National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 9/10/2021 release of VAERS data:

Found 686,636 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 341 out of 6,867

Result pages: prev   242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440   next


VAERS ID: 1484086 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: Within 5 hours of receiving the vaccination, I started having a skin reaction. Hives spread throughout my body, itchy bumps that appeared and disappeared.


VAERS ID: 1484087 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 - / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Differential white blood cell count, Epistaxis, Full blood count, Haemoptysis, Monocyte count increased, Prothrombin time normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: cetirizine 10 mg daily prn (not used recently)
Current Illness: None
Preexisting Conditions: allergic rhinitis
Allergies: Pollen
Diagnostic Lab Data: CBC/diff, PT, and PTT were all normal except for a mild increase in monocytes.
CDC Split Type:

Write-up: Pt woke 7/17 AM and coughed a bit of blood. On 7/18 AM, he woke and had a significant nosebleed. No hematuria, hematochezia, or melena.


VAERS ID: 1484093 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blindness transient, Gait disturbance, Headache, Migraine, Pain, Pyrexia, Visual impairment
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (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: Phenylephrine
Current Illness:
Preexisting Conditions: Multiple sclerosis Rheumatoid arthritis Epilepsy
Allergies: No known allergies to food and other products.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme migraine began within 4 hours of vaccination. Migraine lasted about three more hours, affected sight. Sight completely lost for two hours. Migraine and difficulty seeing have come and gone ever since. Head all over body pain for all day the next day and the following day. Still experiencing side effects such as fever and all over body pain. Can''t walk very much without extreme pain and joints still. Fever comes and goes around the clock.


VAERS ID: 1484103 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Phentermine Maxalt
Current Illness: Migraines
Preexisting Conditions: Migraines
Allergies: Bactrim Cephalexin Dexamethasone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever- resolved Rash- shingles- treated


VAERS ID: 1484114 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Chest X-ray normal, Chest discomfort, Dizziness, Electrocardiogram normal, Full blood count normal, Metabolic function test, Nausea, Throat irritation, Troponin normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: prednisone 40mg and benadryl 25mg taken prior to vaccination
Current Illness: none
Preexisting Conditions: asthma
Allergies: penicillin, eggs, dairy, peanuts, chickpeas, sesame
Diagnostic Lab Data: ED visit 7/18/21 into 7/19/21, EKG, Chest Xray, troponin x2, CBC, BMP all within normal limits
CDC Split Type:

Write-up: impending doom, dizzy, nausea, chest pressure, itchy throat


VAERS ID: 1484270 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 UN / IM

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

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

Write-up: Site: Itching at Injection Site-Medium, Site: Redness at Injection Site-Medium, Additional Details: patient called and said she ended up with an infection at injection site and is on antibiotics


VAERS ID: 1484273 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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? 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, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium


VAERS ID: 1484276 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Headache-Severe


VAERS ID: 1484278 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Fear of injection, Hypotension, Loss of consciousness, Refusal of treatment by patient, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Hypotension-Severe, Additional Details: PATIENT PASSED OUT AFTER ABOUT 5-10 MINUTES OF THE VACCINE, HISTORY OF FAINTING. MAY HAVE BEEN DEHYDRATED DUE TO YARD WORK. FEAR OF NEEDLES AS PER PATIENT. PATIENT CAME BACK BY HIMSELF, CALLED 911 FIRE DEPT MONITORED BP AND DID CHECKS BEFORE LETTING HIM GO. PATIENT REFUSED TO GO TO THE HOSPITAL AND WALKED OUT WITHOUT HELP.


VAERS ID: 1484279 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: swollen, red and warm to the touch


VAERS ID: 1484285 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirena, vitamin D, vitamin C
Current Illness:
Preexisting Conditions: Chronic bronchitis
Allergies: Ibuprofen- swelling in face, tongue lips and airway KFlex - numbness in leg Bactrim- hives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed mild hives on arms, palms, legs and abdomen within a few hours after taking first dose of COVID-19 vaccine. At first I had thought they were bug bites and didn?t think anything about it until later around 4:00pm when I realized they were hives so they had started a couple hours prior. Called clinic that administered vaccine at 4:11pm and they returned my call at 4:27pm; they told me to take benedryl. I had Zyrtec on hand and took that. Hives began to be less itchy after about an hour.


VAERS ID: 1484290 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Injection site swelling, Mouth swelling, Peripheral swelling, Swelling face, Swollen tongue
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Swelling at Injection Site-Severe, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Additional Details: patient reports on right arm had swelling as well as right side of face : cheeks, eyes will go to see urgent care


VAERS ID: 1484422 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Lymphadenopathy, Pain, Pain in extremity
SMQs:, 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: Ceclor, amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm hurt, body ached, lymph nodes on left side of body near neck were very swollen, headaches


VAERS ID: 1484424 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: BP 122/72, Pulse 65, R 20, O22Sat 92.
CDC Split Type:

Write-up: Client became pale and was perspiring. Client was placed in a wheelchair by EMS and then taken to an area in the reconstitution area to be assessed. Patient was placed in supine with legs elevated and given water. Patient color improved stopped perspiring. Patient was asked if he wished to be transported to a hospital and he stated he was okay to go home. Patient walked out at his end of observation time 11:13 am.


VAERS ID: 1484425 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 1816027 / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: The day after the injection I was extremely fatigued and had sore muscles/slight body aches. The injection site was tender and would hurt if I moved my arm in a certain way. Three days later I still feel tired but not as bad and I still have some body/muscle aches/soreness.


