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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 326 out of 7,116

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VAERS ID: 1518388 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Hyperhidrosis, Hypopnoea, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: family reports same event every vaccination and after a recent (this year) podiatric treatment age 17
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: post vaccination patient lost consciousness for a few seconds began to sweat shallow breathing became alert complained of unsteady feeling remained seated took sips of water refused acetaminophen slowly recovered becoming alert and exited to a waiting area to be with family time range about 15 minutes family exited after 15 more minutes post event phone contact patient was recovered after water and Tylenol at home and without complaint committed to a follow up vaccination after 21 days


VAERS ID: 1518396 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

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

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

Write-up: After administration it was recommended that the patient sit and wait 15 minutes in the designated area immediately outside of the pharmacy. Patient did not follow recommendation and within two minutes of administration had an episode of syncope while walking around Walmart and fell over. The patient did not hit their head, pt was responsive and was conscious.


VAERS ID: 1518401 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / ID

Administered by: Work       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Musculoskeletal stiffness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole 20mg daily, Welbutrin 120mg daily, Phentermine 37.5mg daily
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Headache, fatigue, neck stiffness, full boy muscle aches, and chills. Symptoms started at 7pm. Ibuprofen 8mg taken at 1am.


VAERS ID: 1518404 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH L:FA7484 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry mouth, Dyspnoea, Enlarged uvula, Palatal swelling, Retching, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (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? No
Previous Vaccinations: Same for dose 1
Other Medications: Eucrisa. Allegra, Alendronate, Citracal, Centrum Silver
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dry mouth, swollen back of palate and extremely swollen uvula. I woke up in the middle of the night with breathing trouble and slight gagging because of the size of my uvula. The same symptoms were previously reported for dose 1 (VAERS report 600712). Both events were reported on the same day because it now seems highly likely that they are related to the vaccine.


VAERS ID: 1518408 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Left armpit with tenderness and swelling


VAERS ID: 1518412 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site extravasation
SMQs:, Extravasation events (injections, infusions and implants) (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 said there was leakage of a liquid from the injection site .. she noticed that around 30 minutes after receiving the shot .


VAERS ID: 1518413 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine - 2020 - fainting
Other Medications: none
Current Illness: none that were documented on the VAR
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was given first COVID19 vaccine at around 1800 with no obvious signs or symptoms. Patients mother explained the history of fainting after vaccinations with pharmacist, when around 1810 patient started feeling dizzy and fainted. Patient was able to be aroused seconds after feeling dizzy. Patients blood pressure was taken - 88/44 - and water was given. Patient started feeling better minutes after drinking water and was asked to stay in the store for 30 additional minutes. Patient had no additional problems.


VAERS ID: 1518416 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT BEGAN EXPERIENCING IMMEDIATE LIGHTHEADEDNESS, DIZZINESS, FEELING OF FAINTING AND STARTED BEADING SWEAT WITHIN MINUTES AFTER RECEIVING THE VACCINE. PATIENT WAS MONITORED WITH A COLD COMPRESS TO THE FOREHEAD AS WELL AS BOTTLES OF WATER TO ENCOURAGE HYDRATION. AFTER ABOUT 15 MINUTES PATIENT DECIDED HE WAS WELL ENOUGH THAT HE COULD STAND AND LEAVE WITH HIS SIGNIFICANT OTHER WHO THEN DROVE THE TWO HOME.


VAERS ID: 1518438 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Feeling hot, Gait inability, Mobility decreased, Muscle spasms, Musculoskeletal stiffness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aimovig 140mg injection, Vitman D3, Magnesium, Estrodiol 2mg, Escitalopram 10mg
Current Illness: None
Preexisting Conditions: Migraines
Allergies: None
Diagnostic Lab Data: None. I almost went to hospital but didn?t.
CDC Split Type:

Write-up: Woke up with muscle spasms all over body, body would stiffen. Also had a warm sensation come over my body from bottom to top, then severe nausea. I would then vomit and have diarrhea at the same time. This went on for 2-3 hours. I couldn?t keep anything down(sips of Gatorade or water). I got so weak I couldn?t walk or hold my head up. My husband had to put me back in bed. I?m scared to take the 2nd dose.


VAERS ID: 1518440 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Hot flush, Hypersomnia, Migraine, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Got the shot in the morning and that night my arm was sore any movement hurt, body aches, chills, fever, hot flashes, no appetite, migraine, and fatigue. Next morning I woke then after an hour slept again, woke for a few minutes and slept again. Woke up third time pain is just about gone, no fever and almost completely back to normal.


VAERS ID: 1518463 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Lethargy
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Shortly after receiving the shot, the patient was was waiting the 15 minutes monitoring period in the store. She was standing/walking and told her parents that she was feeling dizzy and needed to urgently sit down to prevent herself from falling. I was notified that a patient was having an event. I encountered Pt who was sitting on the floor. She was conscience but seemed lethargic. I attempted a BP measurement with a machine x 2 with no result then obtained a manual pressure of 115/65. I obtained a radial pulse rate of 65. Forehead Temp was 97.4. We placed patient in a chair and encouraged water and bit of orange juice. I took a follow up vital set BP 115/61, HR 65, T 97.2. Patient recovered spontaneously and was observed for approximately 15 minutes and then left store with parents. I followed up with a phone call at 0915 on 7/31/21 and the parents reported a full recovery.


VAERS ID: 1518464 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011DZ 1A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, 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: Just pain (not as bad as 2nd) , no redness
Other Medications: Losartan 25mg
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa Drugs
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Redness and significant pain in injection site, starting day after 2nd Moderna Injection. Day three after, still pain and redness 6" arm area.


