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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 342 out of 6,867

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VAERS ID: 1490812 (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 RA / IM

Administered by: Pharmacy       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: 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: 1490821 (history)  
Form: Version 2.0  
Age: 17.0  
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 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 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: 1490842 (history)  
Form: Version 2.0  
Age: 28.0  
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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 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: 1490855 (history)  
Form: Version 2.0  
Age: 14.0  
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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 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: 1490868 (history)  
Form: Version 2.0  
Age: 71.0  
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 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: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. 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: 1490895 (history)  
Form: Version 2.0  
Age: 38.0  
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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. 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: 1490919 (history)  
Form: Version 2.0  
Age: 29.0  
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 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: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. 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. Pregnancy information is unknown


VAERS ID: 1490928 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-17
Onset:2021-07-17
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: tested positive for COVID on 7/19/2021.
CDC Split Type:

Write-up: patient developed cough, runny nose, and body aches on 7/17/2021. She tested positive for COVID on 7/19/2021.


VAERS ID: 1490983 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-03
Onset:2021-07-17
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anal haemorrhage, Back pain, Blood test, Cold sweat, Feeling hot, Haematemesis, Henoch-Schonlein purpura, Joint swelling, Migraine, Muscle spasms, Nausea, Pain, Skin discolouration, Swollen tongue, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Gastrointestinal haemorrhage (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vasculitis (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: skin issue''s , hot and cold sweats, stomach pains, migraines, nausea, blurred vision, knee swelling, and aching , Pain in the back like a stabbing fan, Dots under skin, in all areas even head. Has thrown up blood once in the beginning and also slight anal bleeding. Swollen tongue, Hand cramps, finger cramps. *diagnosed with ( henoch-schonlein)


VAERS ID: 1491014 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-27
Onset:2021-07-17
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-1 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-1 / 1 AR / 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: ALBUTERAL INHALER,BLACK COHASH,LORATADINE,MULTIVITAMIN 50 PLUS LUTEIN,OMEPRAZOLE,ZOCOR
Current Illness: NONE
Preexisting Conditions: GERD,HYPERLIPIDEMIA,OVARIAN CANCER 11//16/2020
Allergies: BANANAS,BANANA EXTRACT,NUT FLAVOR,PENICILLIN,NUTS,SULFA ANTIBIOTICS
Diagnostic Lab Data: AT HOME TEST KIT FROM pharmacy
CDC Split Type:

Write-up: COVID 19 DIAGNOSED TODAY JULY 21,2021 BY TEST KIT


VAERS ID: 1491453 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Colorado  
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 009D21A / 1 LA / SYR

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

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

Write-up: Pt stated that she had a rash that spread from her injection site that spread to her face, neck and torso. She also had lymph node swelling in her armpits. She has been taking antihistamines without resolution but does not feel that it is getting worse at this time (5 days post vaccination)


VAERS ID: 1491460 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-07-17
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, General symptom, 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: positive covid-19 PCR testing
CDC Split Type:

Write-up: fully vaccinated (2/20/21, 3/31/21). developed symptoms on 7/17/21. tested positive for covid-19


VAERS ID: 1491643 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-07-17
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: fully vaccinated (Pfizer, 2/9/21 and 3/2/21). developed symptoms on 7/17/21.


VAERS ID: 1491646 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-17
Onset:2021-07-17
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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: positive covid19 PCR test
CDC Split Type:

Write-up: fully vaccinated (Pfizer, 3/27/21, 4/17/21). developed symptoms on 7/17/21


VAERS ID: 1491652 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-10-09
Onset:2021-07-17
   Days after vaccination:281
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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: positive covid19 PCR test
CDC Split Type:

Write-up: patient fully immunized (Pfizer, 9/18/2020, 10/9/2020). developed symptoms on 07/17/2021


VAERS ID: 1492879 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-17
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergic reaction (Chest pain one of allergic reaction but no rash, no swelling.); Heart attack (2 Heart Attacks within the past 15 years, had myocardial infarction in 2006 and 2009.); Comments: Patient had 2 stents in both main arteries of the heart.
Allergies:
Diagnostic Lab Data: Test Date: 20210717; Test Name: Electrocardiogram; Result Unstructured Data: Irregular; Test Date: 20210717; Test Name: Electrocardiogram; Result Unstructured Data: Normal; Test Date: 20210717; Test Name: Heart rate; Result Unstructured Data: Irregular
CDC Split Type: USJNJFOC20210743154

Write-up: CHEST PAIN; This spontaneous report received from a patient concerned a 67 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included heart attack, and concurrent conditions included allergic reaction, and other pre-existing medical conditions included patient had 2 stents in both main arteries of the heart. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1820096, and 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 chest pain. Laboratory data included: Electrocardiogram (NR: not provided) Irregular, EKG came back normal, and Heart rate (NR: not provided) Irregular. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from chest pain. This report was non-serious.


VAERS ID: 1493387 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKA
Diagnostic Lab Data: The pdiatrician office checker vitals ,it was all completely normal . I''m not aware if they requested any lab tests .
CDC Split Type:

Write-up: The patient was instructed to wait 15 minutes after the vaccine . after about 10 minutes , while the patient and her mother was waiting in the waiting area , the mother shouted loudly saying " she fainted " . The pharmacist went directly to the waiting area , the mother said "she''s back" . The patient probably fainted for about a minute or so . When the patient gain her concious , she was sweating badly , pharmacist went and got her some gatorade . she was fine , responsive and alert , she had few sips of the drink and felt fine completly . The mother had mentioned before the vaccine the was very nervious about the vaccine and also the face that she didn''t eat any thing all morning . The mother took her to the pediatrician office right after she felt fine , to check her vitals , the pediatrician suggested it could be the vaccine .


VAERS ID: 1493418 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Error: Patient Too Young for Vaccine Administered-


VAERS ID: 1493663 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-14
Onset:2021-07-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Oropharyngeal pain, Pain in extremity, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine was sick for a full year. Never received the flu shot again. I was 55
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: yes itching .
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No medical action. Symptoms are red rash, sore arm after a week, diarrhea and sore throat.


VAERS ID: 1493763 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: C-reactive protein increased, Cardiac imaging procedure abnormal, Chest pain, Echocardiogram abnormal, Ejection fraction decreased, Fatigue, Immediate post-injection reaction, Immunoglobulin therapy, Left ventricular dysfunction, Myocarditis, Palpitations, Pericardial effusion, Right ventricular dysfunction, Right ventricular ejection fraction decreased, Troponin increased
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Melatonin
Current Illness: None
Preexisting Conditions: Autism Spectrum Disorder
Allergies: Amoxicillin
Diagnostic Lab Data: 7/17 Troponin 20,987 at 1450 and CRP 79.4. 7/17 Troponin 28,338 at 2336. 7/18 Troponin 23376, CRP 53. 7/19 Troponin 19,463, CRP 29. 7/20 Troponin 4,658, CRP 16.6. 7/21 Troponin 2,076, CRP 9.3. 7/17 Echo - LVEF 40-50%, with LV+RV mildly depressed systolic function + diastolic function. 7/19 Echo- LVEF 50%, low-normal function, slightly improved. 7/19 Cardiac MRI - Mildly decreased global LV systolic function (EF 47%), decreased RV systolic function (EF 37%), small pericardial effusion. 7/21 Echo normal.
CDC Split Type:

Write-up: Chest pain and palpitations, fatigue immediately post vaccine and chest pain starting 43 hours later. Admitted at 48 hours with troponin 20,000 and decreased biventricular function on echo (RVEF 37%) consistent with myocarditis. Symptomatic improvement post IVIG treatment. Hospital stay 4 days without arrhythmia or other events. Treated with IVIG alone.


VAERS ID: 1493823 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-10
Onset:2021-07-17
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Deep vein thrombosis, Pain, Pain in extremity, Peripheral swelling, Peripheral vein thrombus extension, Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Accidents and injuries (narrow), 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? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA 81mg finasteride 5mg linagliptin 5mg magnesium oxide 400mg lovastatin 40mg lisinopril 40mg pantoprazole 40mg amlodipine 10mg glipizide 10mg tamsulosin 0.8mg hydrocodone 10/325mg colace 100mg
Current Illness: None
Preexisting Conditions: Patient has diabetes mellitus tyye 2, HTN, hyperlipidemia, BPH, chronic kidney disease stage 2, osteoarthritis, cervical spine stenosis, lumbar neuroforaminal narrowing
Allergies: NKDA
Diagnostic Lab Data: patient had lower extremity venous duplex right leg confirmed occlusive thrombus in the right common femoral and greater saphenous veins with subocclusive DVT in the right femoral vein. Patient with no other risk factors for DVT no recent surgeries, trauma to RLE or extended travel via vehicle or airplane. Patient negative age appropriate cancer screening tests recently. Patient with unprovoked DVT except for previous COVID19 Janssen vaccine.
CDC Split Type:

Write-up: patient developed right lower extremity DVT diagnosed ultrasound 7/20/21. He started with acute pain right leg Saturday 7/17 and woke up on Sunday 7/18/21 with swelling right upper thigh and bruising and swelling of right foot. His swelling and pain increased and was seen urgent care where he was referred to emergency room for evaluation DVT.


