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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 328 out of 7,116

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VAERS ID: 1525356 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-07-30
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA COIR2JA / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Dyspnoea, Fatigue, Myalgia, Oropharyngeal pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Cardiovascular Disease
Allergies: Unknown
Diagnostic Lab Data: Covid 19 PCR
CDC Split Type:

Write-up: Case had symptom onset 7/30/21 which included subjective fever, chills, muscle aches, runny nose, sore throat, fatigue, cough, wheezing and shortness of breath. He was still symptomatic at time of case investigation on 8/2/2021. He was seen in the ER department and tested for Covid 19.


VAERS ID: 1525592 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 3 LA / IM

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

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

Write-up: Patient filled out the Vaccine Administration Consent Form and used the incorrect date of birth and received a 3rd COVID vaccine.


VAERS ID: 1525626 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

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

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

Write-up: Itchiness, Some rashes, headache


VAERS ID: 1525656 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Headache, Pain in extremity, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Approx 33 y/o. Reaction to Dtap booster. Severe muscle pain throughout body. Unable to get out of bed for 48 hrs.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: All antibiotics
Diagnostic Lab Data: None
CDC Split Type:

Write-up: My eyes were swollen every morning for one week following the vaccine. Occasional blurred vision throughout the day for about 4 days following the vaccine. Extreme soreness on entire right arm for 48 hours after vaccine. Headache the following day for approximately 4 hours.


VAERS ID: 1525670 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Eye pain, Eye pruritus, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Glaucoma (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: Cephalosporin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: It started with pain in the left eye and then the right eye turned red then both were red and itching.


VAERS ID: 1525751 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

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

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

Write-up: Pt stated prior to vaccination that he gets dizzy often with injections. Pt immediately lost consciousness after injection. Two nurses lowered him to the floor, no injuries were sustained. Recovered consciousness within one minute. Could state name and that he had no other signs or symptoms beyond dizziness. Given Gatorade and observed for 15 minutes with no additional symptoms.


VAERS ID: 1525779 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Diarrhoea, Headache, Inflammation, Malaise, Oropharyngeal pain, Rash, Rash papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: NONE, THAT I''M AWARE OF.
CDC Split Type:

Write-up: ON 7/30/2021, THE PATIENT PRESENTED WITH AN INFLAMED, RAISED RASH ON THE VACCINATED ARM JUST BELOW THE DELTOID MUSCLE. THE PATIENT SELF-TREATED WITH HYDROCORTISONE CREAM AND REPORTED THE RASH WAS INTERMITTENTLY ITCHY AND SORE. ON 8/2/21, THE PATIENT REPORTED THAT THE RASH HAD GOTTEN A LITTLE BETTER, BUT RETURNED IN SIMILAR FASHION....RAISED RASH, ITCHY AND SORE. ALSO, REPORTED THAT SHE EXPERIENCE/D UPSET /STOMACH WITH LOOSE STOOL, HEADACHE, SLIGHT SORE THROAT AND GENERALLY, NOT FEELING WELL.


VAERS ID: 1525798 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Virgin Islands  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: I have developed TINNITUS after receiving the JANNSEN & JANNSEN shot.


VAERS ID: 1525872 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram ST segment depression, Electrocardiogram abnormal, Heart rate irregular, Malaise, Nausea, Pyrexia, Sinus tachycardia, Tachycardia, Troponin normal, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol 1,000 mg
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: Newly diagnosed with COVID-19 vaccination allergy
Diagnostic Lab Data: Troponins drawn 7/31/21 Result #1 <0.02 Result #2 <0.02
CDC Split Type:

Write-up: Fever, General Malaise. Could not control fever on my own. I went to the emergency room where I received another gram of Tylenol and 30mg of toradol. Over the course of my stay I revived 2L normal Saline. I had fever induced tachycardia as well. Fever didn''t break until fans were placed on in the room to cool me down. I received 4mg of zofran and 5mg of compazine for nausea and vomiting. I received 1mg of Ativan for heart rate control to which it did not respond. Repeat EKGs and Troponins were done. EKGs showed Sinus tachycardia with ST depression in leads II, III, aVF, V4, V5, and V6. Troponins came back negative. I was given 5mg of IV metoprolol and my heart rate responded and decreased. Repeat EKG showed improvement with ST depression only showing in leads II and III.


VAERS ID: 1525878 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pain in extremity, Product administered to patient of inappropriate age
SMQs:, Tendinopathies and ligament disorders (broad), 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: No severe allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient, mother, and father each separately gave pts DOB as 06/24/2009, meaning the child would be 12. CDC Vaccination record presented with same DOB and record of previous vaccination. It was not until entering the vaccine into the Database that it was discovered the patients actual DOB was 06/24/2010 making her 11 years old. Her record in database had the same mothers 1st name, same middle initial, and same date and location of 1st dose of COVID vaccine. Attempted to follow up with mother over the phone, the line picked up but there was no response when writer identified self. Patient had ill effects at the time of vaccination. Stated only a sore arm with the first dose and no other side effects.


VAERS ID: 1525887 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Headache, Pain, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), 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: Hydrocodone, Lasix, Gabapentin, Atorvastatin, Symbicort, Vitamin D, Metformin ER, Prazosin, Pantoprazole, Eszopiclone, Ipratropium, Carafate, Budesonide, Ezetimibe, Celexa, Vraylar, Levothyroxine, Daliresp, Singular, Claritin
Current Illness: None
Preexisting Conditions: too many to list
Allergies: Erythromycin, Nicotine patches, Augmentin, Zoloft, Sulfa, Tramadol, Belsomra, Metformin (regular), Tylenol, Wellbutrin, Cefdroxil, Codeine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: chest tightness, congestion, body aches, severe headache, and low grade fever


VAERS ID: 1525901 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Amnesia, Condition aggravated, Headache, Nausea, Seizure
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), 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: KEPPRA
Current Illness: SEIZURE 7/10/2021
Preexisting Conditions: BRAIN CANCER
Allergies: WOOL AND BEES
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: ? SEIZURE, PT FOUND LYING ON FLOOR DOESN''T REMEMBER WHAT HAPPENED, VITALS TAKEN NEURO ASSESSMENT WNL. FELT NAUSEATED AND HAD A HEADACHE. REPORTED LATER THAT NIGHT THAT HE HAD 2 MORE SEIZURES BY JAIL STAFF. AMBULANCE CALLED FOR ONE AND CHECKED PT. OVER AND DID NOT FEEL THE NEED TO BRING HIM TO HOSPITAL. FOLLOWED UP WITH HIM ON 8/2/2021 HE HAS HAD NO FURTHER SEIZURE ACTIVITY AT THAT TIME AND NO NAUSEA, VOMITTING OR HEADACHES.