VAERS ID: 1518473 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 LA / IM

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

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

Write-up: Patient stated that she received first dose of Pfizer vaccine in March but needed second dose in order to return to work. Patient stated that she did not have her vaccine card. First dose was processed at the and date not readily available. Patient stated she never received second dose and dose was given on 07/30/2021 to complete the series. found documentation of patient receiving a shot on 03/04/2021 and on 03/25/2021. Patient was given a 3rd dose in error and has been advised. Patient now has documentation of vacinnation. Patient reports no adverse events from the 3rd dose at this time.


VAERS ID: 1518475 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-17
Onset:2021-07-30
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / UNK - / IM

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

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

Write-up: Rash developed on large area of body. mostly on left side of body.


VAERS ID: 1518476 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-07-30
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Chest X-ray abnormal, Dizziness, Dyspnoea, Lung infiltration, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Hypocholesterolemia, hypertension, A-fib, acute respiratory failure with hypoxia, coronary artery disease, chronic kidney disease (stage 3), Type 2 Diabetes
Allergies: N/A
Diagnostic Lab Data: COVID-19 PCR collected on 7/30/2021 (POSITIVE).
CDC Split Type:

Write-up: The patient was admitted to the hospital on 7/31/2021 with worsening shortness of breath, lightheadedness, and abdominal pain. COVID-19 PCR test was ordered as a part of admission requirements. A chest x-ray shows signs of a right middle lobe infiltrate. Patient is not wheezing. Following the COVID-19 result, the patient was administered dexamethasone and remdesivir on 7/30/2021. At the time of this report, the patient is in stable condition.


VAERS ID: 1518481 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Reported having previously passing out after vaccine. Timing unknown
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Patient care giver reported autism
Allergies: No known drug allergies
Diagnostic Lab Data: Patient was cleared by EMT personal and was not transported to hospital.
CDC Split Type:

Write-up: Patient received first dose of Pfizer LOT FA7484 (Exp 10/21) into left deltoid at 11:15 AM on 7/30/21. Immediately following vaccine, patient was advised to stay at pharmacy for 15-30 minutes to monitor for delayed reactions. At this point, patient passed out in chair and was lowered to the ground and became responsive after a just a few seconds of incident. Pharmacist on duty immediately called 911 and EMT evaluated patient for safety.


VAERS ID: 1518509 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

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

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

Write-up: syncope


VAERS ID: 1518514 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: Patient was given vaccine that had been diluted the previous evening, so vaccine was past the recommended 6 hour dilution time period.


VAERS ID: 1518518 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-16
Onset:2021-07-30
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Women''s multivitamin Daily antihistamine & allergy nasal spray
Current Illness: None
Preexisting Conditions: None
Allergies: Medications-codeine and amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Covid Arm-woke up with a golf ball sized rash on right arm but it was about two inches away from the injection site. Itchy, raised off the skin, hot to the touch. I treated with essential oils and hydrocortisone cream two times. Woke up today and it had spread to the injection site but the itchy, redness was less severe and it was no longer raised. It is now the size of a baseball, but oblong and not symmetrical in appearance.


VAERS ID: 1518520 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-07-30
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LOT # EL3249 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue
SMQs:

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

Write-up: no reaction to dose #1. Dose 2 date: Med Cen Feb 17 LOT # EL9262 side effect was fatigue. no missed work


VAERS ID: 1518528 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Chest pain, Dizziness, Dyspnoea, Fatigue, Headache, Lymphadenopathy, Nausea, Oxygen saturation decreased, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone, theo-24, singular, rovastatin, vitamin D3, advair 500 / 50 disc, trintellix, losartan
Current Illness: COPD, asthma, high blood pressure, severe depression, severe anxiety, low potassium, fatty liver, diverticulitis
Preexisting Conditions: Lung disease, diverticulitis, severe depression severe anxiety.
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Severe headaches, nausea, fatigue, lost a taste, dizziness, chest pains, underarm/left lymph nodes swelled, fever, hard to breathe, oxygen levels low 86


VAERS ID: 1518534 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Hives Fever


VAERS ID: 1518537 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hyperhidrosis, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT AVAILABLE
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I COUNSELED PATIENT BEFORE I GAVE HIM SHOT AFTER VACCINATION HE NEEDS TO SIT DOWN FOR 15 MIN TO MAKE SURE HE IS OK. HE FOLLOWED MY ADVICE AND HE WAS SITTING IN THE CHAIR APPORX 3 MIN AFTER AND SUDDENLY HE FELL INTO GROUND FOR SHORT PERIOD OF TIME APPROX 30 SECONDS . HE WAS SWEATING AND VOMITING. HE LOOKS VERY PALE . HE WAS AWARE ABOUT SITUATION AND I OFFERED HIM JUICES , CANDIES AND GRANOLA BAR. HE WAS ABLE TO DRANK JUICES (6 SMALL PACK OF JUICE) AND STARTED TO HAVE CANDIES AND GRANOLA BAR. AFTER HE ATE SOME FOOD HE FELT BETTER BUT WE WATCHE HIM ABOUT 1HR UNTILL HIS GRANDPA CAME HERE TO GIVE HIM RIDE HOM. I CALLED HIM LEFT MESSAGE TODAY TO CHECK AND NOT RETURN MY PHONE CALL YET.