VAERS ID: 1493946 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-19
Onset:2021-07-17
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic Lung Disease, Diabetes, Hypertension, Smoker, Other underlying conditions and chronic diseases
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1494034 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Malaise, Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Arthritis (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 day after vaccination, patient experienced pain in both arms from shoulder to elbows, headache, and overall felt sick causing patient to lay in bed for several days. Majority of symptoms resolved on 7/21/21. Patient does complain of lingering headache still today (7/22/21). Patient did not take any medications to treat symptoms


VAERS ID: 1494074 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-13
Onset:2021-07-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Atrial fibrillation, Bone density decreased, Chest X-ray abnormal, Chest pain, Deformity, Echocardiogram abnormal, Ejection fraction, Left ventricular hypertrophy, Lung opacity, Pericardial effusion, Pleural effusion, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Imdur, pantoprazole, Tylenol, Miralax, lidocaine patch to the back, Senna-S, Ibuprofen
Current Illness:
Preexisting Conditions: Essential (Primary hypertension), GERD, constipation, other specified disorders of bone density and structure-multiple sites, calculus of gallbladder without cholecystitis without obstruction, Other intervertebral disc degeneration-lumbar region, chronic pain syndrome, presence of left artificial hip joint, wedge compression fracture of T11-T12 vertebra, sequela, Wedge compression fracture of second lumbar vertebra sequela, weakness
Allergies: NKA
Diagnostic Lab Data: 7/17/21 Chest XRay 1. Slight interval increase in interstitial opacities in lung base since 6/28/21 suggestive of interstitial edema 2. There is a small right pleural effusion present, new compared to prior. 3. Diffuse diminshed bone mineral density. 4. Severe, more than 50% compression deformity of T9., probably progress since 6/20/21. Please correlate with point tenderness 7/18/21 Echocardiogram 1. the LVEF is 55-60% 2. Moderate concentric left ventricular hypertrophy 3. The aortic root is normal in size 4. Small pericardial effusion
CDC Split Type:

Write-up: 99 y.o. nursing home resident received 1st Moderna Covid vaccine on 7/13/21. On 7/17/21, Resident complained of chest pain and was transferred to ER and admitted to Acute with A-FIB. Resident returned to LTC unit 7/20/21 on hospice.


VAERS ID: 1494104 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-11
Onset:2021-07-17
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram thorax abnormal, Condition aggravated, Dyspnoea, Pleural effusion, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? 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: Patient started experiencing shortness of breath and fever about 3 days PTA (admitted on 7/17/21) and was treated with a Zpak and doxycycline as an outpatient. Her symptoms did not improve, so she presented to the ED on 7/17. Patient was tested for COVID per protocol and the test came back positive. CT PE came back negative, but a large left pleural effusion was discovered and patient was admitted for treatment. Since pt remained on room air during her hospitalization, Infectious Diseases decided not to treat pt for COVID since pt is fully vaccinated (received Pfizer on 2/8 and 3/11) and they didn''t believe her presentation was caused by COVID. Pt had a similar presentation of LLL PNA with pleural effusion in 12/2019.


VAERS ID: 1494151 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-16
Onset:2021-07-17
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 7808980 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Laboratory test abnormal
SMQs:

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

Write-up: Tested positive 6-17-21-day after receiving vaccine.


VAERS ID: 1494241 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-07-17
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 2 LA / SYR

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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN, ASCORBIC ACID, BUDESONIDE, BUPROPRION HC ER, CALCIUM CARBONATE, CEPACOL, CLOPIDOGREL BISULFATE, VITAMIN D, FLONASE, IPRATROPIUM BROMIDE, MELATONIN, MIRALAX, MIRTAZAPINE, MULTIVITAMIN, NYSTATIN, OMEPRAZOLE, PRESERVISION, PROAI
Current Illness: NONE
Preexisting Conditions: ASTHMA, AUTOIMMUNE NEUTROPENIA, BPH, CALCIFIED GRANULOMA OF LUNG, CHRONIC ANXIETY, CHRONIC CHEST PAIN, CHRONIC CONSTIPATION, CHRONIC DEPRESSION, CHRONIC FATIGUE, CHRONIC RHINITIS, COPD, DIZZINESS, ESOPHAGEAL REFLUX, GRADE 2 FOLLICULAR LYMPHOMA, HYPERLIPIDEMIA, IRRITABLE BOWEL SYNDROME, OBESITY, OBSTRUCTIVE SLEEP APNEA, OSTEOARTHRITIS, PULMONARY EMPHYSEMA WITH FIBROSIS OF LUNG, SUBCLAVIAN STEAL SYNDROME
Allergies: CLINDAMYCIN, SEASONAL ENVIRONMENTAL ALLERGIES
Diagnostic Lab Data: 7/20/21 COVID-19, MOLECULAR POSITIVE
CDC Split Type:

Write-up: POSITIVE COVID TEST (7/20/21) WITH HOSPITALIZATION (7/22/21)


VAERS ID: 1494312 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-06-21
Onset:2021-07-17
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anosmia, Blood prolactin, C-reactive protein, Chest discomfort, Chest pain, Chills, Cough, Dyspnoea, Fatigue, Fibrin D dimer, Hypophagia, Malaise, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: pertinent medical history for HFrEF, Morbid Obesity, Bipolar disorder, Hypertension, T2DM, Anxiety, Asthma, CAD, CKD 3
Allergies: tramadol
Diagnostic Lab Data: 7/16/21 tested positive upon arrival to ED; CRP, D-dimer, prolactin 0.17, pulse ox, O2,
CDC Split Type:

Write-up: cough, malaise and fatigue. He states that he started to have symptoms about 3 days ago with chills, subjective fevers, cough, anosmia. He also had some chest pain that he states was left sided/substernal and felt like squeezing/heavy pain. It started yesterday morning and comes and goes. He has some SOB and he also has had a very poor oral intake.


VAERS ID: 1495679 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Arthralgia, Back pain, Balance disorder, Condition aggravated, Decreased appetite, Diarrhoea, Dizziness, Fatigue, Flatulence, Gait disturbance, Pruritus, Pyrexia, Rash macular, Sensitive skin, Somnolence, Vertigo, Vertigo positional
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, klonopin, remeron, maxide
Current Illness: None
Preexisting Conditions: Hypertension, hyperlipidemia
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 7/16/21 -approx 11 pm extreme pain in stomach, fever 101.1-101.3 diarrhea times 4; 7/17/21 -fever continued, diarrhea and abdominal pain continued, tired and sleepy all day; 7/18/21 -normal temp, no diarrhea but gassy and loss of appetite; 7/19/21 -vertigo started in early morning maybe around 3am. Dizziness and unsteadiness on walking and certain head movements. Do have history if BPPV. Vertigo continues to today 7/22/21 on this reporting; 7/20/21 -itchy skin and sensitive in some places. Mostly back and shoulders. Leading eventually to red blotches and itchiness continuing


VAERS ID: 1495700 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Injection site induration, Injection site irritation, Injection site pain, Injection site pruritus, Injection site reaction, Wound
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (broad), Extravasation events (injections, infusions and implants) (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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Beginning 1 day after the vaccine, the patient states that the injection site became very itchy. 2 days after, she stated she could not breathe very well. She was never tested for covid. Currently, 6 days later (today), the injection site is very hard, irritated, sore, and there is an open sore where the needle was injected.


VAERS ID: 1496140 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

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

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

Write-up: Patient reported on 7/22/21 the following incident: On 7/17/21, the day after receiving the second Pfizer vaccine, the patient fainted and hit his head to the floor. He was taken to the ER. Doctor performed MRI to make sure if there was any internal injury, which did not show internal injuries at the time. Patient was advised to see his family doctor and then discharged after a few hours. Patient saw his family doctor on 7-22-21, which referred him to cardiologists and neurologist. Patient is currently waiting for appointments from the specialists. Patient seemed to be feeling well at the time of talking to the pharmacist and did not have any health complain at the time.