VAERS ID: 1525911 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Blood test, Dizziness, Laboratory test normal, Paranasal sinus discomfort, Sinusitis, Urine analysis, Vertigo
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, Toprol, Hydrochloridazide, tremfya
Current Illness: none
Preexisting Conditions: graves and psoriasis
Allergies: avolox
Diagnostic Lab Data: blood tests for infection and urine samples. labs were all normal.
CDC Split Type:

Write-up: Dizziness, spinning, off balance, and sinus pressure. The dizziness and spinning started less than 24 hours after the vaccine and I still have it 6 days later. Did a visit on Sunday the 8/1/21 and they prescribed me a medicine for dizziness. I also went to the doctors again on 8/3/21 for all the systems. They stated I had vertigo and now the beginnings of sinus infection.


VAERS ID: 1525931 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast, fluoxetine, albuterol
Current Illness:
Preexisting Conditions: asthma, suicide attempt, depression, anxiety
Allergies: clarithromycin, latex, iodine, shellfish, flu virus
Diagnostic Lab Data: vital signs
CDC Split Type:

Write-up: patient developed tingly lips palms and itchy throat. Given PO diphenhydramine and felt better


VAERS ID: 1526011 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Patient complained of numbness down left arm to hand


VAERS ID: 1526027 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-26
Onset:2021-07-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Myalgia, Neck pain, Pain, Paraesthesia, Rash, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: none
Preexisting Conditions: none
Allergies: Buspar
Diagnostic Lab Data: he wouldn''t preform any blood work or anything I don''t have insurance
CDC Split Type:

Write-up: started out as rash then spread to all over the body, looks like shingles, hives and reg. rash. Body Aches and feels like pulled muscles in chest, tingling left arm and sore neck


VAERS ID: 1526081 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Inflammation
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Patient stated that after she got vaccine, she had some soreness in her are and pain on the left and middle part of her chest. Patient went to ER, and was told that there was some inflammation in her heart and her chest. Patient states that the steroids she has been taking have been helping with pain, though her chest is still hurting.


VAERS ID: 1526123 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Elavil 25mg qhs
Current Illness:
Preexisting Conditions: GERD, chronic rhinitis
Allergies: ibuuprofen
Diagnostic Lab Data: nl EKG
CDC Split Type:

Write-up: pt with tachcardia up to 120s had chest pain


VAERS ID: 1526149 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-23
Onset:2021-07-30
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / UNK LA / IM

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

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

Write-up: Positive for Covid 7/30/2021


VAERS ID: 1526277 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Myalgia, Nausea, Pyrexia, Restlessness, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Anastrozole 1 mg Lisinopril 10 mg Venlafaxine 150 mg Mirtazapine 3.25 mg Loratadine 10 mg Vitamin D 1000 g Vitamin B Complex Multivitamin
Current Illness: None
Preexisting Conditions: Breast Cancer High Blood Pressure Osteoarthritis
Allergies: Avelox Antibiotic Tegaderm/ medical tape Highly sensitive to Aspirin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 7/28/21 @ 4 pm Nausea and shoulder/neck muscular pain 7/28/21 - 7/29/21 Restlessness throughout night, nausea, muscular pain 7/29/21 @ 630 am - Vomiting 7/29/21 @ 9 am Fever - 100.4 F 7/29/21 all day - muscle pain, fatigue, loss of appetite 7/30/21 - fever, pain , fatigue all resolved 8/2/21 - neck and upper back muscle pain


VAERS ID: 1526283 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Private       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: Patient was offered and administered Janssen COVID vaccine while admitted to the hospital. Following discharge, it was reported by a family member that patient had already received the two-dose Moderna series. Only one dose of Moderna was found in addition to the Janssen.


VAERS ID: 1526284 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: shingrix dose 1
Other Medications: zyrtec, Zoloft, requip, percocet, ambien
Current Illness: COPD, back pain
Preexisting Conditions: COPD, back pain
Allergies: rubbing alcohol, naproxen
Diagnostic Lab Data: none
CDC Split Type:

Write-up: area of redness and swelling starting 3 hours after injection, continuing to spread to area 4" by 4" on 8/4/2021, upper area had hard lump 1/4" by 1 " on 8/3/21 that decreased in size by 8/4/21. started taking oral benadryl evening of 8/3/21 but redness area continued to increase in size from 2" by 2" on 8/3/21 to 4" by 4" on 8/4/21. she returned to the pharmacy 8/3/21 and showed area and returned again on 8/4/21.


VAERS ID: 1526286 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Back pain, Feeling abnormal, Headache, Heart rate irregular, Neck pain, Pain, Pain in extremity, Rhinorrhoea
SMQs:, Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Cardiac arrhythmia terms, nonspecific (narrow), 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: Hepatitis B Injection
Other Medications: Amlodipine ~ Coreg ~ ASA~ Turmeric tab~Bentyl
Current Illness: HTN~ High Cholesterol~ Tachycardia~ MVP
Preexisting Conditions: MVP~ HTN~
Allergies: PCN ~ Demerol~ Sulfa~ Tylenol~ Some Mycin Drugs~
Diagnostic Lab Data: I have not seen a Doctor.
CDC Split Type:

Write-up: After 9AM on 30 July 2021 I started to have a runny nose persisted for three days. Later the same day I developed a left sided headache and left back pain and left arm pain that radiated up the side f my back very sharp pain. Left sided pain that occurred at the left side of my neck to just beneath my scapula on the left side. On the 01 August 2021 I felt extremely weak and my my heart beat were and still are erratic I have been having uncomfortable heart rhythm since 30 July. They are worse at night. I have this really unusual feeling in my head and I feel horrible and weak.


VAERS ID: 1526290 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: A week later a very itchy rash on both feet. The rash is red and occurs mostly on the tendons and heels. Occasionally a fleeting itch on the index finger of each hand, but not scratching it the itch on both fingers disappears.


VAERS ID: 1526299 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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: Losartan potassium, hydrochlorothiazide, atorvastatin calcium, vivelle-dot, beta Ethan one dipropionate cream
Current Illness:
Preexisting Conditions: Irritable bowel syndrome, high blood pressure, skin rash
Allergies: Penicillin, compazine, coding, Eggs barley, soy, beets Bees, soap
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen lymph node in neck on the left side. Injection was on the left arm.