VAERS ID: 1518544 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

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

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

Write-up: Dizziness, headache, nausea, vomiting, low grade fever, chills, fatigue, started about 9 hours after shot and then lasted about 36 hours


VAERS ID: 1518548 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA 7485 / 1 LA / SYR

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

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

Write-up: Fainted within a few minutes of receiving vaccine


VAERS ID: 1518551 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest X-ray normal, Chest discomfort, Chest pain, Chills, Computerised tomogram thorax normal, Cough, Differential white blood cell count, Dyspnoea, Dyspnoea exertional, Electrocardiogram normal, Fatigue, Fibrin D dimer increased, Full blood count, Headache, Injection site pain, Lethargy, Metabolic function test, Myalgia, Neck pain, Pain, Platelet count, Vaccination complication
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Aspirin
Diagnostic Lab Data: Chest x-ray, Chest CT scan, 12-lead EKG, CBC with differential, Comprehensive metabolic panel, D-dimer test, Platelet check
CDC Split Type:

Write-up: Localized muscle soreness at the injection site occurred within an hour following the vaccination on 7/29/2021. Upon waking on 7/30/2021, I experienced severe widespread muscle soreness, headache, and extreme fatigue. As the day progressed, I developed a dry cough, had chills and body aches, difficulty breathing, and lethargy. By evening, I was having labored breathing (with and without exertion), chest pain and tightness, localized pain in my right neck and shoulder, and pain in lower back. At approximately 10:00 PM on 7/30/2021 I went to the Emergency Room due to my breathing. At the emergency room they examined me for a pulmonary embolism taking an EKG, chest x-ray, and a chest CT scan as well as running a d-dimer, CBC with differential, and platelet lab test. The scans were ordered after my tests revealed a positive result with the d-dimer lab test but revealed no sign of blood clots at the present time. The diagnosis was an adverse reaction to the vaccine and I was told to keep monitoring for signs of blood clots while taking Motrin.


VAERS ID: 1518557 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-19
Onset:2021-07-30
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / IM

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

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

Write-up: covid pos after vaccination


VAERS ID: 1518558 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 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: Patient was administered vaccine that had been diluted the previous evening (more than recommended 6 hours)


VAERS ID: 1518563 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: We have no medications listed at this pharmacy. This patient would not answer the phone and his voicemail is full.
Current Illness: None listed on vaccination form
Preexisting Conditions: None listed on vaccination form
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: This patient had dizziness, blurred vision, and tingling in his arms on the first dose. He presented for his second dose which was administered and we had him wait for 30 minutes just to make sure he did not have an allergic reaction. He ate with this vaccination (unlike the first) and felt fine afterwards. The vaccination was administered at 2:56 and he presented back to the pharmacy at 6:30 complaining of itching all over. He was given 50 mg of Benadryl at 6:34 and his BP was 151/116 with a pulse of 78. At 6:43 his BP was 137/96 with a pulse of 78. At 6:50 his BP was 118/96 with a a pulse of 73 and at 6:55 it was 120/95 with a pulse of 75. He was better at this point and went back to work.


VAERS ID: 1518574 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM

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

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

Write-up: -pt fainted outside the store in parking lot - called 911 . pt was conscious and breathing . 911 advised to see primary care doctor


VAERS ID: 1518580 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-19
Onset:2021-07-30
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillins
Diagnostic Lab Data: + COVID-19 antigen test on 7/30/2021
CDC Split Type:

Write-up: Patient required hospitalization due to COVID-19 infection after being fully vaccinated


VAERS ID: 1518584 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-06
Onset:2021-07-30
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Sulfa drugs
Diagnostic Lab Data: Positive antigen and PCR COVID-19 tests
CDC Split Type:

Write-up: Patient is asymptomatic but has tested positive for COVID-19 upon being hospitalized for unrelated needs. She is fully vaccinated as of 4/20/2021


VAERS ID: 1518588 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Nausea, Paralysis, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

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

Write-up: patient said 2 min after receiving the moderna vaccine he started feeling nauseous, shaky, sweaty and paralyzed for about 2 seconds. then he was fine. EMT checked him out after and he seemed fine


VAERS ID: 1518642 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Pallor, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: fainting about 3 minutes after vaccine injection unresponsive about 30 seconds with body shaking with pale and clammy skin


VAERS ID: 1518644 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site warmth
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B12
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Itching and hot to touch at injection site I week post vaccination


VAERS ID: 1518645 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aggression, Aphasia, Confusional state, Dyspnoea, Feeling cold, Feeling hot, Hyperhidrosis, Malaise, Panic attack, Somnolence, Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin lisinopril metformin
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: Pulse within range Pt refused hospital and went home
CDC Split Type:

Write-up: At approx 10:22 a patient reports ?that lady not doing too well?. I instruct coworker to call 911. I run to patients side. Pt is complaining of being hot and I provide a water. Pt appears to be sweaty and sleepy. I provide a cold lemonade to see if helps. Pt continues to report being hot. Pt begins to intermittent respond. Pt complains ?my throat my throat? and scratches throat. Pt is having difficulty explaining what?s wrong. I give a 25 mg of Benadryl and instruct pt to chew. At 10:3 patients stated I can?t breath and scratches throat. I give first dose of 0.3 epi. Pt does not react. Fire department shows up 2 min later and evaluated vitals. Vitals are within range. Fire dept questions me and questions pt and pt cannot state name or location. After about 5 min ambulance arrives and begins vitals. Pt complains she is ?cold? and fights the blood pressure cuff. EMT states most likely panic attack.