VAERS ID: 1496314 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Breast induration, Costochondritis, Injection site pain, Injection site swelling, Lymphadenopathy, Musculoskeletal chest pain, Myalgia, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: physical examination (7/19/2021)
CDC Split Type:

Write-up: Injection site pain, swelling. On Saturday noticed swelling in underarm and hardening of breast tissues. Went to PCP on Monday 7/19 and was diagnosed with costochondritis and myalgia of the neck, chest and back. Patient given meloxicam and sent home.


VAERS ID: 1496338 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram abnormal, Pleuritic pain
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (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: Chronic Hep B
Allergies: none
Diagnostic Lab Data: ECG - 7/19/2021
CDC Split Type:

Write-up: Pericarditits, mild chest pain, positional, pleurtic chest pain reviewed ECG with cardiology who recommended treatment for mild pericarditis with ibuprofen tapered dosing had abnormal ECG


VAERS ID: 1497947 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Eye pain, Fatigue, Headache, Hyperhidrosis, Injection site pain, Injection site swelling, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (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: Women''s multi-vitamin daily Aldactone 7 days during each month
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, sweats, severe frontal headache, eyes hurt, runny nose, arm swelling and pain at injection site, general fatigue and tiredness which lasted the entire day of Saturday, July 17, 2021 following my July 16, 2021 second injection of the Moderna vaccine.


VAERS ID: 1497959 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-14
Onset:2021-07-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO198 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Extreme stomach cramps, diarrhea multiple times a day for 6 days so far.


VAERS ID: 1498001 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Anion gap normal, Antibody test, Anticoagulant therapy, Band neutrophil percentage increased, Basophil count decreased, Basophil percentage decreased, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood electrolytes normal, Blood glucose normal, Blood lactate dehydrogenase increased, Blood magnesium increased, Blood phosphorus normal, Blood potassium increased, Blood sodium normal, Blood urea normal, Brain natriuretic peptide normal, C-reactive protein increased, C-reactive protein normal, Carbon dioxide normal, Cardiac telemetry normal, Chest X-ray normal, Chest pain, Cytomegalovirus test, Cytomegalovirus test negative, Dyspnoea, Echocardiogram abnormal, Electrocardiogram ST segment elevation, Electrocardiogram repolarisation abnormality, Enterovirus test, Eosinophil count decreased, Eosinophil percentage decreased, Epstein-Barr virus antibody, Epstein-Barr virus test negative, Fibrin D dimer normal, Full blood count normal, Haematocrit normal, Haemoglobin normal, Headache, Herpes simplex test, Hypokinesia, Immature granulocyte count increased, Immature granulocyte percentage increased, Immunoglobulin therapy, Influenza virus test negative, Laboratory test, Lymphocyte count decreased, Lymphocyte percentage decreased, Magnetic resonance imaging heart, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Microbiology test, Monocyte count, Monocyte percentage, Mycoplasma test, Myocarditis, Neutrophil count, Parvovirus B19 test, Platelet count normal, Pyrexia, Red blood cell count normal, Red blood cell nucleated morphology, Red blood cell sedimentation rate normal, Red cell distribution width normal, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Serum ferritin normal, Stool analysis, Systolic dysfunction, Tachypnoea, Transaminases increased, Troponin T increased, Troponin increased, Urine analysis, Viral test, Wall motion score index normal, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (narrow), Conduction defects (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: h/o asthma
Allergies: Penicillin
Diagnostic Lab Data: See above
CDC Split Type:

Write-up: **Please note - we do not have access to the immunization registry and cannot provide lot numbers or exact dates** Admission Date/Time: 07/18/2021 18:23:00 Discharge Date/Time: 07/21/2021 12:53:15 Chief Complaint COVID vaccine myocarditis Patient Narrative ILLNESS SEVERITY: The patient is returning to baseline, requires assessment. PATIENT SUMMARY: Reason for Hospitalization: Chest pain Admission HPI: a 17 year old young man with a remote history of asthma (last used inhaler 5-6 years ago) who is presenting with 1 day chest pain in the setting of recent Pfizer Covid vaccination. He received his second Pfizer vaccine dose 3 days ago. The following day, he experienced low grade fever to 100.4 and mild headache. He felt fine yesterday, but this morning he woke up with dyspnea and feeling like he "couldn''t get air in all the way". He denied feeling chest pressure but endorsed mid sternal chest pain without radiation. The pain was not exacerbated by exercise and was not positional. He presented to an urgent care facility this morning, where they did an EKG that showed ST segment elevations diffusely. He was then transferred to Hospital. he was overall well appearing with slight tachypnea but otherwise normal vital signs. He initially was not endorsing chest pain. They drew a troponin that was elevated to 1515 ng/L with an upper limit of normal 54 (likely 1.5 on our scale). BNP, electrolytes, CBC were all within normal limits. Initial EKG did not have any ST segment elevation. They did a chest XR which did not show any signs of pulmonary edema or cardiomegaly. He later developed chest pain so an EKG was repeated which showed recurrence of the ST elevations diffusely; most prominently in V1-2. Repeat troponin was 2000. He was given a single dose of aspirin 81mg and transferred for further care. In the ED, he was well appearing and no longer endorsing chest pain. He was monitored on continuous telemetry with no abnormalities. His troponin here was 0.27 ng/mL, CRP was elevated to 2.6, he had a mild transaminitis of 41/37 and mildly elevated LDH to 236. Covid antibodies were positive. CBC, ferritin, d-dimer, ESR were all within normal limits, rapid Covid/flu/RSV negative. Repeat EKG was similar to the second EKG with very minimal ST-segment elevations. He denies any URI symptoms, rashes, N/V/D, and joint pain. He''s had good PO intake until today. He is an athlete (currently playing baseball) and has never experienced chest pain with exercise. Surgical hx: T&A Family history: Negative for any cardiac pathology or autoimmune disease Allergies: rash with penicillin Social: here with grandma who is legal guardian Hospital Course: admitted to the cardiology floor for continued monitoring of his troponin levels and EKG. The morning after his admission, his troponin was uptrending slightly to 0.37 and echocardiogram showed mildly depressed systolic function and longitudinal strain, so the decision was made to treat. Cardiac MRI performed prior to treatment showed good systolic function but mild LV late gadolinium enhancement and corresponding hypokinesis. He received one time IVIG 2g/kg and IV methylprednisolone 30mg BID for 2 doses. His chest pain came and went throughout his admission and was treated with ibuprofen and Tylenol as needed. He was transitioned over to PO steroids on 7/20 which he tolerated well. On day of discharge, his troponin levels were trending down. Pt was scheduled for outpatient follow up including ECHO at that time. By time of discharge, patient was well-appearing, vitals stable, demonstrating good PO intake. Chest pain was fully resolved. Prescriptions sent to preferred pharmacy. Follow up with cardiology in place. Discharge instructions and return precautions reviewed with patient and parent, who expressed good understanding and agreement with plan. Reasons for new, changed, and discontinued medications: Prednisone for myocarditis to complete 5 day steroid course (last dose morning of 7/24) Famotidine (GI protection while taking prednisone) Reasons for new, changed, and discontinued equipment: NA Relevant Diagnostic Images/Studies: Echocardiogram 7/19: ? Technically difficult examination due to suboptimal echocardiographic windows. Unable to evaluate the atrial septum, systemic and pulmonary veins, pulmonary arteries, and aortic arch. Coronary artery dilation is not excluded. ? Normal valvular function. ? Normal left ventricular size and low-normal systolic function. Reduced longitudinal strain. ? Qualitatively normal right ventricular systolic function. ? No pericardial effusion. Cardiac MRI 7/19: ? Normal left ventricular size and global systolic function. ? Basal inferoseptal, inferior, and inferolateral left ventricular late gadolinium enhancement with corresponding mild hypokinesis. ? Normal right ventricular size and global systolic function. No right ventricular late gadolinium enhancement or regional wall motion abnormalities. ? No significant valvular dysfunction. ? No coronary artery aneurysms. ? No pericardial effusion. Admission EKG 7/18: ST segment changes, non-specific. Discharge EKG: minimal ST segment changes, improved from admission. Tests Pending Adenovirus PCR QuaNT, Stool Adenovirus PCR QuaNT, Urine CMV Antibody IgG CMV Antibody IgM EBV Antibody IgG EBV Antibody IgM EBV Antibody to EA-D, IgG EBV Antibody to NA, IgG Enterovirus PCR QuaL, Stool HSV I/II Combined Antibody IgG Lyme Antibody, Total Mayo Misc Test Miscellaneous Lab Test Miscellaneous Test Arup Miscellaneous Test Arup Miscellaneous Test Arup Parvovirus B-19 IgG Parvovirus B-19 IgM Parvovirus DNA PCR QuaNT, Blood Respiratory Virus PCR Panel - sendout Viral Culture, Non Respiratory These tests will be followed by the Primary Service at Discharge after Discharge Vitals and Discharge Physical T: 37.1 ?C HR: 64 (Monitored) RR: 20 BP: 120/58 SpO2: 96% HT: 167 cm WT: 94.9 kg BMI: 34 Discharge Physical Exam Gen: Well-appearing, well-developed teenager sitting up in bed. Appropriately interactive./ HEENT: Normocephalic, atraumatic. Moist mucous membranes. EOMI, no conjunctivitis. Resp: Clear to auscultation bilaterally, no increased work of breathing. No wheezes CV: Normal rate, RR with no murmurs, rubs, or gallops. Capillary refill <2 sec. Distal pulses 2+. Abd: Soft, non-distended, non-tender. Normal bowel sounds Ext: Normal range of motion of all extremities, no peripheral edema Skin: Pink, warm, no bruising Neuro: Alert, responsive, developmentally appropriate, normal tone Diagnosis List 1. Chest pain, 07/18/2021 2. Shortness of breath, 07/18/2021 3. Myocarditis, 07/18/2021 Procedure History No Procedure History Social History Smoking Status No Smoking Status Documented Allergies penicillin Laboratory Results Returned 48 Hours Prior to Discharge Labs Last 48 Hours Event Name Event Result Date/Time WBC 7.88 K cells/uL 07/20/21 Hemoglobin 12.6 g/dL 07/20/21 Hematocrit 36.6 % Low 07/20/21 Platelet 298 K cells/uL 07/20/21 MPV 9.1 fL Low 07/20/21 RBC 4.17 M cells/uL Low 07/20/21 MCV 87.8 fL 07/20/21 MCH 30.2 pg 07/20/21 MCHC 34.4 g/dL 07/20/21 Red Cell Distribution Width CV 11.9 % 07/20/21 Nucleated Red Blood Cell % 0 /100 WBC 07/20/21 Nucleated Red Blood Cell Count 0 K cells/uL 07/20/21 Absolute Neutrophil Count 6.38 K cells/uL High 07/20/21 Absolute Lymphocyte Count 0.97 K cells/uL Low 07/20/21 Absolute Eosinophil Count 0.02 K cells/uL Low 07/20/21 Absolute Basophil Count 0.01 K cells/uL Low 07/20/21 Absolute Monocyte Count 0.45 K cells/uL 07/20/21 Absolute Immature Granulocyte Count 0.05 K cells/uL High 07/20/21 Neutrophil/Band 81 % High 07/20/21 Immature Granulocytes 0.6 % High 07/20/21 Lymphocyte 12.3 % Low 07/20/21 Monocyte 5.7 % Low 07/20/21 Eosinophil 0.3 % Low 07/20/21 Basophil 0.1 % Low 07/20/21 Sodium 137 mmol/L 07/19/21 Potassium 5.14 mmol/L High 07/19/21 Chloride 102 mmol/L 07/19/21 CO2 21 mmol/L Low 07/19/21 Anion Gap 14 mmol/L 07/19/21 Glucose Level 133 mg/dL 07/19/21 BUN 11 mg/dL 07/19/21 Creatinine 0.61 mg/dL 07/19/21 Calcium 9.3 mg/dL 07/19/21 Phosphorus 4.5 mg/dL 07/19/21 Magnesium 1.9 mg/dL 07/19/21 Troponin T 0.21 ng/mL Critical 07/21/21 Troponin T 0.22 ng/mL Critical 07/20/21 Troponin T 0.22 ng/mL Critical 07/20/21 C-Reactive Protein 0.77 mg/dL High 07/20/21 Mycoplasma pneumoniae, IgG 1.87 High 07/19/21 Mycoplasma pneumoniae, IgM 0.47 07/19/21 Microbiology Results (Last 30 Days) Micro Results: Updates since 06/21/2021 00:00. Collection date displayed. Cytomegalovirus PCR, blood, QuaNT: (Blood) 07/19/2021. Final Report: No CMV detected by PCR. This test does not detect latent CMV infections. A reference range for this test has not been established. Results should be interpreted in the context of other clinical and laboratory information. This test should not be used to diagnose latent or previous CMV infection. People with latent or previous CMV may not have detectable CMV DNA by this test. The variability of this test should be considered when interpreting results. Changes of approximately three fold in the quantity of CMV DNA detected may be due to variation in the test rather than actual changes in the level of CMV DNA in the sample. Note: This test was developed and its performance characteristics determined by the Hospital. It has not been cleared or approved by the Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. Epstein-Barr Virus PCR, QuaNT: (Blood) 07/19/2021. Final Report: No EBV detected by PCR. This test does not detect latent EBV infections. A reference range for this test has not been established. Results should be interpreted in the context of other clinical and laboratory information. This test should not be used to diagnose latent or previous EBV infection. People with latent or previous EBV infection may not have detectable EBV DNA by this test. The variability of this test should be considered when interpreting results. Changes of approximately three fold in the quantity of EBV DNA detected may be due to variation in the test rather than actual changes in the level of EBV DNA in the sample. Note: This test was developed and its performance characteristics determined by the Hospital. It has not been cleared or approved by the Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. Health Care Proxy: Under 18 years old MOLST: Under 18 years old Follow-Up and Patient Instructions Patient Instructions He was admitted for management of myocarditis thought to be due to his SARS-CoV2 vaccination. Myocarditis is inflammation of the heart muscle that can happen with many different types of infections and virusesHe received IVIG and steroids. He had multiple EKGs, echocardiograms, and a cardiac MRI which showed mild changes but overall good heart function. His chest pain and heart studies improved throughout his stay and he was safe for discharge home. He should refrain from strenuous exercise for the next couple of months and you should discuss when it is safe to return to exercise with your outpatient cardiologist. Medications: --- Prednisone 30mg twice per day for _ days (last day _) --- Famotidine 20mg twice per day for _ days (last day _) It is important to minimize activity that raises his heart rate for the next 3 months. This will be discussed in more detail at cardiology appointment. Until then, no strenuous exercise. Attending Attestation CARDIOLOGY INPATIENT ATTENDING DISCHARGE NOTE: I reviewed the history and hospital course, examined the patient on rounds, reviewed the testing, discussed the findings with the Cardiology Team, and participated directly in formulation of the assessment and plan for discharge. I have reviewed and agree with the documentation above with the following additions/revisions:17yo admitted with COVID vaccine associated myocarditis, with repolarization abnormalities on ECG, elevated troponin, and chest pain within days after receiving his 2nd dose. He remained hemodynamically stable with preserved ventricular systolic function. Echo did show abnormal strain, and MRI showed LGE with focal hypokinesis. Due to increasing troponin level, he was treated with IVIG and steroids with improvement in troponins. No significant arrhythmia. Plan for follow-up next week with MISC/vaccine myocarditis group, and to complete a 5-day course of steroids. Restricted from sports and intense activity for likely at least 3 months.


VAERS ID: 1498023 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Chronic obstructive pulmonary disease, Chronic respiratory failure, Dyspnoea, Left ventricular failure, Polyuria, Pulmonary oedema, Troponin normal
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Hypokalaemia (broad)

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

Write-up: Presented to ED with history of chronic respiratory failure with COPD and CHF- presented with shortness of breath, he was found to have no rhonchi or wheezing but he was found to have pulmonary edema from left ventricular heart failure. Patient admitted. He was diuresing watching his kidney function and urine output, his oxygen requirement has come to his baseline-that is treated per minute. He has no chest pain or shortness of breath, no reason to suspect PE. Troponin negative. Patient stable for discharge.


VAERS ID: 1498252 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-02
Onset:2021-07-17
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: actos, rosuvastatin, synthroid, lisinopril, vitamin d3, aspirin 81mg
Current Illness: none
Preexisting Conditions: htn, hyperlipidemia, dm type 2
Allergies: penicillin
Diagnostic Lab Data: ultrasound left leg 7-20-2021 showed extensive DVT
CDC Split Type:

Write-up: developed extensive blood clotting left leg within 3 weeks after JJ vaccine. no underlying known malignancy or coagulopathy or prolonged travel. placed on eliquis and will be following with vascular


VAERS ID: 1498260 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Muscular weakness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: TOPROL XL 50MG TWICE DAILY LISINOPRIL 10MG TWICE DAILY SYNTHROID 112MCG DAILY FLEXERIL 10MG EVERY 8 HOURS AS NEEDED NORCO 7.5/325MG EVERY 6 TO 8 HOURS AS NEEDED XANAX 1MG TWICE DAILY AS NEEDED PROAIR INHALER AS NEEDED NEURONTIN 300MG 1 E
Current Illness: NONE
Preexisting Conditions: HIGH BLOOD PRESSURE ANXIETY COPD CHRONIC PAIN ARTHRITIS HYPOTHYROID
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: SEVERE MUSCLE PAIN AND WEAKNESS IN QUADS AND GASTROC MUSCLES. STARTED SAME DAY AS PATIENT RECEIVED VACCINE AND LASTED FOR ALMOST 1 WEEK. PAIN AND WEAKNESS DECREASED EACH DAY UNTIL RESOLVED.


