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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 35 out of 4,799

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VAERS ID: 1446995 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Administered vaccine from vial that''s BUD was 6-26-21 at 10:15 A.M. Vial was kept in refrigerator entire time prior to administration.


VAERS ID: 1447007 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Influenza like illness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Na
Current Illness: Na
Preexisting Conditions: Weak immune system, low blood pressure
Allergies: Ammoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme nausea diz ziness and flu like symptoms.Extreme nausea diz ziness and flu like symptoms.


VAERS ID: 1447076 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site warmth, Vaccine positive rechallenge
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: Bupropion, levothyroxine, warfarin, alprazolam, multivitamin, calcium, vitamin D, vitamin C, biotin
Current Illness: Grave?s disease, anti phospholipid syndrome, Raynaud?s disease
Preexisting Conditions: Grave?s disease, anti phospholipid syndrome, Raynaud?s disease
Allergies: Morphine (via injection)
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Approximately 10 days after my first dose (5/28/21) my arm (around the injection site) got very red, hot to the touch and sore; bad at first but subsided the next day. HOURS after my second dose on 7/2/21 the same thing started. It is now 3 days later and it is still, red, hot and sore but the pain isn?t as bad as it was initially.


VAERS ID: 1447099 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-29
Onset:2021-07-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Chest X-ray normal, Chest pain, Echocardiogram normal, Palpitations, Sleep disorder, Troponin increased
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 24hr Allegra, Melatonin 5mg
Current Illness: No
Preexisting Conditions: 1. Eczema 2. Had kidney stones for 2 years but has been clear almost 1 year.
Allergies: No
Diagnostic Lab Data: July 2nd he was taken to ER about 5:30am after contacting physician''s office on-call Dr who instructed the ER. He had chest X-rays and a Heart Echo. Those looked ok. No enlargement of his heart or fluid. He was then admitted after his blood test showed his Troponin was 171 around 11:30am (I could be wrong on time 10:30? Maybe). At about 2pm that same day his Troponin level was 195. After giving 600mg ibuprofen for this inflammation during this whole timeframe and with rest, by 2am on July 3rd his Troponin level was 86 if I?m remembering correctly and by 8am on same day it was 66. The hospital released him at about 1:00pm July 3rd
CDC Split Type:

Write-up: My son experienced palpitations and racing heart, described an 8-10 chest pain level from Midnight to 4am on July 1st, before this poor boy finally came to wake me up. He said he?d been trying to relax himself and felt like he had been exercising. He had only been laying in bed trying to go to sleep. No electronics, no sugar as these are things we asked him thinking he riled himself up somehow. No to all those questions. Just laying down the whole is what he said.


VAERS ID: 1447153 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Lymph node pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), 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: Lisinopril Atorvastatin Amlodipine besylate
Current Illness: High blood pressure
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at site injection, 4 inch red and swollen area around injection site, muscle ache and sore lymp nodes by left arm and neck.


VAERS ID: 1447356 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / -

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

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

Write-up: Pt was given Moderna COVID vaccine on 18 Mar 2021 for his first dose, however this vaccine was no longer available at the clinic after April 2021. The clinic switched to using the Pfizer vaccine. Due to the exceptional situation/unavailability of the same series vaccines for both doses, pt was given Pfizer for his second dose. "In exceptional situations in which the mRNA vaccine product given for the first dose cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimum interval of 28 days between doses to complete the mRNA COVID-19 vaccination series. In situations where the same mRNA vaccine product is temporarily unavailable, it is preferable to delay the second dose (up to 6 weeks) to receive the same product than to receive a mixed series using a different product. If two doses of different mRNA COVID-19 vaccine products are administered in these situations (or inadvertently), no additional doses of either product are recommended at this time. Such persons are considered fully vaccinated against COVID-19 ?2 weeks after receipt of the second dose of an mRNA vaccine." Pt tolerated well/No reported side effects.


