctured July 30th, 2021 at approximately 4:45pm EST. The patient has not reported any adverse events at this time.


VAERS ID: 1529389 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-08
Onset:2021-07-31
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: colchicine, allopurinol, losartan
Current Illness:
Preexisting Conditions: hyperlipidemia, prediabetes, hypertension, gout, sleep apnea
Allergies: sulfa
Diagnostic Lab Data: as above
CDC Split Type:

Write-up: positive COVID disease, diagnosed 8/3/2021


VAERS ID: 1529399 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-31
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Diarrhoea, Hypoaesthesia, Malaise, Pain in extremity, Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Linzess, vitamins, potassium, phernagen
Current Illness: None
Preexisting Conditions: Ibs
Allergies: Antibiotics, steroids, sulfa drugs
Diagnostic Lab Data: Blood test August 1
CDC Split Type:

Write-up: I was deathly ill the night of shot with diarrhea and vomiting and severe pain In my arm, the next morning I was numb and tingling on tight side it has spread to whole body over 6 days and getting worse


VAERS ID: 1529420 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 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: CELEBREX, ATORVASTATIN, LEVOTHYROXINE
Current Illness: NONE REPORTED
Preexisting Conditions: HYPERCHOLESTEROLEMIA, HYPOTHYROID
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT STATED HE WAS GETTING HIS FIRST DOSE OF PFIZER BUT UPON BILLING HIS INSURANCE AFTER THE DOSE WAS GIVEN, IT WAS FOUND BY LOOKING IN THE IMMUNIZATION REGISTERY THAT THE PATIENT HAD ALREADY RECEIVED 2 DOSES OF THE COVID PFIZER SHOT ON 01/21/21 AND 02/11/21 AT ANOTHER FACILITY THEREBY RECEIVING 3 TOTAL DOSES.


VAERS ID: 1529713 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-26
Onset:2021-07-31
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site warmth
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 known
Preexisting Conditions: none known
Allergies: Penicillin, flu vaccine
Diagnostic Lab Data: none known
CDC Split Type:

Write-up: Symptoms were noticed by patient on 7/31/2021 and were visible by pharmacist on 8/5/2021 at 6:45pm. She states she has a 3 inch red area at injection site and it is hard in the middle. It is warm to the touch. On 8/5/21 she noticed burning, hardness and itching at vein in fold of left arm. She has not seen any physicial. I recommended to take Benadryl tablets or capsules orally for the itch, take acetaminophen for the pain, and apply a cold pack to the area.


VAERS ID: 1529991 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-03
Onset:2021-07-31
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004225 / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3003184 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Deafness, Hypoaesthesia, Tinnitus
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Sexual dysfunction (broad)

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

Write-up: After the 1st dose of vaccine on the 3rd of July 2021, I have developed loss of hearing on the 4th of July and tinnitus. Went to see GP after the next 3 days as I thought it will recover by itself but it lasted until my second dose of vaccine on the 31/7/21. I had a loss of hearing again and numbness on the outer ear on the 1/8/21 and my tinnitus condition got worse. Next Tuesday I will go and refer to the ENT specialist for further check up


VAERS ID: 1529993 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-26
Onset:2021-07-31
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Fatigue, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID PCR+ 8/3/21
CDC Split Type:

Write-up: COVID infection test resulted 8/3/21. symptoms started 7/31/21: subjective fever, loss of taste/smell, fatigue, headache. Currently remains symptomatic.


VAERS ID: 1530032 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pruritus, Skin burning sensation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Syncope after hepatitis B vaccine, age 16
Other Medications:
Current Illness:
Preexisting Conditions: Hypermobile ehlers danlos syndrome Mast cell activation syndrome Long haul covid
Allergies: Allergic to tomatoes. Mast cell activation syndrome reactions to multiple foods and substances.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives appeared along the neck on the side of the injection site within 4 minutes followed by a burning skin sensation in the entire upper body and itchiness along the entire upper body, including the trunk, arms, chest and neck. Anti-histamines were successfully used to treat the hives. Hives resolved in 15-20 minutes. Burning/itching and mild dizziness continued for approximately 4 hours and then subsided.