VAERS ID: 1498336 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-25
Onset:2021-07-17
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

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

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

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


VAERS ID: 1498399 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Influenza, SARS-CoV-2 test, Streptococcus test negative
SMQs:, 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: Gabapentin and daily multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa drugs
Diagnostic Lab Data: On July 18 had negative strep and COVID-19 test
CDC Split Type:

Write-up: Flu symptoms


VAERS ID: 1499087 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Fatigue, Headache, Injection site pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine Bupropion XL Lorazepam Adrenal Complex Vitamin Supplement by Standard Process Dupixent Dupilumab
Current Illness: None
Preexisting Conditions: Eczema Mental Health - Anxiety, Depression, Bipolar
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Day 1, Fri: ~6hrs post injection: tired Day 2, Sat: strong pain at injection site and whole arm soreness; tired; headache; chest pain/shortness of breath Day 3, Sun: tired; headache; shortness of breathe. Day 4-7: tired and headache


VAERS ID: 1500566 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-17
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Eye swelling, Pruritus, Swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma (Can not see well)
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210743241

Write-up: RIGHT EYE STARTED TO BE SWELLING; FACE STARTED TO BE A LITTLE SWELLING/SEMI-FALLEN FACE; WHOLE BODY STARTED TO BE SWELLING; ITCHY FROM SCALP TO TOES; SEVER STOMACH PAIN; This spontaneous report received from a consumer concerned a 72 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included asthma. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported ,batch number: 207A21A expiry: UNKNOWN) dose was not reported, administered on 17-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-JUL-2021, the subject experienced sever stomach pain. On 20-JUL-2021, the subject experienced right eye started to be swelling. On 20-JUL-2021, the subject experienced face started to be a little swelling/semi-fallen face. On 20-JUL-2021, the subject experienced whole body started to be swelling. On 20-JUL-2021, the subject experienced itchy from scalp to toes. Treatment medications (dates unspecified) included: diphenhydramine hydrochloride, and famotidine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from sever stomach pain, and itchy from scalp to toes, and was recovering from right eye started to be swelling, face started to be a little swelling/semi-fallen face, and whole body started to be swelling. This report was non-serious.; Sender''s Comments: V0: Medical assessment comments not required as per the standard procedure as the case is assessed as non-serious.


VAERS ID: 1500577 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-07-17
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac stress test, Chills, Coeliac disease, Cold sweat, Gait disturbance, Hot flush, Hyperhidrosis, Hypertension, Malaise, Paraesthesia, Tongue disorder
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Ex-alcohol user (Stopped drinking); Nonsmoker
Preexisting Conditions: Comments: The patient had no known drug allergies and had no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Date: 20210719; Test Name: Stress test; Result Unstructured Data: Not reported
CDC Split Type: USJNJFOC20210745177

Write-up: CELIAC DISEASE; COLD SWEATS; TROUBLE WALKING DOWN STEPS; TINGLING TIP OF LEFT HAND; HOT FLASHES; TIP OF TONGUE SWEAT; FEET SWEATING; SHIVERS; OVERALL BODY NOT FEELING WELL; SUDDEN HIGH BLOOD PRESSURE; This spontaneous report received from a patient concerned a 50 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included alcohol use (stopped drinking), and nonsmoker, and other pre-existing medical conditions included the patient had no known drug allergies and had no drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A expiry: UNKNOWN) dose was not reported, 1 total administered on 21-JUN-2021 to left arm for prophylactic vaccination. No concomitant medications were reported. On 17-JUL-2021, the patient experienced cold sweats, trouble walking down steps, tingling tip of left hand, hot flashes, tip of tongue sweat, feet sweating, shivers, overall body not feeling well and sudden high blood pressure. On 19-JUL-2021 the patient was concerned about sudden high blood pressure and was admitted to the emergency room, the patient undergone stress test and was given lorazepam and was diagnosed with celiac disease. The patient was hospitalized for 1 day and was discharged on 20-JUL-2021. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from cold sweats, shivers, trouble walking down steps, tingling tip of left hand, hot flashes, tip of tongue sweat, feet sweating, overall body not feeling well, and sudden high blood pressure, and the outcome of celiac disease was not reported. This report was serious (Hospitalization Caused / Prolonged, and Other Medically Important Condition).; Sender''s Comments: V0: 20210745177-COVID-19 VACCINE AD26.COV2.S-sudden high blood pressure, celiac disease, cold sweats, trouble walking down steps, tingling tip of left hand, hot flashes, tip of tongue sweat, feet sweating. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210745177-COVID-19 VACCINE AD26.COV2.S-shivers, overall body not feeling well. This event(s) is labeled per RSI and is therefore considered potentially related.


VAERS ID: 1500745 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2020-12-28
Onset:2021-07-17
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Adverse event, Appendicectomy, Appendicitis, Complicated appendicitis, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Laparoscopic surgery, Scan with contrast abnormal, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: * Myrbetriq 25mg, once daily * Lamotrigine (Lamictal) 200mg, once daily * Adderall 20mg, twice daily * Zolpidem ER (Ambien ER) 12.5mg, once daily * Lorazepam (Ativan) 1mg, once daily * Aspirin 81 mg, once daily * Rosuvastatin (Crestor) 10 m
Current Illness: None
Preexisting Conditions: * Bi-Polar * Generalized anxiety disorder * Adult ADHD * Hyperlipidemia * Heterozygous MTHFR mutation A1298C * Heterozygous MTHFR mutation C677T * PAI-1 4G/4G genotype * High grade squamous intraepithelial cervical dysplasia * Insomnia
Allergies: None
Diagnostic Lab Data: Medical Test: CT Abdomen and Pelvis With Contrast performed 07/17/21 Result: Acute uncomplicated appendicitis Laboratory Test: WBC performed 07/17/21 Result : 18.0 x10E3/uL
CDC Split Type:

Write-up: Adverse Event: Appendicitis Treatment: Appendectomy Outcome: Symptoms devolved 07/16/21. Presented to ER on 07/17/21, CT confirmed acutely inflammed non-perforated appendicitis. Laparoscopic appendectomy performed 07/17/21. Hospital discharge 07/18/21.


VAERS ID: 1500820 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-11
Onset:2021-07-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6786 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Ear pain, Facial paralysis, Headache, Laryngeal pain, Neck pain, Pain in extremity, Rhinalgia
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Centrum, aspirin Pamprin multi-symptom
Current Illness: Hashimoto''s thyroiditis
Preexisting Conditions: Chronic tonsillitis
Allergies: No
Diagnostic Lab Data: No study or test has been done yet.
CDC Split Type:

Write-up: A day later after the vaccine, pain started with the arm, neck and right shoulder. After three days after the vaccine severe pain in the ear, nostril, larynx and neck left side, including severe headache for the next 5 days. As the pain decreases, a notable type II degree II facial paralysis is generated on the left side. Two days after performing muscular facial and muscular exercises, a decrease begins to be noticed. To date the affected person also has pain in the neck, shoulder and arm


VAERS ID: 1500843 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-02
Onset:2021-07-17
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis
SMQs:

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

Write-up: Cellulitis in the abdomen. Treatment with two antibiotics. No other factors to contribute to cellulitis. In the middle of treatment currently.


VAERS ID: 1500844 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026DZIA / 2 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Oral herpes, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diovan HCT
Current Illness: Upper respiratory infection (not Covid)
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe body and joint pain, fever (103.1), chills. Fever broke in 24 hours however I developed multiple large fever blisters on my lower lip (2), upper lip (4), corner (right side), and the entire roof of my mouth.


VAERS ID: 1500895 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, 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: Alavert allergy medicine
Current Illness: None
Preexisting Conditions: None
Allergies: Zithromax
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, high fever, headache


VAERS ID: 1501020 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site pruritus, Injection site urticaria, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl and ibuprofen.
Current Illness: No
Preexisting Conditions: Polycystic kidneys, heart murmur, scoliosis.
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, vomiting, fever, sore muscles (7/17-7/21) Hives on injection site with burning and itching feeling (7/24)


VAERS ID: 1501073 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nexplaon
Current Illness:
Preexisting Conditions: Obesity
Allergies:
Diagnostic Lab Data: I just went to an emergency department down at the city. The doctor prescribed me medication and asked me to report this because he believe it was a reaction to the vaccine.
CDC Split Type:

Write-up: I had a rash come up bilaterally in my arms, legs, hands, and feet. I am currently taking Benadryl every 6 hours, Zyrtec, prednisone, and hydrocortisone cream . Twice a day. I?ve been in this medication for three days. It?s getting better but not fully there.