VAERS ID: 1484447 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-13
Onset:2021-07-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Hypoaesthesia, Myalgia, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: patient initially had myalgias and then 5 days after second vaccination patient had acute onset of burning, numbness and tingling of his feed and legs.


VAERS ID: 1484505 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / SYR

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

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

Write-up: Chills, body aches, fever


VAERS ID: 1484509 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-05
Onset:2021-07-17
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anger, Anxiety, Blood oestrogen increased, Depression, Menstrual disorder, Sleep disorder
SMQs:, Hostility/aggression (narrow), 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: Progesterone cream, Montelukast,
Current Illness:
Preexisting Conditions: Asthma, anaphylaxis to peanuts
Allergies: Peanuts, tree nuts, milk, wheat, barley, rye, shellfish, pineapple, pumpkin, seeds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Prior to the Covid vaccine, periods were very regular, generally lasting 28 days, severe cramps the first day, treated with Motrin, then bleeding lasting 6 days, moderate flow. May 1 (day 1), cycle lasted 26 days with regular bleeding and regular weekly symptoms. July 27 (day 1), cycle lasted 28 days with regular bleeding and regular weekly symptoms. June 24, cycle lasted 23 days, nearly a week early. Irregular weekly symptoms including irregular estrogen surges (causing anger, sleep disturbances, anxiety and depression), and NO severe cramping on July 17 (day 1 of next cycle). I described the weekly symptoms to my parents as "weird."


VAERS ID: 1484510 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 - / -

Administered by: School       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? 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: Received Moderna vaccination underaged. Patient 12 years of age.


VAERS ID: 1484535 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BNT162B2(PF) / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Electrocardiogram, Heart rate increased, Paraesthesia, Tachycardia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vraylar, Klonopin.
Current Illness: None.
Preexisting Conditions: Depression, anxiety, childhood asthma.
Allergies: Penicillin family.
Diagnostic Lab Data: EKG, blood chemistry from IV, vital sign monitoring.
CDC Split Type:

Write-up: Acute tachycardia, rate up to 105 bpm accompanied with a rise in blood pressure with a maximum reading of 155/98. My normal blood pressure reading is 130/80 with a pulse rate of 70 bpm. Accompanied with a body wide tingling sensation like an adrenal release.


VAERS ID: 1484538 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-12
Onset:2021-07-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dysstasia, Hypoaesthesia, Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Sexual dysfunction (broad)

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

Write-up: Nausea, loss of ability to stand or feel feet.


VAERS ID: 1484544 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Blister, Cardiospasm, Cold sweat, Dyspnoea, Electrocardiogram, Immediate post-injection reaction, Palpitations, Pharyngeal swelling, Pruritus, Swollen tongue
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Swine Flu Shot in 1976 swole up
Other Medications: Amlodipine 10mg, daily vit
Current Illness:
Preexisting Conditions: lupus, hep c, brain aneurysm, high blood pressure, arthritis, asthma, ddd
Allergies: every antibiotics, codeine, Vicodin, haldol, Elavil, newtron, lisinopril, red dye, hot dogs, bee stings, percocets
Diagnostic Lab Data: yes EKG
CDC Split Type:

Write-up: As soon as she got the shot she got immediately sick to her stomach, started itching and broke out in a cold sweat. Took Benadryl when she got home and by that evening her tongue and throat started swelling, heart palpitations and couldn''t breathe. Went to the ER blood pressure started going up, heart started racing and was having spasms. When released from ER started getting blisters. Went to Hospital ER.


VAERS ID: 1484600 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-26
Onset:2021-07-17
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Laboratory test, Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Asymptomatic testing of patient for discharge to a subacute rehabilitation facility


VAERS ID: 1484656 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-03
Onset:2021-07-17
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Bilevel positive airway pressure, COVID-19, Cough, Dyspnoea, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ANTACID, CALCIUM CARBONATE, 200 mg calcium (500 mg), ketoconazole (NIZORAL) 2 % cream
Current Illness:
Preexisting Conditions: HFpEF, pHTN, permanent AF (on eliquis), HTN, carcinoid tumor in lung
Allergies: Glycopyrrolate
Diagnostic Lab Data: SARS-CoV-2 test positive on 7/17
CDC Split Type:

Write-up: Patient contracted COVID-19 after receiving two COVID-19 vaccine doses (Pfizer series completed on 4/3/21). Patient was admitted to the hospital on 7/17/21 with 3 days of SOB, cough and fever and tested positive for SARS-CoV-2. On admission patient required HFNC however, developed rapidly escalating O2 requirements and was transitioned to BiPAP. She was initiated on corticosteroids, anticoagulation (LMWH), remdesivir and tocilizumab. Today patient is afebrile, still requiring supplemental O2 with HFNC 100/60 and being continued on remdesivir (day #3 of 5).


VAERS ID: 1484693 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-07
Onset:2021-07-17
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS-CoV2 Rapid Antigen Positive
CDC Split Type:

Write-up: Hospitalized with COVID-19, tested +7/17/21. Pt has a cough, SOB, CP.


VAERS ID: 1484744 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-18
Onset:2021-07-17
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Based on lab report unknown symptoms started on 7/17/21. 2019 Coronavirus SARS-CoV-2 Rapid~2019 Coronavirus SARS-CoV-2 Rapid test performed on 7/17/21 and came back positive. Case investigation interview with patient has not been performed as of the time of this written note.