VAERS ID: 1518647 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-26
Onset:2021-07-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 1 LA / IM

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

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

Write-up: Shingles


VAERS ID: 1518651 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: pt has a needle phobia. After getting the vaccine he started sweating and started feeling light headed. He layed down and we gave him some water and some juice. He started feeling better and left after 30 mins


VAERS ID: 1518659 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-20
Onset:2021-07-30
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: pre dm osteo arthritis
Preexisting Conditions: pre dm osteo arthritis
Allergies: nkda
Diagnostic Lab Data: positive covid 19 test post exposure on 7/30/21
CDC Split Type:

Write-up: positive covid 19 test post exposure on 7/30/21


VAERS ID: 1518666 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

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

Write-up: PATIENT REPORTED NAUSEA, DIARRHEA, DIZZINESS. PHARMACIST RECOMMENDED PEDIALYTE, PEPTO-BISMAL, BENADRYL, HYDRATION, AND STAY AT HOME. PATIENT WAS RESTING AT HOME AT LAST PHONE CONVERSATION 7/31/21.


VAERS ID: 1518668 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Anti-Hypertensive drugs. (patient does not remember her name)
Current Illness: Asthmatic; Pre-Diabetic; Hypertensive
Preexisting Conditions: No
Allergies: Norflex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports pain in chest. Patient is evaluated by personnel at medical emergency. Vital signs are monitored. BP 140/90 P 90. Sat% 99 Dx. 140mg/dl. Doctor is notified by phone. Patient is observed for 30 minutes. Patient indicates not having taken her blood pressure medications and indicates a history of Costochrondritis. Symptoms are reevaluated and vital signs BP 130/80 P 86 Sat% 99. Patient reports feeling better.


VAERS ID: 1518673 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-06
Onset:2021-07-30
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulation drug level normal, Bacterial test negative, Drug screen negative, Immune thrombocytopenia, Laboratory test normal, Platelet count decreased, Smear test, Viral test negative
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine Tamsulosin
Current Illness: Known
Preexisting Conditions: Cryptogenic Cirrhosis
Allergies: Aspirin
Diagnostic Lab Data: Platelet of 8, no schistocytes on smear, no new medications (negative for recent heparin use), no drug use, no recent infections, and no known malignancies.
CDC Split Type:

Write-up: Pt was diagnosed with ITP.


VAERS ID: 1518692 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-10
Onset:2021-07-30
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Extra dose administered, Intensive care
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM, HTN, HLD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7/10: Patient got a third shot of Pfizer vaccine (scheduled for 4th dose - told him to cancel it) 7/30: admitted for CVA (In ICU)


VAERS ID: 1518710 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 under 18 years of age was given Moderna vaccine. Patient presented to clinic with father, requested vaccine. Vaccine questionnaire reviewed, age was not acknowledged and vaccine administered by medical assistant.


VAERS ID: 1518711 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / UNK LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8235 / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Dexlansoprazole 60 mg 1 tab at night before meal Ibgard 2 tab at night before meal Claritin 10 mg as needed Acetaminophen 650 mg every 4 hours (after vaccinations)
Current Illness: No
Preexisting Conditions: Gerd
Allergies: Not known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body was shaking for 2 to 3 hours and have fever,pain all over the body,tiredness . I have taken one tablet acetaminophen 650 mg every 4 hours.


VAERS ID: 1518729 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Paraesthesia, Pruritus, Rash, Tongue discolouration, Ulcer
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Gastrointestinal ulceration (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Toprol XL, amitriptyline, lo-setting Fe
Current Illness:
Preexisting Conditions: Unexplained tachycardia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Experienced tingling/prickly feeling down my entire right arm with beginning of rash within 1 hour of receiving the vaccine. Took Benadryl which helped. Also developed a white tongue and ulcer sore during the night after receiving the vaccination. Have had random spurts of sharp prickling pain in various parts of my body throughout the day today. My right arm (same side as injection) has been itchy today.


VAERS ID: 1518741 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

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

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

Write-up: Alcohol (beer) is causing hives on my face neck and back. Even vegan alcohol, which I can normally drink without any problems.


VAERS ID: 1518743 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267100001 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site scab, Musculoskeletal stiffness, Pain in extremity
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: EXTREME soreness in left arm the day after shot (Felt like I got beat with a baseball bat) EXTREME headache the day after shot EXTREME stiff neck the day after shot Shot site has very large scab


VAERS ID: 1518748 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Feeling cold, Insomnia, Pain, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Refer to : Temporary VAERS E-Report No: 601059 Date Form Completed: 08/01/2021
Other Medications: N/A
Current Illness: No illnesses
Preexisting Conditions: N/A
Allergies: No allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1-my body felt cold and I felt tightness in my chest 2-not easy to take my breath 3-left and right foot started to get swollen. Gotten worse over night but i was able to sleep. 4-both left and right foot got more swollen(mostly the left one) and chest tightness got worse. 5-I''m having pulsing pain on mainly the left foot. Right foot also have pulsing pain but not as much as left foot 6-it''s 3:20 am now and im Having very hard time to sleep with. Both feet specially the left one have pulsing pain and my chest feels tight. This is my 2nd vaccine shot. I have already made a report to VAERS please refer to : Temporary VAERS E-Report No: 601059 Date Form Completed: 08/01/2021


VAERS ID: 1518766 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Pallor, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Patient had a mild reaction after Janssen Covid 19 vaccine. Observed pt pale in appearance, diaphoretic & unresponsive for 30 seconds. A/O x4. Verbalized feeling lightheaded after injection and has hx of fainting and feeling anxious. Pt given water, tolerated well. Assisted pt back to clinic room. Walked with no difficulty. Vitals taken, BP 133/85, P66, R20, O2 sat @99%. Verbalized feeling better. NP aware. No C/O lightheadedness or dizziness. Walking with steady gait. Pt discharged to home.


VAERS ID: 1518770 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

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


VAERS ID: 1518773 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 2 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1518778 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Limb injury, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Arthritis (broad)

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

Write-up: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1518807 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: never had vaccination
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Pt felt nausea/feinting/weak/sweat. I called the ambulance and ask Pt to turn on his heart monitor on his phone device. His pulse rate was 75 and BP 110/75.