VAERS ID: 1530049 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: nothing know
Current Illness: Pneumonia due to COVID-19 virus; Suspected COVID-19 virus infe
Preexisting Conditions: PMHx of CAD, HLD, HTN, and COPD
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt. presented to ED with symptoms, SOB, cough and 85% Room air; pneumonia due to COVID


VAERS ID: 1531313 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Back pain, Blood test, Chest X-ray, Chest pain, Computerised tomogram abnormal, Dyspnoea, Echocardiogram abnormal, Ejection fraction normal, Palpitations, Pulmonary embolism, Tachycardia, Ultrasound Doppler normal, Ventricular hypokinesia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium with vitamin D 1200mg/25mcg 2 tabs daily, Tylenol arthritis 650mg bid 1 tab daily, vitamin d3 20,000 IU daily
Current Illness: None
Preexisting Conditions: Osteoporosis arthritis of left knee, BMI 54, oophretomy, left me icus repair, tubal ligation
Allergies: PCN
Diagnostic Lab Data: 8/4/21 ER: CXR, blood work, CT scan positive PE right pulmonary artery. Heparin drip started . Admitted to hospital for vascular consult for possible clot retrieval. 8/5/21 Echo normal with EF 50-55%, with right hypokensis, no pulmonary HTN, US of legs are negative for DVT. Plan to remain on heparin drip with plans to switch to anticoagulant orally when determined by MD
CDC Split Type:

Write-up: 7/31/21 chest pain mid sternum, palpitations, pain middle of back, SOB, tachycardia rates to 130


VAERS ID: 1531490 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

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

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

Write-up: Swelling in left leg and painful injection site with excessive fatigure and swollen lymph nodes


VAERS ID: 1531570 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-09
Onset:2021-07-31
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Chest X-ray abnormal, Clostridium test, Diarrhoea, Dyspnoea, Myocardial necrosis marker, Nausea, SARS-CoV-2 test positive, Stool analysis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unkown
Preexisting Conditions: COPD, CHF, CVA, CAD, AFIB
Allergies: shellfish, mold, dust allergy
Diagnostic Lab Data: COVID swab, 8/5/2021- positive Chest Xray 8/3/2021 - moderatley advanced COPD- no acute process change CDif and fecal on 8/3/2021 Cardiac enzyme testing 8/3/2021
CDC Split Type:

Write-up: 8/3/2021- patient to ED with SOB, nausea,vomit and abd cramping, diarrhea. Held in ED and admitted on 8/4/2021


VAERS ID: 1531901 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-28
Onset:2021-07-31
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Discomfort, Dysarthria, Facial paralysis, Limb discomfort, Loss of personal independence in daily activities, Paraesthesia oral
SMQs:, Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (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: none
CDC Split Type:

Write-up: Patient awoke that morning with slurred speech , right side of face drooping, tongue feels tingly, right arm feels heavy. Face felt heavy and when drinking fluid it ran out of her mouth,. Mother took her to Urgent Care and they diagnosed her with Bell''s Palsy.


VAERS ID: 1531965 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-24
Onset:2021-07-31
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Dyspnoea, Fatigue, Headache, Oropharyngeal pain, Pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID test was positive on 8/5/2021
CDC Split Type:

Write-up: patient developed symptoms including cough, new loss of taste or smell, shortness of breath, fatigue, body aches, headache, sore throat, and runny nose on 7/31/2021. His COVID test was positive on 8/5/2021


VAERS ID: 1531974 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

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

Write-up: Client reports she received Moderna COVID-19 Vaccine (035C21A), 6/1/2021. Client missed second dose appointment on 6/29/21 and was told by a healthcare family member, that she would have to start the series over again. Client presented for services 7/31/21 and did not report that she previously received Moderna vaccine and given Pfizer.


VAERS ID: 1531982 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-07-31
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / UNK - / -

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

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

Write-up: COVID-19


VAERS ID: 1531993 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Mood swings, Pain, Pain in extremity, Pyrexia, Rash, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine 2007
Other Medications: Bactrim
Current Illness: UTI
Preexisting Conditions:
Allergies: Allergic to oysters but not all shellfish
Diagnostic Lab Data: Got a Covid test done on 08/05/2021 and results were negative Called my dr and she said take Benadryl for 4 days if still bad come in
CDC Split Type:

Write-up: Headache, sore arm - 2nd day Headache - 3rd day Fever (101.5), chills, body aches, mood swings, fatigue- 4th day Fever (100.5) chills, body aches, fatigue- 5th day Rash all over body, fever (101.7), body aches, fatigue, mood swings - 6th day Rash, soreness in legs - 7th day


VAERS ID: 1532048 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-27
Onset:2021-07-31
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion 150, Amitryptaline 10mg, Flomax, Vitamin D, Zinc, Livalo, Vitamin C, CoQ10, melatonin, baby aspirin
Current Illness: No
Preexisting Conditions: Anxiety, IBS
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 4 days after the shot I woke up with Vertigo and it was mostly annoying. It became worse on Sunday evening. It has persisted through today Friday, 10 days after the shot and shows no signs of letting up.


VAERS ID: 1532058 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-07-31
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

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

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

Write-up: U07.1 - COVID-19 virus infection breakthrough infection covid


VAERS ID: 1532060 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-22
Onset:2021-07-31
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrioventricular block second degree, Bilirubin conjugated, Blood albumin, Blood bilirubin, Blood catecholamines, Blood creatine phosphokinase, Blood culture, Blood gases, Brain natriuretic peptide, C-reactive protein, Cardiac pacemaker insertion, Chest X-ray, Coagulation test, Differential white blood cell count, Dizziness, Electrocardiogram, Full blood count, Glycosylated haemoglobin, Inflammatory marker test, Intensive care, Laboratory test normal, Lipids, Magnetic resonance imaging heart, Metabolic function test, Red blood cell sedimentation rate, Seizure like phenomena, Syncope, Thyroid function test, Toxicologic test, Troponin, Viral test
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Convulsions (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Melatonin as needed
Current Illness: None
Preexisting Conditions: None at time of vaccine
Allergies: Azithromycin: hives
Diagnostic Lab Data: BMP, CMP, CBC with diff, coagulation studies, blood gases, T bili, D bili, albumin, lipids, CPK, troponins, BNP, HbA1c, thyroid function tests, metanephrines, CRP, ESR, viral panel, toxicology screen, blood culture, CXR, cardiac MRI, EKG. These tests were ordered, some multiple times, throughout the patient''s 6 day hospital stay. In summary, inflammatory markers and infectious workup was negative.
CDC Split Type:

Write-up: One week after the patient received the second dose of the COVID-19 Pfizer vaccine, he started experiencing episodes of seizure-like activity, dizziness, and syncope. He experienced these symptoms on day 9 after receiving the vaccine, and continued experiencing episodes on day 10 when he presented to the emergency department. He was diagnosed with high-grade second degree heart block, requiring the implantation of the pacemaker and a 6 day hospitalization with time in the pediatric intensive care unit. The patient is improving clinically is currently still in a deconditioned state however is recovering from the new diagnosis and recent procedure.


VAERS ID: 1532176 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / UNK - / -

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

Write-up: patient had reaction from her first dose moderna vaccine on 07/31 FEW MINUTES AFTER THE SHOT. she had a fainting feeling but recovered soon.


VAERS ID: 1532201 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: patient stated that one eye started swelling on 7/31/21, thought he may have gotten something in it, then he noticed 8/5 that his other eye was beginning to swell as well. this vaccine was the only thing new he has had; instructed pt to seek medical attention


