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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 349 out of 6,867

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VAERS ID: 1483803 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Blood sodium decreased, Blood thyroid stimulating hormone, Chest pain, Chills, Dizziness, Echocardiogram normal, Ejection fraction normal, Electrocardiogram T wave abnormal, Feeling hot, Fibrin D dimer, Full blood count, Myalgia, Neutrophil percentage increased, Pain, Pain in jaw, Troponin I increased
SMQs:, Rhabdomyolysis/myopathy (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (broad), Vestibular disorders (broad), Osteonecrosis (broad), Chronic kidney disease (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fluoxetine HCL 10mg Ventolin Inhaler 90mcg Melatonin PRN
Current Illness: NONE
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: She had a mildly elevated troponin level of 0.11 (normal high 0.08) and her electrocardiogram demonstrated non-specific T-wave abnormalities. Na 132,CBC 6000,82% neuts,TSH 3. 66 D dimer normal 0.46 7/16/2021 20:35 CDT Troponin I 0.11 ng/mL (H) (Ref. Range 0.00 - 0.08) 7/17/2021 7:34 CDT Troponin I 0.18 ng/mL (H) (Ref. Range 0.00 - 0.08) 7/17/2021 11:38 CDT Troponin I 0.12 ng/mL (H) (Ref. Range 0.00 - 0.08) 7/17/2021 16:25 CDT Troponin I 4.18 ng/mL (H) (Ref. Range 0.00 - 0.08) 7/17/2021 17:24 CDT Troponin I 3.73 ng/mL (H) (Ref. Range 0.00 - 0.08) 7/18/2021 1:39 CDT Troponin I 5.48 ng/mL (H) (Ref. Range 0.00 - 0.08) ECHONormal intracardiac anatomy. 2. Normal chamber sizes, wall thickness, septal position, and systolic function. 3. Biplane LV ejection fraction 65%. 4. Estimated RV systolic pressure 21 mmHg plus CVP (BP 110/61). 5. Normal systemic venous connections, coronary artery origins, and left aortic arch with normal branching. 6. No pericardial effusion. 7. Normal study CARDIAC MRI scheduled for 7/19/2021 Repeat ECHO 7/18 10 am Normal
CDC Split Type:

Write-up: 12 hrs after vaccine administration reported chest pain upper retrosternal area with radiation to jaw .back with dizziness,feeling warm with chills and muscle aches and joint pains for next 36 hrs Admitted to Hospital 7/16/21 Symptoms resolved 7/18/21 at 10 am


VAERS ID: 1483816 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-29
Onset:2021-07-16
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Intermenstrual bleeding, Menstrual disorder, Vitamin D decreased
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plexus probiotics
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Had recently had some standard bloodwork done and everything came back normal except that I had very low vitamin D
CDC Split Type:

Write-up: Very early spotting in cycle, irregularly early cycle by about a week


VAERS ID: 1483832 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling of body temperature change, Influenza, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies: pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 7/16/21 patient received second dose of Covid-19 at approximately 10:00 AM. At around 5:00 PM patient starting feeling hot and cold which slowly progressed to where he felt like he had the normal flu around 8:00 PM. About 15 minutes later he experienced slight tingling in hands, progressed to almost full body tingling sensation, most powerful in hands and feet. It was at its most powerful around 10:00 PM and he considered going to the hospital but did not. The tingling sensation subsided around midnight 12:00 AM. When he woke up on 7/17/21 he felt better and has been feeling better ever since. None of the symptoms have returned as of 7/18/21. Patient will follow up with his doctor.


VAERS ID: 1483833 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot, age 22, 3 days of extremely high fever immediately after flue shot
Other Medications: None
Current Illness: None
Preexisting Conditions: Chronic back pain
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 7-8 hours after the shot, I ended up with 2 red spots on my upper body. Not injection site, but very close to it. Looked like bug bite. I dismissed it as such. By the next morning those became big in size (1 inch in diameter) and very itchy. And 5 more appeared on my stomach and legs within next 24 hours, also about in inch in diameter and extremely itchy.


VAERS ID: 1483877 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-16
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Ocuvite, Lostartin
Current Illness: None
Preexisting Conditions: Alergic to chemicals and scented products. Adverse reactions include throat tightening, trouble breathing, difficulty in swallowing , sneezing headache, stomach, achy feeling like having the flu
Allergies: Penicillins, Claritin,
Diagnostic Lab Data:
CDC Split Type:

Write-up: A bruise at injection site the size of a silver dollar appeared 8 days after injection. . No severe pain, just light discomfort when pressed on . Nothing else


VAERS ID: 1483896 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Blood urine present, Chest discomfort, Chills, Hypertension, Nausea, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Not yet done going to do it today
CDC Split Type:

Write-up: High blood pressure, blood in urine , chill, body ache,pressure on the chest, nausea,


VAERS ID: 1483936 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 02IC2IA / 1 LA / SYR

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

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

Write-up: Sever swelling of left foot/ankle


VAERS ID: 1483949 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Electrocardiogram normal, Fall, Head injury, Headache, Hypersomnia, Malaise, Seizure, Tongue biting
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Fish Oil
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG, chest X Ray, blood test and multiple vital tests. I was pumped with fluids at the hospital after receiving the tests.
CDC Split Type:

Write-up: I received the Moderna vaccine. The pharmacist administering commented on the odd response I had to the shot in my arm and within 1 minute, I said, "I don''t feel so good" and began to have my first seizure. I fell out of my chair and hit my head on one of the CVS shelves. My wife was with me and the pharmacist called 911. The nurse came from the back and propped my legs up as I laid on the floor. Within minutes, the fire department and EMS arrived. They took my blood pressure, blood sugar and vitals which all were normal. I then began to have another seizure in which the EMS team assisted. They loaded me onto a stretcher and took me to the hospital in an ambulance. This entire course of events occurred within approximately 6 minutes of receiving my first COVID-19 vaccine. At the hospital, I received a chest X-ray, EKG and blood and vitals tests which all were normal. They concluded that it was an unexplainable reaction to the vaccine. I have no history of seizures and am a healthy 27 year old male. I take no prescription drugs, walk daily, work out regularly, eat a healthy diet and drink a gallon of water a day. Since receiving the vaccine, I have soreness on my head from hitting it on the shelf and a bite mark on my tongue from the seizures. I have been sleeping 12+ hours a day for the last two days.