VAERS ID: 1484782 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-29
Onset:2021-07-17
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fibrin D dimer normal, Full blood count normal, International normalised ratio normal, Paraesthesia, Prothrombin time
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: osteoarthritis
Allergies: Voltaren gel
Diagnostic Lab Data: CBC, CMP, d-dimer, PT-INR within normal limits
CDC Split Type:

Write-up: paresthesia of right hand, left face, left/right leg


VAERS ID: 1484811 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-04
Onset:2021-07-17
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OIIL2OA / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fall, SARS-CoV-2 test positive, Transfusion
SMQs:, Anaphylactic reaction (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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: o Test date: 7/17/2021 o Test performed: SARS-COV-2 RNA PNL XXX NAA+PROBE~CORONAVIRUS (COVID 19) o Route: Nasopharyngeal o Result: POSITIVE
CDC Split Type:

Write-up: Tested prior to hospital admission. Started with a cough on 7/17/21 and fell at home. Was brought to ER for evaluation. Per nurse on the floor, he was admitted for fall and COVID, and has no issues from fall so continued admission is due to COVID treatment. Currently receiving plasma treatment and oxygen.


VAERS ID: 1484814 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bystolic Junel Levothyroxine
Current Illness:
Preexisting Conditions: Htn Hypothyroidism
Allergies: PCN, Keflex Blue cheese
Diagnostic Lab Data:
CDC Split Type:

Write-up: Exactly 12 hours after receiving the vaccine, I began to feel fever, Chills, systemic bodyaches and pains. Additionally is a lymph node in my left axilla swelled to the size of a baseball.


VAERS ID: 1484816 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-04
Onset:2021-07-17
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fall, SARS-CoV-2 test positive, Transfusion
SMQs:, Anaphylactic reaction (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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: o Test date: 7/17/2021 o Test performed: SARS-COV-2 RNA PNL XXX NAA+PROBE~CORONAVIRUS (COVID 19) o Route: Nasopharyngeal o Result: POSITIVE
CDC Split Type:

Write-up: Tested prior to hospital admission. Started with a cough on 7/17/21 and fell at home. Was brought to ER for evaluation. Per nurse on the floor, he was admitted for fall and COVID, and has no issues from fall so continued admission is due to COVID treatment. Currently receiving plasma treatment and oxygen.


VAERS ID: 1484827 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-19
Onset:2021-07-17
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Phos-Nak supplement (250 mg phosphorus, 160 mg sodium, 280 mg potassium) Aspirin 81 mg daily
Current Illness: No
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: SARS Covid Antigen nasal swab (resulted positive on 7/19/21)
CDC Split Type:

Write-up: Patient completed 2-dose series on 1/19/2021. On 7/17/21 patient displayed symptoms of CoVid-19. Seen in clinic today with positive diagnosis of CoVid-19. Test will be sent on to the MN DOH for further testing to determine varient.


VAERS ID: 1484829 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-29
Onset:2021-07-17
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Perimyocarditis requiring hospitalization. Treatment with colchicine and ibuprofen. Hemodynamically stable and discharged after a day of monitoring. Presented due to refractory chest pain originally.


VAERS ID: 1484843 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-23
Onset:2021-07-17
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough
SMQs:, Anaphylactic reaction (broad)

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

Write-up: 24 year old male presents to the ED for evaluation of cough. Patient reports cough present for about 3 weeks. Denies shortness of breath, chest pain. No other concerns. History of COVID infection winter, 2020, as well as COVID vaccination (2nd dose March 2021).


VAERS ID: 1484848 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Headache, Injection site induration, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth, Nasal congestion, Pain
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: Flu shot, Dec. 2020, 25 years old. Flu like symptoms 24-48 hours after vaccination.
Other Medications: Prenatal vitamins
Current Illness: Head cold the week before vaccination: mild symptoms of headache, sore throat, stuffy nose that lasted about a week.
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Arm started feeling sore, tender, and warm to the touch, itchy, and a hard lump formed at the vaccination site about 8-9 hours after vaccination. Started having headache, body aches, stuffy nose, and fatigue around the same time. Headache, body aches, stuffy nose, and fatigue lasted roughly 24 hours and improved slightly with Tylenol, Ibuprofen, and rest. Injection site swelling and pain were made better by an ice pack, but symptoms are still present 48 hours after vaccination.


VAERS ID: 1484856 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Migraine
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: Severe migraine lasting 12+ hours and reoccurring for the next two days


VAERS ID: 1484977 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 RA / IM

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

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

Write-up: Patient received vaccine on Thursday, July 15th. On Saturday, July 17th, the patient began having chest pains. This resolved itself with a few hours. Patient did not go to the doctor or hospital and she reported it to us on Monday, July 19th. She was also advised to go see her primary physician for further assessment.


VAERS ID: 1485018 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 RA / IM

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

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

Write-up: Pt. states after receiving the Moderna 2nd dose 07/16/2021, 07/17/2021 experienced swelling under the arm of the right side and soreness. Currently no visible swelling or soreness visible/detectable. 07/19/2021 Physician visit Dr. suggested just observation.


VAERS ID: 1485104 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O26DZIA / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Fatigue, Heart rate increased, Migraine, Nausea, Peripheral swelling
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Dehydration (broad)

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

Write-up: Swollen arm for a constant 4 days migraine nausea fatigue increased heart rate and blood pressure.


VAERS ID: 1485116 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-07-14
Onset:2021-07-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Influenza like illness, Lymphadenopathy, Vomiting, Wound
SMQs:, Acute pancreatitis (broad), Accidents and injuries (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Arthritis in the left shoulder
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had the normal flu-like symptoms for 2 days which included vomiting. He started to develop swollen lymph nodes in his armpit, but the it opened like a blister. Then, he had to be placed on antibiotics for the open wound.