VAERS ID: 1532266 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adenovirus test, Alanine aminotransferase normal, Aspartate aminotransferase increased, Asthenia, Blood alkaline phosphatase increased, Blood creatinine normal, Blood culture negative, Blood electrolytes normal, Brain natriuretic peptide increased, C-reactive protein increased, Chest X-ray normal, Chest pain, Cough, Cytomegalovirus test negative, Cytomegalovirus test positive, Dyspnoea, Electrocardiogram ST segment elevation, Enterovirus test negative, Epstein-Barr virus antibody negative, Fatigue, Full blood count abnormal, HIV antibody negative, Haemodynamic test normal, Haemoglobin normal, Headache, Hepatitis viral test negative, Herpes simplex test negative, Human herpes virus 6 serology negative, Liver function test normal, Neutrophil count, Pain in extremity, Parvovirus B19 test negative, Platelet count normal, Red blood cell sedimentation rate normal, Respiratory viral panel, SARS-CoV-2 antibody test positive, Sleep disorder, Troponin increased, Varicella virus test negative, Viral test negative, White blood cell count increased
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PRN ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: Azithromycin - rash Penicillin - rash
Diagnostic Lab Data: 8/2: troponin 9.24 and BNP 26. Viral respiratory panel was obtained and negative. CRP slightly elevated at 2.5. and a normal ESR at 2 CBC had a WBC 7.2 without evidence of a shift, Hgb 16.4, platelets 277, ANC 4. Electrolytes were appropriate and creatinine was 0.81. LFTs were notable for a normal alk phos 197, slightly elevated AST at 61, and normal ALT 28. 8/3 troponin: 6.64, 6.56, 6.74, 8.31 8/4 troponin: 7.61, 4.45, 3.85, 4.42, 4.49, 3.60, 2.95 8/6 troponins 1.96 and 1.74 Infectious work-up: Adenovirus (VRP and NP swab negative) CMV IgG +, IgM - COVID-19 IgG by CIA Spike protein: positive EBV antibody panel: negative Enterovirus (serum PCR): negative Hepatitis panel: negative HHV6: negative HSV: negative HIV 1/2 Ab/Ag: non-reactive Parvovirus IgG+ and IgM- VRP: negative VZV IgG+, IgM- Infectious work-up still pending: Blood cultures (no growth to date) Enterovirus culture (in process) COVID IgG qualitative CIA (Nucleocapsid) For results of pending tests or additional clinical information, please contact the hospital.
CDC Split Type:

Write-up: Patient is a previously healthy child without known chronic medical conditions and is full-immunized. He received his first Pfizer COVID vaccine on 7/9 which he tolerated well with the exception of a sore arm. He received his second Pfizer COVID vaccine on Friday, 7/30. He endorses a headache and arm soreness that day but otherwise felt well. Saturday (7/31) he was in his usual state of health until that night when he woke up with central chest pain that was worse with laying down. The pain was not worse with deep breathing, coughing, or other activities. Sunday morning the pain improved slightly but was still there. Sunday night to Monday morning the pain significantly worsened and parents took him to a clinic for evaluation. Dad reports that while they were checking in, patient was very short of breath and significantly fatigued. Denies fevers, chills, myalgias, abdominal pain, n/v, diarrhea, sore throat, rashes. Chest x-ray at an outside clinic was normal and EKG showed diffuse ST elevation, concerning for pericarditis, , possibly postvaccination. Dad reports that the clinic arranged for patient to be directly admitted to hospital for further evaluation. Following the clinic visit and prior to arriving at hospital, his pain did improve slightly as did his SOB. Upon arrival to hospital, he was hemodynamically stable. Labs were notable for a troponin 9.24 and BNP 26. Viral respiratory panel was obtained and negative. CRP slightly elevated at 2.5. and a normal ESR at 2 CBC had a WBC 7l.2 without evidence of a shift, Hgb 16.4, platelets 277, ANC 4. Electrolytes were appropriate and creatinine was 0.81. LFTs were notable for a normal alk phos 197, slightly elevated AST at 61, and normal ALT 28. Since admission patient reports that his chest pain has resolved and that his energy has returned. His troponin continues to be elevated but is downtrending (6.56 this morning). He has been afebrile and his blood culture is currently no growth. The week prior to his admission, patient denies any diarrhea, nasal congestion, cold symptoms, or recently illnesses. His Dad does endorse having a cold over the past week with nasal congestion and a mild sore throat. Please see below for full exposure history but largely, exposure history is benign with no recent travel, no significant bug bites or concern for rickettsial diseases, and low risk for Salmonella or other bacterial infections.


VAERS ID: 1532638 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site inflammation, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (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: sertraline, levothyroxine, gabapentin, losartan, omeprazole
Current Illness: none
Preexisting Conditions: hypothyroid, depression, HTN, GERD
Allergies: none
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: inflammation, erythema and calor over the upper arm surrounding and distal to injection site, Initially had pain but that has resolved after 7 days.


VAERS ID: 1532666 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-21
Onset:2021-07-31
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Blood test, Contusion, Differential white blood cell count, Full blood count, Heart rate increased, International normalised ratio, Metabolic function test, Platelet count, Prothrombin level, Pruritus
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 60 mg daily, Klonopin 1 mg as needed
Current Illness: None
Preexisting Conditions:
Allergies: Sulfa antibiotics
Diagnostic Lab Data: Physical examination. Bloodwork: CBC, Differential, platelet count. PT, aTTP, PT-INR, CMP.
CDC Split Type:

Write-up: Day of vaccine and day after- elevated heart rate, 100 bpm. Approximately 8-10 days after vaccine, bruising on left and right legs, and inner thighs, and persistent itching all throughout body without rash.