VAERS ID: 1483951 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 1 LA / IM

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

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

Write-up: patient had welts all over legs and back


VAERS ID: 1484067 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-07-16
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

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

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

Write-up: Covid positive 7/17/2021. Rec''d covid vaccine 1/2021


VAERS ID: 1484105 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-07-16
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Ultrasound scan abnormal
SMQs:, 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole 10mg, Zyrtec, Montelukast, Endommune
Current Illness: None
Preexisting Conditions: IBS, Acid Reflux, Psoriasis
Allergies: Sulfa, Amoxicillin
Diagnostic Lab Data: May, 1, 2021 ultrasound of enlarged lymph node above collarbone and chain of lymph nodes in neck. Result was abnormal. I was prescribed steroid dose pack and broad spectrum antibiotic for possible infection in mastoid sinus. Lymph nodes seemed to return to normal.
CDC Split Type:

Write-up: The day after the second shot April 6, 2021, I had a swollen lymph node and a very swollen and painful right armpit. On approximately April 30 2021, I had a large swollen lymph node above my right collar bone, and a series of smaller swollen lymph nodes along my neck to the an area near the mastoid sinus behind my right ear. On approximately July 10, 2021 I had a swollen lymph node and moderate pain in right armpit. On July 19, 2021 the swollen lymph node and enlarged right armpit returned. PLEASE NOTE that the incidents of lymph node and armpit swelling that occurred in July were smaller and less painful than the initial event that occurred the day after my second injection.


VAERS ID: 1484281 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Additional Details: patient fainted but quickly recovered. patient stated he had a phobia of needles.


VAERS ID: 1484294 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Feeling hot, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: At 6:03 PM, Client stated that he felt a warm feeling in both feet. He stated that numbness and tingling he had in his feet was not new. Reported that this is a S/E from the medication Mitazopine that he takes at night. Client stated that his feet feel better after he removed his socks and lifted up his feet. Client instructed to go to ER if he felt worse. He said he would if the symptoms of warming feeling returned.


VAERS ID: 1484452 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Lymphadenopathy, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Welbutrin Apri Paroxetine One A Day Vitamins
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: NAUSEATED, FEVER, ACHEY, DIZZY, SWOLLEN GLAND UNDER ARM, TIRED NO ENERGY


VAERS ID: 1484483 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error, Underdose
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: NOT AN ADVERSE EVENT--ADMINISTRATION ERROR--vaccine dose given outside the manufacturer''s recommended temperature. Vaccine was punctured and sat at room temperature an hour longer than recommended time frame. Patient notified, recommended that he come back for another dose since he would have received a subpotent dose. Pt verbalized understanding .


VAERS ID: 1484487 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Electrocardiogram, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Sexual dysfunction (broad)

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

Write-up: 15 minutes post vaccination patient complained of shortness of breath and numbness of left side of body


VAERS ID: 1484500 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-19
Onset:2021-07-16
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Cough, Diarrhoea, Exposure to SARS-CoV-2, Pyrexia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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:
CDC Split Type:

Write-up: 7/19/21 Spoke with patient. Patient was exposed to a unknown source. Patient is FULLY vaccinated and states she was masked the entire time. Patient has not been to work for two weeks. Patient was tested 7/18 when patient arrived into (Privacy). Patient is sx (7/16): cough, diarrhea, fever & loss of taste. Patient understands to be out 10 days and sx free/improved for 24 hours. Patient will call for clearance. Patient understands to be out 10 days and sx free/improved for 24 hours. Patient will call for clearance.


VAERS ID: 1484515 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-17
Onset:2021-07-16
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 RNA increased
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: COVID-19 RNA DETECTION BDMAX 07/16/2021
CDC Split Type:

Write-up: Vaccine #1 01/27/2021 Pfizer, Lot # EL3249 Pt currently has covid 19


VAERS ID: 1484531 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Gait inability, Insomnia, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (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: Vitamin B, C, D. Zinc.
Current Illness: None.
Preexisting Conditions: Cholinergic urticaria, eczema, psoriasis, gluten sensitivity.
Allergies: Sulfa.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: It started with just extreme exhaustion. Within about an hour I had extreme pain in both legs, starting from my waist all the way down to my toes. It was not a "coming and going" type of pain. It was constant, and severe. It was so painful that I could not walk. The pain was not relieved by lying down and elevating my feet. It was so painful that I could not really rest or sleep. It lasted about 48 hours before it started getting a little better. It has been nearly 72 hours now, and I''m starting to feel a bit normal again. I did not seek treatment because I did not think there was anything a doctor could do to help me.


VAERS ID: 1484614 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-12
Onset:2021-07-16
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Nasal congestion, 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: None
Allergies:
Diagnostic Lab Data: Date of Test: 7/18/2021 Lab Test Performed: 2019-nCoV RNA XXX NAA+probe-lmp Route: Nasopharynx Result: POSITIVE
CDC Split Type:

Write-up: Sx onset 7/16/2021 with cough, runny nose, nasal congestion and headache. Tested positive for COVID-19 on 7/18/21


VAERS ID: 1484622 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-02
Onset:2021-07-16
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Nasal congestion, 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: None
Allergies:
Diagnostic Lab Data: Date of Test: 7/18/2021 Lab Test Performed: 2019-nCoV RNA XXX NAA+probe-lmp Route: Nasopharynx Result: POSITIVE
CDC Split Type:

Write-up: Sx onset 7/16/2021 with cough, headache, runny nose and nasal congestion. Tested positive for COVID-19 on 7/18/2021


VAERS ID: 1484633 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Hypoaesthesia, Hypoaesthesia oral, Pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Diabetes
Allergies: NKA
Diagnostic Lab Data: To be ordered 7/19/21
CDC Split Type:

Write-up: Numbness to mouth and bilateral legs, dizziness, crushing headache, generalized body pain


VAERS ID: 1484664 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DIFFERIN 0.1% GEL , BENZOYL PEROXIDE
Current Illness: NO
Preexisting Conditions: ADHD
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: NO ADVERSE EVENT


VAERS ID: 1484666 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

Write-up: ? Dose administered after improper storage and handling (more than allowed time after first vial puncture). Vial reconstituted at 0822, expired six hours later at 1422. dose administered at 1532, 70 minutes after expiration


VAERS ID: 1484692 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / 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: Prozac 40mg Mag OX 400mg Buspar 5mg SM fexofedadine 180mg Maxalt 10mg
Current Illness: NA
Preexisting Conditions: ADHD
Allergies: Chocolate, Cinnamon, eggs ,iodine, Nuts and Milk
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Age 17/ Given Moderna Covid vaccine/ Won''t be 18 until 8/25/21/ No adverse reaction


VAERS ID: 1484696 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Condition aggravated, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (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: information was not collected other than self report of fainting after vaccines.
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Shellfish - carries an Epi pen.
Diagnostic Lab Data: None known.
CDC Split Type:

Write-up: Vasovagal syncope, code blue called, patient regained consciousness and did not require further treatment. Patient did not visit ED. Patient did report after vasovagal episode that they typically respond like this after administration.