VAERS ID: 1526935 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Dizziness, Fatigue, Headache, Respiratory tract congestion
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Vestibular disorders (broad)

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

Write-up: Patient experienced progressive worsening of side effects from pfizer vaccine per husband. Patient experienced headache, congestion, back pain, dizziness and extreme fatigue. Recommended that patient get a PCR test for covid-19 because some of the symptoms described by patients husband seemed abnormal. Recommended to follow up with PCP in a week or so if symptoms continue to worsen.


VAERS ID: 1527146 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-01
Onset:2021-07-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Eye pain, Headache, Injection site swelling, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (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: Rabies, HRIG
Other Medications: Natures way multivitamin
Current Illness: N/a
Preexisting Conditions: Prior history Hodgkin?s lymphoma
Allergies: N/a
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Left arm: swelling, site of injection was elevated and enlarged -frontal headaches/ eye pain -chills -general body aches


VAERS ID: 1527337 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram normal, Dizziness, Head discomfort, Headache, Red blood cell count normal, Vertigo, Vision blurred, White blood cell count normal
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT scan on 8/4/2021 did not reveal anything of interest. No dye was used to aid in the interpretation of CT scan data. White and red blood cell count normal.
CDC Split Type:

Write-up: Pressure in head; pain in head; vertigo; blurry vision; dizzy. Pain did not go away with medication.


VAERS ID: 1527857 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-03-01
Onset:2021-07-30
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: tested positive for COVID on 7/31/2021.
CDC Split Type:

Write-up: Patient states she was fully vaccinated with Moderna COVID vaccine, completed second shot in March. We do not have a copy of her COVID vaccination card or know her lot numbers, she was advised to e-mail this information to her primary care provider''s office. Her symptoms of fatigue, fevers, body ache, headache, and nasal congestion started on 7/30/2021. She tested positive for COVID on 7/31/2021.


VAERS ID: 1528134 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: The patient had no history of drug abuse or illicit drug usage
Allergies:
Diagnostic Lab Data: Test Date: 20210730; Test Name: COVID-19 virus test; Result Unstructured Data: positive
CDC Split Type: USJNJFOC20210800587

Write-up: TESTED POSITIVE FOR COVID-19; This spontaneous report received from a consumer concerned a 43 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non-alcohol user, and non-smoker, and other pre-existing medical conditions included the patient had no history of drug abuse or illicit drug usage.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and expiry: 23-AUG-2021) dose was not reported, administered on 10-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-JUL-2021, the subject experienced tested positive for covid-19. Laboratory data included: COVID-19 virus test (NR: not provided) positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from tested positive for covid-19. This report was non-serious. This report was associated with product quality complaint: 90000187968.; Sender''s Comments: V0: Medical assessment comments not required as per standard procedure as the case is considered non serious.


VAERS ID: 1528136 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210730; Test Name: SARS-CoV-2 antibody test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210800862

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned a 69 year old male. Initial information was processed along with the additional information received on 03-AUG-2021. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805020 expiry: UNKNOWN) dose was not reported, 1 total administered on 12-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-JUL-2021, the patient underwent antibody test which came negative (confirmed immunological vaccine failure). Laboratory data included (on 30-JUL-2021), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody test (NR, not provided) Negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210800862 -Covid-19 vaccine ad26.cov2.s-Confirmed immunological vaccine failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1528137 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Headache, Hypoaesthesia oral, Oedema peripheral, Pain in extremity, Paraesthesia, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: TEGRETOL; KEPPRA
Current Illness: Asthma; Blood pressure high; Convulsive disorder
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210730; Test Name: Body temperature; Result Unstructured Data: 99.5 F; Test Date: 20210731; Test Name: Body temperature; Result Unstructured Data: 99.4 degree Fahrenheit
CDC Split Type: USJNJFOC20210801173

Write-up: SWOLLEN LEFT ANKLE; NUMBNESS AROUND HER MOUTH; MILD LEG PAIN; TINGLING SENSATION ALL OVER THE BODY; FEVER; HEADACHE; This spontaneous report received from a patient concerned a 51 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included high-blood pressure, asthma, and seizure disorder. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A, expiry: UNKNOWN) dose was not reported, administered on 30-JUL-2021 for prophylactic vaccination. Concomitant medications included carbamazepine for anti-convulsant, and levetiracetam for anti-convulsant. On 30-JUL-2021, the subject experienced swollen left ankle. On 30-JUL-2021, the subject experienced numbness around her mouth. On 30-JUL-2021, the subject experienced mild leg pain. On 30-JUL-2021, the subject experienced tingling sensation all over the body. On 30-JUL-2021, the subject experienced fever. On 30-JUL-2021, the subject experienced headache. Laboratory data included: Body temperature (NR: not provided) 99.5 F. On 31-JUL-2021, Laboratory data included: Body temperature (NR: not provided) 99.4 degree Fahrenheit. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from numbness around her mouth, fever, swollen left ankle, mild leg pain, tingling sensation all over the body, and headache. This report was non-serious.


VAERS ID: 1528138 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Gait disturbance, Hypokinesia, Impaired driving ability, Myalgia, Pain in extremity, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: The patient had no known drug or non-drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210801219

Write-up: FEELS DEAD; DIZZINESS; CAN''T MOVE ARM; SHAKINESS; CAN BARELY WALK UP THE STAIRS; UNABLE TO DRIVE; ARM PAIN; MUSCLE ACHES FROM HEAD TO TOE; FEVER; This spontaneous report received from a patient concerned a 35 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non alcohol user, and non smoker, and other pre-existing medical conditions included the patient had no known drug or non-drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, expiry: 21-SEP-2021) dose was not reported, administered on 30-JUL-2021 15:00 for prophylactic vaccination. No concomitant medications were reported. On 30-JUL-2021, the subject experienced feels dead. On 30-JUL-2021, the subject experienced dizziness. On 30-JUL-2021, the subject experienced can''t move arm. On 30-JUL-2021, the subject experienced shakiness. On 30-JUL-2021, the subject experienced can barely walk up the stairs. On 30-JUL-2021, the subject experienced unable to drive. On 30-JUL-2021, the subject experienced arm pain. On 30-JUL-2021, the subject experienced muscle aches from head to toe. On 30-JUL-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from feels dead, fever, muscle aches from head to toe, shakiness, arm pain, dizziness, can barely walk up the stairs, unable to drive, and can''t move arm. This report was non-serious.; Sender''s Comments: V0-Medical Assessment Comment is not required as per standard procedures, as the case was assessed as non-serious.