VAERS ID: 1532672 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

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

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

Write-up: Patient was revaccinated. She requested and was administered the first dose of Pfizer COVID-19 because her PCP told her to get it to give her better protection from the Delta variant. She had already received Janssen COVID-19 vaccine five months earlier at a different facility. The first vaccine was not in the database. No adverse effects have been reported.


VAERS ID: 1532884 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-23
Onset:2021-07-31
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Ultrasound Doppler normal
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: magnesium sulfate 400 mg, Vit-D3 5,000 ius, 10 mg zrytec
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: doxycycline, morphine, codeine
Diagnostic Lab Data: Upper extremity venus ultrasound of left arm. Negative for DVT
CDC Split Type:

Write-up: Severe left arm swelling from shoulders into arm and hand. Started Medrol Dose pack today 08/06/2021.


VAERS ID: 1533275 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Dizziness, Fatigue, Haemoglobin decreased, Headache, Laboratory test, Myalgia, Nausea, Pancytopenia, Platelet count normal, Vomiting, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Myelodysplastic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Olmasartan 40 mg a day
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Lab tests done in ER at JPS on Aug 1
CDC Split Type:

Write-up: Headache, fatigue, muscle aches, dizziness, nausea and vomiting started 6-8 h after vaccine and was maximal at 40 hours. Pancytopenia with WBC of 2.2, platelets to 150,000 and anemia of 9.8


VAERS ID: 1534163 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-07-31
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Immune system disorder
Allergies:
Diagnostic Lab Data: Test Date: 20210731; Test Name: Covid-19; Test Result: Positive
CDC Split Type: USPFIZER INC202100994270

Write-up: My friend, received both shots of the vaccine a few months back. She know has COVID.; My friend, received both shots of the vaccine a few months back. She know has COVID.; This is a spontaneous report from a contactable consumer. A 48-year-old non-pregnant female patient received first dose of BNT162B2(reported as "COVID vaccine", via an unspecified route of administration on an unspecified date, at 48-year-old, as single dose (Batch/Lot number was not reported) and a second dose of BNT162B2(reported as "COVID vaccine", via an unspecified route of administration on an unspecified date, at 48-year-old, as single dose (Batch/Lot number was not reported) for covid-19 immunisation. The patient was not pregnant at the time of vaccination. Medical history included compromised immune system. The patient''s concomitant medications were not reported. It was unknown if the patient received any other vaccines with 4 weeks prior to the COVID vaccine. Prior to vaccination, patient was not diagnosed with COVID-19. The patient received both shots of the vaccine a few months back and she had COVID on 31Jul2021. The patient underwent lab tests included Covid-19 (with unknown test type): positive on 31Jul2021. It was unknown if the patient received any treatment. The outcome of events was recovering. Pfizer is a marketing authorization holder of COVID vaccine in the country of incidence or the country where the product was purchased (if different). This may be a duplicate report if another marketing authorization holder of COVID vaccine has submitted the same report to the regulatory authorities. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1534644 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-31
Onset:2021-07-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling cold, Headache, Muscle contracture, Poor peripheral circulation
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: 7 days prior multi vit 2/day, adrenal 2/day, zenadapt 2/day
Current Illness: Hypothyroid NAFLD Constipation
Preexisting Conditions: Progressive Autoimmune symptom history IBS constipation long term NAFLD Typical thyroid hypo: hair loss, brittle , nails, etc. Joint ache
Allergies: Headache from MSG and red wine tannins and high anxiety after Naproxen sodium and NSAIDs
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme cold, chills, teeth chatter, contraction in upper chest area( more than a shiver), feeling of blood leaving hands and feet, mild headache Started 12:30 am aug 1 Added wool afghan, small airline style microfiber blanket, large king size dpuble layer microfiber blanket, polyester filled quilt Ended 4:30 AM. TOTAL 4 hours


VAERS ID: 1534799 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-27
Onset:2021-07-31
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Headache, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin
Current Illness: None
Preexisting Conditions: Diverticulitis, sleep apnea
Allergies: Sulfur, shrimp, pineapple, strawberries
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Heart racing at rest/during sleep. Headaches, fatigue, weakness, severe dizziness. All are present and have been since a couple of days after the vaccine


VAERS ID: 1534831 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

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

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

Write-up: Patient reported pain that started at the site and worked up her arm to involve her shoulder. The pain has persisted for a week now. She reported visiting a chiropractor thinking it would help, which it did not. There is no visible swelling at the sight.