VAERS ID: 1484706 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Limb discomfort, Myalgia, Pain, Peripheral swelling, Pruritus, Sensory disturbance, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide 50mg (once daily) Potassium CLER 10 MEQ capsule Claritin 10mg Nature Made Brand Burpless Ultra Omega-3 from fish oil 1400mg (1000mg-3) Equate Brand Complete Multi Vitamin Adults
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim Bactro Macroditon Flagyl Erythromycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Felt as if needle was still inside of arm, arm felt heavy, light headed, dizziness, sore, warm , muscle in arm hurt, looked like a big mosquito bight, swollen, itchy


VAERS ID: 1484711 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Headache, Rash, Rash erythematous, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (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: Current Outpatient Medications: ? diphenhydramine HCl (BENADRYL PO), , Disp: , Rfl: ? cyproheptadine (PERIACTIN) 4 mg tablet, Take by mouth before meals and at bedtime, Disp: , Rfl: ? ondansetron (ZOFRAN) 8 mg tablet, Take 1 Tablet (8
Current Illness: Mom states she is a long-hauler and has had migraines and developed POTS following having COVID-19. She is currently in enrolled in a study and has been seen and followed up there for the symptoms. It was recommended that she obtain a COVID-19 vaccine
Preexisting Conditions: POTS
Allergies: avocado, banana, seafood, amoxicillin, clindamycin, clindamycin Hcl, corn all fruits cause blisters in mouth, omnicef
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 12-year-old female who presents with rash, back pain, and pain with deep breaths following her COVID-19 shot today. Patient has a history of having COVID-19 in September 2020. Mom states she is a long-haul her and has had migraines and developed POTS following having COVID-19. She is currently in enrolled in a study and has been seen and followed up there for the symptoms. It was recommended that she obtain a COVID-19 vaccine. Today she got her second vaccine and within 10 minutes she began having headache and then developed a generalized red rash with facial swelling about an hour later. Mom gave 25 mg of Benadryl and rash seemed to improve. Patient was complaining of pain to her mid back. She stated she had worsening pain when she took a deep breath. She denies any frontal chest pain. No shortness of breath. She did not take any Motrin or Tylenol at home. Mom states she also got a rash with COVID-19 shot. Patient denies any vomiting. No diarrhea. No cough. No difficulty breathing just pain when she takes a deep breath. No drooling. No difficulty swallowing.


VAERS ID: 1484723 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Fatigue, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benzonatate, Flonase, Guaifenesin, Ipratropium, Montelukast, Oxcarbazepine, Potassium Chloride ER, Pulmicort, Venlafaxine
Current Illness: none
Preexisting Conditions: COPD, Skin Cancer
Allergies: Macrodantin, Sudafed, Erythromycin, Hydrocodone, Keflex, Red Dye, Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right arm noted with redness, warmth, states she thinks it has gotten worse since it has started. Was initially noted 2 hrs post administration, applied vics mentholatum then ice pack. States she did not notice any other symptoms for the next 2-3 days as she was sleeping due to the excessive fatigue from the vaccine as well.advised pt to see physician or to go to ER to seek treatment if her physician is not available for the redness on her arm.


VAERS ID: 1484726 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: On Friday, July 16,2021, Patient was wrongly administered 0.5ml of Pfizer Vaccine instead of 0.3ml by a Volunteer Nurse vaccinator. Incident was reported to Management, Patients will be notified by medical staff.


VAERS ID: 1484727 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 RA / IM

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

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

Write-up: fainting and hit head....pt opened eyes within 30 seconds of fainting- no difficulty breathings. called EMS due to patient hitting head


VAERS ID: 1484733 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-03
Onset:2021-07-16
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Echocardiogram, Electrocardiogram, Electroencephalogram, Hemiplegia, Hypoaesthesia, Magnetic resonance imaging, Neurological symptom, Paraesthesia, Sensory loss
SMQs:, Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: yes blood work, mri''s, ct scan, eeg, ekg and echocardiogram
CDC Split Type:

Write-up: 2am in the morning she experience numbness and tingling in her right foot which progress to her leg and her head. Lost sensation and couldn''t move or feel the right side of her body. Went to ER and while in the ER she begin to have stroke like symptoms which she went paralyze for about 5hrs on her right side.


VAERS ID: 1484742 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: On Friday, July 16,2021, Patient was wrongly administered 0.5ml of Pfizer Vaccine instead of 0.3ml by a Medical Nurse. Incident was reported to Management, Patients will be notified by medical staff.


VAERS ID: 1484756 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bone pain, Chills, Fatigue, Feeling cold, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Osteonecrosis (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: Metoprolol Ambien
Current Illness:
Preexisting Conditions: high blood presssure
Allergies: Sulfa products
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever treated with acetominophen Cold chills Severe bone pain Sensation like being stung by wasps headache severe fatigue


VAERS ID: 1484758 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-07-16
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Angiogram cerebral normal, Blood magnesium normal, Electrocardiogram normal, Full blood count normal, Hypoaesthesia, Injection site pain, International normalised ratio normal, Magnetic resonance imaging abnormal, Metabolic function test normal, Muscular weakness, Pain in extremity, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wixela inhaler; Flonase nasal spray, loratadine
Current Illness: sinusitis 6/9/2021 treated with prednisone and Augmentin
Preexisting Conditions: breast cancer 1997, asthma
Allergies: aspirin
Diagnostic Lab Data: 7/17/2021 visit to ED: -physical exam "Questionable pronator drift of the left. " -CBC, BMP, magnesium, PT/INR, PTT all normal -EKG reportedly normal -MRI & MRA head reportedly normal
CDC Split Type:

Write-up: she had mild injection site soreness for a few days after receiving vaccine, this resolved; then severe pain in left upper arm on 7/16/2021 along with numbness, tingling, and weakness in left arm; also facial numbness


VAERS ID: 1484778 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-07-16
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: In the past 14 days are any of the following symptoms new to you and not related to an existing health condition?: No symptoms noted In the past 14 days have you had close contact* with a person who has a LABORATORY CONFIRMED case of COVID-19?: Yes exposure noted.