VAERS ID: 1501406 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Nausea, Palpitations, Vomiting
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: Heart racing followed by sporadic chest pain, nauseau and vomiting


VAERS ID: 1501850 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, 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: None
CDC Split Type:

Write-up: COVID -19 vaccine given to 11 yr old patient. No adverse symptoms known to date.


VAERS ID: 1501881 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-05
Onset:2021-07-17
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 RNA
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Based on report attached on patient file, exposed to wife who is COVID-19 positive. Outpatient visit on 7/22/21 presenting with runny nose and sore throat that started 7/17/21. SARS-CoV-2 (COVID-19) RNA [Presence] in Nasopharynx with non-probe detection~SARS-CoV-2 (COVID-19) RNA [Presence] in Nasopharynx with non-probe detection performed on 7/22/21. Came back positive. Case investigation interview with patient has not been conducted as of the time of this note.


VAERS ID: 1501882 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Headache
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

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

Write-up: Headache, elevated blood pressure since vaccone, dizzy feeling since


VAERS ID: 1501921 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-07
Onset:2021-07-17
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Fatigue, Headache, Nasal congestion, Oropharyngeal pain, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Cough,runny nose,loss of smell,sore throat,nasal congestion,headache,fatigue,loss of taste


VAERS ID: 1502165 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amitriptyline 25mg, levocetirizine 5mg, clonazepam 0.5mg, meloxicam 15mg, acetaminophen 500mg
Current Illness:
Preexisting Conditions: multiple back surgeries
Allergies: gabapentin, allegra, nsaids
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states she has bumpy rash on arms, legs, stomach, and back. She states it is not itchy


VAERS ID: 1502214 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neck pain, Pain, Pain in extremity, Sleep disorder
SMQs:, Arthritis (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: Gabapentin 100mg, Medrol dose pak, Clonazepam 1mg, sertraline 100mg, dexamethasone 6mg,.
Current Illness:
Preexisting Conditions: Meralgia paresthetica
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports having shooting arm pain up her left arm and neck the day after her vaccination. Difficulty sleeping and pain in her arm.


VAERS ID: 1502307 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Muscle spasms
SMQs:, Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine every year of my childhood. I would get very sick for 5-7 days after vaccine. I was too sick to attend school.
Other Medications:
Current Illness:
Preexisting Conditions: Well managed endometrosis
Allergies: Sea food Tramadol
Diagnostic Lab Data:
CDC Split Type:

Write-up: I started cramping pretty bad after the 1st shot. I do have endometriosis which is well managed & I haven''t had issues with cramps for a while. I thought it would go away but I''m still having them & its been a week and 2 days. I was not on my cycle at the time of vaccination and it was not near time for it either.


VAERS ID: 1502308 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-13
Onset:2021-07-17
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None listed
Allergies: NKA
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: Pt reported exposure to Covid + person, reported symptoms starting 7/17/2021, unknown what symptoms experienced.


VAERS ID: 1502463 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Blood glucose increased, Decreased appetite, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Digoxin 125mcg 1 daily, Coreg 25mg 2x day, Demadex 20 meq daily, losartan potassium 100mg daily, Amlodipine 5mg daily, Metformin 100 mg daily
Current Illness:
Preexisting Conditions: Diabetes, COPD, CHF, Heart disese
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: My entire face was swollen. I lost my appetite for 3 days. My blood sugar is still elevated by 400 points and I didn''t eat anything but water. I had pain in my lower back up until yesterday. I''m petrified of taking the final dose next week. I went to the e r and het gave me Benadryl and prednisone. What''s happening with my blood sugar?


VAERS ID: 1502483 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 1 LA / IM

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

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

Write-up: Patient started to develop full body rash and itching the day after the shot. She took Benadryl over the counter until it was not keeping her symptoms under control. On 07/21/2021, she went to her doctor and was given steroids to control her allergic reaction. Dr. told her to not receive the second dose.


VAERS ID: 1502533 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Myalgia, Nausea, Pain in extremity, Pyrexia, Respiratory tract congestion, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Desvenlafaxine ER 50mg once per day Bupropion XL 150mg once per day
Current Illness: None
Preexisting Conditions: Carpal tunnel syndrome Anxiety Depression
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in left arm for several days beginning7/17 Tiredness and muscle ache since 7/18 Fever and chills on 7/21 & 7/22 Nausea on and off since 7/18 Congestion and severe cough since 7/22 Severe neusea and vomiting 7/25 at night


VAERS ID: 1502941 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / N/A RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiomyopathy, Electrocardiogram, Magnetic resonance imaging, Ventricular arrhythmia
SMQs:, Torsade de pointes/QT prolongation (broad), Ventricular tachyarrhythmias (narrow), Cardiomyopathy (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Celexa, Methadone
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI 07-20-2021 EKG 07-/17-18-19-20-21-22/-2021
CDC Split Type:

Write-up: Ventricular arrhythmia nonischemic cardiomyopathy


VAERS ID: 1503508 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone increased, Periorbital swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypothyroidism (broad), Hyperthyroidism (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Exercise induced Asthma,
Allergies: None
Diagnostic Lab Data: TSH 100
CDC Split Type:

Write-up: after a week or so i started feeling puffy eyes and face and was concerned about it. i went to the doctor and upon consulting he asked me to get the TSH test done. when the report came back the TSH levels were through the roof. my TSH score came back above 100 while i never had any problems with the Thyroid before. no family history either.


VAERS ID: 1504878 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-07-17
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210752724

Write-up: COUGH; CONGESTION; CHILLS; NAUSEA; HEADACHE; FEVER; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A expiry: UNKNOWN) dose was not reported, administered on 16-JUL-2021 13:07 for prophylactic vaccination. No concomitant medications were reported. On 17-JUL-2021, the subject experienced chills. On 17-JUL-2021, the subject experienced nausea. On 17-JUL-2021, the subject experienced headache. On 17-JUL-2021, the subject experienced fever. On 21-JUL-2021, the subject experienced cough. On 21-JUL-2021, the subject experienced congestion. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from chills, nausea, headache, and fever, and had not recovered from cough, and congestion. This report was non-serious.


VAERS ID: 1505508 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK LA / IM

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

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

Write-up: Approximately 2min after injection patient slumped down in chair and fainted. She came too briefly then fainted again with snoring resperations. I immediately placed her on the floor and opened airway. I got more help and elevated her feet. Patient came too. Her face was flushed but no other rash on body. No signs of difficulty breathing or cramping. Vitals were b/p of 92/60 with pulse of 88. I placed an ice pack behind her neck and gave her something to drink I monitored her for about an hour. She was able to sit in a seat with no dizziness or difficulty and b/p came up to 96/72. Patient ended up walking out with dad feeling better.


VAERS ID: 1505703 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-12
Onset:2021-07-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest discomfort, Muscle spasms, Musculoskeletal pain, Pain, Pain in extremity, Sensory disturbance, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mercaptopurine 25 mg daily; Turmeric 2000mg daily; Hyaluronuc acid 1800 mg daily Flint stones vitamin with iron one daily; N-Acetyl Glucosamine 500 mg -2 daily; Co Q10 - 400 mg daily; Vitamin D3 2000 IU daily; Magnesium Glycinate 200mg dai
Current Illness: N/A
Preexisting Conditions: Rheumatoid arthritis; ALopecia universalis; Crohn?s disease; Asthma; Had symptoms of GB. approx 20 years ago
Allergies: Sulfa; Iodine; Latex; Tetracycline; Erythromycin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Had only a very sore arm until on Saturday 7/17/21 woke up with severe pain, cramping, tightness, fizzing sensation in the calves of both legs. This sensation then spread to the backs of my thighs and buttocks on Sunday. 7/18. This burning, fizzing, tight pain has since spread to soles of my feet and I often have hip joint pain too. I have experienced this pain intermittently throughout the day and am awoken every night at 2or 3am with this pain in the calves, backs of my thighs, buttocks and joint pain in my hips.