VAERS ID: 1518816 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiopathy, Capillary disorder, Hypoaesthesia, Pallor, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Sexual dysfunction (broad)

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

Write-up: Microvascular changes and paresthesia in distal fingers bilaterally. Blanching of skin and delayed capillary refill at 4-5 seconds. Numbness and tingling that lasted for 4-5 hours.


VAERS ID: 1518825 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Headache, Hypersomnia, Injection site pain, Injection site swelling, Injection site warmth, Neck pain, Pain, Renal pain, Spinal pain
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine lorazepam mscontin , calcium, fish oil, probiotics, vitamin c
Current Illness: Seasonal allergies
Preexisting Conditions: Arthritis ,kidney stones
Allergies: Sulfa drugs codeine and pineapple
Diagnostic Lab Data: No testing so far
CDC Split Type:

Write-up: First day bad headache, neck and spine were sore. Second day my entire body is in pain, my brain hurts, my kidneys hurt . I?m I excruciating pain. No energy been sleeping off and on since the vaccine. My arm where I got this injection is swollen hot to touch and in extreme pain.


VAERS ID: 1518844 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Asthenia, Chills, Decreased appetite, Diarrhoea, Faeces discoloured, Headache, Injection site pruritus, Pain, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Having neurological issues that causes tingling/numbing on right side of face/head and chest pain. Seeing neurologist next month.
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Chills, fever, headache, diarrhea (that was yellow and clear), entire body ache, weakness, loss of appetite, loss of taste, runny nose, itchiness on injection site.


VAERS ID: 1518853 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Maternal exposure during pregnancy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Diclegis Pepcid
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pregnant - 33w5d - EDC 09/11/2021 Injection Site Pain - For 36 hours post injection Fatigue - For 6 hours post injection


VAERS ID: 1518858 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 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: unknown
Current Illness: none
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: When patient arrived at pharmacy, he said he needed his 2nd dose of pfizer covid vaccination. We gave him form to fill out, he listed 1st dose as 2/20/21 and said he didn''t have his card with him. After vaccination when going to enter into system, it was discovered that patient lied on vaccination form and to the pharmacy, system showed a 1st dose on 2/3/21 and 2nd dose on 2/24/21. When we notified out vaccine coordinator and let them know, they said to report it to VAERS. Patient was told to wait 15 minutes in the chair at pharmacy after vaccination, pt got up and left. We tried to call patient regarding prior doses, left voicemail, patient has not returned phone call.


VAERS ID: 1518895 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sulfamethoxazole/trimethoprim Atorvastatin Fish oil Daily vitamin Probiotic Calcium Cinnamon Potassium Magnesium
Current Illness: UTI
Preexisting Conditions: High blood pressure
Allergies: Morphine Levaquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy rash developed on neck during the evening 1 day after the vaccine. Spread somewhat to my face and 8/1/21 spread to my chest.


VAERS ID: 1518897 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chills, Confusional state, Cyanosis, Hyperhidrosis, Lethargy, Muscle spasms, Nasopharyngitis, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 30 mg daily
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Cefzil
Diagnostic Lab Data: Blood panel on 7/31/21
CDC Split Type:

Write-up: Received vaccine on 7/29/21 and next day started feeling cold symptoms. Then the following day (7/31/21), profuse sweating, muscle cramping, confusion, lethargic, nauseous and vomiting. Ambulance was called and was transported to hospital. Upon arrival, they noticed that patient was shivering and had blue lips and extremities. Rectal temp was 92 degrees and CO2 levels were low. IVs, Zofran, and warming blankets and fluids were given until levels returned to a normal range. Initial blood testing showed some out of range values but after temp was restored-subsequent bloodwork was normal. Nurse advised me to report this incident since he had just recently received the vaccine and she thought his symptoms were very odd.


VAERS ID: 1518909 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-18
Onset:2021-07-30
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / IM

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

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

Write-up: Covid pos after vaccination


VAERS ID: 1518919 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cardiac flutter, Chest discomfort, Chest pain, Feeling hot, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (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: levothyroxine 112mcg
Current Illness: None
Preexisting Conditions: Hashimotos
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After about 5-7 minutes of receiving the C-19 vaccine I was sitting in the lobby and I felt hot all over my body, I felt pressure in the middle of my chest and my heart began to flutter. At the same time this was happening i felt like a tingling sensation in my chest and weak. I alerted the receptionist and she told me to come up and she would let the nurse know. As I went to get up I was concerned if I would be able to stand because I felt very weak. I have never felt any of this before. It was all new. As soon as the let me in to the back office, the temperature was cool and as walked in to the cold room, my side effects were complexity gone. Vitals signs normal. I am concerned about getting the second does and I don?t want to after I had chest pain.


VAERS ID: 1518923 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Condition aggravated, Dehydration, Fatigue, Hot flush, Insomnia, Migraine, Pain, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Tri-Linya Birth Control
Current Illness:
Preexisting Conditions:
Allergies: Bananas, oats
Diagnostic Lab Data:
CDC Split Type:

Write-up: At time of the injection, very little side effects took place; after 1 hour of receiving vaccine heat flashes was the first major side effect. 7 hours prior to vaccination, dizziness/exhaustion took place. Very little sleep due to severe body aches and chills. Woke up next morning (7/31/21) with fever just around 101. Fever lasted 3 hours, body aches persisted for the entire day along with chills and migraines. Taking over the counter medications seemed to have mitigated symptoms temporarily. Had to take stronger cold/flu medications in order to sleep. 8/1/21: no fever, body aches still persist, exhaustion and dehydration still persist.