VAERS ID: 1484780 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 2 LA / IM

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

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

Write-up: Pt developed rash on injection arm 24 hours after vaccination. Rash was faint in color and very itchy. It started below injection site and travelled down forearm.


VAERS ID: 1484783 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Limb discomfort, Nausea, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control, vit d, vit c, flintstone w/iron, fish oil, biotin keratin
Current Illness: no
Preexisting Conditions: graves disease, complex regional pain syndrome on right leg
Allergies: allergic to 90% of everything outside, peanuts, shellfish, feathers
Diagnostic Lab Data: no
CDC Split Type:

Write-up: got hives, nausea, diarrhea, from knee down feels like carrying a ton of weights


VAERS ID: 1484828 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-11
Onset:2021-07-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: I am experiencing a water like sound in my left ear. This feels like like my eardrum can be touched by finger or Qtip that make a louder popping or similar to water in the ear. This has came and gone over the past few days. Also very sore at the injection site for about 3 days after shot. I have not been treated for the ear problem.


VAERS ID: 1484832 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-05
Onset:2021-07-16
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cellulitis, Pyrexia, SARS-CoV-2 test positive, Skin ulcer
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: HTN, DM TYPE 2, ESRD ON DIALYSIS
Allergies: ULTRAM
Diagnostic Lab Data: 7/16/2021 COVID ANTIGEN = DETECTED 7/16/2021 COVID PCR = DETECTED
CDC Split Type:

Write-up: MODERNA VACCINE DOSE 1 GIVEN ON 02/05/2021 MODERNA VACCINE DOSE 2 GIVEN ON 03/05/2021 PATIENT ADMITTED TO HOSPITAL 7/12/2021 WITH FEVER, CELLULITIS OF LEFT HAND/THUMB, LEG ULCERS THAT DO NOT APPEAR INFECTED AT TIME OF ADMIT. ON 7/16/2021 PATIENT TESTED FOR COVID TO MEET SNF ADMISSION. COVID ANTIGEN TEST AND PCR TEST BOTH = DETECTED. DUE TO THE POSTIVE RESULT PT REMAINS HOSPITALIZED AT THIS TIME.


VAERS ID: 1484846 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-14
Onset:2021-07-16
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: OSA, prediabetes
Allergies: none
Diagnostic Lab Data: Positive PCR test on 7/18/21
CDC Split Type:

Write-up: Positive PCR test on 7/18/21


VAERS ID: 1484857 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-16
Onset:2021-07-16
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Antibody covid test schedule for the week of August 2, 2021
CDC Split Type:

Write-up: 1. Entered store and met female technician. She came out from the back and told us to come over to a closed aisle. 2. We told her we were walk in patients. She was a bit confused at first, but then asked for our insurance and my ID. After we provided both to her ( she found our insurance on her system) she told us to wait. 3. About 15 minutes later she came back and handed me a vaccination consent form and told me to fill it out. (Blank form can be provided) 4. I filled out the form and mommy signed on the back. I returned the form to another male technician. 5. After 5 minutes later, the female technician signaled us to follow her into a small room a few feet away from the main pharmacy area. 6. The room was quite small and there was a curtain separating the room. I sat down in the chair. Mommy stepped out the room so that the technician would have room to work. 7. The technician briefly told me about the side effects of the vaccine (fatigue, headache, etc.) then attempted to administer the shot into my left arm. 8. Immediately after placing in the shot, she pulled out the needle and said there was an issue and the fluid had all leaked out. I did not see any fluid. She wiped up the arm rest and the surrounding area with a tissue. I think she discarded the used needle, but I cannot recall. She told me I would need another shot. 9. At this point Mommy entered the room and she was quickly briefed on the situation. She informed us that the clinic was out of COVID vaccines and had to ?mix? a new batch. 10. The technician left the room through a door pass the curtain (I could not see this door from my angle). 11. She came back in a minute later to wait with us. 12. About 10 minutes passed and then mommy and I left the room. Mommy went outside while I stayed in the store. 13. The female technician signaled me and told me my shot was ready. 14. The technician was about to administer the shot into my left arm, when Mammy came in and told her no. 15. We left the room and went back to the main pharmacy area to set up another appointment. 16. Mommy changed her mind about making another appointment and asked for a report about the incident that had occurred. 17. At this point, I left the store and left Mommy in there alone. 18. I got something to drink and then returned to the car about 15 minutes later. 19. About 30 minutes after I left the store, mommy entered the car with a sticky note in hand (picture provided below)


VAERS ID: 1484861 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), 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: Pro-Biotic, B12, D3, K, C, Magnesium
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: bananas
Diagnostic Lab Data:
CDC Split Type:

Write-up: I woke from sleeping feeling extremely sick and started convulsing non-stop. This went on for over an hour. I took Benadryl and it subsided with sporadic convulsions through the night and next morning. I ran a 102 temperature throughout, which was helped a little by Tylenol. Spent most of the next 24 hours sleeping.


VAERS ID: 1484879 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: On Friday, July 16,2021, Patient was wrongly administered 0.5ml of Pfizer Vaccine instead of 0.3ml by a nurse. Incident was reported to Management, Patients will be notified by medical staff.


VAERS ID: 1484889 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-05
Onset:2021-07-16
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose :04/12/21pfizer,Lot# EW0150 2nd dose: 05/05/21,Pfizer,Lot# ER8736 Diagnosed covid positive:07/16/2021 Exposure:Travel Symptoms:SOB, cough,fatigue,muscle ache,chills, fever. sore throat.


VAERS ID: 1484902 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Induration, Nodule, Skin warm
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: 5 areas that were stung by wasp were reactivated by vax, 2 areas hard knotty areas. all were fevered.


VAERS ID: 1484903 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: On Friday July 16,Patient was administered 0.5ml of Pfizer vaccine instead of 0.3ml by . An Incident report has been filed, management was informed. Patient will be notified by medical staff.


VAERS ID: 1484905 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

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

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

Write-up: Moderna administered to patient under 18 years of age.


