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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 34 out of 8,010

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VAERS ID: 1771646 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Electric shock sensation, Feeling abnormal, Jugular vein thrombosis, Limb discomfort, Pain in extremity, Peripheral artery thrombosis, Subclavian vein thrombosis, Ultrasound Doppler abnormal, Venous thrombosis limb
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall
Current Illness: none
Preexisting Conditions: vitiligo
Allergies: Sulfa
Diagnostic Lab Data: Ultrasound of left upper extremity showed results above. 10/8/2021
CDC Split Type:

Write-up: Uncomfortable pain and abnormal feeling of the left arm and electrical sensation in arm. Developed thrombus of the Left internal jugular, subclavian, axial and brachial vein. Requires to be fully anticoagulated for 3 months. With repeat Ultrasound in 3 months to confirm resolution of thrombus''s.


VAERS ID: 1771690 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Headache, Injection site pain, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Headache (10/5 through 10/7) Fever 99.1 (10/6) Chills (10/6) Loss of appetite (10/6) Tiredness (10/^0 Injection site pain and swelling (10/5 and continues )


VAERS ID: 1771713 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-30
Onset:2021-10-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 05ZE21A / 1 LA / SYR

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

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

Write-up: I can feel a lump underneath my left armpit that results in sustained or sharp pain (when active). The lump is starting to gradually decrease in size


VAERS ID: 1771719 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM

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

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

Write-up: PATIENT RECIEVED TWO DOSES OF PFIZER COVID VACCINE ON THE CLINIC DAY BY SEPERATE NURSES.


VAERS ID: 1771724 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Joint swelling, Laboratory test, Migraine, Oral herpes
SMQs:, Oropharyngeal infections (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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? No
Previous Vaccinations: 1 Moderna shot caused cold sore so didn?t get second 07/2020
Other Medications: Dextroamphetamine ER, Exalgo XR
Current Illness: HLA-B27+ Ankylosing Spondylitis Adhd, OCD, MDD, GAD
Preexisting Conditions: HLA-B27+ Ankylosing Spondylitis Adhd, OCD, MDD, GAD
Allergies: Too many to list
Diagnostic Lab Data: Hospital did several labs. Would need to request records.
CDC Split Type:

Write-up: Caused servers flare- severe swelling of all joints, ligaments, and intense pain, migraine, as well as a cold sore on my lip. ER gave me steroids and pain med and I?m treating the cold sore with valtrex rx.


VAERS ID: 1771725 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 - / -

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

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

Write-up: Headache, achy, itching over entire body. Took Benadryl.


VAERS ID: 1771727 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Decreased appetite, Headache, Heart rate increased, Lymph node pain, Lymphadenopathy, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine (age 30, 1 month ago)?103 degree fever for 2 days, face swelled up and turned beat red
Other Medications: Spiriva, advair, xyzal, singulair, nasonex, azelastine, levalbuterol
Current Illness:
Preexisting Conditions: Severe asthma, migraine with aura
Allergies: Wheat/gluten, augmentin , environmental/pet allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 103 degree fever (while taking fever reducing medication) for 2-3 days, extremely swollen and tender lymph nodes on the side of the injection site, nausea/inappetence, severe headache that did not respond to painkillers, high heart rate at rest


VAERS ID: 1771742 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Illness, Migraine, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, migraine, nausea, fatigue, body aches. Major illness for 24 hours, migraine remains 3 days later (10/8/21)


VAERS ID: 1771754 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Bed rest, Chills, Fatigue, Impaired work ability, Pain
SMQs:

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

Write-up: Fatigue, chills, body aches. Bed rest and called in 3 days in order to rest. Haven?t been able to move a lot without substantial pain


VAERS ID: 1771829 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chills, headache the night of injection, fatigue every day and then fever, chills, and sore throat again on Thursday night


VAERS ID: 1771869 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK LA / UN

Administered by: Other       Purchased by: ?
Symptoms: Breast pain, Dyspnoea, Headache, Pain in extremity, Paraesthesia, Pyrexia, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Lipodystrophy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pins and needles on tongue started mins after the vaccine was administered . Swollen tongue a few mins after and had to take benadryl for the allergic reaction. Fever for 3 days 102.3 being the highest. Pain on the left arm where vaccine was placed, pain on the left underarm and left breast. Shortness of breath and headaches.


VAERS ID: 1771881 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7330MA / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin c, d, zinc, lorazepam 0.5mg prn sleep, Maxalt 10mg prn HA
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: latex, avocado, sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Redness, swelling, itching, pain and rash occurred around injection site on left arm where Covid vaccination was administered. Area is ~6 inches in diameter currently. Symptoms started 4-5 hours after vaccination was received but diameter of rash/redness enlarged over the next several days. Symptoms have not subsided at this point. I did not have a rash/redness with the first and second dose that I received on 12/21/20 and 1/12/21. I receive the flu shot annually and have never had a reaction.


VAERS ID: 1771903 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Pain
SMQs:

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

Write-up: symptoms: headaches/chills/body aches/fatigue (48 hours). treatment: rest and OTC NSAIDs.


VAERS ID: 1771938 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Larin Fe 1/20 Dexilant Atenolol Duloxetine Celecoxib Zolpidem Atorvastatin Diltiazen Cyclobenzaprine Tylenol 3
Current Illness: None
Preexisting Conditions: Rheumatoid arthritis, PSVT, GERD
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Circular area of approximately 1 - 1/2 inches around injection site red, swollen, and painful. Armpit of same arm swollen approximate size of grapefruit and painful. Lasted 4 days.


VAERS ID: 1771940 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OMEPRAZOLE,GLIPIZIDE,SIMVASTATIN,HCTZ,METFORMIN,FLUOXETINE,VITAMIN C ,LUTEIN,PRESERVISION,ASP LOW
Current Illness: NO KNOWN
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: SENT TO ER
CDC Split Type:

Write-up: CARDIAC


VAERS ID: 1771948 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Chills, Fatigue, Feeling abnormal, Feeling hot, Headache, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Eosinophilic pneumonia (broad), Osteonecrosis (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: Musinex, allergy shots, OHM allergy pil, magnesium, Vit E, A, C, B12, E, Zinc
Current Illness: Just a lot of sinus infections
Preexisting Conditions: Chronic Sinus infection
Allergies: Sulfa and Bactrium
Diagnostic Lab Data: haven not gone in just still tired 3 days later
CDC Split Type:

Write-up: 5:30 that evening, foggy, chills, but hot couldn''t get warm, full body muscle aches couldn''t hardly touch anything everything hurt including my bones had a headache and fully exhausted.