VAERS ID: 1518932 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: RECEIVED HAVRIX, BOOSTRIX AND PNEUMOVAX 23 TOGETHER WITH MODERNA (1ST SHOT) IN THE SAME SITTING
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: patient received 4 vaccines listed above in the same sitting, "passed out" as per colleague report upon returning to work later that day, was then hospitalized; patient currently in hospital


VAERS ID: 1518950 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-07-30
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 LA / IM

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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive 8/1/2021
CDC Split Type:

Write-up: Patient developed COVID despite vaccine.


VAERS ID: 1518958 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Hypoaesthesia, Mechanical urticaria, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxyzine - 25 mg before bed
Current Illness: Stomach flu end of June.
Preexisting Conditions: Dermatographia Diverticulosis Seborrheic Dermatitis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: A week after vaccination, I felt pain in my right forearm while at work in the morning from around 9:00-11:00 a.m. Around noon I had realized that the pain had stopped and when I rubbed my right forearm, I realized there was no feeling in my forearm. I did not immediately go to the urgent care, as I did not want to over react. I tried to make myself feel pain, to include pinching with my nails as hard as I could with my left hand and and also scratching, thus triggering my dermatographia. This numbness lasted until about 2:00 p.m. and I had read online that Guillain-Barre Syndrome had been associated with the Janssen vaccine and I left and went to a medical provider to be seen, even though feeling had returned in my arm.


VAERS ID: 1518976 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-17
Onset:2021-07-30
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: hyperlipidemia, prediabetes. h/o leprosy
Allergies: none
Diagnostic Lab Data: Positive COVID PCR on 7/30/21
CDC Split Type:

Write-up: Positive COVID PCR on 7/30/21, patient asymptomatic


VAERS ID: 1518987 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-09
Onset:2021-07-30
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Appendicectomy, Appendicitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, calcium, magnesium, hydrocortisone cream
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Appendicitis leading to appendectomy


VAERS ID: 1518995 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cardiac dysfunction, Dyspnoea, Dysstasia, Extrasystoles, Fatigue, Feeling hot, Headache, Hypoacusis, Injected limb mobility decreased, Muscular weakness, Presyncope, Respiration abnormal, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Hearing impairment (narrow), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Hypokalaemia (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: They just sent me home claiming I was impressionable.
CDC Split Type:

Write-up: In order. Weak legs. Heavy breath and rush of heat. I started skipping beats and my heart and breath weren''t keeping up. Headache and gradual sense of vertigo. When medical staff realized I was about to collapse after 2 minutes they had me stand up to go lay on the stretcher. I realized I couldn''t stand on my feet and sit on a near bench. My ears were obtunded as if I couldn''t hear properly anymore. When I laid down with my legs up I started feeling blood flowing again on my face and my ears regained sensibility. After ten minutes I was almost all right. I felt tired the rest of the day but I worked my shift as usual. Next day I couldn''t lift my left arm and I was just a little tired. The day after it was manageable.


VAERS ID: 1519002 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling of body temperature change, Heart rate increased, Hyperhidrosis, Hypoaesthesia, Injection site pain, Maternal exposure during pregnancy, Nausea, Neck pain, Pain, Pain in extremity, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, Claritin, prenatal vitamins
Current Illness: NA
Preexisting Conditions: Fibromyalgia Endometriosis Inappropriate sinus tachycardia
Allergies: Seasonal and environmental allergies, Effexor, ibuprofen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 6 weeks pregnant at time of vaccine, due date 3/22/2022. Instant burning and pain in arm following injection, which radiated to neck and down arm. Sweating and hot all over, increased heart rate, then dizziness, facial numbness, nausea and fainted for a minute.


VAERS ID: 1519007 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: unknown
Current Illness: Asthma
Preexisting Conditions: Asthma
Allergies: Keflex, Varicella vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient described shortness of breath, was taken to ER my mother. per mother, she was treated with albuterol Inhaler, steroid and benedryl and released after a few hours. told to follow up with asthma dr on Monday 8/2/21.


VAERS ID: 1519016 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO181 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Diarrhoea, Fatigue, Headache, Myalgia, Rhinorrhoea, Upper-airway cough syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fexofenadine 180mg, Famotidine 20mg, One-A-Day Men''s Silver Multi-vitamin gel tab, Red Yeast Rice, CoQ10
Current Illness: none
Preexisting Conditions: Allergies to Bahia Grass, Red Cedar, Short Ragweed, Mugwort, mold spores
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: On Friday morning, I was feeling fatigued and my nose started running severely, with post nasal drip. As the day went on, the fatigue got worse, I started getting muscle aches all over and a headache. These continued through Saturday and I started getting chills. These still continued today (Sunday) along with diarrhea.


VAERS ID: 1519040 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: The patient did not experience any adverse events other than sore arm, but the vaccine was administered a week early.


VAERS ID: 1519050 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO217 (HARD TO / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram abnormal, Laboratory test abnormal, Myocarditis, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 8/1 - elevated cardiac markers, and abnormal EKG. Echo will be done but pending
CDC Split Type:

Write-up: Peri/myocarditis - chest pain, pending treatment. At this point, just planning on NSAIDs


VAERS ID: 1519073 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Injection site pain, Myalgia, Nasal congestion, Productive cough
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: All in daily doses:; buPROPion HCL XL 450 MG; metFORMIN HCL 1000 MG; SIMVASTATIN 10 MG; DESVENLAFAXINE SUCCNT 50 MG; LOSARTAN POTASSIUM 50 MG; Asprin 81 MG Vitamin 125 MG; Men''s Daily Vitamin; OMEPRAZOLE 20 MG; Loratadine 10 MG; PSEUDOEPHE
Current Illness: none
Preexisting Conditions: diabetes; overweight
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Very mild soreness in arm at site of injection started roughly 12 hours after injection. Severe headache and severe nasal congestion started roughly 28 hours are injection. Wet cough developed by 30 hours after injection. Extreme fatigue started when I woke up 44 hours after injection. Cold chills started 56 hours after injection. Symptoms began subsiding when I woke up roughly 70 hours after injection. Muscular pain in the back shoulder area started roughly 75 hours after injection.