VAERS ID: 1528566 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Electrocardiogram, Heart rate decreased, Hypotension
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad), Hypokalaemia (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: shoulder injury following flu vaccine
Other Medications: multi-vitamin
Current Illness: na
Preexisting Conditions: na
Allergies: penicillin bees
Diagnostic Lab Data: ekg
CDC Split Type:

Write-up: shortness of breath with oxygen saturation of 84% low heart rate 42 low blood pressure 90/60


VAERS ID: 1528601 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW6183 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, nrco, ibuprofen, levonorgestrel-ethinyl estradiol, lisinopril 20
Current Illness: none
Preexisting Conditions: hypertension and lumbar radiculopathy
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient on long term birth control to suppress periods. Developed breakthrough bleeding following the vaccine 1 day after the vaccine.


VAERS ID: 1528628 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-02
Onset:2021-07-30
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 - / -

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

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

Write-up: Unknown LOT number for second dose in vaccine series. Symptom onset of 7/30/2021. Tested positive on 8/3/2021. Patient admitted to hospital on 8/2/2021 and is currently hospitalized.


VAERS ID: 1528658 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest pain, Dyspnoea, Headache, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Pt. reports that symptoms started 2 hours after vaccination (weakness, SOB, headache, leg pain). She stated she had left-sided pain including the left side of her chest that developed last p.m. with shortness of breath. She had the leftsided chest pain that felt like a stabbing and a sharp knife running from the lateral left side through her chest. Shortness of breath. Hospitalized with PE.


VAERS ID: 1528689 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norvasc, Lipitor, Tamacor, Warfarin, Tylenol, Osteobiflex, Mult-Vitamin, Cod-Liver Oil
Current Illness: N/A
Preexisting Conditions: Arthritis, Enlarged Heart, Congestive Heart Failure
Allergies: Vidacan, Lasitapril, Amirodien, Wool
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 1st dose of Moderna 07/29/2021, started experiencing symptoms 07/30/2021 of a rash forming throughout the body. Still continuing to form under the breast and back of the shoulders. No Primary visit noted.


VAERS ID: 1528747 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-26
Onset:2021-07-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin, fish oil, magnesium, vitamin D
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None yet, clinic nurse advised me to file VAERS report and wait until 2 weeks post-vaccine.
CDC Split Type:

Write-up: Tickle in respiratory system. When I breathe deeply, I feel the urge to cough and a tickle sensation in my chest. This has been occurring for much of the past week.


VAERS ID: 1528992 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-25
Onset:2021-07-30
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple Vitamin everyday. Daily Multi
Current Illness: NO
Preexisting Conditions: Sleep Apnea
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath starting last week. Whet to doctor. On Steroids and antibodies. Never felt this short of breath in my life.


VAERS ID: 1529035 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2020-12-21
Onset:2021-07-30
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR
CDC Split Type:

Write-up: Tested positive for COVID after vaccination


VAERS ID: 1529115 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Fall, Malaise, Pain in extremity, Pallor, 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), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: blood work at the hospital the night his thigh was aching. It was fine. Monday he went to the doctor for having fainted and fell in the shower. He had no serious injury.
CDC Split Type:

Write-up: The night of the shot at midnight Pt had a right thigh aching and hurting... He woke up next morning feeling very sick and was very pale in color...Then at 11:00 A.M. That same day day he fainted in the shower and fell, i was unable to wake him for at least 1 minute! That is the first time he has ever fainted!


VAERS ID: 1529142 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 RA / IM

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

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

Write-up: Patient was given a Moderna vaccine at 17 years old and it is not yet recommended by a nurse who was unaware. The patients father was notified and given information about what happened. It was recommended that the patient still receive the second dose of the Moderna vaccine if that is what the family/ patient wanted and it is. So the patient will come receive their second dose still. The patient had a minor headache the day following her vaccine but she has not had any other side effects or issues since receiving it.


VAERS ID: 1529157 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: pt said "kidney numbers were off" in the past. She was concerned about getting the vaccine. She left and came back days later. Asked again whether she should get it. She left and came back after speaking with her doctor about it. Finally decided to get it because she is going to be taking care of someone.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: numbness and weakness in her arm


VAERS ID: 1529186 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-13
Onset:2021-07-30
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN-NOT IN / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN-NOT IN / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Computerised tomogram thorax abnormal, Exposure to SARS-CoV-2, Hypoxia, Lung opacity, Mental status changes, Respiratory failure, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Received Moderna vaccines on 1/15/21; 2/13/21 Tested positive for COVID by PCR on 7/30/21 Admitted to Hospital on 7/23/21 for altered mental status, hypoxemic/hypercapnic respiratory failure. Testing on admission for COVID-19 was negative. Tested on 7/30 as a family member that was exposed to the patient was just recently diagnosed with COVID-19. CT scan shows bilateral ground glass opacities, treated w/ Dexamethasone, remdesivir. Diagnosed w/ moderate to severe COVID-19 pneumonia.


VAERS ID: 1529250 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-12
Onset:2021-07-30
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram abnormal, Culture positive, Drainage, Erythema, Klebsiella infection, Peripheral swelling, SARS-CoV-2 test positive, Skin warm, Tenderness, Vaccine breakthrough infection, Wound closure
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 325 MG Oral Tablet Take 325 mg by mouth daily. atorvastatin (LIPITOR) 40 MG PO Tablet Take 80 mg by mouth nightly at bedtime. cholecalciferol (VITAMIN D-3) 1000 units PO Tablet Take 2,000 Units by mouth daily.
Current Illness:
Preexisting Conditions: Anxiety ? Depression ? Diabetes mellitus ? Essential hypertension 9/28/2018 ? Heart attack ? Hypertension ? Type 2 diabetes mellitus with other specified complication 9/28/2018
Allergies: NKDA
Diagnostic Lab Data: SARS-COV-2, NAA Detected 07/30/21.
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. He received Pfizer vaccine second dose in series on 04/12/21. Hospitalization from 07/30/21 - 08/05/21. Below is copied from discharge summary: Pt. is a 62 YO male with a paste medical history of HTN, DM, CAD and MI s/p CABG(2018). Pt presented to the ER with complaints of swelling in his left thigh near his groin for the past 10 days, which has become progressively larger, tender, red and warm. CT showed irregular rim enhancing fluid collection within the medial aspect of the proximal high measuring up to 11.8 cm with adjacent fat stranding concernin for abscess. Pt was taken to OR for I&D on 7/30 300cc of pus evacuated, culture grew klebsiella. Zosyn was given x 4 days ended on 08/02. Wound vac was placed on 08/02 and changed out on 08/04. Additionally pt was found to be COVID + however is fully vaccinated as of April. Pt hospital course was otherwise unremarkable. Pt is currently medically cleared for discharge with instructions to follow up with surgery clinic on 08/10.