VAERS ID: 1484926 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: On Friday July 16,Patient was wrongly administered 0.5ml of Pfizer Vaccine Intramuscular instead of 0.3ml by the Management was informed ,Incident report filed and patients are being notified by medical staff.


VAERS ID: 1484931 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: On Friday July 16,Patient was wrongly administered 0.5ml of Pfizer Vaccine Intramuscular instead of 0.3ml by the Medical Volunteer Vaccinator. Management was informed ,Incident report filed and patients are being notified by medical staff.


VAERS ID: 1484945 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: On Friday July 16,Patient was wrongly administered 0.5ml of Pfizer Vaccine Intramuscular instead of 0.3ml by the Medical Center. Management was informed ,Incident report filed and patients are being notified by medical staff.


VAERS ID: 1484957 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: On Friday July 16,Patient was wrongly administered 0.5ml of Pfizer Vaccine Intramuscular instead of 0.3ml by the Medical Center. Management was informed ,Incident report filed and patients are being notified by medical staff.


VAERS ID: 1484963 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: On Friday July 16,Patient was wrongly administered 0.5ml of Pfizer Vaccine Intramuscular instead of 0.3ml by the Volunteer Vaccinator. Management was informed ,Incident report filed and patients are being notified by medical staff.


VAERS ID: 1484971 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: On Friday July 16,Patient was wrongly administered 0.5ml of Pfizer Vaccine Intramuscular instead of 0.3ml by the Medical Reserve Corp Volunteer Vaccinator. Management was informed ,Incident report filed and patients are being notified by medical staff.


VAERS ID: 1485055 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Brain natriuretic peptide normal, C-reactive protein decreased, C-reactive protein increased, Chest X-ray abnormal, Chest pain, Chills, Cor pulmonale acute, Drug screen negative, Echocardiogram normal, Electrocardiogram normal, Fibrin D dimer normal, Headache, Immunoglobulin therapy, Pain in jaw, Red blood cell sedimentation rate normal, Troponin increased
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Osteonecrosis (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 7/16: Troponin 0.22ng/mL -$g 0.29ng/mL, BNP 25, D-dimer 0.29, ESR 4, CRP 0.8, chest xray with acute cardiopulmonary process. 7/17: EKG and echocardiogram normal. Troponin 66ng/L. Urine drug screen negative 7/18: Troponin 48ng/L. NT-pro BNP 14.35. CRP 6.16 7/19: Troponin 38ng/L
CDC Split Type:

Write-up: developed symptoms of intermittent chills, headache, jaw pain, and chest pain 2 days after receiving the shot. The next day went to an emergency room, was transferred to hospital. treated with one dose of IVIG and tylenol which led to resolution of symptoms.


VAERS ID: 1485057 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-12
Onset:2021-07-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Chest pain, Deep vein thrombosis, Fibrin D dimer, Pulmonary embolism, 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), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: methadone, aspirin, nifedipine, hydrochlorthiazide, lisinopril, lipitor, senna
Current Illness:
Preexisting Conditions: h/o CVA, h/o Drug abuse, hypertension
Allergies: shellfish
Diagnostic Lab Data: D Dimer of 2776 on 7/16 CTA chest positive for Acute PE on 7/16. Duplex US positive for Lt DVT on 7/16
CDC Split Type:

Write-up: Chest pain, diagnosed of Acute PE and DVT


VAERS ID: 1485062 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Breast pain, Chills, Diarrhoea, Fatigue, Feeling cold, Nausea, Pain, Pain in extremity, Peripheral coldness, Peripheral swelling, Taste disorder
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine
Other Medications: Vitamin D, Amlodipine, sertraline.
Current Illness: No
Preexisting Conditions: Hypertension, anxiety, insomnia.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, swollen left arm very painful arm and breast limp notes. Whole body pain very weak, headache, stomach cramps leading to diarrhea. Cold chills, nasty sick taste in my mouth. I also had a shooting pain going from my left arm and back to my leg. Cold hand on left arm where I was vaccinated. Slept for hours had to call out the whole weekend which I will not be paid for even though my job forced me to be vaccinated or be fired. Today will make it my fourth day since I been vaccinated and I am still in pain. My fingers also hurted. And also I was nauseous after I ate from Saturday to today.


VAERS ID: 1485078 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Injection site bruising, Injection site discolouration, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: woke up with a massive headache, then had nausea since then, my body aches all over, and the injection site has turned to a yellow bruise.


VAERS ID: 1485096 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Angiogram pulmonary abnormal, Blood glucose normal, Dyspnoea exertional, Echocardiogram normal, Erythema, Fatigue, Fibrin D dimer, Limb mass, Malaise, Pain, Pain in extremity, Palpitations, Paraesthesia, Pulmonary embolism, Tenderness
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, sertaline, probiotic, multivitamin
Current Illness: None
Preexisting Conditions: Auto accident 1998 requiring craniotomy, rod placement right leg. Subsequent additional surgeries right leg and ankle.
Allergies: No known allergies
Diagnostic Lab Data: CTA chest in ED: Bilateral multiple pulmonary emboli in all lobes, no central components. ECHO-negative for heart strain. D-Dimer 3.11, Glucose (random)-146, ALT-55.
CDC Split Type:

Write-up: Synopsis of event from ED and attending physician documentation, and pt. interview by this nurse: ...not feeling well for two days with dyspnea on exertion, fatigue, palpitations and mild body aching. Denies any chest pain, shortness of breath at rest or pleuritic pain, noticed lump over anterior right lower leg. Denies hx of leg swelling, calf or thigh pain, no recent travel by air or car. Received first COVID-19 vaccine 7/15/2021. States Friday, 7/16/2021 had ''pins and needles'' sensation anterior lower leg then developed lump in that area, painful to touch, slightly reddened. Hx of torn fascia in area per pt. Denies fever, no nausea, vomiting or diarrhea.


VAERS ID: 1485105 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-04-01
Onset:2021-07-16
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN8732 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test normal, Coagulopathy, Heavy menstrual bleeding, Menstruation irregular, Muscle spasms
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Dystonia (broad), Fertility 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: Metoprolol, acyclovir, advil, excedrin
Current Illness: Cold sore
Preexisting Conditions: Hypertrophic Cardiomyopathy Hypertension Herpes simplex (mouth)
Allergies: Some raw fruits and vegetables
Diagnostic Lab Data: Blood tests undergone seemed normal
CDC Split Type:

Write-up: Super light, barely-there period May 16 Missed period June 16 long period July 4 -July 19 and ongoing (16 days and counting).: heavy menorragia with large clots (quarter- silver dollar size) cramping.