VAERS ID: 1771951 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-10-05
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Diarrhoea, Myalgia, Nausea, Respiratory failure, SARS-CoV-2 test positive, Vaccine breakthrough infection, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), 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: Positive COVID-19 PCR Nasopharyngeal
CDC Split Type:

Write-up: Breakthrough symptomatic COVID-19 infection- onset 10/5/21, positive PCR 10/7/21 Respiratory failure, cough, chills, nausea, vomiting, diarrhea, and myalgias


VAERS ID: 1771966 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 RA / IM

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

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

Write-up: No adverse symptoms; staff member received Moderna for first 2 doses


VAERS ID: 1771978 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 RA / IM

Administered by: Other       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: No adverse events; staff member received Moderna for first 2 doses


VAERS ID: 1771999 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 UN / IM

Administered by: Work       Purchased by: ?
Symptoms: Discomfort, Dizziness, Electrocardiogram, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen 800 mg PO QHR PRN
Current Illness: recent pregnancy
Preexisting Conditions: None
Allergies: simethicone
Diagnostic Lab Data: ECG was normal
CDC Split Type:

Write-up: Patient feels like her entire body is heavy and tingling. She is very dizzy. She is having some mile check pain that she rates as a 1 out of 10. She denies any fevers. She is otherwise healthy. BP 97/83 at 1014, 114/74 at 1030, HR 95 at 1014, 82 at 1030. She got 1 L of NaCl and felt better, discharged home.


VAERS ID: 1772044 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, 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: Provider mistakenly pulled J and J vial and gave a 0.3ml dose as a 3rd dose booster of a previous 2 dose Pfizer series. No adverse reaction reported by the individual who received the incorrect dose and brand for the booster.


VAERS ID: 1772049 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Provider mistakenly pulled J and J vial and gave a 0.3ml dose as a 3rd dose booster of a previous 2 dose Pfizer series. No adverse reaction reported by the individual who received the incorrect dose and brand for the booster.


VAERS ID: 1772054 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Provider mistakenly pulled J and J vial and gave a 0.3ml dose as a 3rd dose booster of a previous 2 dose Pfizer series. No adverse reaction reported by the individual who received the incorrect dose and brand for the booster.


VAERS ID: 1772055 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Flushing, Hypoaesthesia, Injection site pain, Lethargy, Nausea, Pain, Paraesthesia, Sluggishness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine-swelling of face/hives 2011
Other Medications: RX: escitalopram 10mg PO daily OTC: 81mg aspirin, calcium, magnesium, zinc
Current Illness: none
Preexisting Conditions: obesity, depression
Allergies: Flu vaccine
Diagnostic Lab Data: none. I did not seek medical intervention.
CDC Split Type:

Write-up: ~12 hours after the injection, my left arm was numb and tingling from the mid-fore arm down through my hand and fingers. I was flushed and sluggish with tolerable nausea the nest morning. The second morning post vaccine, I had sharp pain that felt like a vice grip clamped over half my body radiating in an orb from the injection site. Sharp shooting pains through my chest most of the day, not helped by ibuprofen & acetaminophen. The second day I was so lethargic. I was unable to wake up to go to work. I had very little energy and took a long nap that afternoon. When I woke up I was still tired. Shot on Monday-side effects lasted through Thursday.


VAERS ID: 1772114 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, Wrong product administered
SMQs:, Medication errors (narrow)

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

Write-up: Pt is fully vaxed for moderna and went to get a flu shot and was given a pfizer shot


VAERS ID: 1772121 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Hyperhidrosis, Musculoskeletal stiffness, Pallor, Tension, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt stated he has fainted with a previous vaccine. Of note, is that his two siblings also fainted. One had received Pfizer, and o
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10 seconds after vaccination, pt''s body tensed, he became pale and unresponsive. Arms and body became flexed and stiff. He was placed on floor, 911 called, Ammonia inhalant used with immediate response. VS stable, pt continued to be responsive. Skin was pale and diaphoretic. Denied headache, chest pain, SOB, nausea. No rash noted on skin, lungs clear, no wheezing. Pt improved, took sips of water and ate a snack. Tolerated well, no emesis. Medics arrived, assessed pt, offered transport to hospital but pt refused. Medics provided instruction to seek medical attention if symptoms return or worsen. Pt monitored for 30 minutes post event, no further symptoms. Ambulated without assist, steady gait to car.


VAERS ID: 1772149 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD809 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Pt felt dizzy after receiving Pfizer vaccine. She was placed on floor, continued to be responsive, denied headache, chest pain, SOB. VS stable. Denied nausea, took sips water, tolerated well. Monitored for 30 min, no further symptoms. Sibling who received Janssen that day had vasovagal event, as did another sibling who was present but not vaccinated that day.


VAERS ID: 1772162 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-29
Onset:2021-10-05
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tramadol; multi vitamins; Xarelto; Metoprolol; Lisinopril; Arava; Prednisone
Current Illness: none
Preexisting Conditions: polyarthritis; HTN; hyperlipidemia; rheumatoid arthritis; atrial fib; gout
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: He started with some nasal congestion and sinus pressure about 3 days ago. He felt a bit feverish a couple of days ago, but his temp was not elevated. He feels like he perhaps had a mild head cold. starting 10/5/21


VAERS ID: 1772164 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-03
Onset:2021-10-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Full blood count normal, Headache, Hypoaesthesia, Hypoaesthesia oral, Metabolic function test, Neurological examination, Paraesthesia, Paraesthesia oral, Photophobia
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro, Wellbutrin, multi vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Oct 6th: TSH, CMP, CBC all WNL. Neuro exam WNL (minus the decreased sensation and tingling).
CDC Split Type:

Write-up: Decreased sensation and tingling began in my lower lip down to my chin on 10/5/21 @1220, and over the course of 24 hours spread to the rest of my body. I contacted my family doctor on 10/6, who requested I go to an urgent care for an in person neuro exam. The urgent care sent me to the ED to have labs drawn. Around 1830, while I was in the ED waiting room I developed a 7/10 headache and had sensitivity to light. I didn''t have anything with me to take for the headache until they gave me a headache cocktail at about 1am. I''m 32 y.o. and have absolutely no hx of migraines. Today, 10/8, my extremities no longer have tingling and decreased sensation but my lower face still does have a little. No more headaches since.