VAERS ID: 1529272 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-02-06
Onset:2021-07-30
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, Type 1 Diabetic, Sleep Apnea, CHF
Allergies:
Diagnostic Lab Data: Pneumonia, Covid postive test
CDC Split Type:

Write-up: shortness of breath


VAERS ID: 1529392 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dermatitis, Paraesthesia, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), 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: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have been getting hives and my skin feels inflamed. My skin will start getting hot and tingly to the touch. This is through out my whole body


VAERS ID: 1529421 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (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: Patient was given J&J vaccine 25 hours after vial had been punctured. The vial remained in the refrigerator. We followed CDC guidance to call manufacturer who did not provide clear guidance. The health department advised NOT to revaccinate.


VAERS ID: 1529426 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: Patient became flushed, diaphoretic, and became unresponsive for approximately 10 seconds. Patient observed for 30 minutes, drank water and lay in recumbent position. Patient walked out of facility in stable condition.


VAERS ID: 1529610 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Mobility decreased, Neck pain, Pain
SMQs:, Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (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: Centrum Women 50+ multigummies, Osteo Bi-flex joint health,
Current Illness: No illnesses
Preexisting Conditions: No health conditions, (borderline type 2 diabetic)
Allergies: Nka
Diagnostic Lab Data: I HAVE NOT SEEN A DOCTOR BUT THE PAIN IS DRIVING ME TO GO TO A DOCTOR VERY SOON. I JUST CANNOT MISS WORK.
CDC Split Type:

Write-up: A COUPLE DAYS AFTER INJECTION I WOKE UP WITH PAIN IN THE LEFT SIDE OF MY NECK AND LEFT SHOULDER. EVERY DAY THE PAIN BECOMES MORE NOTABLE AND THE PAIN CONTINUES DAY AND NIGHT LIKE A CONTINUOS THROBBING IN MY LEFT SHOULDER. I CAN NOT TILT MY HEAD BACK ON THE LEFT SIDE AND I FEEL A SHARP PAIN WHEN I TRY.


VAERS ID: 1529987 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-23
Onset:2021-07-30
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Bilevel positive airway pressure, COVID-19, Infection, Intensive care, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, DM, CAD, obesity, CABG
Allergies:
Diagnostic Lab Data: PCR + Covid 7/30/2021
CDC Split Type:

Write-up: Pt who reportedly completed second dose of vaccine in May was admitted for acute respiratory failure to the ICU. He tested positive for Covid-19 by PCR on 7/30/2021. At the time of reporting, patient remains tenuous in the ICU on BiPAP with the potential to deteriorate to intubation over the next 48 hours. Report is being submitted per recommendation of Dept of Health as it represents a breakthrough case with ICU level care.


VAERS ID: 1530043 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-03-17
Onset:2021-07-30
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Pyrexia, SARS-CoV-2 test positive, Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM CKD4 htn lipids chf chrohn''s bladder ca
Allergies:
Diagnostic Lab Data: covid NAAT, + 8/4/21
CDC Split Type:

Write-up: COVID infection - cough, scratchy throat, fatigue, low grade fever.- resolved


VAERS ID: 1530050 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-01
Onset:2021-07-30
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: positive covid19 PCR test 8/4/2021
CDC Split Type:

Write-up: fully vaccinated (moderna, patient misplaced vaccination card); symptom onset 7/30/21


VAERS ID: 1530060 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Fatigue, Headache, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid test on 8/4 that returned negative on 8/5
CDC Split Type:

Write-up: Fatigue over a week, then a week following receiving the vaccine had a fever, bad aches, dry cough, headache, and still persisting at day 8


VAERS ID: 1530487 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Connecticut  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Decreased appetite, Headache, Nasopharyngitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210807728

Write-up: COLD-LIKE SYMPTOMS; HEADACHE; LOSS OF APPETITE; BODY JOINTS PAIN; FEVER; This spontaneous report received from a patient concerned a 50 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN) dose was not reported, administered on 29-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 30-JUL-2021, the subject experienced loss of appetite. On 30-JUL-2021, the subject experienced body joints pain. On 30-JUL-2021, the subject experienced fever. On an unspecified date, the subject experienced cold-like symptoms, and headache. Treatment medications (dates unspecified) included: caffeine/paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the loss of appetite, cold-like symptoms, body joints pain, fever and headache was not reported. This report was non-serious.


VAERS ID: 1531303 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Bell's palsy, Confusional state, Disorientation, Flushing, Hyperhidrosis, Hypoaesthesia, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Bell''s Palsy-Mild, Systemic: Confusion-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Weakness-Medium, Additional Details: Approximately 5 minutes after receiving the Pfizer covid vaccine, the patient''s mother reported that the patient was having a reaction the vaccine. Upon examination, the patient was sweating profusely, complained of feeling numbness/tingling in her hands and appeared severly disoriented. After approximately 30 minutes she felt well enough to be transported to urgent care to be examined. Several hours later that day, the patient returned to the pharmacy with no issue.


VAERS ID: 1531483 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood electrolytes normal, Chest discomfort, Computerised tomogram head, Dyspnoea, Feeling abnormal, Fibrin D dimer increased, Head discomfort, Nausea, Tremor, Urine analysis normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen celecoxib cyanocobalamin esomeprazole silodosin
Current Illness: BPH GERD
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data: XRay Chest CT Angio D-dimer US Carotid
CDC Split Type:

Write-up: Pt presents with shakiness and chest pressure. States these episodes come and go. Pt becomes SOB and feels like its hard to breathe. The patient is here with some vague complaints of pressure that starts above his eyes and moves down into his neck, down to his arms and and occasionally down to his toes. According to the patient he has been experiencing this for quite a while but it varies in degree of severity. He stated since Tuesday he is just felt more off. He has been having more shaking when the episodes come on and more pressure in his chest. He stated just comes out of nowhere. He did go to his PCP earlier this week and he had a CT of the head with and without contrast yesterday. The results are normal. He denies any changes in his medications. Said he did just get the Covid vaccine yesterday. He said he does have some shortness of breath but that is also been going on for a few years. He occasionally gets nauseated with the pressure. He denies any vomiting or fevers though. I do not suspect an adverse reaction to the vaccine at this time. He did have a head CT that was performed yesterday. There were no acute findings. We did do a cardiac work-up today which came back unremarkable. His electrolytes are normal. His urine sample was also normal. His D-dimer did come back slightly elevated so we did do a CT of the chest. For the most part it was unremarkable no acute findings. Some scarring from back when he had Covid last year. We also discussed the nodule in his lungs. I do not suspect a stroke at this time. I do not suspect ACS. His EKG is unremarkable. We did schedule him for outpatient ultrasound Doppler of his bilateral carotids. Unfortunately we are unable to do those today. He was given strict return precautions. Patient is stable. He verbalizes understanding and is agreeable. I did discuss the patient with his PCP. They are possibly leaning a little bit more towards anxiety related.