VAERS ID: 1485131 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

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

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

Write-up: Patient received vaccine 7/16/21 and complained of numbness is the arm. Patient''s mother called today, 7/19/21, to inform us of the reaction. She stated the patient was experiencing numbness from the shoulder down to the hand. He can move his arm, but cannot feel. Mother was advised to call patient''s PCP.


VAERS ID: 1485181 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Headache, Nausea, Photophobia, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Severe head pain lower right side of skull. Naseua, blurred vision and light sensitivity. Head pain does not go away with advil. Feels different than a normal headache. Short of breath.


VAERS ID: 1485397 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None at this time
Current Illness: None
Preexisting Conditions: None
Allergies: No allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated she started a day after the shot having a rash on her back on her left side as well as as rash on her chest.


VAERS ID: 1485634 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

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

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

Write-up: Patient was given vaccine that was expired and past usable time window. Vaccine was reconstituted on 7/15/21 at 12:00PM, and vaccine was administered around 5:00PM on 7/16/21.


VAERS ID: 1485636 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain, Interchange of vaccine products, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Medication errors (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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received the wrong second dose vaccine. He received a Pfizer vaccine instead of the Moderna. His wife requested he get his second dose and told the pharmacy it was Pfizer. Unfortunately, we did not verify this and when we processed his vaccine later in the day, we received a message that we couldn''t process because it did not match his previous dose which was Moderna. The patient did not report any side effects except a slight fever, a mild headache and soreness at the site.


VAERS ID: 1485640 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK AR / IM

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

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

Write-up: Patient was given expired vaccine, given beyond the 6 hour window after reconstitution. Vaccine was reconstituted at 12:00PM on 7/15/21 and vaccine was given around 5:00PM on 7/16/21.


VAERS ID: 1485642 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Alanine aminotransferase increased, Aspartate aminotransferase increased, Cardiac telemetry, Chest X-ray normal, Chest pain, Chills, Diarrhoea, Dysphagia, Dyspnoea, Dyspnoea paroxysmal nocturnal, Echocardiogram normal, Ejection fraction, Ejection fraction normal, Electrocardiogram, Electrocardiogram QT interval, Electrocardiogram T wave inversion, Lipase normal, Myalgia, Myocarditis, Nausea, Orthopnoea, Pain in extremity, Palpitations, Pyrexia, Red blood cell sedimentation rate increased, Sinus rhythm, Tachypnoea, Troponin I increased, Vaccination complication, Vomiting, Weight increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: HLD
Allergies: none
Diagnostic Lab Data: In the ED, patient was found to be tachypneic RR 26 chest x-ray revealed no acute pulmonary disease. Elevated troponin I 0.33 EKG revealed sinus rhythm without ST elevation or depression HR 62 T wave inversion V1 QTC 430 AST/ALT slightly elevated 33/43 lipase negative, sed rate 49.4 ESR 51. Patient was administered Tylenol 650 mg, lidocaine patch and patient was admitted to the telemetry for medicine nonteaching for further evaluation of chest pain rule out viral pericarditis in the setting suspected of adverse effect COVID-19 vaccination from Moderna . During a 1 day stay on the telemetry floor medicine nonteaching, patient remained hemodynamically stable echocardiogram performed on 7/19/21 revealed LVEF of 55% without segmental wall abnormality, left ventricle and right ventricle normal in size and thickness. Cardiology was consulted and recommended Initiate colchicine 0.6 mg every 12 X 3 months and ibuprofen 800 mg every 8 X 2 weeks for suspected COVID-19 mRNA vaccine induced myopericarditis.
CDC Split Type:

Write-up: Pt is a 19-year-old male with past medical history of hyperlipidemia, obesity who presents this hospital on 7/19/21 for chest pain and shortness of breath following administration of COVID-19 vaccination Moderna X 4 days. Patient noted to persistent substernal chest pain radiating to left upper extremity present upon exam at its worst 3/10 relieved with Advil and aspirin for which patient was taking daily following a COVID-19 vaccination Moderna first dose 7/15/2021. Patient stated pain persisted despite taking over-the-counter analgesics and had difficulty breathing today thus transported himself to the emergency department for further evaluation. Patient d admitted to subjective chills without recorded temperature, myalgias without rash, difficulty swallowing, palpitations, orthopnea, PND, increased weight gain, abdominal pain, nausea vomiting or diarrhea. Patient prior allergic reactions. Patient denied history of MI, TIA, CVA, thromboembolic events. Significant family history of mother MI and Graves'' disease.


VAERS ID: 1485667 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-05
Onset:2021-07-16
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / UNK - / -

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

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

Write-up: Rash, treated with steroids and Benadryl


VAERS ID: 1485827 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Headache, Lymphadenopathy, Pain, Pain in extremity, Pyrexia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms began morning after shot. Sore arm (left), headache, high fever, facial swelling, left axillary lymph node inflammation, general discomfort and pain. Lasted approximately 2-3 days.


VAERS ID: 1485998 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Pyrexia, SARS-CoV-2 antibody test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202011; Test Name: COVID-19 antibody test; Result Unstructured Data: POSITIVE
CDC Split Type: USJNJFOC20210738451

Write-up: FEVER; FEELING VERY TIRED; This spontaneous report received from a patient via a company representative concerned a 21 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 15-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On NOV-2020, Laboratory data included: COVID-19 antibody test (NR: not provided) POSITIVE. On 16-JUL-2021, the subject experienced fever. On 16-JUL-2021, the subject experienced feeling very tired. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from fever on 16-JUL-2021, and had not recovered from feeling very tired. This report was non-serious.


VAERS ID: 1486006 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no known drug or non-drug allergies. The patient was otherwise healthy adult.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210739084

Write-up: SEVERE BODY ACHES/STARTED IN NECK AND EXPANDED FROM HEAD TO TOE AND EVEN TEETH; This spontaneous report received from a parent concerned an 18 year old female. The patient''s weight was 110 pounds, and height was 60 inches. The patient''s concurrent conditions included no alcohol use, and non-smoker, and other pre-existing medical conditions included the patient had no known drug or non-drug allergies. the patient was otherwise healthy adult.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, expiry: UNKNOWN) dose was not reported, administered on 16-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 16-JUL-2021, the subject experienced severe body aches/started in neck and expanded from head to toe and even teeth. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from severe body aches/started in neck and expanded from head to toe and even teeth. This report was non-serious.