VAERS ID: 1485235 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: CDC card 2nd date was unclear. Patient thought date was July 19th for second dose (which was originally written on card and written over). Date on front of card said 1st vaccination was July 5. Second dose was given 12 days early. Vaccine was administered before this was discovered. Patient was observed for 15 minutes and no adverse reaction was noted. Patient was advised that it was a week early and we would contact him if need for concern.


VAERS ID: 1485407 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-09
Onset:2021-07-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Muscle strain, Neck pain, Oropharyngeal pain, Sensory disturbance, Sleep disorder
SMQs:, Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Accidents and injuries (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: On July a7the neck and shoulder pain. Later that evening really bad throat pain .Can not lay down and can not sleep . on the 18th pulled muscled feeling in back and chest. also jaw chattering on the right . When sitting for a while felt like bones were shattering


VAERS ID: 1485408 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Vomiting projectile
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: VITAMIN C, LEVOTHYROXINE SODIUM, PAROXETINE HCL, PANTOPRAZOLE SODIUM, LISINOPRIL, LASIX, FOLIC ACID, CYANOCOBALAMIN, VITAMIN E, CHOLECALCIFEROL, BACLOFEN, ATORVASTATIN, ASPIRIN, ALIGN,
Current Illness:
Preexisting Conditions: POSTERIOR DISPLACED TYPE 2 DENS FRACTURE, OSTEOARTHRITIS, ABNORMAL POSTURE, REDUCED MOBILITY, DEPRESSIVE DISORDER, GERD, BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS, HYPER
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: PROJECTILE VOMITING


VAERS ID: 1485433 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: Pt and her parents filled out her vaccine form as being 12 years old (3/1/2009). The confidential system has the same patient listed as 11 years old (3/1/2010). Patient is adopted and the parents said they have multiple birthdays listed for their child. They will look for the birth certificate and will try to get the date clarified with the State.


VAERS ID: 1485644 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Headache, Myalgia, Pain, Respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (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: Multivitamin,Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Codiene,epinephrine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, chills, body/muscle aches, fatigue, cough, congestion. I rested the whole day, drank plenty of fluids, ate what I could. The next morning I woke up and I was fine


VAERS ID: 1485665 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-09
Onset:2021-07-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hemiplegia
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

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

Write-up: Half body paralysis.


VAERS ID: 1485995 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin 1800mg
Current Illness: None
Preexisting Conditions: Chronic pain
Allergies: Codeine, hydrocodone, Demerol, Dilaudid, morphine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vertigo ongoing specifically when moving head left or right or up or down or changing from standing to seated or seated to standing or while laying down.


VAERS ID: 1485997 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-07-17
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dysuria, Headache, Nausea, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Food allergy (The patient experiences chills and hives when having certain food.); Non-smoker
Preexisting Conditions: Comments: The patient had no known drug allergies. The Patient is very healthy (athlete).
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210738435

Write-up: BURNING SENSATION WHEN URINATING; CHILLS; HIVES; HEADACHE; NAUSEA; This spontaneous report received from a consumer concerned an 18 year old male. The patient''s weight was 168 pounds, and height was 68 inches. The patient''s concurrent conditions included food allergy, non smoker, and non alcohol user, and other pre-existing medical conditions included the patient had no known drug allergies, patient is very healthy (athlete).The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, expiry: UNKNOWN) dose was not reported, administered on 16-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-JUL-2021, the subject experienced burning sensation when urinating. On 17-JUL-2021, the subject experienced chills. On 17-JUL-2021, the subject experienced hives. On 17-JUL-2021, the subject experienced headache. On 17-JUL-2021, the subject experienced nausea. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from nausea on 17-JUL-2021, and had not recovered from hives, headache, burning sensation when urinating, and chills. This report was non-serious.


VAERS ID: 1486073 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), 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: N/A
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Sore arms. No other adverse reaction, however patient received Pfizer vaccine for 2nd dose. Patient received Moderna for her 1st dose of COVID vaccination series


VAERS ID: 1486593 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-09
Onset:2021-07-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain, Injection site swelling, Vaccination complication
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Bruising at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: covid arm


VAERS ID: 1486594 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-09
Onset:2021-07-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain, Injection site swelling, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (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? 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: Bruising at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild, Additional Details: rash at injection site about a week after administration. covid arm


VAERS ID: 1486596 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthropod bite, Hypersensitivity, Injection site erythema, Injection site pain, Injection site swelling, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Systemic: Allergic: Itch Generalized-Mild, Systemic: Allergic: Rash Generalized-Mild, Additional Details: she had a picture of large red swollen bump on arm. She also had mosquito bites on right leg and 3 large bumps lower left arm that she said her doctor recognized as bug bites. At the injection site though it was a little swollen but not red.


VAERS ID: 1486858 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-13
Onset:2021-07-17
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Skin ulcer
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: End-stage renal disease on hemodialysis Type 2 diabetes mellitus Bilateral lower extremity venous stasis ulcers Bilateral lower extremity lymphedema History of recalcitrant left foot infection Status post left transtibial amputation (03/03/2021)
Allergies: Acetaminophen (rash) Amlodipine (rash) Metoprolol (rash, skin peeling) Piperacillin-tazobactam (itching, redness)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has a history of bilateral lower extremity ulcers but is adamant about them getting worse after he received the Covid19 vaccine (dose 1 02/09/2021 and dose 2 04/13/2021).