VAERS ID: 1519105 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Dizziness, Fatigue, Feeling hot, Headache
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Feeling warm, fatigue, dizzy, light headed, cramps in abdomen, headache


VAERS ID: 1519112 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site ulcer, Myalgia, Pain, Pain in extremity
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle pain under collar bone starting the day after the shot. Hurts to move my right arm anywhere. Had a red sore at the injection sight the next day. The sore only lasted a day but the collar bone muscle pain I still have.


VAERS ID: 1519137 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-19
Onset:2021-07-30
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Atrial flutter, Cardiac failure congestive, Pleural effusion
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, arterial (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute CHF, pleural effusion, atrial flutter and NSTEMI


VAERS ID: 1519150 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-24
Onset:2021-07-30
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / UN

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Heart rate increased, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad), Hypokalaemia (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: Heart rate increase to 110 bpm, low pressure, tiredness


VAERS ID: 1519160 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Approximately 2 hours after receiving vaccine patient described delayed urticaria occurred on numerous areas on the body. Including stomach, hands , feet, arms, legs, and thighs.


VAERS ID: 1519285 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Headache, Heart rate, 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:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: Patient had no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210730; Test Name: Heart rate; Result Unstructured Data: 101bpm; Test Date: 20210730; Test Name: Body temperature; Result Unstructured Data: 100.7
CDC Split Type: USJNJFOC20210764491

Write-up: BODY ACHES; BODY CHILLS; HEADACHE; FEVER; This spontaneous report received from a patient concerned a 22 year old male. The patient''s weight was 180 pounds, and height was 182 centimeters. The patient''s concurrent conditions included non alcoholic, and non smoker, and other pre-existing medical conditions included patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 041A21A, and expiry: UNKNOWN) dose was not reported, administered on 29-JUL-2021 15:00 for prophylactic vaccination. No concomitant medications were reported. On 30-JUL-2021, the subject experienced body aches. On 30-JUL-2021, the subject experienced body chills. On 30-JUL-2021, the subject experienced headache. On 30-JUL-2021, the subject experienced fever. Laboratory data included Body temperature (NR: not provided) 100.7, and Heart rate (NR: not provided) 101bpm. Treatment medications (dates unspecified) included naproxen sodium. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from body chills on 30-JUL-2021, and had not recovered from body aches, headache, and fever. This report was non-serious.


VAERS ID: 1519303 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Wrong dosage formulation
SMQs:, Medication errors (narrow)

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

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


VAERS ID: 1519309 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Vaccination site swelling, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: Allergy to cherries
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On Friday, 7/30, the vaccination site was itchy and there was a large red swollen area which was warm to the touch. By Monday 8/2, the red swollen area had decreased but was still slightly warm to the touch a little bit itchy.


VAERS ID: 1519452 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LL / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Hypoaesthesia, Paraesthesia, Paraesthesia oral, Pruritus, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Synthroid, Zoloft, daily vitamins, lorazapam,Co Q10 ,..aspirin,tylenol.,vitamin d ,
Current Illness: none
Preexisting Conditions: anxiety, depression, OCD
Allergies: Sulphur drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: With 4 hours of the vax my legs began to feel numb and tingly, ,got worse thru the afternoon and night, headache, Called Drs office Saturday, still felt like legs were numb, Sunday same thing, then about 2 pm started to slightly itch all over,. Had a hive beak out on my right cheek, lips are tingling, have a scratchy throat.


VAERS ID: 1519461 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Fatigue, Lymph node pain, Lymphadenopathy, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Jolessa, Bentyl, vitamin D, Allegra, zinc, vitamin C, melatonin
Current Illness: None
Preexisting Conditions: Hypothyroidism, Chronic Migraines, IBS, Raynaud?s
Allergies: Demerol, Reglan, CT barium, milk, gluten, strawberry, sesame,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, right armpit lymph node soreness/tenderness, muscle weakness, joint pain, chest pain


VAERS ID: 1519463 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-16
Onset:2021-07-30
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Breast swelling, Breast tenderness, Nipple pain
SMQs:, Angioedema (broad), Lipodystrophy (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had my vaccine administered on my left arm 7/16/2021. I?ve recently began having left breast pain. This is new pain I have not had before. It is a sharp pain on top of breast to my nipple. To touch it hurts. The left breast also feels slightly swollen and tender. I began to notice the pain Friday 7/30/2021. The pain is slightly worse as the days go on. There is nothing new that I was doing. I do not typically use my left arm for anything, besides I sleep sometimes on my left side. Undergarments are the same I?ve used before vaccine. I have not had any new supplements, or exercise in the last 14 days.