VAERS ID: 1447998 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

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

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

Write-up: Pt was given Moderna COVID vaccine on 18 Mar 2021 for his first dose, however this vaccine was no longer available at the clinic after April 2021. The clinic switched to using the Pfizer vaccine. Due to the exceptional situation/unavailability of the same series vaccines for both doses, pt was given Pfizer for his second dose. "In exceptional situations in which the mRNA vaccine product given for the first dose cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimum interval of 28 days between doses to complete the mRNA COVID-19 vaccination series. In situations where the same mRNA vaccine product is temporarily unavailable, it is preferable to delay the second dose (up to 6 weeks) to receive the same product than to receive a mixed series using a different product. If two doses of different mRNA COVID-19 vaccine products are administered in these situations (or inadvertently), no additional doses of either product are recommended at this time. Such persons are considered fully vaccinated against COVID-19 ?2 weeks after receipt of the second dose of an mRNA vaccine." Pt tolerated well/No reported side effects.


VAERS ID: 1449715 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-07-02
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Muscular weakness, Nausea, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210704653

Write-up: FELT DIZZINESS; SORENESS IN RIGHT ARM; WEAKNESS IN RIGHT LEG AND RIGHT ARM / CAN''T PICK UP ANYTHING OVER 5 POUNDS; SORENESS AT INJECTION SITE TRAVELLED DOWN RIGHT ARM; NAUSEOUS; This spontaneous report received from a patient concerned a 56 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: 1821281, and expiry: 06-SEP-2021) dose was not reported, administered on 01-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUL-2021, the subject experienced felt dizziness. On 02-JUL-2021, the subject experienced soreness in right arm. On 02-JUL-2021, the subject experienced weakness in right leg and right arm / can''t pick up anything over 5 pounds. On 02-JUL-2021, the subject experienced soreness at injection site travelled down right arm. On 02-JUL-2021, the subject experienced nauseous. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from felt dizziness on 02-JUL-2021, and had not recovered from soreness at injection site travelled down right arm, nauseous, weakness in right leg and right arm / can''t pick up anything over 5 pounds, and soreness in right arm. This report was non-serious.


VAERS ID: 1449720 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-01
Onset:2021-07-02
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Human chorionic gonadotropin, Intermenstrual bleeding, Progesterone
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B-12 500mcb d3 4000 iu liquid Slow release iron 50mg Pre natal with DHA Benedryl 50 mg Ambien 10mg - on occasion CoQ10 DHEA
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, Ceclor, Sulfa
Diagnostic Lab Data: HcG and Progesterone
CDC Split Type:

Write-up: I had bleeding for my period 5 days earlier the month of my second vaccine. I subsequently got pregnant that month and miscarried at 5 weeks.


VAERS ID: 1449768 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-28
Onset:2021-07-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 AR / IM

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

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

Write-up: Systemic: Lymph Node Swelling-Medium


VAERS ID: 1449773 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Bradycardia, Chills, Dizziness, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Bradycardia-Severe, Systemic: Flushed / Sweating-Severe, Additional Details: Patient had not eaten all morning and felt very anxious about vaccine prior to administration.


VAERS ID: 1450009 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-15
Onset:2021-07-02
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea
SMQs:, Fertility disorders (broad)

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

Write-up: Pt states that she "missed her period" after receiving her vaccine. She received her vaccine 06/15/2021. Her period was due 07/02/2021. On 07/01/2021 she noticed a very light "brownish tint only" that last 4 days. She has very normal 4-5 days of bright red blood, heavier flow periods and has never missed a period.


VAERS ID: 1450147 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JSN206A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRIUMEQ 600 MG-50 MG-300 MG TABLET
Current Illness: None Stated
Preexisting Conditions: HIV positive
Allergies: None Stated
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient stated he never received a covid 19 vaccination or any other vaccination per heath questionnaire, no other form of verification is used to determine if patient is telling the truth. This writer found out due to immunization supervisor that this patient had received the Moderna vaccination prior. This writer was asked to fill out Vaers form.