VAERS ID: 1531513 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Full blood count normal, 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 noted
Current Illness: None
Preexisting Conditions: History of two Syncope events in the last five years; most recent post surgical procedure. No significant findings per records.
Allergies: No known allergies
Diagnostic Lab Data: Finger-stick in-house CBC was performed with normal results and Random Blood Glucose that was within normal limits.
CDC Split Type:

Write-up: Patient had syncope event 12 minutes after COVID-19 Vaccine. Patient recovered after event. Vitals remained stable. Provider cleared to leave with parent without having to go to hospital.


VAERS ID: 1531526 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Drainage, Dysgeusia, Muscle spasms, Pain in extremity, Taste disorder, Thrombosis
SMQs:, Taste and smell disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humalog Toujeo Baby asprin birth control hydroxycholoroquine Biotin Vitamin D Zolpidem
Current Illness: Diabetes Lupus Grave''s Disease Antiphospholipid Syndrome
Preexisting Conditions: Diabetes Lupus Grave''s Disease Antiphospholipid Syndrome
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 5min of the vaccine my mouth tasted like metal. It tasted like I was eating pennies and there was drainage in my mouth. It has been 1 week and nothing tastes normal, it is all metal tasting still. I also got a blood clot in my right calf. It was not a DVT but one closer to the skin. I have horrible calf pain and get Charlie horses nightly. Neither of these were an issue before the vaccine


VAERS ID: 1531598 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-18
Onset:2021-07-30
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye irritation, Herpes zoster, Joint swelling, Laboratory test, Pulmonary congestion
SMQs:, Cardiac failure (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Corneal disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: losartan potassium 50mg, black seed oil
Current Illness: no
Preexisting Conditions: high blood pressure
Allergies: strawberries, gabapin, amlodipine,
Diagnostic Lab Data: yes
CDC Split Type:

Write-up: Got Shingles and congestion around his heart, swelling in the joints and eye irritation


VAERS ID: 1531610 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D214 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Angiogram, Anticoagulant therapy, Arteriogram carotid, Arthralgia, Asthenia, Cerebrovascular accident, Computerised tomogram head, Confusional state, Dysarthria, Echocardiogram, Full blood count, Hemiparesis, International normalised ratio, Magnetic resonance imaging, Metabolic function test, Myalgia, Prothrombin time
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Enalapril Chlorthalidone Metoprolol Atorvastatin Dilt XR
Current Illness: None
Preexisting Conditions: HTN High cholesterol A fib
Allergies: NKDA
Diagnostic Lab Data: Head CT/CT angio/Neck angio CBC CMP PT/INR/PTT MRI/MRA ECHO
CDC Split Type:

Write-up: Joint pain and weakness, muscle pain 8/6/21 presented to emergency department with right sided weakness, confusion and slurred speech Received TpA for CVA


VAERS ID: 1531638 (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: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Blood test normal, Dizziness, Formication, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood work was done and was all reported to be normal.
CDC Split Type:

Write-up: Pt received vaccine on 07/30/2021 about 9:15 am. She went to a local ER around 9:25 pm. She started experiences weakness, dizziness at about 6:15 pm and then it started to worsen to the point of having uncontrollable shaking, but not seizure like and a sensation like bugs were crawling all over her. No rash. No fever. No other sign and symptoms.


VAERS ID: 1531662 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-15
Onset:2021-07-30
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Antinuclear antibody, Balance disorder, Blood thyroid stimulating hormone, Dizziness, Ehrlichia test, Feeling abnormal, Immunology test, Metabolic function test, Parasite blood test, Thyroxine free, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (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: none
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: cmp, tsh, free t4, lyme, ehrlichia, babesia, ana
CDC Split Type:

Write-up: Memory Loss, Dizziness, Balance Off, In a Fog, Visual Disturbances


VAERS ID: 1531696 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / N/A RA / IM

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

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

Write-up: Patient received 2 doses of J&J


VAERS ID: 1531711 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site pruritus, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Medications: Stem Release 3 supplement for abdominal pain other medications prescribed but not filled at the pharmacy
Current Illness:
Preexisting Conditions: PMH includes Thyroid disease, Obesity, Migraines, Hypercholesterolemia, Hernia, Gestational DM, GERD, Depression, Asthma, Arthritis, fibrocystic breast. s/p sterilization and C-section in 2011.
Allergies: Pt w/ hx of allergies to shrimp (severe), codeine (rxn unspecified), morphine (rxn unspecified).
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/ hx of allergies to shrimp (severe), codeine (rxn unspecified), morphine (rxn unspecified). PMH includes Thyroid disease, Obesity, Migraines, Hypercholesterolemia, Hernia, Gestational DM, GERD, Depression, Asthma, Arthritis, fibrocystic breast. s/p sterilization and C-section in 2011. Current Medications: Stem Release 3 supplement for abdominal pain other medications prescribed but not filled at the pharmacy ~30 mins post vaccination, pt c/o itching of the left arm and between her toes on both feet (no rash, redness or warmth). Vitals @12pm BP 142/84, HR 66 -- $g @12:15 138/83, 68. Pt denied any other new/abnormal sxs - no SOB, chest pain, fever, palpitations. Pt declined Benadryl PO, and during assessment period, stated that itchiness is fading. Pt brought to recliner chair, encouraged pt to drink more water. 45mins post vaccination pt verbalized resolution of sxs. Per NP instruction, pt OK to be released from clinic. Pt left clinic in steady gait, AxOx4.