VAERS ID: 1505855 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-11
Onset:2021-07-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Blood test normal, Chest X-ray normal, Chest pain, Computerised tomogram head normal, Disorientation, Drug screen negative, Electrocardiogram normal, Electroencephalogram normal, Endotracheal intubation, Infection, Intensive care, Lumbar puncture normal, Magnetic resonance imaging normal, Pyrexia, Seizure, Sepsis, Tremor, Urine analysis normal
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (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: omega-3 fish oil multivitamins
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: This are the test they did. Full blood work, urinalysis, drug screen, XR chest, CT SCAN of the head, EKG, MRI , spinal tab, EEG
CDC Split Type:

Write-up: During the week he complianed about chest pain, but we didn''t pay any attention. On Saturday morning he was ok, went out and when he cema back he laid down. In the afternoon i woke him up and he had a fever of 102.2, blood pressure 157/96, he was shaking and desoriented. I called 911, in the ER he continue like tat. The doctor did some labs and came out negative, everything they did came out negative, he has seazures the next day and was sent to ICU. He was intubated for 4 days. The doctors said that it was a brain infection but all the test results are negative. The doctors at first thought that it was either menigitis or encephalitis, all the test were negative . His final diagnosis was Sepsis, unspecified organism. He still recovering and does not have any recolection of what happened to him.


VAERS ID: 1507893 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-07-17
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210717; Test Name: COVID-19 Test; Result Unstructured Data: Test Result:Positive
CDC Split Type: USPFIZER INC202100922589

Write-up: positive COVID 19 test; Fully vaccinated and confirmed positive COVID 19 test and symptomatic; This is a spontaneous report from a contactable consumer (patient). A 40-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Batch/Lot number was not reported), dose 2 via an unspecified route of administration on an unspecified date as DOSE 2, SINGLE, and also received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Batch/Lot number was not reported), dose 1 via an unspecified route of administration on an unspecified date as DOSE 1, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. On 14Jul2021 fully vaccinated and confirmed positive COVID 19 test and symptomatic (medically significant). On 17Jul2021 Confirmed positive test result on Saturday. On 14Jul2021 started showing symptoms as sinus infection, headache, cough, fatigue. Further reported as event did not take place after use of the product. The outcome of events was unknown. Information about lot/batch number is requested.


VAERS ID: 1509238 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1509240 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0176 / 1 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1509246 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1509249 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       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:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1509252 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1509259 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1509264 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       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:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1509475 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1509519 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Headache, Hypoaesthesia oral, Mobility decreased, Nausea, Paraesthesia oral, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D Vitamin B
Current Illness: None
Preexisting Conditions: Herniated Disc Asthma
Allergies: Pain Meds Rizatriptan
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Constant fever, constant diarrhea, mild headaches, unable to get out of bed, nausea, numbness and tingling around mouth


VAERS ID: 1509898 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Pharmacy       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:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1509924 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       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:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1509940 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-02-13
Onset:2021-07-17
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Catheterisation cardiac, Dyspepsia, Gastrooesophageal reflux disease, Myocardial infarction, Troponin increased, Viral sinusitis, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific dysfunction (narrow), 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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamins, Tylenol, Amovig
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I''m test showing elevated troponin levels, cardiac catherization and blood pressure monitoring
CDC Split Type:

Write-up: Started having indigestion/acid reflux. Was vomiting on occasion. Started to investigate if I had a gall bladder issue but before that could be done I had a heart attack. No blockages or blood clots. Have not gotten an explanation yet but I was in great health before a shoulder surgery in December. EKG done before surgery was good. I had some viral sinus issue that Dr gave me Prednisone for just before the heart attack so any heart inflammation would have been masked by medication.


VAERS ID: 1510008 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-23
Onset:2021-07-17
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cough, Fatigue, Muscle strain, Musculoskeletal chest pain, Oropharyngeal pain, Respiratory tract congestion, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo shot for Birth control; Levothyroxine Thyroid Medication; Trazadone
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: Tuesday - the 20th, COVID test - negative
CDC Split Type: vsafe

Write-up: I woke up that Saturday - sore throat, cough, congestion a lot of fatigue - lasted four days. That following Thursday I saw DR. (who is a PA in my office) - pain in my ribs when I coughed - he thought it might be a pulled muscle and he gave me muscle relaxers. I took over the counter Day quill and nigh quill and Mucinex. By last weekend, I woke up and felt much better.


VAERS ID: 1510221 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-17
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Fever, no treatment


VAERS ID: 1512189 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Decreased appetite, Dyspnoea, Fatigue, Pain, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, Norco, GNC Mega Man Energy and Metabolism Vitamin, Adderall, Klonopin, Soma
Current Illness:
Preexisting Conditions: Chronic pain, Anxiety disorder, Tinnitus
Allergies: Cipro, Levaquin, Tramadol, Buprenorphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: I?ve been disabled for more than a year due to what I reported on the previous page. However, after getting the vaccine, I?ve had fatigue, occasional shortness of breath, increased pain & anxiety, no appetite and issues with sleep. Since I don?t know if the vaccine has caused this I?m going to check with my psychiatrist (since I haven?t seen a doctor I?ll Mark none of the above below) but since it?s not improving, thought I should report it as well in case other people have had similar issues.


VAERS ID: 1512400 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling abnormal, Headache, Oropharyngeal pain, Rash erythematous, Skin irritation
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 50mg 1x daily
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache and fatigue 24 hours later. Continued extreme fatigue/brain fog through present (13 days later). Red ?rash like? irritated skin on face and neck which is exacerbated by touching/rubbing, this appeared suddenly at day 10 and is still present. Sore throat, chills starting day 11 thru present.


VAERS ID: 1512860 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-07-17
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Cerebrovascular accident
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Tumour lysis syndrome (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? 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: I63.9 - Cryptogenic stroke (CMS/HCC) I63.9 - Cerebrovascular accident (CVA), unspecified mechanism (CMS/HCC) N17.9 - Acute kidney failure, unspecified


VAERS ID: 1512883 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-11
Onset:2021-07-17
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood cholesterol increased, Blood creatinine normal, C-reactive protein increased, COVID-19, Cardiac telemetry normal, Chest X-ray normal, Fibrin D dimer increased, Full blood count abnormal, Hypertension, Infection, Metabolic function test, Procalcitonin, Red blood cell sedimentation rate increased, Respiratory failure, SARS-CoV-2 test positive, Serum ferritin increased, White blood cell count decreased
SMQs:, Anaphylactic reaction (broad), Dyslipidaemia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow), Lipodystrophy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol 108 (90 Base) MCG/ACT Inhalation Aerosol Solution Inhale 2 puffs every 6 hours as needed for wheezing. benzonatate (TESSALON) 200 MG Oral Capsule Take 1 capsule by mouth 3 times daily. 7/12/21 cetirizine (ZyrTEC) 10 MG Oral
Current Illness: Copied from ED note on 7/17/21: Patient reports that his first started having symptoms about a week ago after returning from vacation. He reports that time he was having a headache, congestion, cough and some generalized fatigue. He came to the emergency department and was evaluated and discharged with prescriptions for albuterol, Tessalon, ibuprofen, Robaxin and Mucinex. It does not appear that he had any labs or imaging done during done visit. He reports the symptoms he went to an office visit on 07/15 at which time he endorsed ongoing headache, cough, fatigue, shortness of breath and fevers. He was prescribed a Medrol Dosepak and Levaquin and sent for some x-rays and labs including COVID testing. He tested positive for COVID on 7/15. Chest x-ray at the time did not show any acute process. CBC and BMP were fairly unremarkable with the exception of a white count of 3.12. Patient reports that he has continued to feel poorly at home since that office visit and has not been able to take the prescribed medications as they would make him nauseous and he would throw up. He called EMS today after his home pulse ox was showing his saturation was low.
Preexisting Conditions: ? Arthritis ? Diverticulosis ? Epicondylitis syndrome of elbow ? GERD (gastroesophageal reflux disease) ? Hematochezia ? Hyperlipidemia ? Hypertension ? Low back pain ? NAFLD (nonalcoholic fatty liver disease) ? Nephrolithiasis ? Plantar fasciitis of right foot ? PONV (postoperative nausea and vomiting) ? Rotator cuff tendonitis ? Tinea barbae ? BMI 34
Allergies: Codeine (itching)
Diagnostic Lab Data: SARS-COV-2, NAA, Detected 7/15/21 (at urgent care)
CDC Split Type:

Write-up: Patient hospitalized from 7/17- 7/21/21 due to breakthrough infection. Patient fully vaccinated with Pfizer: received dose #1 on 12/21 /20 and dose #2 on 1/11/21. The following is copied from the discharge summary: Hospital Course: a 56 y.o. male with PMHx of HTN who is being admitted for evaluation of COVID. Patient reports that his first started having symptoms about a week ago after returning from vacation. He is vaccinated with pfizer, 2nd dose completed back in 1/2021. COVID 19 infection/ Acute Hypoxemic Respiratory failure - Continue Dexamethasone 6 mg Po daily to complete 5 more days - Completed Remdesivir 5 days - Supplemental oxygen for target saturaion $g90% - CRP 6.7, ESR 30, Ferritin 817, D-dimer 494, procalcitonin 0.18 - Telemetry, no arythmias - PRN albuterol as needed - Ambulation oxygenation test done, originally qualified for oxygen but today repeat doing ok at room air. - Cm consulted for home oxygen, awaiting delivery for discharge Elevated Cr - resolved - Cr 0.89 HTN: stable - Continue home lisinopril HLD - Atorvastatin Vitals and labs personally reviewed. Dispo: Discharge Home today with above.