VAERS ID: 1486868 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-12
Onset:2021-07-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valum Cingular Depocho
Current Illness: no
Preexisting Conditions: no
Allergies: Bees
Diagnostic Lab Data: saw pCP on 07/19 has another appt
CDC Split Type:

Write-up: Patient reported that as of 07/14 that her entire arm is numb and she has tingling sensations in her shoulders and jerks...


VAERS ID: 1486886 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-06
Onset:2021-07-17
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abortion threatened, Exposure during pregnancy, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

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

Write-up: O20.0 - Threatened miscarriage in early pregnancy vaginal bleeding


VAERS ID: 1486976 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-14
Onset:2021-07-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 003A21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: PCOS
Allergies: None
Diagnostic Lab Data: Complete blood work (7/20/2021) - no results yet
CDC Split Type:

Write-up: Numbness/tingling that started in both hands and both legs/feet and has now spread throughout body, including chest, back, neck, etc.


VAERS ID: 1486983 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Brain natriuretic peptide normal, C-reactive protein increased, Chest pain, Myocarditis, SARS-CoV-2 test negative, Troponin I increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: Tropinin I 5.23 (7/19@1936), 5.08 (7/19@2014), 3.63 (7/20@0215). C-Reactive Protein 10.2 (7/20@0806), BNP 24 (7/19@1936). COVID Negative.
CDC Split Type:

Write-up: Pfizer COVID-19 Vaccine EUA: Myopericarditis Patient reported receiving 2nd Pfizer COVID vaccine on 7/16/21. On 7/17/21 patient started experiencing chest pain and presented to the Medical Center on 7/19/2021. Patient was then transferred to another hospital.


VAERS ID: 1486993 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-17
Onset:2021-07-17
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Hypophagia, Malaise, Nausea, Small intestinal obstruction
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient not feeling well, decrease in oral intake, general weakness, abdominal pain, nausia. Diagnose with moderate to high grade small bowel obstruction. Patient was given IV fluid, Zofran, Steroids and pain meds. Patient still in hospital


VAERS ID: 1486998 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-29
Onset:2021-07-17
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

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

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

Write-up: PCR test performed on 7/17/21 at 17:15. Test came back positive. Case investigation interview with patient has not been performed at the time of this written note.


VAERS ID: 1487028 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Distractibility, Electrocardiogram, Fatigue, Heart rate increased, Impaired driving ability, Metabolic function test, Nausea, Pallor, Palpitations, Sleep disorder
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levocetirizine oral tablet.
Current Illness: no
Preexisting Conditions: ocd Gilberts syndrome
Allergies: benzo(versed) flu zone honey bees slight allergy to epinephrine
Diagnostic Lab Data: EKG Blood test triponid cmp
CDC Split Type:

Write-up: 1 .03:00 P.M received vax around 6 or 7 became tired and slept for 14 hours 2. went into town around 10.00 next day heart started pounding and was severely nauseous, , while driving became very distracted. pulled into parking lot still nauseous, 3. Called worker health around 11:00 went To ER around noon, heart still beating rapidly , pulse was extremely high, was discharged around 3 , Later that evening heart began rapidly accelerating again, Pt began to walk and exercise to bring down his heart rate. His heart would accelerate and fall , then he passed back out again and slept through night. 4. next day went to open gate around10 a.m. noticed his hands were very white and heart had become rapid, he began to walk and decelerate his heart this did not help, 5. Went back to ER and was discharged around 9 p.m. that night 6. that night was awaken around 3 a.m. to rapid heart beat and heart rate. this lasted 4.5 hours and then finally subsided


VAERS ID: 1487089 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, 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: Age was not verified with patient. Mother filled out consent form and wrote the wrong age and date of birth of child. Patient is 11 years old and received a Pfizer vaccine.


VAERS ID: 1487092 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-12
Onset:2021-07-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin Vitamin D 5,000IU
Current Illness:
Preexisting Conditions:
Allergies: Bee Stings Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Constant feelings of vertigo from 7/17/21 to as of writing report (7/20/21 12:16pm CST)


VAERS ID: 1487162 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-04
Onset:2021-07-17
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: A week or two after the second shot I started filling pain in middle of the chest. It was getting better if I was taking an Aspirin. The pain disappeared two weeks later. The pain appeared again three days ago after I swam for 5-10 minutes at the moment I got tired. Now I have the pain occurring from time to time...


VAERS ID: 1487171 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-04-17
Onset:2021-07-17
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS-COV-2 NAA (COVID-19) SARS-COV-2, QUALITATIVE, NAA (COVID-19), KP LAB Collected: 07/19/21 1027 Result status: Final Reference range: Not Detected Value: Detected
CDC Split Type:

Write-up: patient contracted COVID-19 on 7/18/21. Fully vaccinated on 4/17/21- mild COVID symptoms see below Immunizations COVID-19 Vaccine, PFIZER, External administration 4/17/2021, 3/27/2021 Dose Site Route Manufacturer Lot # Product 4/17/2021 Given 0.3 mL ER8735 Delete History 3/27/2021 Given 0.3 mL ER8732 Delete History


VAERS ID: 1487185 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: The day after getting the second Covid shot my daughter fainted. (same thing happened to my other daughter several weeks before)
CDC Split Type:

Write-up: The day after getting the Covid shot


VAERS ID: 1487317 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-27
Onset:2021-07-17
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adenovirus test, Alanine aminotransferase increased, Aspartate aminotransferase increased, Brain natriuretic peptide normal, Chest pain, Cytomegalovirus test, Dyspnoea, Echocardiogram normal, Electrocardiogram ST segment elevation, Enterovirus test, Epstein-Barr virus antibody, HIV test negative, Immunology test, Parvovirus B19 test, Pericarditis, Respiratory viral panel, SARS-CoV-2 antibody test, SARS-CoV-2 test, SARS-CoV-2 test negative, Troponin
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: minocycline
Current Illness: cold symptoms, cannot remember timeline but in the month prior to vaccination
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Administered morphine for pain with improvement. Obtained troponin and BNP, troponin elevated to 0.1 (normal upper limit 0.05) and BNP 23. Transferred for further evaluation given elevated troponiN. PE unremarkable. Chest pain and difficulty breathing resolved, did not require any medications. Obtained repeat troponin, elevated to 0.09. Another level obtained approx 6hrs later decreased to 0.03. EKG showed mild ST elevations suggestive of pericarditis. Echo showed normal biventricular systolic function. Hospital Course: Troponins were trended and normalized prior to discharge. Serial EKGs performed and normalized prior to discharge. Echo performed and showed normal function. Chest pain resolved prior to discharge. Will plan to follow up in cardiology clinic in 4 weeks for repeat Echo and in 3-6 months for cardiac MRI. Will need exercise restriction for the next 3 months until cardiac MRI results back. Infectious disease was consulted and the following studies were obtained: Lyme Disease Screen with reflex to western blot (negative), EBV antibody panel (pending), EBV quantitative blood PCR (negative), CMV IgM (pending) , CMV IgG (pending), CMV quantitative blood PCR (negative), Adenovirus blood PCR (negative), Enterovirus blood PCR (pending), Parechovirus blood PCR (pending), Parvovirus blood PCR (pending), HIV 1/2 Ag/Ab screen (4th gen) (negative), Respiratory Pathogen Panel (negative), COVID PCR (negative), COVID IgM and IgG (pending). Received 2nd dose COVID vaccine 3 weeks prior, therefore will report to VAERS. Patient tolerated regular diet throughout admission. AST and ALT elevated on admission, downtrading prior to discharge.
CDC Split Type:

Write-up: chest pain, shortness of breath


VAERS ID: 1487340 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: On Saturday,7/17/21, received her second dose of Pfizer Covid-19 vaccine (LOT #: EW0191, exp: on 8/2021) at 12:20 pm on her left deltoid. During assessment questions, client denied any underlying medical conditions or allergic reactions and was to be a 15 minute observation. At 1:25 pm, while waiting in Observation Area with her significant other, client stated to RN , she is feeling "anxious and dizzy" and stated she did not experience this reaction after her first dose. Client stated to RN & Lead PHN she does not take any medications. At 1:27pm, client was seated in the anti-gravity chair and vitals were offered but refused by patient. Client was given a bottle of water, juice and emesis bag and was asked to wait in the Observation Area until she felt better. After 20 minutes in the anti-gravity chair, client stated to RN & PHN that she was feeling much better and denied anymore anxiousness or dizziness. No further interventions needed. Client was educated by RN on signs and symptoms of adverse reactions and when to go to the ED/call MD. Client was also encouraged to sign-up on v-safe. Client left vaccination site with a steady gait at approximately 2:00 pm.


VAERS ID: 1487347 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA2485 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary mass, Injection site erythema, Injection site mass, Oedema peripheral
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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called office and reported redness and bump at vaccine injection site. Patient reports the next day had a lump/swelling in her arm pit area of her left arm.


VAERS ID: 1487365 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Dizziness, Hypoaesthesia, Pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol for pain.
Current Illness: anxiety
Preexisting Conditions: anxiety
Allergies: NKDA
Diagnostic Lab Data: Escorted to ED
CDC Split Type:

Write-up: Vaccinated 7/16, 7/17 developed mild chest pain, fever and body aches. 7/19 developed dizziness in addition to previously reported symptoms. 7/20 developed right leg numbness and reported symptoms to this clinic. Was escorted to ED


VAERS ID: 1487395 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-23
Onset:2021-07-17
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 - / -

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

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

Write-up: Patient hospitalized due to COVID-19. Patient is fully vaccinated.


VAERS ID: 1487464 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea, Electrocardiogram normal, Heart rate increased, Insomnia, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (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 (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: Egg
Diagnostic Lab Data: EKG showed my heart looked healthy. Heart rate was high, but not dangerously so.
CDC Split Type:

Write-up: Chest began to feel very tight, breathing became labored within 6 hours of getting the vaccine. I could not sleep the night of the vaccine because lying down on my back or side made the pain/tightness in chest worse. This continued through the next day and night (still could not sleep due to pain and discomfort in chest lying down). The tightness and pain were at the very center of my chest. Breathing hurt, and I felt like I couldn''t get enough air even though I was breathing fully. These events are still going on today (7/20/21) 3 days after the vaccine. I had fever and nausea last night, and my chest pain seems to be doing better today but still present.


VAERS ID: 1487749 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 643A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle strain, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Developed muscle pain in left leg. No swelling, tenderness, or visible signs of issue. Other symptoms from vaccine have resolved, but this area is still sore. States it feels like a pulled muscle. Patient was advised to seek medical care if symptoms have not resolved soon.


VAERS ID: 1488509 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-03-12
Onset:2021-07-17
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 - / -

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

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

Write-up: + COVID testing despite being fully vaccinated


VAERS ID: 1488516 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-14
Onset:2021-07-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Hypoaesthesia, Somnolence
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan lamotragine, terbinafine, duloxatine
Current Illness: Bronchitis a few.minths ago
Preexisting Conditions: Bipolar, CFS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fatigue and sleepiness. Numbness in 3 right toes and part of foot.