VAERS ID: 1534911 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-27
Onset:2021-07-31
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040L21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Gait inability, Loss of personal independence in daily activities, Vertigo
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 10 mg once daily, Ashlyna birth control once daily
Current Illness: None
Preexisting Conditions: none
Allergies: erythromycin
Diagnostic Lab Data: No
CDC Split Type:

Write-up: slight dizziness on 07/31/21 and 08/01/2021. Unable to walk or drive 08/02/2021 and that continued until today 08/07/2021 which I am still completely spinning when I move any at all. I am not able to drive. I am taking Meclizine to help with the nausea from the dizzziness.


VAERS ID: 1535230 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-04
Onset:2021-07-31
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Fatigue, Hypophagia, Hypoxia, Oxygen saturation decreased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol 25 mg PO BID Famotidine 40 mg PO daily Rosuvastatin 5 mg PO daily Levothyroxine 75 mcg PO daily Aspirin 81 mg PO daily
Current Illness: None known
Preexisting Conditions: Hypertension Hypothyroidism Low back pain Vitamin D deficiency
Allergies: Penicillin G (rash)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed with COVID-19 after vaccination. Patient was sent to the ED by her PCP for monoclonal antibody therapy (received casirivimab/imdevimab on 8/4), but was subsequently admitted (hypoxic, satting 89% on room air). Her symptoms consisted of cough, decreased PO intake, and worsening weakness. She was started on 2L of oxygen via nasal cannula. She is receiving dexamethasone 6 mg PO daily (on day 4 of 10), remdesivir 200 mg IV x 1 followed by 100 mg IV x 4 additional days (on day 4 of 5). On 8/7, her oxygen requirement increased to 5L and she reported feeling fatigue and experiencing non-productive cough. Today, she is on 6L of oxygen and is still admitted.


VAERS ID: 1535313 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: Red itchy rash not at injection site but covering armpits, chest, bikini area.


VAERS ID: 1535430 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Sexual dysfunction (broad)

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

Write-up: Patient states swelling of left hand and cannot feel thumb and palm. Started the next day and is present currently.