VAERS ID: 1512989 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose increased, Blood test abnormal, Diarrhoea, Dyspnoea, Fatigue, Hyperglycaemia, Hypoxia, Nausea, Pollakiuria, Thirst, Type 2 diabetes mellitus, Vision blurred, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None known of at time of vaccination
Allergies: None
Diagnostic Lab Data: Blood work done and results showed Type 2 Diabetes.
CDC Split Type:

Write-up: Employee had shortness of breath, diarrhea, vomiting, fatigue and hypoxia and was taken by ambulance on 7/17/21 where he was given IV fluids and sent home. He returned to Emergency Room on 7/22/21 due to excessive thirst, frequent urination, blurred vision, and nausea. Employee was hyperglycemic with a blood sugar of 600. IV fluids given.


VAERS ID: 1515246 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dizziness, Dyspnoea, Echocardiogram, Electrocardiogram, Electrocardiogram ambulatory, Headache
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data: 28 July: Pediatrician visit 29 July: Echocardiogram and EKG, Holt monitor
CDC Split Type:

Write-up: Chest pain and tightness, shortness of breath, headache, dizziness


VAERS ID: 1515418 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-10
Onset:2021-07-17
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute sinusitis, Oropharyngeal pain, Pharyngitis, Rhinorrhoea, Throat irritation
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: 7/17 Acute maxillary sinusitis (5 days), runny nose, watery eyes 7/20 Acute pharyngitis (1 day), throat pain, white spots at the back of my throat Both these events were possibly a result of an RSV infection


VAERS ID: 1515433 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-07-17
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, Dyspnoea, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, aspirin, atorvastatin, bacitracin topical, busp
Current Illness:
Preexisting Conditions: multiple sclerosis, asthma, hypothyroid, chronic psych conditions
Allergies: nubain, tussionex
Diagnostic Lab Data: SARS CoV 2 PCR COVID19 positive on 7/20/2021
CDC Split Type:

Write-up: 7/20/2021: Patient presents with progressive shortness of breath, associated hypoxemia necessitation oxygen supplements. Patient previously received the Pfizer COVID-19 vaccine on 1/19/2021 and 2/10/2021. Patient tested positive for COVID-19 3 days ago and again on admission. 7/21/21: patient discharged back to assisted living facility. Chest X-ray does not identify any significant infiltrates.


VAERS ID: 1517962 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW-196 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Confusional state, Disturbance in attention, Dizziness, Fatigue, Hypoaesthesia, Loss of consciousness, Peripheral coldness, Vertigo
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100908580

Write-up: extremely tired; cant focus; cant work due to slow response time and confusion; arm went numb and cold; arm went numb and cold; Chest pains; blacked out 15 minutes after shot; Dizzy; vertigo; This is a spontaneous report from a contactable consumer (patient). A 50-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number was EW-196 and expiration date was not reported), via an unspecified route of administration, administered in Left Arm on 17Jul2021 at 14:30(at the age of 50-years-old) at dose 1, single for COVID-19 immunization. Medical history included diabetes. The patient''s concomitant medications were not reported. The patient did not receive any other vaccine in four weeks and did not have any other medications in two weeks. Patient had no allergies to medications, food or other products; was not diagnosed with COVID-19 prior vaccination and since the vaccination, patient had not tested for covid-19. The patient experienced dizzy, vertigo and blacked out 15 minutes after shot on 17Jul2021at 14:45. Two days later the vaccination(19Jul2021), patient''s arm went numb and cold and this would come and go, had the chest pains where the heart was. 3 days after shot patient felt extremely tired, cant focus, cant work due to slow response time and confusion. This has been ongoing since day 3 and now on day 7 (at the time of report). The patient had most recent COVID-19 vaccine at Pharmacy or Drug Store. Patient was given Ibuprofen to resolve the chest pains and unspecified treatment was given for the events. The outcome of the events (tired, cant focus, cant work due to slow response time and confusion) was not recovered where as outcome of ret of the events was unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1517963 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Condition aggravated, Fibromyalgia, Hyperhidrosis, Meniere's disease, Migraine, Nausea, Sleep disorder
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy (known allergies Yes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100909450

Write-up: meuniere in my right ear; Migraine; fibromyalgia flare ups; sweating; restless sleep; severe back aches; nausea; All my conditions are exasperated; This is a spontaneous report from a contactable consumer, the patient. A 65-years-old female non-pregnant patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Solution for injection, Lot Number: UNKNOWN), via an unspecified route of administration in the left arm on 16Jul2021 at 11:30 (at the age of 65-years-old) as a dose number unknown, single for COVID-19 immunization. Medical history included allergies. Concomitant medication(s) included levothyroxine sodium (SYNTHROID). The patient did not receive any other vaccines within 4 weeks prior to the COVID-19 vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient experienced meuniere in her right ear, migraine, fibromyalgia flare ups, sweating, restless sleep, severe back aches, nausea and all her conditions were exasperated on 17Jul2021. The patient did not receive any treatment. The clinical outcome for the events was not recovered. Information on the lot/batch number has been requested.


VAERS ID: 1518006 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-07-17
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210718; Test Name: COVID-19 test; Test Result: Positive
CDC Split Type: USPFIZER INC202100917837

Write-up: Breakthrough Covid-19 diagnosis.; Breakthrough Covid-19 diagnosis.; This is a spontaneous report from a contactable consumer or other non hcp. A 40-year-old non-pregnant female patient received bnt162b2 (BNT162B2, Batch/Lot number was not reported) via an unspecified route of administration on Mar2021 (at the age of 40-years) as dose number unknown, single for covid-19 immunisation. She was no pregnant. The patient medical history was not reported. The patient''s concomitant medications were not reported. No covid prior vaccination, no covid tested post vaccination. On 17Jul2021, the patient experienced breakthrough covid-19 diagnosis. She had taken doctor or other healthcare professional office/clinic visit. The patient underwent lab tests and procedures which included Covid test: positive on 18Jul2021. Treatment for event was Unknown. The outcome of the event breakthrough covid-19 diagnosis was recovering.


VAERS ID: 1518391 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Dizziness, Ear pain, Headache, Lethargy, Nausea, Oropharyngeal pain, Paraesthesia oral, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rainbow, women''s daily vitamin, fish oil, stork menopause herbal supplements
Current Illness: none
Preexisting Conditions: none
Allergies: Cephlesporines in high doses
Diagnostic Lab Data: None. sleeping and drinking fluids in hopes symptoms will subside.
CDC Split Type:

Write-up: Nausea, diarrhea,stomach ache, head ache, lethargic, sore throat, tingling mouth, ear ache, dizzy, trouble focusing,


VAERS ID: 1518407 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-07-17
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Diplopia, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Ocular motility disorders (broad), Hypoglycaemia (broad)

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

Write-up: dizziness , double vision


VAERS ID: 1518535 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-14
Onset:2021-07-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Facial paresis, Oral herpes
SMQs:, Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: On July 17, 2021 he developed a small fever blister on right side of upper lip. On July 19 noted to have weakness on Right side of mouth then on July 20,2021 he was diagnosed with Bell?s palsy at pcp office


VAERS ID: 1518658 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonazepam, Buspirone, Hydroxyzine, amlodipine,.
Current Illness:
Preexisting Conditions:
Allergies: Bactrim, Levofloxacin, penincillins.
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient reported intense dizziness as well as some shortness of breath several hours after receiving their first dose of the Pfizer vaccine. According to the patient, these symptoms lasted for 24 hours approximately.


VAERS ID: 1518672 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient has had a dull pain in the arm since the vaccine administration. Starting on 7/27 the pain increased. When the injection site is pressed there is shooting, jabbing pain. Patient says that it feels like it is nerve related, pain at the back of his arm, through his elbow, and into his forearm. Certain positions cause more pain.


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