VAERS ID: 1489551 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-07-17
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
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: USJNJFOC20210738565

Write-up: ADMINISTERED PRE-FILLED SYRINGE THAT WAS 10 MINUTES PAST ITS 6 HOUR MAXIMUM IN THE REFRIGERATOR; STORED PRE-FILLED SYRINGE THAT WAS 10 MINUTES PAST ITS 6 HOUR MAXIMUM IN THE REFRIGERATOR; This spontaneous report received from a physician concerned a 57 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808982, expiry: 07-AUG-2021) dose was not reported, administered on 17-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-JUL-2021, the subject experienced administered pre-filled syringe that was 10 minutes past its 6 hour maximum in the refrigerator. On 17-JUL-2021, the subject experienced stored pre-filled syringe that was 10 minutes past its 6 hour maximum in the refrigerator. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the administered pre-filled syringe that was 10 minutes past its 6 hour maximum in the refrigerator and stored pre-filled syringe that was 10 minutes past its 6 hour maximum in the refrigerator was not reported. This report was non-serious.


VAERS ID: 1489770 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-22
Onset:2021-07-17
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Diarrhoea, Fatigue, Headache, Myalgia, Nasal congestion, Oropharyngeal pain, Pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ascorbic acid, vitamin C, (VITAMIN C) 1,000 mg tablet atorvastatin (LIPITOR) 20 mg tablet calcium phosphate trib/vit D3 (CITRACAL + D3, CALCIUM PHOS, ORAL) docosahexanoic acid/epa (FISH OIL ORAL) eszopiclone (LUNESTA) 2 mg tablet ketoconazo
Current Illness: None
Preexisting Conditions: Nervous Chest pain Circulatory External hemorrhoids Hypertension Internal hemorrhoids with complication Digestive Gastroesophageal reflux disease with esophagitis without hemorrhage Musculoskeletal Achilles tendinitis of both lower extremities Cervical spondylosis Lumbar spondylosis Osteopenia Rotator cuff tendonitis Atypical nevus Endocrine/Metabolic Adrenal cortex neoplasm Hypercholesterolemia Hyperglycemia Other Insomnia Overweight(278.02)
Allergies: Hydrocodone-acetaminophenNausea Only HydromorphoneNausea and Vomiting MeperidineNausea and Vomiting MorphineNausea and Vomiting NickelRash
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: Fever or Chills Cough Fatigue Muscle or body aches Headache Sore throat Congestion or running nose Diarrhea


VAERS ID: 1490273 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 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: Systemic: Dizziness / Lightheadness-Mild, Additional Details: At about 5:30pm on Saturday 07/17/21, patient was given covid vaccine, patient verbalized that she was very nervous while receiving the vaccine. Five minutes after the vaccine was given, patient fell on the floor, no loss of conscious, Alert and oriented x3, able to move all four extremities, no shortness of breath, responded to all questions. Patient assisted to chair by pharmacist and patient father. After 15 minutes patient stated she feels good. Patient refused to go to hosp.


VAERS ID: 1490283 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Lymphadenopathy, Lymphoedema
SMQs:, Retroperitoneal fibrosis (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Severe, Systemic: fluid pocket under right arm pit-Medium, Systemic: Lymph Node Swelling-Medium


VAERS ID: 1490326 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Unknown  
Location: Maryland  
Vaccinated:2021-07-10
Onset:2021-07-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Influenza, Influenza A virus test negative, Influenza B virus test positive, Nausea, SARS-CoV-2 test negative, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Covid test - negative, influenza a - negative. Tested positive for influenza B.
CDC Split Type:

Write-up: Sudden onset of severe headache, nausea, vomiting and blurred vision in one eye (one week after 2nd Pfizer shot) that required visit to Urgent care. Patient reported it was the most severe headache experienced to date. Patient tested positive for Influenza B and was sent home with instructions to go to Emergency room if headache returned.


VAERS ID: 1490396 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Just under 24 hours later developed a fever, chills, shaking and a dull head ache. Arm pain at injection sight began within 12 hours but was not sever. Head ache persisted and required 3 aspirin. Head ache continued through the evening into the next day while the fever & chills resolved itself by the next morning. Pain killers were taken over night. Head ache remained present throughout following day although it was milder and resolved within approximately 36 hrs.


VAERS ID: 1490427 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Decreased appetite, Echocardiogram normal, Electrocardiogram normal, Fibrin D dimer normal, Full blood count normal, Hypertension, Metabolic function test, Pyrexia, Tachycardia, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), 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? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/20 EKG-normal, echocardiogram-normal. troponin 0.16, CBC- normal, dDimer-normal, BMP-normal 7/21 troponin- 0.18 and 0.13
CDC Split Type:

Write-up: Patient developed fever day of vaccine. One day later developed chest pain and decreased appetite which prompted seeking medical care. In ED, found to have tachycardia, orthostatic changes (was hypertensive) and elevated troponin level


VAERS ID: 1490453 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: nausea


VAERS ID: 1490523 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Full blood count normal, Musculoskeletal chest pain, Pain
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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 7/20/2021: CBC results were all normal
CDC Split Type:

Write-up: Sharp pain under the left rib cage (around spleen area) when bending, laughing, etc. It started the night after receiving my second shot of Pfizer vaccination.


VAERS ID: 1490574 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination


VAERS ID: 1490588 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-15
Onset:2021-07-17
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Headache, Nasal congestion, Paranasal sinus discomfort, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: SARS-CoV-2 Ag Resp Ql IA.rapid~SARS-CoV-2 Ag Resp Ql IA.rapid performed on 7/19/21. Came back positive. Per documentation from case investigation interview, case manager charted, "symptoms began 7-17-21" which included nasal congestion, runny nose, headache and sinus pressure. Safely isolating at home.