VAERS ID: 1772167 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased, Hypersensitivity, Paraesthesia, Pharyngeal swelling, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Daily multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Mild allergy to strawberries and bananas
Diagnostic Lab Data: I was diagnosed with an allergic reaticon.
CDC Split Type:

Write-up: About an hour and a half after the shot, my arm started tingling, my heart began to beat quickly, my face and throat started to swell, and I had difficulty breathing.


VAERS ID: 1772199 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 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: Acyclovir 400mg Atorvastatin 10mg Diclofenac 1% topical Diltiazem 240mg Omeprazole 20mg Trazodone 100mg
Current Illness: Acute Vaginits
Preexisting Conditions: Osteoarthritis GERD Hyperlipidemia Insomnia Hypertension HPV Enthesopathy Vit D Deficiency Overweight Rosacea
Allergies: Indocin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was given Pfizer Covid vaccine as booster dose in error. Patient''s first and second covid vaccine dose was Moderna.


VAERS ID: 1772202 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-29
Onset:2021-10-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site reaction, Rash erythematous
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: Potassium, Furosemide, medication for Parkinson, Gabapentin, 81 mg aspirin, calcium, Vit C, Vit D, Zinc
Current Illness: no recent illnesses. Was hospitalized cellulitis 7/17 to 7/18/21. Went to rehab for 2 weeks subsequently
Preexisting Conditions: Parkinson''s disease, Intermittent unilateral swelling of the left leg. DVT was ruled out.
Allergies: no medication allergies, no food allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported that while showering yesterday morning she noticed a red rash on left arm at the injection site extending to the left elbow. Rash did not extend to the shoulder. There were red patches on the ventral aspect of the upper arm. She denied having throbbing or tenderness at the site. Denied having urticaria, lip swelling or tongue swelling. Denied having a fever. Reported that she had full use of the left arm


VAERS ID: 1772209 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3014758A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tylenol align biscadoyl Vit D3 prolia dicyclomine diltiazem tizanidine tamsulosin terbinafine oxycodone psyllium nitrofurantonin flonase loperamide imipramine multivitamin
Current Illness:
Preexisting Conditions: lumbar spondylosis neurogenic bowel and bladder hx of spinal cord injury osteoporosis paraplegia quadriplegic spinal paralysis
Allergies: baclofen hayfever
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt came in and wanted flu, shingles and covid booster He was informed that we only have Pfizer boosters and that is what he said he received, I asked for his card and it was in his vehicle /BNeing that he is quadriplegic I did not aske him to go get it as he has and assist on his vehicle to get in and out I also informed him that we would not do the shingles at the same time He was given his immunizations I went outside with him to get his card to document and realized that he had Moderna vaccine and he said he didn''t know that. I informed him that he should not have received the Pfizer vaccine and that he needed to let us know immediately if he had any sort of redness, swelling or fever or SOB he said he would. I have been unable to reach pt to follow up


VAERS ID: 1772210 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dizziness
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: 23mins post vaccination pt c/o feeling faint; chest tightness (neg for hsx of anxiety) Vitals: @16:55 BP 123/66, HR 81, RR 20, O2 Sat 98% -- $g @17:01 116/70, 81, 98% -- $g @17:10 123/68, 80, 99% No pallor or SOB @17:01 Pt continues to c/o tightening in chest @17:10 pt states he feels better justed wanted to check his BP before departing. Pt stable and released from the vaccination site.


VAERS ID: 1772299 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling hot, Flushing, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (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: Unknown
Current Illness:
Preexisting Conditions: PMH: Fibroadenoma of Left Breast, Heart murmur
Allergies: Allergies: Amoxicillin and Penicillin (hives/anaphylaxis); Latex (hives)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 13mins post vaccination pt c/o flushing, feeling shaky and hot all over. Pt states that she''s a very anxious person. Vitals: BP 149/84, HR 94, RR 16, Temp 99.7 OT Sat 100% RA Pt stayed for 30 mins observation. Pt stable and released for the vaccination site.


VAERS ID: 1772321 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-03
Onset:2021-10-05
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Fatigue, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen 500mg prn for fever atorvatatin 20mg HS bifidobacterium-lactobacillus cholecalciferol daily gabapentin 300mg QID ibuprofen 400mg prn for pain loratadine-pseudoephedrine daily prn for allergies melatonin 3mg HS prostate vitamin
Current Illness: None documented
Preexisting Conditions: plantar fasciitis, obstructive sleep apnea, erectile dysfunction, hyperlipidemia, overweight, insomnia
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated Runny nose, congestion, sore throat, fatigue


VAERS ID: 1772348 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-23
Onset:2021-10-05
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Appendicitis, Asymptomatic COVID-19, 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? 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: acute appendicitis, asymptomatic covid


VAERS ID: 1772776 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-02
Onset:2021-10-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Bone pain, Dizziness, Fatigue, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Osteonecrosis (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: Testosterone, Protonix, Levothyroxine, Vit D, Vit C, Alpha Lipoic Acid, DIM, NAC, L-Lysine,
Current Illness: None
Preexisting Conditions: Lyme Disease
Allergies: Codeine
Diagnostic Lab Data: No current test completed.
CDC Split Type:

Write-up: Started as muscle soreness then fatigue, dizziness. Bone and joint pain. Bone and joint pain extreme on day 4 and day 5. Headache and muscle / joint paint day 6.


VAERS ID: 1772997 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electric shock sensation, Headache
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Moderately painful (6/10) intermittent headache from 05:30 am to 3:00 pm. Pain was across the back of my head starting at the back of each ear, and across the back. Back of the head and ears were tender to palpation. Headache felt like an electrical shock across the back of my head, happening about 5-10 times per hour. Only treatment I tried was Excedrin, without benefit. Pain succeeded on its own approx. 3 hours after Excedrin was taken by mouth. I rarely have headaches <6 times per year.