VAERS ID: 1519507 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Acute myopericarditis


VAERS ID: 1519514 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 891D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Decreased appetite, Eye irritation, Influenza like illness, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Corneal 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: Librax 5/2.5 1 daily, Ambien as needed
Current Illness: Fever within 2 hours, lasted for the rest of the day, 100-101 fahrenheit. Extreme weakness continues to date (now day 4). Loss of appetite, struggling to eat. Extreme flu-like symptoms
Preexisting Conditions: 18 years IBS-D
Allergies: Penicillin, tylenol, Clindamycin, Bactrim, toradol, TRAMADOL
Diagnostic Lab Data: refused by doctor
CDC Split Type:

Write-up: for got to include in previous info, Burning eyes ans very painful at injection site


VAERS ID: 1519523 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091021A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Fatigue, Headache, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: various vitamins, metoprolol, latanoprost, morphine extended release
Current Illness: none
Preexisting Conditions: back pain
Allergies: none
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: Mild headache soon after injection (Friday afternoon) which got worse through the night. Severe headache all day Saturday and moderate headache all day Sunday. Mild headache still today, Monday morning. Saturday I had major fatigue and couldn''t walk up a short hill without being out of breath. Some chills Saturday afternoon. And periodic periods of abnormal sweating throughout the weekend and this morning as well./ My prescription morphine for back pain wasn''t working for the headache. 2 ibuprofen tablets were taken at 4 different times this weekend with no real noticeable impact. Didn''t know anything else to try. Drank a lot of water.


VAERS ID: 1519533 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / UNK RA / IM

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

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

Write-up: Pt started having body aches on Friday and rash began on Saturday under armpit


VAERS ID: 1519552 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-08
Onset:2021-07-30
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 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: 8/1/21 Home COVID test - Positive
CDC Split Type:

Write-up: COVID positive after completing COVID vaccine series.


VAERS ID: 1519556 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Body ache


VAERS ID: 1519558 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-12
Onset:2021-07-30
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Other       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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Alprazolam, Buproprion XL, Diclofenac, Diflucan, hydrochlorothiazide, pantoprazole, rizatriptan, simvastatin and zolpidem
Current Illness:
Preexisting Conditions: Obesity, HTN, HLD
Allergies: Macrolide Antibiotics, Sulfa, Erthromycin
Diagnostic Lab Data: Testing was performed using the SARS-CoV-2 RT-PCR Cepheid assay. - Covid (+)
CDC Split Type:

Write-up: Patient COVID positive 7/30 currently hospitalized requiring oxygen and receiving dexamethasone and remesidivir therapy.


VAERS ID: 1519562 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cardiovascular function test, Computerised tomogram, Dyspnoea, Endoscopy, Endotracheal intubation, Epistaxis, Hypertension, Intensive care, Laboratory test, Mechanical ventilation, Mouth haemorrhage, Pruritus, Pulmonary haemorrhage, Pyrexia, Respiration abnormal, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: CT scan, endoscopy, pulmonary work, Cardiovascular- heart test. Tube down his throat. 7/30-8/1 2021, respiratory therapy.
CDC Split Type:

Write-up: My Son took the Johnson&Johnson vaccine on 7/30 at 2:35pm. Then was unresponsive by 8:25pm. His father performed CPR and blood was coming out of his nose and mouth. EMS, fire department came and his dad did enough until help came. He was in the ICU with blood in his lungs, the doctors did not know what was wrong with him. I explained he took the shot and had stated minutes earlier his foot was itching and then he went to sleep with gasps trying to breathe. He is still in the hospital. He knew that it was the vaccine, as soon as he was able to talk that is what he stated, the vaccine almost killed me. These are facts and he is still in the hospital, off the ventilator after two days but his breathing is off. as of today 8/2/21 he is still in the hospital. His Blood pressure is high and he is running a fever. Breathing is erratic still.


VAERS ID: 1519583 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: anaphylaxis


VAERS ID: 1519598 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: UNDER 12 Y/O GOT COVID VACCINE ~20 minutes before closing, a customer brought her daughter in to get a Pfizer Vaccine as a walk-in. Before I asked her to fill out the consent form, I asked both mom and the child how old was she, they both answered me that she''s 12 & DOB as 07/20/2009, so we went ahead to do the vaccine. While they were waiting for 15 minutes after the vaccine, I batched the vaccine, got a rejection from Organization saying "name not matching". I confirmed with mom the information while she''s still waiting in the store. She again stated the same thing. I later called Organization and they told me that Organization has patient''s DOB 08/20/2009, not 07/20/2009 as mom wrote in the form and confirmed it. I then called mom to ask for DOB, again, she told me DOB "07/20/2009". I told her about what Organization told me, she then admitted that she said that so her daughter could get the vaccine before the school starts.


VAERS ID: 1519610 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-04
Onset:2021-07-30
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin 20 mg Tablet Directions: 1 tablet oral daily at bedtime (Active) buPROPion HCl 300 mg Tablet Extended Release 24 hr Directions: 1 tablet oral daily (Active) buPROPion HCl 150 mg Tablet Extended Release 24 hr Directions: 1
Current Illness:
Preexisting Conditions: CAD, Dyslipidemia, HTN;
Allergies: Penicllins
Diagnostic Lab Data: COVID-19 PCR Positive
CDC Split Type:

Write-up: Hospitalized on 7/30/2021 for COVID 19 +


VAERS ID: 1519616 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrocodone 5-325 mg 1 tablet 2 - 3 times daily Cyclobenzaprine 10 mg 2 tablet daily ( 1 am, 1 pm) Fish oil 2400 mg daily Zinc 50 mg daily Vitamin C 500 mg daily
Current Illness: None
Preexisting Conditions:
Allergies: Cocaine, anything latex. Also allergic to grass, dirt, dust,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen gland in armpit of left arm (injection arm)


VAERS ID: 1519625 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Vaccination site cellulitis
SMQs:

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

Write-up: Patient received her first Pfizer Covid-19 vaccine on 7/29/2021 and on 7/30/2021 patient notices cellulites on her left arm were she received the vaccine. .Patient was seen by health professional and was started on Keflex , ibuprofen, and an antihistamine.


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