VAERS ID: 1486561 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Allergies: Chicken (itching, swelling), Chicken Protein (Rash), Penicillin (itching)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient c/o itchiness overall her body. Patient is alert and oriented x 4, denied SOB, chest pain, or any respiratory distress. Vital signs stable. Administered 50mg Benadryl, IM injection at 10:29am. Patient stated the itchiness subsided at 11am. Patient was sent home at 12pm.


VAERS ID: 1486838 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / UNK - / IM

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

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

Write-up: A few minutes after receiving the vaccine, patient''s husband was calling for help. The patient appeared to be passed out but woke up. An ambulance was called and she reported to the hospital.


VAERS ID: 1486856 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-06
Onset:2021-07-16
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18050231 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis, Peripheral swelling, Thrombosis, Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aleve
Current Illness: none
Preexisting Conditions: none
Allergies: MSG, Soy Sauce, Citric Acid
Diagnostic Lab Data: Ultrasound performed on right leg on July 17, 2021
CDC Split Type:

Write-up: Right leg swollen, went to ER on July 17, 2021and was diagnosed with Deep Vein Thrombosis (right leg - blood clot). Currently taking Xarelto 15 mg 2x a day for 3 weeks, then Xarelto 20 mg for 6 months.


VAERS ID: 1486880 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-08
Onset:2021-07-16
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 RA / IM

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

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

Write-up: Positive for covid-19


VAERS ID: 1486908 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-21
Onset:2021-07-16
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: Symptom Onset Date of symptom onset: 07/16/21


VAERS ID: 1486944 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, 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: this child came through a Covid vaccine clinic. the parents intentionally put the incorrect date of birth on the consent form of the child, so he could be vaccinated sooner. the parents were educated on how dangerous and inappropriate this was. no adverse reactions to report from father, who verified, that he was deceitful when putting his sons date of birth on form.


VAERS ID: 1486953 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-07-16
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 UN / UN

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

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

Write-up: positive for covid-19


VAERS ID: 1486955 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-07-16
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Systemic inflammatory response syndrome
SMQs:, Tumour lysis syndrome (broad), Sepsis (broad), Opportunistic infections (broad)

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

Write-up: R65.10 - SIRS (systemic inflammatory response syndrome)


VAERS ID: 1486994 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies: don''t know
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was fully vaccinated with Moderna Vaccine on 1/28 and 3/2. Yet he came to our clinic for the Janssen vaccine. For the screener, He was asked "Have you received a COVId vaccine in the past.? He answer was No.


VAERS ID: 1487010 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-10
Onset:2021-07-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Myalgia, Pain, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: do not wish to disclose
Current Illness: none
Preexisting Conditions: hypertension
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Fatigue, muscle soreness, body aches, and hives. Hives were only thing treated, went to ER because it was all over entire body. was given steroids and Benadryl. after follow up was given an additional steroid shot.


VAERS ID: 1487072 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-30
Onset:2021-07-16
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Lumira covid 19 antigen test. Patient tested positive for covid infection after having been fully vaccinated for covid.
CDC Split Type:

Write-up: Patient was vaccinated with Moderna covid vaccine on 3/2/21 and 3/30/21. Patient subsequently tested positive for covid infection on 7/16/21 and 7/20/21.


VAERS ID: 1487136 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-24
Onset:2021-07-16
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Computerised tomogram thorax abnormal, Lung opacity, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Interstitial lung disease (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, loratadine
Current Illness:
Preexisting Conditions: hyperlipidemia, OA
Allergies: NKDA
Diagnostic Lab Data: 7/19/21 SARS-CoV-2: detected (by both Biofire and Diasorin platforms), CT values off Diasorin with S-gene 27.7 and ORF-1AB 33.2 7/19/21 CT-pulmonary arteries: 1. No pulmonary embolism. 2. Patchy peripheral predominant and basilar predominant ground-glass opacities throughout both lungs consistent with multifocal pneumonia. Appearance is typical of COVID-19 pneumonia.
CDC Split Type:

Write-up: Breakthrough COVID19 infection,. Patient''s vaccination dates were 2/4/21 and 2/24/21. Developed symptomatic COVID19 infection on 7/16/21.


VAERS ID: 1487189 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

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

Write-up: This employee presented for Janssen vaccination on 7.16.21. He filled out the COVID 19 form as never having had a covid vaccination. In addition he verbally asked this question and denied. On 7/20/21 I received a call notifying us that he had previously had a Janssen vaccination on April 10th, 2021 (LOT # 1808982) Never presented to this medical facility with any c/o or s/s of adverse reaction.


VAERS ID: 1487197 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient fainted but recovered immediately, we helped him up and elevated his feet and at the same time we call 911 for help and everything was taken care of by the medic. The patient is fine.


VAERS ID: 1487220 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-06
Onset:2021-07-16
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: Diltiazem, lactobacillus acidophilus, loperamide-simethicone, melatonin, sertraline, tiotropium, chamomile supplement
Current Illness:
Preexisting Conditions: HTN, COPD, Dementia, Osteoporsis
Allergies: Shellfish, iodine compounds
Diagnostic Lab Data: Venous Duplex
CDC Split Type:

Write-up: Bilateral DVTs


VAERS ID: 1487267 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Condition aggravated, Dysarthria, Feeling abnormal, Headache, Insomnia, Memory impairment, Pain in extremity, Palpitations, Reading disorder
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aliskirin 150mg QD Biotin Calcium D Vitamin D3 Iron Glucosamine Chondroitin Zinc
Current Illness: Stress headache week prior
Preexisting Conditions: Sleep apnea Hypertension (controlled with aliskirin) Anemia (controlled with iron supplement)
Allergies: Sulfur based meds - rash reaction in past
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Brain fog and speech difficulty - was having trouble forming sentences and speaking extemporaneously on subjects I?m extremely familiar with and then was unable to even read familiar sentences aloud without pausing/struggling. Also heart was racing, easily close to 100 resting heart rate. Also had a headache (but I?d had a headache earlier in the week). These issues Lasted several hours and though I had issues sleeping that night, everything was resolved by the next morning (except the sore arm which started day one, that lasted until Sunday).