VAERS ID: 1531734 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO150 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site swelling, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: swollen right upper arm; muscle aches


VAERS ID: 1531741 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Ear discomfort, Hyperhidrosis, Pallor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (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: unavailable
Current Illness:
Preexisting Conditions: PMH significant for ADJUSTMENT DISORDER W MIXED ANXIETY AND DEPRESSED MOOD.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PMH significant for ADJUSTMENT DISORDER W MIXED ANXIETY AND DEPRESSED MOOD. 10mins post vaccination pt c/o feeling faint w/ blurred vision and is visibly pale. Writer transferred pt from observation to triage area via w/c. Pt is present with mother and brother. Pt received 2nd dose Pfizer today. Pt appears pale, slight perspiration noted on forehead. Offered and provided water for hydration. Pt stated that he felt lightheadedness and stuffy ear, which had resolved soon after being placed in triage. V/S @ 100PM: BP - 83/48, HR - 60 Continued to monitor pt for add''l 30 min. Provided juices and water. Pt verbalized improvement to sx. V/S @ 1:30PM: BP - 130/60, HR: 66 Pt verbalized resolution of sxs, stated OK to go home. Per NP, pt OK to be released from clinic. Pt denied experiencing any more abnormal/new sxs. Pt left with family, steady gait, AxOx4.


VAERS ID: 1531807 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, NAC, Vitamin D, Xyzal
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: IV Contrast, Penicillin, Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm, very achy, headache, fever


VAERS ID: 1531842 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-25
Onset:2021-07-30
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / SYR

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

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

Write-up: Shingles.


VAERS ID: 1531909 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 inadvertently given Pfizer dose #2 seven day early. Dose #1 was administered 7/16/21 and dose #2 on 7/30/21. Patient waited in observation for the recommended 15 minutes; no adverse events reported.


VAERS ID: 1531916 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-16
Onset:2021-07-30
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / -

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

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

Write-up: U07.1 - COVID-19


VAERS ID: 1531932 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-07-30
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

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

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

Write-up: U07.1 - COVID-19


VAERS ID: 1532071 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-07-30
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -

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

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

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


VAERS ID: 1532074 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: A couple hours after vaccination her hand swelled up. Vaccine was given on 7/30 and she is still experiencing pain and swelling in her hand


VAERS ID: 1532129 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Injection site mass, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: None
Preexisting Conditions: History of Tourette''s (no need for medication).
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received first dose of Pfizer COVID-19 vaccine, 9 days ago, in left arm. Knot developed on arm at injection site, which has come and gone since then. Fatigue for 2 days after getting vaccine; back to normal now. Knot on arm is mildly tender. No fevers. Prior history of seizures, none in past 4 years. Stopped medicines 2 days ago. History of Tourette''s (not on medicine). Mom noted increase of vocal and motor tics in the past week (they had been gone for a year or more).


VAERS ID: 1532258 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Parents reported similar symptoms when patient receive any treatment involving needles.
Other Medications: Not reported
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received his first dose of the Pfizer vaccine and experienced a syncopal episode immediately after receiving the vaccination. Patient remained seated in treatment escorted by his parents and observed by nursing staff. Vital signs were taken and the results were within normal limits. Patient regained consciousness within 15 seconds from the episode not requiring any treatments beside comfort and safety measures. After approximately 30 minutes of direct observation by nursing staff the patient was able to ambulate without any difficulty, remained symptoms free, and was accompanied by his parents to their vehicle leaving the area.


VAERS ID: 1532283 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Swelling face
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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: penicillin silver chocolate cat scan dye
Diagnostic Lab Data: none
CDC Split Type:

Write-up: she said about 15 minutes after the vaccine she had a rash on her arm, the next morning her face was swollen - no breathing issues


VAERS ID: 1532448 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-02
Onset:2021-07-30
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 07/13/21 (C) INSULIN DETEMIR (LEVEMIR) FLEXTOUCH PEN #30 (30 days) INJECT 50 UNITS UNDER THE SKIN TWICE A DAY FOR DIABETES 07/13/21 (C) MULTIVIT W/MINERALS & FA TAB SRC #90 (90 days) TAKE 1 TABLET BY MOUTH E
Current Illness: Chronic pain (bilateral knee;LBP; right ankle) Osteoarthritis of knee bilateral Spondylolistheis grade 1
Preexisting Conditions: Hypertension, morbid obesity, sleep apnea, non-alcoholic fatty liver, asthma
Allergies: Allergies: PENICILLIN (verified) - IBUPROFEN (verified) - HIVES CODEINE (verified) - RASH INTRAVASCULAR CONTRAST MEDIA (verified) - RASH BACTRIM DS (verified) - URTICARIA LIDOCAINE (verified) - URTICARIA Adverse Reactions: LISINOPRIL (verified) - COUGH TRAMADOL (verified) - HEADACHE PRAVASTATIN (verified) - LEG CRAMP
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccine breakthrough infection


VAERS ID: 1532466 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-04-21
Onset:2021-07-30
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Hypertension, Hx of Hepatitis C (Post treatment)
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Positive Covid test. Post vaccination.


VAERS ID: 1532473 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-17
Onset:2021-07-30
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 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: none
Current Illness: none
Preexisting Conditions: h/o breast cancer
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: tested positive for covid after completing the covid vaccine series


VAERS ID: 1532477 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-05
Onset:2021-07-30
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, zrytec, fluoxetine, lisinopril, metoprolol
Current Illness:
Preexisting Conditions: HTN, asthma, gerd, copd, osteoarthritis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: tested positive for covid after completing covid vaccine series


VAERS ID: 1534703 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head discomfort, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: Systemic: Hypertension-Mild, Additional Details: Patient complains of having HTN since receiving first Pfizer COVID vaccine. Describes his head feeling "heavy" one week later and symptoms persist. Went to his PCP and Dr changed his HTN medication to control his blood pressure


VAERS ID: 1534806 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Chills, Dyspnoea, Fatigue, Hyperhidrosis, Myalgia, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Keppra, Mylan, zoloft
Current Illness:
Preexisting Conditions: Anxiety, depression, ibs-c, migraines
Allergies: Albuterol
Diagnostic Lab Data: Chest xray Aug 2nd Covid test Aug 3rd Echocardiogram and ekg not done yet
CDC Split Type:

Write-up: Muscle aches, chills, sweating, extreme fatigue and chest tightness with shortness of breath all started within 2 hours after 2nd dose administered. Pcp contacted at the beginning of the following week. She ordered a chest xray which showed nothing and wanted updates on symptoms. Since chest tightness, shortness of breath and fatique isn''t going away by Friday Aug 7, pcp ordered echocardiogram and ekg


VAERS ID: 1534816 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-26
Onset:2021-07-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dislocation of vertebra, Joint dislocation, Muscle rigidity, Muscle spasms, Musculoskeletal chest pain, Spinal pain
SMQs:, Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (narrow), Accidents and injuries (narrow), Arthritis (broad)

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

Write-up: Right side trap muscle in upper back spasmd and locked into a flex. Keeps pulling vertebrae and ribs out of place. Severe excruciating pain. I''ve been seen by 3 chiropractors , no one can explain why this happened other than from the vaccine, and no one can fix it.