VAERS ID: 1450149 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Migraine, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Migraine all over pain in head. Nausea. Weakness. Sore Body.


VAERS ID: 1450234 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoacusis, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: The patient stated that one hour after receiving his second dose, everything started to turn yellow, he got dizzy and lightheaded, and his hearing was "off"/impaired. He closed his eyes for about 20-30 seconds, and when he opened his eyes again, he felt better. He has not had any issues since that episode.


VAERS ID: 1450250 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-29
Onset:2021-07-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Condition aggravated, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: I woke up in my sleep feeling my chest vibrating like a cell phone . Every day since I have chest pains. I am nauseous off and on.


VAERS ID: 1450264 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-28
Onset:2021-07-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blood creatine phosphokinase MB increased, C-reactive protein increased, Chest pain, Chills, Dyspnoea, Electrocardiogram ST-T change, Headache, Myalgia, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Diffuse ST changes on EKG, increased initial troponin of 0.249. peaked at 0.673. CRP 2.1. CK MB 6.0.
CDC Split Type:

Write-up: received Moderna COVID-19 vaccine on 6/28 and since 6/29 has had worsening chest pain with shortness of breath, but it was most notable yesterday. He went to urgent care , and had an EKG, with the results being abnormal. He reports it feels better when laying down and is exertional. He had chills, abdominal pain and myalgias, headache.. impression is myocarditis likely related to the vaccine.


VAERS ID: 1450279 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MMR vaccine in approximately 1996
Other Medications: Levothyroxine and daily vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Clindamycin ICG contrast dye Penicillin Sulfa MMR (adverse reaction) Preparation H
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itching over entire body, raised rash on back and belly


VAERS ID: 1450309 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Influenza like illness, Injection site pain, Muscular weakness, Throat irritation
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Itchy throat, headache,flu like symptoms, pain and weakness on vaccination site(RightArm)


VAERS ID: 1450313 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-01-22
Onset:2021-07-02
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Dyspnoea, Endotracheal intubation, Intensive care, Mechanical ventilation, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (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? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN HLD CAD CVA CKD stage III NIDDM
Allergies: Sulfa
Diagnostic Lab Data: 6/25 - COVID-19 positive
CDC Split Type:

Write-up: Patient presented 7/2 with SOB, fever, muscle aches, generalized weakness, and dry cough. Diagnosed with COVID-19. Reportedly started on ivermectin, dexamethasone, azithromycin, and an inhaled steroid by PCP with initial improvement, and then significant worsening warranting admission. Was admitted to ICU, and emergently intubated on 7/2. As of 7/6, patient remains intubated on mechanical ventilation in the ICU.


VAERS ID: 1450340 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-06-24
Onset:2021-07-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone, loratadine
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Patient visited Primary care doctor on 6 July 21. Doctor diagnosed patient had shingels.
CDC Split Type:

Write-up: Shingels


VAERS ID: 1450343 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-28
Onset:2021-07-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac telemetry, Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Intensive care, Myocarditis, Pericarditis, Troponin increased
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Update 7/4: 16yo male admitted with myocarditis after COVID vaccine. Trop peaked at 19, now down to 2.7 ECHO normal function. Initial EKGs with concern for inferior MI. NO arrhythmias. Exam as above. Pt without current chest pain. Will monitor and check troponin at 1400 with hope that he can go home if < 1 or downtrending. Repeat EKG with 2pm troponin. Ad lib PO off IVFs F/U pending myocarditis evals. Tylenol/motrin prn. F/U in 1 week. Reason for ICU level care: continuous telemetry for myocarditis after COVID vaccination
CDC Split Type:

Write-up: 16 year old male with no past medical history, recently received 2nd pfizer vaccine on monday 6/28, here with chest pain since . EKG shows ST elevation: consistent with pericarditis. troponin 15.2. will admit to healthcare faciility.