VAERS ID: 1773158 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-10
Onset:2021-10-05
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: mild intermittent asthma BMI greater than or equal to 95th percentile in childhood
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: there was no adverse reaction to any dose. Patient was given a third booster dose in error. She is only 16 and does not qualify. system will not let me enter this on subsequent page, but patient received the Afluria quadravalent flu vaccine, lot #P100352313 on 9/18/2021 (within one month prior to 3rd COVID dose)


VAERS ID: 1773418 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-10-05
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Decreased appetite, Fatigue, Headache, Hypokinesia, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (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: Test Date: 20211005; Test Name: Body temperature; Result Unstructured Data: 103 or 102 F; Test Date: 20211005; Test Name: Body temperature; Result Unstructured Data: 104 F
CDC Split Type: USJNJFOC20211014855

Write-up: LACK OF APPETITE (FORCING HERSELF TO EAT AND DRINK); BODY ACHES; UNABLE TO MOVE (CAN''T GO TO THE BATHROOM); FEVER; NAUSEA; EXTREME FATIGUE; BAD HEADACHE; This spontaneous report received from a physician concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 04-OCT-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 05-OCT-2021, the patient experienced lack of appetite (forcing herself to eat and drink). On 05-OCT-2021, the patient experienced body aches. On 05-OCT-2021, the patient experienced unable to move (can''t go to the bathroom). On 05-OCT-2021, the patient experienced fever. On 05-OCT-2021, the patient experienced nausea. On 05-OCT-2021, the patient experienced extreme fatigue. On 05-OCT-2021, the patient experienced bad headache. Laboratory data included: Body temperature (NR: not provided) 104 F, 103 or 102 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from fever, body aches, nausea, extreme fatigue, bad headache, lack of appetite(forcing herself to eat and drink), and unable to move (can''t go to the bathroom). This report was non-serious.


VAERS ID: 1773472 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500 mgAtorvastatin 20 mg Losartan/HCTZ Meloxicam 15 mg Vitamin D 3 125mg Iron 65mg
Current Illness: None known
Preexisting Conditions: Pre High blood presssure Pre diabetes History of elevated cholesterol
Allergies: None Known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 24 hours after COVID booster shot felt itchy, and tired.


VAERS ID: 1774966 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-03
Onset:2021-10-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily vitamin, D3 2000
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness followed by swelling of lips


VAERS ID: 1775021 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-03
Onset:2021-10-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: C-reactive protein, Chest discomfort, Dyspnoea, Echocardiogram, Electrocardiogram, Fibrin D dimer, Full blood count, Pericarditis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Indomethacin
Diagnostic Lab Data: 10-7-21 and 10-8-21: ECG, CBC, D-Dimer, CRP, Echogram
CDC Split Type:

Write-up: Received first does on Sunday October 3, 2021. Began to feel chest tightness and shortness of breath on Tuesday October 5, 2021. Symptoms persisted and worsened over the next 48 hours, so I decided to go to urgent care on Thursday October 7, 2021. The physician assistant suspected pericarditis and placed a stat referral to see a cardiologist and obtain an echogram. I had my initial appointment with the cardiologist on Friday October 8, 2021 who setup the stat echogram. The echogram was able to rule out myocarditis and cardiologist confirmed pericarditis as the diagnosis. I was prescribed colchicine, an anti-inflammatory, for the treatment of pericarditis.


VAERS ID: 1775029 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-03
Onset:2021-10-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Chest pain, Myocarditis, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Heart/chest pain, suspected myocarditis or pericarditis


VAERS ID: 1775034 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 - / -

Administered by: Work       Purchased by: ?
Symptoms: Neuralgia, Skin burning sensation
SMQs:, Peripheral neuropathy (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: Gabapentin Zoloft Valtrex
Current Illness:
Preexisting Conditions: Trigeminal neuralgia Occipital neuralgia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Burning skin throughout body-never pain feeling


VAERS ID: 1775188 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (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 presented to the vaccination site on 10/05/21. The client notified RN that he received a single dose of the (AstraZeneca) COVID vaccine on (5/29/21). RN submitted a medical consult via text message requesting to proceed with the COVID vaccine Janssen. Per CDC guidance, approval to proceed with COVID vaccine Janssen was obtained via text message. Client received COVID vaccine Janssen Lot# 211A21A on 10/05/2021. The client did not report any symptoms during the observation period. The client left the vaccination site at 1401.


VAERS ID: 1775245 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Extra dose administered, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: This was patients "booster dose of pfizer" Patient reports about 24 hour fever with persistent wheezing for 3 days and dry cough.


VAERS ID: 1775272 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Headache, Nausea, Pyrexia, Tachycardia, Testicular pain, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: Severe headache, fever, nausea, vomiting, tachycardia, lower back pain, testicular pain.


VAERS ID: 1775279 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

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

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

Write-up: Inflammation at injection site, (redness, swelling, itching, warm). Cleansed w/alcohol pad, applied lavender oil. Still present Day 5 Headache on top of head as though had hit head on low-hanging door. Tylenol and Advil. Sill present Day 5 Fatigue similar to post-influenza. Present until Day 4


VAERS ID: 1775286 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Cough, Decreased appetite, Full blood count, SARS-CoV-2 test, Weight decreased
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Guillain-Barre 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: Aspirin
Current Illness: None
Preexisting Conditions: Crohn''s Diabetes Heart
Allergies: None
Diagnostic Lab Data: Blood count Chest x-ray Covid swab
CDC Split Type:

Write-up: Persistent frequent cough Loss of energy Loss of appetite Dramatic weight loss


VAERS ID: 1775287 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Herpes zoster, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations:
Other Medications: Osteo Bi-Flex, Joint Health, Triple Strength; Pataday 0.1%
Current Illness: Internal derangement of right knee, with possible medial meniscus tear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, body aches, strong pain in injection arm a few hours after injection. Herpes Zoster (shingles) outbreak covering the full injection arm and shoulder with strong pain (especially around arm joints) starting the day after injection (10/6). Visited the emergency room at 4:30 am on 10/8 due to worsening symptoms. Prescribed methylprednisolone 4 MG Tablets (6 tablets first day and decrease by 1 tablet each day for 6 days) and Valacyclovir HCL 1000 MG Tablets (3 tablets a day for 7 days). Continues to have rash and strong pain in arm and shoulder as of today (10/9).