VAERS ID: 1487306 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW10171 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Laboratory test
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depakote 125mg tab 3tabs in the am 4 tabs in the PM
Current Illness:
Preexisting Conditions: epilepsy, heart murmur
Allergies: nkda
Diagnostic Lab Data: Pt saw a cardiologist and had labs unknown outcome since we are not the PCP
CDC Split Type:

Write-up: on 7/16/21 3 days after the COVID vaccine patient started experiencing chest pain.


VAERS ID: 1487333 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-02-22
Onset:2021-07-16
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 - / IM

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

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

Write-up: positive covid test after full vaccination


VAERS ID: 1487336 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-01-13
Onset:2021-07-16
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 - / IM

Administered by: Work       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: COVID PCR Test 7/18, 7/19/2021
CDC Split Type:

Write-up: COVID Positive 7/18, congestion, cough, loss of taste and smell


VAERS ID: 1487413 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-11
Onset:2021-07-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthritis, Furuncle, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: - As expected high fever, - Increased arthritis pain for the following 24 hours. - Unexpected effect, in the week following she has developed boils in her skin: forearm close to wrist, legs close to ankles. Nothing else has changed, other than the COVID vaccine being 2nd shot that week. Applying Triamcinolone Acetonide topically to help control the itch.


VAERS ID: 1487431 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 Moderna vaccine on 3/19/21 at another facility Patient received Pfizer vaccine on 06/25/21 and 07/16/21 here. It was recommended by his specialist that he restart the series


VAERS ID: 1487465 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, Blood fibrinogen increased, C-reactive protein increased, Chest X-ray abnormal, Chest pain, Echocardiogram normal, Electrocardiogram ST segment abnormal, Fibrin D dimer, Headache, Hypotension, Inflammatory marker increased, Influenza like illness, Intensive care, Myalgia, Nausea, Pleuritic pain, Procalcitonin, Pulmonary oedema, Pyrexia, Respiratory distress, SARS-CoV-2 antibody test positive, Syncope, Troponin increased, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flonase
Current Illness: Patient had stuffy nose sometime within the last month. Family is not sure if it was allergies, dryness from being in the AC a lot. Did not feel that it was a URI.
Preexisting Conditions: Psoriasis and scoliosis of the thoracic spine
Allergies: Cefdinir, Amoxicillin, Penicillins
Diagnostic Lab Data: Initial EKG demonstrated diffuse ST changes Repeat EKG was normal and echo was unremarkable. Toponin highest 2.16 Elevated inflammatory markers CKMB 23.2, CK 345, procalcitonin 0.49, CRP 12.17, Fibrinogen 448, D-dimer 483 COVID SARS antibody spike 4002 COVID Antibody IgG nucleocapsid 0.1
CDC Split Type:

Write-up: Patient had flu like symptoms that developed the evening of vaccination including fever, headache, myalgias, nausea and vomiting. He had a syncopal episode on 7/18 (2 days after vaccination) and family found him on the ground. Following this episode he complained of substernal pleuritic chest pain. Initial EKG demonstrated diffuse ST changes. He became hypotensive and developed respiratory distress with evidence of pulmonary edema on CXR. He was admitted to the PICU on 35L HFNC and received an epinephrine drip for blood pressure control. Respiratory status improved.


VAERS ID: 1487475 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-13
Onset:2021-07-16
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: The at-COVID-19 Ag home test delivered a positive result for COVID on July 18, 2021
CDC Split Type:

Write-up: Contracted a breakthrough infection of COVID-19 on July 16, 2021, testing positive on July 18, 2021 via the at-COVID-19 Ag home test


VAERS ID: 1487491 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-01
Onset:2021-07-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin K 100 mcg QD Omega-3 1000mg Capsule QD Vagifem 10 mcg twice weekly
Current Illness:
Preexisting Conditions: COVID-19 Jan 2021
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Persistent dizziness since vaccine


VAERS ID: 1487527 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate irregular, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiac arrhythmia terms, nonspecific (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Congestive Heart Failure and Atrial Fibrillation
Allergies: Pregabalin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient informed me that 24 hours after he received his vaccination he was transported and admitted to the hospital. He was running a 104 degree fever and was suffering from a very erratic heath rhythm. It took them a significant amount of time to get his heart rhythm under control and or him to be discharged.


VAERS ID: 1487963 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-07-16
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Apparent life threatening event, Cerebellar infarction, Cerebellar stroke, Laboratory test, Subclavian artery aneurysm
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Neonatal disorders (broad), Respiratory failure (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Multiple, all occurring between 16 Ju;y 2021 and 19 July 2021
CDC Split Type:

Write-up: R cerebellar stroke/left subclavian aneurysm , specifically an acute infarct in the superior medial aspect of the right cerebellum extending to the superior right aspect of the cerebellar vermis in the distribution of the right superior cerebellar artery. I had a life-threatening stroke at 6 AM on 16 July 2021, resulting in a trip to the local emergency room and 4 days'' hospitalization.


VAERS ID: 1487969 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-26
Onset:2021-07-16
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6203 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP 7534 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cholangitis, Exposure to SARS-CoV-2, Hepatic infection, Pyrexia, SARS-CoV-2 test positive, Sick relative
SMQs:, Liver infections (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (narrow), Infectious biliary disorders (narrow), Biliary tract disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Has been dealing with liver and bile duct infection Choleangitis since March 2021. Has been hospitalized 4 times since March 2021.
Preexisting Conditions: choleangitis since March 2021
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: has had ongoing liver and bile duct infections since March 2021. She went to hospital ER on 7/16/2021 with a fever. Her family members were sick with COVID-like symptoms the week before and she was exposed to them. Thus the family requested that she be tested for COVID and was found to be (+). Her MDs admitted and treated her for liver and bile infection issues primarily and oxygenation was fine and was on room air. She was not formerly hospitalized due to COVID but was put on COVID floor bc of positive test. ONce liver and bile infection issues were resolved, she was discharged home on 7/20/2021.


VAERS ID: 1488501 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-04-03
Onset:2021-07-16
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Dyspnoea, Headache, Nasal congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID test on 7/19/2021
CDC Split Type:

Write-up: Patient developed cough, loss of taste or smell, shortness of breath, headache, and nasal congestion on 07/16. She was tested for COVID on 07/19 and found to be positive.


VAERS ID: 1488508 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-16
Onset:2021-07-16
   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 EW0198 / 2 LA / IM

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

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

Write-up: Rash of small red bumps starting on the chest and spreading up the next and across the back over 4 days to date


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