VAERS ID: 1450345 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-25
Onset:2021-07-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injection site rash, Rash erythematous, Rash papular, 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
Current Illness: none
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient developed a circular red, raised rash that initially itched around injection site 6 inches in a oval shape covering outside of arm. Rash is still evident 5 days after start.


VAERS ID: 1450352 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-05
Onset:2021-07-02
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / ID

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Actemra IV Amlodopine 5 mg Hydralazine 25 mg Ipratropium nasal spray Iron 325 mg Levothyroxine 25 mcg Omeprazole 20 mg Restasis ophthalmic emulsion Vitamin D3 25 mcg
Current Illness: None
Preexisting Conditions: Auto-immune diseases - RA, Scleroderma, Renaud?s
Allergies: Penicillins Azathiaprine Adhesives
Diagnostic Lab Data: COVID-19 test on July 2, 2021. Positive result.
CDC Split Type:

Write-up: Tested POSITIVE for COVID-19 on Friday, July 2, 2021. Was held a tele-med appointment over the phone. Referred me as a candidate to receive a monoclonal antibody infusion which I had on July 5, 2021. My symptoms are deep cough, tightness in my chest, sore throat, slight headache, tiredness and loss of taste.


VAERS ID: 1450353 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-12
Onset:2021-07-02
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 2 UN / UN

Administered by: Unknown       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: 7/2/2021-SARS Coronavirus-2, PCR detected
CDC Split Type:

Write-up: Pt had pre screening for COVID prior to a scheduled procedure. Her COVID testing was positive so the procedure was cancelled/rescheduled


VAERS ID: 1450356 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Extra dose administered, Hospitalisation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: A FAMILY MEMBER OF PATIENT WITH RX# 7006047-1041, CAME OVER STATING THAT WE GAVE PATIENT A 3RD MODERNA SHOT. SHE STATED THE VACCINE CARD ALREADY REFLECTED 2 SHOTS WHICH SHE VERIFIED WITH DOCTOR (THERE WAS ONLY ONE LOT NUMBER) AND WE GAVE HIM A THIRD ONE. PATIENT CAME IN ON 7/1/2021 AS A WALK IN AND REQUESTED HIS SECOND SHOT. PATIENT FILLED CONSENT FORM AND SHOT WAS BILLED AS 2ND SHOT VIA MEDICAID, FL SHOTS WAS VERIFIED AND ONLY SHOWED ONE SHOT, AND WE ASKED PATIENT "IS THIS YOUR FIRST SHOT OR SECOND SHOT?" AS IS OUR STANDARD PROCESS. Family member claims pt had dizziness and fainting resulting in hospitalization.


VAERS ID: 1450373 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Ear pain, Fatigue, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Employee calling to report a reaction after receiving a COVID-19 vaccine. Vaccine Name - Pfizer Vaccine Date - ? 07/01/2021 Is this your first or second dose- Second Date of symptom onset - ? 07/02/2021 Symptoms - ? chills, fever, fatigue, headache and right ear pain Last day of work and shift - ? 07/01/2021 nights Home remedies- Employee stated she took tylenol (500mg) right after receiving COVID-19 vaccine, and then took Motrin after getting home that evening. Any improvement- Symptoms resolved after 24 hours Recommendation- Advised employee if symptoms return to take Tylenol and/or Motrin according to directions on label, and to inform us of any returning symptoms. Employee voiced understanding Employee of information ? Yes Employee voiced any concerns ? No Employee?s questions answered to employee?s satisfaction -Yes


VAERS ID: 1450430 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash around my eyes and forehead, itchiness and they look inflamed


VAERS ID: 1450450 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-03
Onset:2021-07-02
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Came down with Shingles as a side affect.


VAERS ID: 1450463 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

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

Write-up: Redness, swelling, soreness and stiffness around injection site.