VAERS ID: 1775348 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 LA / IM

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

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: Daily Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: FEVER HEADACHE NAUSEA CHILLS FATIGUE


VAERS ID: 1775362 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-04
Onset:2021-10-05
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Gastrointestinal disorder, Pyrexia, Respiratory symptom
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: admitted to hospital 10/8/21 with covid. had fever, respiratory and GI symptoms


VAERS ID: 1775403 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-01
Onset:2021-10-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Computerised tomogram, Dyspnoea, Fibrin D dimer, Painful respiration, Thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine 175 mcg, Lexapro 10 mg, Wellbutrin XL 150 mg, Magnesium 100 mg, zinc 50 mg, Vit D3 5000 units,
Current Illness: adhesive capsulitis left shoulder
Preexisting Conditions: hypothyroidism, depression, osteoarthritis
Allergies: morphine-severe headache, Cymbalta-mental impairment, visual changes, imbalance, Chantix-insomnia for days
Diagnostic Lab Data: D-Dimer, perfusion CT scan of chest
CDC Split Type:

Write-up: severe left chest pain, shortness of breath, severe pain on deep breathing-perfusion CT scan showed multiple blood clots in the left lung


VAERS ID: 1775450 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / UNK - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood pressure decreased, Computerised tomogram normal, Decreased appetite, Dizziness, Echocardiogram normal, Fall, Fatigue, Laboratory test, Mobility decreased, Night sweats, Pollakiuria, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin (LIPITOR) 20 mg PM statin ? lower cholesterol Irbesartan 300 mg ? tab AM, ? tab PM blood pressure Amlodipine Besylate 2.5 mg 1 tab AM, 1 tab PM blood pressure Omeprazole 20mg AM Glucosamine/Ch
Current Illness: No
Preexisting Conditions: Have completed three rounds of chemo for lung cancer
Allergies: No
Diagnostic Lab Data: Echocariogram, CTs.
CDC Split Type:

Write-up: Too weak following day to even roll over in bed Tues); some mobility the second day, although still mostly bedbound due to extreme fatigue (Wed). Excessive urination throughout the period; able to eat very little; took some fluids the second day. Massive night sweats that second night. Felt much better at beginning of third day (Thurs), but over the space of four hours became dizzier and dizzier, blood pressure fell gradually and steadily. When it reached 60/40, decided ER visit would be necessary. While attempting to reach bedroom to get some clothes, fainted and fell in hallway. County Fire had to establish IV and transport to Medical Center ER. ER continues hydration through IV all that day (Thurs) thru 4:00 PM Fri, then released me from hospital. Extensive tests during this period were all negative.


VAERS ID: 1775494 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Axillary pain, Depression, Insomnia
SMQs:, Depression (excl suicide and self injury) (narrow), Hypoglycaemia (broad)

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

Write-up: High anxiety, depression, insomnia, pain under left arm pit


VAERS ID: 1775534 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-07
Onset:2021-10-05
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: Rapid + test for Covid on 108/2021
CDC Split Type:

Write-up: Client was vaccinated with Pfizer vaccines for Covid on 3/7 and 3/29, 2021. Symptoms started 10/5 - continuous coughing. Had monoclonal antibody infusion at Hospital on 10/9 with symptom improvement 24 hrs. later. Reported as a case of breakthrough Covid in a fully vaccinated person.


VAERS ID: 1775554 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3182 / 3 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Breast swelling, Chills, Fatigue, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (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: Multi-vitamin women over 50; ca-mg-zc vitamin; Ultram 50 mg; vit D 1000 iu
Current Illness: none
Preexisting Conditions: migraine headaches
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Expected sore arm started about 6pm day of injection 10-4. Brief episode of chills at 4:00 am 10-5. Fatigue & very sore arm during day 10-5, but went to work. About 7pm on 10-5, painful swelling under right arm noticed. Swelling spread to encompass right breast tissue by 10-7; large area still painful. Pain mostly controlled with Tylenol q 6 hrs. I have not seen my doctor yet. Tomorrow will be one week since injection. I would expect to see some resolution starting within the week. If not, I will make an appt.


VAERS ID: 1775595 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

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


VAERS ID: 1775613 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-14
Onset:2021-10-05
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Confusional state, Disturbance in attention, Impaired work ability, SARS-CoV-2 test negative, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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:
CDC Split Type:

Write-up: Patient requested reporting of her effects on 10-5, she attempted to go to a doctors appointment but started shaking a lot prior to getting to the appointment, temp went from 99.6 to 101 throughout the day. She took an at home covid test on the next day, it came back negative. On Friday she was unable to focus at her job, which needs to be done on the computer, felt very confused and struggling to make it through her day.


VAERS ID: 1775827 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling hot, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal 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: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received her first dose Pfizer COVID vaccine lot # FF8839 exp. 12/2021 on 10.05.21. At 1758, client reported to the first vaccinator RN at the vaccination table that she was ?feeling blurry vision for 3-5 seconds and a feeling of wave of heat from the top of her head down to her thighs.? At 1759, she said it ?went away.? Client denied any SOB, dizziness or any other anaphylactic signs or symptoms. The second vaccinator RN took client?s vitals at 1802: blood pressure (BP) 130/67, pulse (P) 69, respiration (R) 15, oxygen saturation rate (O2) 99 %, and at 1816: BP 117/64, P 67, R 13, and O2 99%. At 1816, client?s friend came over to check on client who was the driver for client and another friend who was waiting at the observation area which client stated she was ready to leave because she said she ?felt fine? and denied any anaphylactic signs or symptoms. PHN suggested to client to go continue her observation time until 1828 at the observation area with her friends. She verbalized understanding. PHN educated client to follow-up with health care provider regarding if should receive second Pfizer dose and about immediate medical care if symptoms returned or escalated. No medications or other interventions were indicated. Lead RN checked on client at 1825 which client told her via second vaccinator RN interpreter she drank water provided at the observation area and stated, ?all good.? Lead RN walked client who was walking with a steady gait and her friends at 1831 from site to the parking lot.