VAERS ID: 1535439 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Montana  
Vaccinated:1931-04-27
Onset:2021-07-31
   Days after vaccination:32968
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 mg tablet Take 2 tablets by mouth every 4 hours as needed for Pain (or fever $g= 38.6 C (101.5 F)). 10/1/20 atorvaSTATin (LIPITOR) 80 MG tablet TAKE 1 TABLET BY MOUTH EVERY DAY AT NIGHT Patient taking differen
Current Illness: Actinic keratosis ? Acute on chronic diastolic heart failure due to valvular disease 9/17/2020 ? AKI (acute kidney injury) 1/30/2019 ? Anticoagulated on Coumadin 9/24/2020 ? Aortic regurgitation ? Aortic stenosis ? Ascending aorta dilation ? Benigh Prostate Hypertrophy/BPH 10/31/2011 ? Benign hypertension 4/4/2006 ? BPH (benign prostatic hyperplasia) ? Cancer prostate ? Carotid stenosis ? Chronic pain of both shoulders 1/14/2019 ? Colon polyp ? Colon polyps 4/4/2006 ? Diverticulitis 11/06 neg CT ? Diverticulosis colonoscopy w/ BX ? Elevated troponin 2/1/2019 ? Generalized headaches ? History of CVA (cerebrovascular accident) 9/18/2020 ? History of skin cancer 11/25/2008 ? Hyperlipidemia ? Impotence low testosterone ? Inguinal hernia ? Lumbosacral spondylosis without myelopathy 1/14/2019 ? Macular degeneration 2019 getting injections ? Mitral regurgitation ? Orthopnea 2/2/2019 ? Paroxysmal atrial fibrillation 9/17/2020 9/10/2020: 48'' Holter: Rhythm is atrial fibrillation with rates between 47 and 148 BPM, with an average rate of 89 BPM. Occasional VE, bigem, trigem, couplets and rare V-runs. The longest r-r is 2.0. Taking coumadin ? Right carotid artery occlusion 9/17/2020 ? Risk for falls 5/13/2015 ? S/P L4-5 PLIF, decompression L2-4 1/29/2019 ? S/P mitral valve clip implantation ? Seborrheic keratosis ? Severe sepsis 1/30/2019 ? Skin Tags ? Spinal stenosis of lumbar region with neurogenic claudication 10/24/2018 ? Syncope 9/17/2020 9/10/2020: 48'' Holter: Rhythm is atrial fibrillation with rates between 47 and 148 BPM, with an average rate of 89 BPM. Occasional VE, bigem, trigem, couplets and rare V-runs. The longest r-r is 2.0. ? Tricuspid regurgitation ? Urine retention 2/4/2019 ? Weakness of both lower extremities 1/14/2019
Preexisting Conditions: See # 11
Allergies: Morphine
Diagnostic Lab Data: Ordered Test: SARS-CoV-2 (COVID-19) RNA [Presence] in Specimen with probe detection (SARS Coronavirus 2) Ordered Test Codes: 94309-2 (LN LOINC)/2019nCoV (L LOCAL) Status: Final Accession Number: 1573290 Specimen Source: Other Specimen Site: Specimen Collection Date/Time: 2021-07-27 00:00:00.0 _____________________________________________________________________________________________ Ordered Test: SARS-CoV-2 (COVID-19) RNA [Presence] in Specimen by NAA with probe detection (SARS Coronavirus 2) Ordered Test Codes: 94309-2 (LN LOINC)/2019nCoV (L LOCAL) Status: Final Accession Number: 1492734 Specimen Source: Other Specimen Site: Specimen Collection Date/Time: 2021-07-31 00:00:00.0
CDC Split Type: 1051760

Write-up: Case received Covid-19 vaccines on 2/5/2021 and 3/5/2021, and was subsequently hosptialized for Covid Pneumonia on 7/31/21.


VAERS ID: 1535593 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Axillary mass, Axillary pain, Chest pain, Feeling abnormal, Pain in extremity
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: I haven''t gotten any laboratory test
CDC Split Type:

Write-up: After I took this vaccine I be feeling very weird I be having this chest pain that goes thorough my arms and also I feel weak and im very concerned about the inflammation of the heart muscles (myocarditis) because before i was vaccinated I didnt have any of this problem and now I do and if is something wrong with my heart I would like to get help as soon as posible and also I notice on my body a bump under my armpit and it hurts and also I didnt have that until the day after I got vaccinated


VAERS ID: 1535656 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-01
Onset:2021-07-31
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Retinal detachment
SMQs:, Accidents and injuries (broad), Retinal 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole Mestinon Meloxicam Losaratan
Current Illness: Lung Cancer Myasthenia gravis
Preexisting Conditions: Generally healthy until the last few months
Allergies: None
Diagnostic Lab Data: I am having retina surgery Tuesday, August 10,2021
CDC Split Type:

Write-up: I experienced a retina detachment six months after my second shot of the Moderna vaccine. I am reporting this as a possible side effect because several others in my area have experienced the same condition after receiving the Moderna vaccine.


VAERS ID: 1535883 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-27
Onset:2021-07-31
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Confusional state, Hemiparesis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ATENOLOL 50mg/1, 1 bottle for 100 days / take one by mouth once daily - Prescribe Again ATORVASTATIN CALCIUM TRIHYDRATE 80mg/1, 1 bottle for 90 days / One by mouth daily - Prescribe Again CLOPIDOGREL BISULFATE 75mg/1, 1 bottle for 100 days
Current Illness: n/a
Preexisting Conditions: Cardiovascular: High Blood Pressure, High Cholesterol Endocrine: Diabetes, Hypothyroidism Neurological: Peripheral neuropathy from alcoholism Other: Alcoholism with continued alcohol use
Allergies: NKDA or food allergies
Diagnostic Lab Data: not currently available
CDC Split Type:

Write-up: 7 days after vaccination, patient woke up with right side weakness and confusion. Was hospitalized and found to have CVA (ischemic). No intervention given.


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