VAERS ID: 1450484 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / UNK AR / IM

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

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

Write-up: patient is 17 years of age at time of administration and Moderna vaccine is currently indicated for 18 years and older


VAERS ID: 1450524 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omacitine
Current Illness: n/a
Preexisting Conditions: High Blood pressure Lymphdema Heart Murmur May have a small leak in her heart Vale
Allergies: Penicillin Tylenol Codeine mold Cortozine Sulfer Drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that 2-3 hours after taking the shot she got a rapid heart rate like her heart was going to beat out her body. Heart rate was 162. Patient stated that she took Aspirin with warm water. Patient stated that she had the same reaction with the flu Vaccine. Patient stated that the rapid heat beat lasted about a day.


VAERS ID: 1450544 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

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

Write-up: Patient given vaccine without dilution of vial, thus receiving six times the normal dose. Patient notified immediately upon realization at the pharmacy (30-60 minutes post injection). Patient monitored with phone calls throughout the weekend. Pt reported feeling a little tired Friday/Saturday, but is otherwise doing well at time of this report. Polices, procedures, and re-education implemented to prevent for future vaccines.


VAERS ID: 1450550 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

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

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

Write-up: Patient given vaccine without dilution of vial, thus receiving six times the normal dose. Patient notified immediately upon realization at the pharmacy (30-60 minutes post injection). Patient monitored with phone calls throughout the weekend. Pt reported feeling fine, nothing atypical from normal second dose symptoms. Polices, procedures, and re-education implemented to prevent for future vaccines.


VAERS ID: 1450560 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient given vaccine without dilution of vial, thus receiving six times the normal dose. Patient notified immediately upon realization at the pharmacy (30-60 minutes post injection). Patient monitored with phone calls throughout the weekend. Pt reported fever of up to 102F Friday/Saturday & treated with Tylenol, but is otherwise doing well at time of this report. Polices, procedures, and re-education implemented to prevent for future vaccines.


VAERS ID: 1450564 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Product preparation issue
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (broad)

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

Write-up: Patient given vaccine without dilution of vial, thus receiving six times the normal dose. Patient notified immediately upon realization at the pharmacy (30-60 minutes post injection). Patient monitored with phone calls throughout the weekend. Pt reported severe soreness in injection arm Friday/Saturday, headache, and extreme tiredness. Pt otherwise doing fine at time of this report. Polices, procedures, and re-education implemented to prevent for future vaccines.


VAERS ID: 1450589 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 & EW0180 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VALTREX
Current Illness: NONE
Preexisting Conditions: RX for right eye. Allergy shots for above listed allergens.
Allergies: MOLD MILDEW DUST MITES GRASS COCROACHES
Diagnostic Lab Data: NONE, Called Pharmacist & got lame response ; suggested OTC-Rx (Tylenol & Pepto-Bismol) which i was already taking.
CDC Split Type:

Write-up: INJECTION SITE PAIN & REDNESS, ARM PAIN. TIREDNESS, HEADACHES, MUSCLE + JOINT PAIN. CHILLS, FEVOR, NAUSEA, VOMITING, FEELING OFF/UNWELL.


VAERS ID: 1450617 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hyperhidrosis, Nausea, Pallor, Sluggishness, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: During monitoring period 5 minutes post Pfizer COVID-19 vaccine, pt experienced nausea, clammy skin, lightheadedness, dizziness (slow/sluggish), body tremors, fainted x 3 seconds. VS: 112/67, P 50, O2 on RA 96%. Pupils slightly enlarged. Patient arousable after 3 seconds Oriented x 4, pale. Patient states she does not take any medications normally and BP runs in 110s/70s. BP rechecked after -5 minutes 106/67, P 56, O2 on RA 98%. VS rechecked in other arm (L) BP 98/67, HR 50, patient placed in trendelenberg, ice applied, still somewhat nauseous.-15 minutes: BP 108/68, P 60, O2 on RA 98%, color returning to face, nausea lessened, still sweaty. -25 minutes: BP 109/72, P 60, O2 on RA 98%. After an hour and 30 minutes in Observation, patient was sitting upright in chair, stated she felt much better, no nausea, lightheadedness or dizziness, therefore, she decided to leave the clinic in the care of her family.