VAERS ID: 1490592 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Product storage error
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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination


VAERS ID: 1490609 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Product storage error
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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination


VAERS ID: 1490631 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination


VAERS ID: 1490642 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product preparation error
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: No illnesses at the time of vaccination
Preexisting Conditions: unknown
Allergies: No Known Allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The Pfizer bottle had already been diluted, drawn up and administered to other patients. No vaccines left in Pfizer bottle. RN inadvertently re-diluted empty Pfizer bottle and vaccinated patient with only diluent. Not realizing that the patient did not receive correct vaccination, the patient was observed for 15 minutes, no adverse effects seen during that time. This error was not discovered until the end of the day when staff was confirming the number of vials and wasted vaccinations matched up with the number of patients seen.


VAERS ID: 1490673 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination


VAERS ID: 1490677 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product preparation error
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: Penicillin-unknown
Other Medications: unknown
Current Illness: No illnesses at the time of vaccination
Preexisting Conditions: unknown
Allergies: Penicillin-unknown reaction
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The Pfizer bottle had already been diluted, drawn up and administered to other patients. No vaccines left in Pfizer bottle. RN inadvertently re-diluted empty Pfizer bottle and vaccinated patient with only diluent. Not realizing that the patient did not receive correct vaccination, patient was observed for 15 minutes, no adverse effects seen during that time. This error was not discovered until the end of the day when staff was confirming the number of vials and wasted vaccinations matched up with the number of patients seen.


VAERS ID: 1490694 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Product storage error
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: Pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?


VAERS ID: 1490702 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product preparation error
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: No illnesses on day of vaccination
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The Pfizer bottle had already been diluted, drawn up and administered to other patients. No vaccines left in Pfizer bottle. RN inadvertently re-diluted empty Pfizer bottle and vaccinated patient with only diluent. Not realizing that the patient did not receive correct vaccination, patient was observed for 15 minutes, no adverse effects seen during that time. This error was not discovered until the end of the day when staff was confirming the number of vials and wasted vaccinations matched up with the number of patients seen.


VAERS ID: 1490708 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
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: Unknown
Current Illness: No illnesses on day of vaccination
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The Pfizer bottle had already been diluted, drawn up and administered to other patients. No vaccines left in Pfizer bottle. RN inadvertently re-diluted empty Pfizer bottle and vaccinated patient with only diluent. Not realizing that the patient did not receive correct vaccination, patient was observed for 15 minutes, no adverse effects seen during that time. This error was not discovered until the end of the day when staff was confirming the number of vials and wasted vaccinations matched up with the number of patients seen.


VAERS ID: 1490711 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-02-10
Onset:2021-07-17
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pravastatin, Diltiazem, Omeprazole, Gabapentin, Maczide Doxylamine
Current Illness:
Preexisting Conditions: HTN, GERD, HLD, insomnia
Allergies: NKDA
Diagnostic Lab Data: CareStart COVID-19 Rapid Antigen Test
CDC Split Type:

Write-up: Breakthrough COVID19 infection


VAERS ID: 1490718 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?


VAERS ID: 1490752 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-21
Onset:2021-07-17
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Computerised tomogram, Electrocardiogram abnormal, Myocardial strain, Oedema peripheral, Pulmonary embolism, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol, alprazolam, aspirin, atorvastatin, b complex, vitamin d, vitamin b12, coq10, dapagliflozin, dexilant, dicyclomine, diltiazem, furosemide, metformin, metoprolol, oxybutynin, tramadol
Current Illness: bilateral leg edema 2 months after vaccine... started on furosemide.
Preexisting Conditions: diabetes, HTN, obesity, hyperparathyroidism
Allergies: Iodine, sulfa
Diagnostic Lab Data: CT and EKG
CDC Split Type:

Write-up: Massive PE with R heart strain. Possible RA thrombus. Duplex LE with extensive residual B/L lower extremity clot. Was given heparin and needed tPA due to high risk for decompensation. Transitioning to Eliquis


VAERS ID: 1490777 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Lymphadenopathy, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole 20mg OD ,fluoxetine hcl 20mgOD,montelukast 10mg, OD vitamin D 50,000 units/weekly,albuterol HFA prn, naproxen 500mg prn, diclofenac sodium 50mg, hs, ibuprofen 200mg q 8h, tylenol 325mg prn
Current Illness:
Preexisting Conditions: endometriosis, uterine fibroma, pseudocholinesterase deficiency, h/o + covid 19 in 2021
Allergies: bactrim, nickel, eggs, peach, pineapple, green apples, plum
Diagnostic Lab Data:
CDC Split Type:

Write-up: Enlarged axillary lymph nodes, ( left), left side of neck swelling, fever ( 100.5). Patient evaluated in ED on 07/18/2021, f/u at Health Center on 07/21/2021


VAERS ID: 1490779 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Loss of personal independence in daily activities
SMQs:, Dementia (broad)

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

Write-up: Experienced headaches, chills and extreme fatigue approximately 9 hours after receiving the injection. The fatigue lasted approximately a day and a half. I was unable to perform normal daily activities due to the fatigue.


VAERS ID: 1490782 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 LA / IM

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

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

Write-up: This was an administration error. Patient received a dose from a refrigerated vial that was punctured more than 12 hours ago.


VAERS ID: 1490791 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 LA / IM

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

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

Write-up: This was an administration error. Patient received a dose from a refrigerated vial that was punctured more than 12 hours ago.


Result pages: prev   242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=341&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166