VAERS ID: 1775846 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-11
Onset:2021-10-05
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Deep vein thrombosis, Thrombectomy
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: thromectomy
CDC Split Type:

Write-up: bilateral lower extremity thrombis with need for intervention


VAERS ID: 1775924 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-10-05
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MRNA
Current Illness:
Preexisting Conditions: Comments: Patient was needed to take steroids.
Allergies:
Diagnostic Lab Data: Test Date: 20211005; Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20211010258

Write-up: MEDICATION ERROR; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION (BREAKTHROUGH); SEVERE REACTION TO JNJ VACCINE; This spontaneous report received from a consumer via a company representative concerned a female of unspecified age, race and ethnic origin. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: Patient was needed to take steroids. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry date: unknown) dose was not reported, 1 total, administered on APR-2021 for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch and lot numbers. Concomitant medications included mrna 1273 for covid-19 vaccine. On 05-OCT-2021, the patient experienced suspected clinical vaccination failure, suspected covid-19 infection (breakthrough) and severe reaction to JNJ vaccine. Laboratory data included: COVID-19 virus test (NR: not provided) Positive. On an unspecified date, the patient experienced medication error. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from suspected covid-19 infection (breakthrough), and the outcome of severe reaction to JNJ vaccine, suspected clinical vaccination failure and medication error was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint 90000196555.; Sender''s Comments: V0: 20211010258-covid-19 vaccine ad26.cov2.s-suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1775990 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USMODERNATX, INC.MOD20213

Write-up: The patient received an expired vaccine as a 1st dose,dose administered after manufacture date of expiry; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (The patient received an expired vaccine as a 1st dose,dose administered after manufacture date of expiry) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 040B21A) for COVID-19 vaccination. No Medical History information was reported. On 05-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (The patient received an expired vaccine as a 1st dose,dose administered after manufacture date of expiry). At the time of the report, EXPIRED PRODUCT ADMINISTERED (The patient received an expired vaccine as a 1st dose,dose administered after manufacture date of expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant drug information does not provided. Treatment information does not provided. Most recent FOLLOW-UP information incorporated above includes: On 06-Oct-2021: The follow up received on 06-OCT-2021 includes no new information.


VAERS ID: 1776056 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Dyspnoea, Fatigue, Injection site pain, Insomnia, Lethargy, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Chills-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fever-Severe, Systemic: loss of appetite-Severe, Systemic: Unable to Sleep-Severe, Additional Details: patient upset about side effect stated her employer required her to receive covid vaccine


VAERS ID: 1776304 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Back pain, Decreased appetite
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Abdominal swelling and pain around the belly and back. Pain Similar to after effects of passing kidney stone. Loss of appetite due to this. Abdominal swelling subsided after 48 hours.


VAERS ID: 1776334 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Pain, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: In the hours following injection I became febrile ( T- 101.6) and extremely achy with severe joint pain. Treatment consisted of acetaminophen and rest. Fever lasted for 48 hours. Body aches continued to through the 72 hour mark.


VAERS ID: 1776338 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-08
Onset:2021-10-05
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal wall wound, COVID-19, Cellulitis, Purulent discharge, Ultrasound abdomen abnormal, Wound drainage
SMQs:, Retroperitoneal fibrosis (broad), Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: History of Present Illness Patient is a 68 years old white female who has past medical history significant for history chronic right upper extremity stricture and also has past medical history significant for history of alcoholic cirrhosis. Patient apparently also has past medical history significant for history of chronic constipation and previous cervical laminectomy and cholecystectomy and hysterectomy. Patient comes into the hospital from her nursing facility for the reason of abdominal wound with drainage. She was evaluated in the emergency room for the reason of 1 week history drainage from the right groin/right lower quadrant wall. She was noted to have cellulitic changes in the abdominal wall area and was evaluated with an ultrasound which showed a purulent collection and was recommended to come to the hospital where she was evaluated and was recommended admission. She denies any documented fevers. She denies any chest pain. She was currently on antibiotics in the form of Cipro and Bactrim. She denies any nausea or vomiting or diarrhea or any shortness of breath or cough. Worth mentioning is that she was recently diagnosed of COVID-19 and apparently was recovering in rehab for COVID-19.


VAERS ID: 1776397 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Vision blurred, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient was sitting in observation area and complained of vision changes. Patient states mild blurred vision. Escorted back to EMS room. Patient laid down on cot to rest eyes and relax. SaO2 100%, HR: 86. Patient denies improvement or worsening of symptoms after 15 minutes. Discussed situation and options with patient and father further. Options of staying in EMS room, going home, or calling PCP were discussed. Father believed patient will feel better after resting at home. Patient did have increased anxiety in clinic setting and I agreed that they would be more comfortable at home. @1615: Discussed follow up care if symptoms change. Dad verbalized understanding. Patient states they are "ok" but still have mild blurred vision. Dad was ready to take patient home. Patient walked out and appeared to be managing activity without any problem., RN was notified of interaction with this patient and agreed to treatment recommendation.


VAERS ID: 1776421 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

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

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

Write-up: Localized skin reaction with rash and swelling.


VAERS ID: 1776513 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-04
Onset:2021-10-05
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Decreased appetite, Oesophageal discomfort, Oesophageal pain, Pain, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Tightening and pain in esophagus for 6 weeks. Lost 12-15 pounds due to lack of appetite and pain.


VAERS ID: 1776521 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-10-05
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acquired diaphragmatic eventration, Blood gases abnormal, COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Hypercapnia, Hypoxia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ALS, Hyperlipidemia, Chronic Hypoxic Respiratory Failure
Allergies: SulfAdiazine
Diagnostic Lab Data: Covid + 10/03/2021
CDC Split Type:

Write-up: Breakthrough Covid + a 69y.o. female presents to the EDwith worsening dyspnea and cough for the last 2-3 days. Admission CXR in the ED demonstrates chronic elevation of the left diaphragm but no obvious infiltrates. ABG in the ED demonstrates both hypoxemia and hypercapnea.


VAERS ID: 1776587 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLUOXETINE 20MG CAP. 2 TIMES DAILY, IBUPROFEN 600MG 1 TABLET 3
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: UNEVENTFUL AT TIME OF VISIT,NEXT MORNING AT 5AM WHILE PT. WAS HOME, PT. HAD SEVERE PAIN 7/10 ET STATED IT FELT SWOLLEN, THIS WAS A SATURDAY AND NURSE WAS NOT AVAILABLE TO ASSESS. PAIN WAS THERE 48 HOURS LATER BUT NOT AS BAD AND SWELLING SUBSIDED ACCORDING TO PT. PT. IS AN EMPLOYEE AT SAME FACILITY AS SHE RECEIVED VACCINE, SHE STOPPED BY NURSING SUPERVISOR OFFICE TO INFORM US ONLY.