VAERS ID: 1534848 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 2 LA / IM

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

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

Write-up: Patient request Covid Vaccine on 7/30/2021 got a Moderna dose but did not mention got a previous Pfizer dose at other non pharmacy location on 6/5/2021. Pharmacy screening protocol was followed which asked if got any vaccine on the prior eight weeks and he answered "no" . Patient said he is doing fine, no other symptoms related to the incident.


VAERS ID: 1534904 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-07
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, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benazepril, Metformin, Lansoprazole, Xarelto, Lasix, Gabapentin, Atorvastatin
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: KNDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: No adverse event reported- was given 14 days after first shot not 21.


VAERS ID: 1535123 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atelectasis, Body temperature increased, Computerised tomogram thorax abnormal, Pneumothorax
SMQs:, Neuroleptic malignant syndrome (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT scan of chest.
CDC Split Type:

Write-up: Lung collapsed due to atelectasis, from a strong immune response. Oxygen sat 83% temperature 103.2. HR 157.


VAERS ID: 1535170 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-26
Onset:2021-07-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site infection, Injection site pain, Injection site swelling, Pain in extremity, Peripheral swelling, Skin discolouration
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Additional Details: Patient reporting infection on arm and site where she had recieved her Covid vaccine. Patient reports swelling, discoloration, and soreness throughout the arm. She has been taking antibiotics since 8/2/21 but per her own account the infection appearance has not improved. Will come into the pharmacy today to show her arm.


VAERS ID: 1535191 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Dizzy ness, fainting, vision blurred, foggy mentally, overall terrible feeling since receiving first dose of Vaccine


VAERS ID: 1535203 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Hypoaesthesia oral, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Pfizer COVID-19 vaccine, dose #1, 45 years old, allergic reaction, 4/13/2021
Other Medications: vitamin B, vitamin D, Larissia, acetaminophen
Current Illness: none reported
Preexisting Conditions:
Allergies: sulfa
Diagnostic Lab Data: None reported
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: patient presents for second dose of vaccine reporting allergic reaction to first dose. After leaving vaccine clinic after first dose patient reports throat closing, lips going numb, and metallic taste. Patient went to urgent care that advised allergy medications and follow-up with an allergist. Before second dose patient took two doses of oral diphenhydramine and a few minutes after receiving immunization reported throat closing. Emergency response team called and patient was evaluated. Patient reported symptoms improving, declined emergency department evaluation, and left clinic in stable condition.


VAERS ID: 1535260 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

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

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

Write-up: rash started 2 hours after receiving COVID 19 vaccine


VAERS ID: 1535347 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Oral pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: shingrix
Other Medications: valacyclovir, thevothyroxine, spironolactone, levetiracetam, linzess
Current Illness:
Preexisting Conditions: digestive issues being looked at.
Allergies: latex, some rubber/plastics, certain fragrances, banana, avocado, guacamole, fentanyl, hydromorphone,
Diagnostic Lab Data: N/A Monitored symptoms on my own & took Benadryl for about 24 hours & extra strength Tylenol for 6 days.
CDC Split Type:

Write-up: Upper arms rash (back of arms not bicep). Slight rash upper back. Forehead small welts. Roof of mouth slightly itchy. Hard headache that started later the day that got progressively worse by the next day. Getting better about 5 days later. Gone in about 9 days.


VAERS ID: 1535563 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (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: none
Preexisting Conditions: none
Allergies: Allergic to penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Menstrual spotting in the afternoon/evening on the day of vaccination after receiving vaccine. No strenuous activity was done to cause the spotting. Heavy bleeding with ovulation less than a week after vaccination, which is abnormal for patient.


VAERS ID: 1535573 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

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

Write-up: Hot and cold flashes, rash is beginning to be present.


VAERS ID: 1535628 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Hypoaesthesia, Immediate post-injection reaction, Paraesthesia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None as of yet. Symptoms will be reported to Doctor tomorrow, August 10, 2021.
CDC Split Type:

Write-up: Immediate: weakness and blurred vision. Difficulty focusing my eyes. This lasted through the evening of July 30th. Since the 30th, (a little over a week now) my carpal tunnel symptoms seem much more severe! I?m experiencing numbness and tingling in my fingers and entire hands, both left and right . The right seems more intense. I have a scheduled appointment with my rheumatologist tomorrow, August 10th for a follow up and plan to discuss this with him.


VAERS ID: 1535933 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Bone pain, Fatigue, Headache, Malaise, Nausea, Pain, Pain in extremity, Pyrexia, Vertigo
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Upset stomach, fatigue, body aches, malaise. Soreness in left arm down to ''bone''. Feverish throughout the day, duration of side effects have lasted for up to 1 week. Nausea the next day. Headache and some vertigo like symptoms for next three days after vaccine. Ibuprofen was taken to help with aches


VAERS ID: 1535947 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-21
Onset:2021-07-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Vaccination site discolouration, Vaccination site 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 50 mcg once daily 2 fish oil capsules daily 1 multi B-vitamin daiy Lunesta Lyrica
Current Illness: none
Preexisting Conditions: Hypothyroidism
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Red, itchy rash approximately 5 inches by 3 inches on left deltoid in the area of the vaccine injection.


VAERS ID: 1536040 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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: Synthroid, Amlodipine
Current Illness:
Preexisting Conditions: Thyroid Disease
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen Lymph Node - still present today 08/09/21


VAERS ID: 1536120 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injected limb mobility decreased, Limb discomfort, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vimpat, flonase, pepcid, ranexa, coreg, plavix, zoloft, lasix, imdur, protonix, aspirin, nitro, pravastatin, gabapentin, xanax, zyrtec, valtrex, ventolin albuterol inhaler, stiolto respimat inhaler, buspar, trazodone
Current Illness: Heart failure, congestive heart disease
Preexisting Conditions: Heart failure, congestive heart disease
Allergies: Nicotin patch
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 2 days after 2nd vaccine injection left arm began hurting and has only become worse over time. Arm feels very heavy, extremely sore going up into my neck. Hard to use arm because of pain


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