VAERS ID: 1776705 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ711AB / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Atrial flutter, Blood test, Chest X-ray, Condition aggravated, Electrocardiogram, Heart rate increased, Ultrasound chest
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zocor Eliquis daily vitamin, Vit C, D, black pepper, lysine, beet root, fish oil
Current Illness:
Preexisting Conditions: Afib
Allergies:
Diagnostic Lab Data: EKG 10-5 to 10-7, chest x-ray, 10-5 chest ultrasound 10-6, blood drawn
CDC Split Type:

Write-up: Afib/flutter with high heart rate


VAERS ID: 1776706 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Gait disturbance, Impatience, Loss of personal independence in daily activities, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lictulose, Amlodginebecyae, carbidopa-ladzpa, Vitamin B1, Donepezil, multi Vitamin Centrum.
Current Illness: N/A
Preexisting Conditions: Liver disease, Parkinson.
Allergies: Coconut.
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: Arm was sore for a few days after injection, been less stable walking but with vaccine has gotten worse, extremely tired and less patient, a really big change on how well he could walk, Things that I was doing before I wasn''t able to do, Vomiting his regular medication.


VAERS ID: 1776749 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-25
Onset:2021-10-05
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: acetaminophen prn as needed for pain, hydrochlorothiazide-lisinopril 12.5mg-20mg BID, multivitamin
Current Illness: None documented
Preexisting Conditions: Hypertension, former smoker.
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated. Muscle aches, fatigue, cough


VAERS ID: 1776795 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-26
Onset:2021-10-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Headache, Migraine, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Meloxicam ( 7.5mg 2xday ) Claritin ( 1xday )
Current Illness: NA
Preexisting Conditions: Osteoarthritis Melanoma ( has been treated- all good now)
Allergies: Erythromycin Antibiotic
Diagnostic Lab Data: CT Scans IV''S while in hospital
CDC Split Type: vsafe

Write-up: I had horrible migraines and headaches. I had one bad last Tuesday 10/5/21 and on Wednesday evening 10/6/21. On Thursday 10/7/21 it go so bad I went the ER. I had a CT scan in the ER, I had no bleeds they were looking to see if I had a stroke. I had some IVS while I was there, and it really helped the pain while I was there. I was in the hospital for about 3 hours. The ER also prescribed me amoxicillin for 10xdays thinking I may have a bad sinus infection. This past Friday, Saturday, and Sunday I had bad headaches as well I took some medicine Maxalt, and Benadryl and it helped tremendously in about 1 hour. I had a bad headache again last night about 2 AM and I took 1 Tylenol and 1 Excedrin, and it helped it and I was able to go to sleep. Today is the first day since last Tuesday that I have not had a headache.


VAERS ID: 1776796 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-16
Onset:2021-10-05
   Days after vaccination:262
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: hospital admission for COVID PNA with hypoxia requiring supplemental O2


VAERS ID: 1776819 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-10-05
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Headache, Myalgia, Oropharyngeal pain, Pyrexia, Rhinorrhoea, 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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Fever, chills, muscle aches, runny nose, sore throat, headache, fatigue, coughing and wheezing.


VAERS ID: 1776872 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 4 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

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

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

Write-up: I contact doctor and she stated that her record is accurate. She got 2 doses of the Moderna and a Pfizer vaccine and a Moderna Booster. She said she lied to the place she got the Pfizer from and told them that she got the Pfizer vaccine because she heard that it could protect you from different strains of COVID. I informed her that is not following the manufacturers recommendations and shouldn?t of been done. She said she consulted with her husband and that is what she was going to do. She said it was not a med error on our part because she qualified for her Moderna booster. I said at this point I am going to consult you to reach out to your DR, I am not sure what kind of adverse effects one would have having 4 covid vaccines. She said ok.


VAERS ID: 1776896 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Malaise, Unresponsive to stimuli
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient became dizzy/diaphoretic during 15-minute post-vaccination waiting period in pharmacy waiting area; patient reported feeling unwell to pharmacy staff; this pharmacist escorted patient back to vaccination room with assistance of pharmacy manager; cold compress applied to patient''s forehead, water offered- patient experienced brief loss of consciousness and became unresponsive to verbal commands for approximately 60 seconds; pulse strong; upon regaining consciousness determined patient had worked an overnight shift and had nothing to eat all day prior to vaccination; provided food/water/direct observation for at least 30 minutes, and indirect observation for additional 15 minutes- symptoms fully resolved


VAERS ID: 1776961 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-25
Onset:2021-10-05
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / UNK - / -

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

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

Write-up: coughing, nausea, vomiting, diarrhea


VAERS ID: 1776994 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 3 - / IM

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

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

Write-up: Patient received third dose and did not meet the immunocompromised criteria. COVID-19 immunization history- 2/8/21 and 3/8/21.


VAERS ID: 1777007 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-18
Onset:2021-10-05
   Days after vaccination:260
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/9 COVID Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1777060 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: Patient seems to have become light headed and fell out of chair.


VAERS ID: 1777327 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Fatigue, Feeling abnormal, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Muscle pain in back at times arms and legs Tired more often Headaches on and off Feeling...not right


VAERS ID: 1777355 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Diarrhoea, Headache, Nausea, Night sweats, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: 65, Covid in 2/21 and 3/21- on 2nd Covid only: sore arm, aches, low grade fever x1 day.
Other Medications: Statin, aspirin, Proanolol
Current Illness: None
Preexisting Conditions: Reactive airway Benign arrythmias ET Bilateral vestibular weakness
Allergies: Latex,
Diagnostic Lab Data: I called my GI doctor in Day 5 and he wanted me to be seen but I could not find a local urgent care within network so I did not go in. I was better by day 6.
CDC Split Type:

Write-up: Extreme body pain/aches Chills, headache, nausea Severe stomach pains, especially at night- same symptoms as pancreatitis Fever of 102 for 24 hours then severe night sweats for 3 days Diahrea x1 day


VAERS ID: 1777625 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Product administered to patient of inappropriate age, Weight bearing difficulty, Wrong product administered
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: He received this vaccine by mistake due to pharmacy error. He is under age 12. He was supposed to get a flu shot. He could not bear weight on his right leg the following day. Has increased tiredness. We are waiting to see if he has any other symptoms.


VAERS ID: 1777801 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 RA / SYR

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

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

Write-up: He received this vaccine by mistake due to pharmacy error. He is under age 12.


VAERS ID: 1777818 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Dysmenorrhoea, Fatigue, Headache, Hyperhidrosis, Injection site swelling, Injection site warmth, Menstruation irregular, Musculoskeletal pain, Nausea, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Fertility disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), 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: None
CDC Split Type:

Write-up: Side effects within hours of injection that lasted approximately 48-72 hours: Left arm soreness that radiated around shoulder to left shoulder blade. Pain when lifting arm. Injection site warm to touch and swollen. Headache, fatigue, and nausea. Started normally scheduled period on October 8. Period was the worst in my life. Very severe cramps with sweating, nausea, and diarrhea. The cramps were so bad that I contemplated going to the hospital. I took ibuprofen and the cramps became more typical after about 2 hours. The nausea and headache continued for 24 hours.


VAERS ID: 1778884 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Fatigue, Influenza like illness, Insomnia, Malaise, 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: 3/18/21 similar reaction to flu or pneumonia vaccine, this occurred between 1st and second Pfizer covid vaccine
Other Medications: vitamins
Current Illness: none
Preexisting Conditions: bladder cancer diagnosed Nov 2015, Prostate cancer diagnosed April 2018, toothache started a day or two before receiving the vaccine and has still not been treated.
Allergies: sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting the evening of the vaccination I felt fever and flu like symptoms. I took ibuprofen to bring down the fever and was able to sleep. The next day, I still felt ill, little or no fever. On and off since then, I have felt achiness in my joints and generally tired. Symptoms similar to cold or flu.


VAERS ID: 1778894 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA FE3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dyspnoea, Palpitations
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: patient complained of chest pain, difficulty breathing, racing heart rate, dizzy. She said it lasted for 5-10 minutes then went away


VAERS ID: 1778917 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-28
Onset:2021-10-05
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, COVID-19, Coronary arterial stent insertion, SARS-CoV-2 test positive
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Other ischaemic heart disease (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, insulin glargine,JARDIANCE, latanoprost, lisinop
Current Illness:
Preexisting Conditions:
Allergies: Morphine, Oxycodone, Metformin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted as Observation on this day (10/7/2021) for STEMI (ST elevation myocardial infarction) (*) involving pRCA and mLAD. Patient was transfer to hospital from outside ER and was taken to the cath lab as priority 1. Now S/P DES to pRCA and mLAD. Patient was tested for COVID-19 and was positive on 10/7/2021.


VAERS ID: 1778987 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Flushing, Hyperhidrosis, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (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: 10:25am Attendee received injection. 10:35am Had reaction dizziness, flushing, sweaty, cool clammy, and pale. Put on cot with legs bent. EMS contacted. 10:50 Given water. Stable V/S. Refused EMS transport. Mother came and stated patient had prior reaction before. 11:11 Patient and mother left.


VAERS ID: 1778990 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-24
Onset:2021-10-05
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Cough, Dizziness, Dyspnoea, Immunosuppression, Inflammatory marker test, Lymphopenia, SARS-CoV-2 test positive, Urine output decreased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol, atorvastatin, calcitriol, clindamycin, furosemide, insulin lispro, insulin NPH, losartan, mycophenolate, prednisone, psyllium, tacrolimus, tamsulosin, vitamin D
Current Illness:
Preexisting Conditions: AKI, Arthritis, Arteriosclerotic heart disease, asthma, barrett''s esophagus without dysplasia, BMI 42, BPH, CKD with Kidney transplant in 2018. Crohn''s disease, DM, dialysis AV fistula malfunction, current Dialysis patient, HTN, GERD, gout, H. pylori infection, Morbid obesity, normocytic anemia, OSA on CPAP, postprocedural urethral stricture, Spinal stenosis, S/p total colectomy.
Allergies: amoxicillin, amoxicillin-pot clavulanate, azithromycin, cefdinir, ibuprofin, mesalamine, sulfa antibiotics, ace inhibitors, aspirin, ciprofloxacin, lisinopril, metformin, terfenadine, adhesive tape, mesalamine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt is fully vaccinated against COVID 19 with the Pfizer 2 dose series (given 8/3/2021 and 8/24/2021 respectively). Pt tested positive against covid on 10/5, received Regeneron on 10/8, presented to ED 10/10 with dyspnea, weakness, cough, decreased urinary output, and dizziness. He was admitted to the hospital at this time (10/10) and diagnosed with COVID-19 pneumonia. Covid treatment course thus far: " COVID-19 pneumonia o SARS-CoV-2 + 10/5/21, symptom onset about 9/26 o Fully vaccinated, immunosuppressed o S/p monoclonal antibody therapy 10/8 (casirivimab/indevimab) o Oxygen supplementation as needed o Continue dexamethasone 6mg daily o Monitor inflammatory markers o Empiric antibiotics are appropriate given onset of symptoms and significant immunosuppression-will give ceftriaxone and azithromycin initially but will have a low threshold to discontinue if respiratory status improves quickly o Lymphopenia noted but can be med effect (tacrolimus, mycophenolate) o Note that recent case study in Ann Rheum Disease indicated that holding mycophenolate perivaccination can increase humoral response to COVID vaccination-unfortunately, this was released $g1 month after he received his vaccine series and his indication for immunosuppression is transplant status so may not have been appropriate regardless "


VAERS ID: 1779035 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-09
Onset:2021-10-05
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (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 did not disclose previous vaccinations with of the following: 5/5/21 Covid19 Lot #023C21A at Pharmacy 6/2/21 Covid19 Lot #033C21A at Pharmacy Patient completed Pfizer series at Health Center 10/4/21 Lot #30130BA IM right arm. After this, it was discovered that the patient had completed presumably a Moderna series in June. Attempts to reach the patient have been unsuccessful.


VAERS ID: 1779043 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Dyspnoea, Full blood count normal, Headache, Metabolic function test, Nausea, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: NONE
Current Illness: RECENTLY DELIVERED BABY ON SEPT 22ND.
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: COVID TEST NEGATIVE. CMP ALL NEGATIVE, , CBC NEGATIVE, CHEST XRAY NEGATIVE
CDC Split Type:

Write-up: FEVER 103.2, HEADACHE, NAUSEA, SHORTNESS OF BREATH


VAERS ID: 1779087 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-25
Onset:2021-10-05
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / UNK - / -

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

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

Write-up: Covid positive household member


VAERS ID: 1779157 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312856 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pneumonia, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: not known
Current Illness: not known
Preexisting Conditions: new patient to us-not known
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patients daughter called and said the patient was in the hospital with pneumonia that the doctor said was caused by the Covid booster. Daughter also mentioned that the patient had blood clots


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