VAERS ID: 1450635 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oropharyngeal discomfort, Pruritus, Swelling of eyelid, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient stated was feeling okay after receiving shot about 8:45 pm. Patient went to sleep and woke up around 2 am due to itching. Patient stated was itching, noticed a little swelling around eyelid and felt as if her tongue were slightly swollen. Patient took a Claritin reditab and went back to sleep. About an hour later patient stated felt like she had something in her throat. Stated trying coughing and was not able to get it out so contacted family member in the home and then went to ER. At ER received IV Benadryl, steroid and Pepcid. Swelling receded and when doctor came to see at 8 am most of swelling had resolved.


VAERS ID: 1450655 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 0000000 / UNK - / -

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

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

Write-up: Patient received COVID -19 vaccine Johnson & Johnson on 7/1/21. On 7/2/21 from an outside facility, patient presented to urgent care with chest pain/tightness, SOB, lightheadedness and fatigue with headache. She was referred to the Hospital ED department for further evaluation. Per ED visit, patient reassessed and feeling better. She felt comfortable discharged home. File this incident for record keeping.


VAERS ID: 1450659 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-20
Onset:2021-07-02
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM

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

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: None stated.


VAERS ID: 1450661 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Vaccine vial was not diluted with the full dilatant amount. Patient got more than the 30 microgram recommended dose due to the dose being concentrated.


VAERS ID: 1450677 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Nausea, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium


VAERS ID: 1450713 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Inappropriate schedule of product administration, Lip dry, Lip haemorrhage, Lip injury, Lip scab, Lip swelling, Oral discomfort, Pyrexia, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Per Director of Nursing: patient stated that the day she got the vaccine she also got her allergy shot as she gets them 2 x a week. On Friday she woke up with fever, GI issues then her lips swelled and she got welts on them and she developed wheezing. She went to the ER on Friday, they gave her Benadryl , Prednisone and an antibiotic. On Sunday her lips were burning and swollen and burst open and started to bleed so she returned to the ER again. She states she is feeling better now but her lips are scabbed and dry. She stated that the ER doctor wasn?t sure if she may have had a reaction to the allergy shot in combination with the vaccine.


VAERS ID: 1452425 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Ear pain, Headache, Sleep disorder
SMQs:

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

Write-up: Middle left ear blockage since July 2, 7pm Severe pain in left ear since July 2 Severe headache Pain was severe enough to disrupt sleep. There is some relief for a few hours whenever she takes advil. I went to a CVS Pharmacist on July 4th and she recommended melatonin to help her sleep As of the time of this report, the ear blockage comes and goes, the ear pain and accompanying headache was still severe. She has taken Advil to ease the pain so she can sleep


VAERS ID: 1453601 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-07-02
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: No previous medical history
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210708251

Write-up: BODY ACHE; BAD CONGESTION; CHILLS; HEADACHE; FEVER/ FELT WARM; This spontaneous report received from a consumer concerned a 47 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included no previous medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 25-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 02-JUL-2021, the subject experienced body ache. On 02-JUL-2021, the subject experienced bad congestion. On 02-JUL-2021, the subject experienced chills. On 02-JUL-2021, the subject experienced headache. On 02-JUL-2021, the subject experienced fever/ felt warm. Treatment medications (dates unspecified) included: paracetamol, and ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from body ache, chills, fever/ felt warm, bad congestion, and headache. This report was non-serious.


VAERS ID: 1453610 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-07-02
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Dyspepsia, Ear pain, Feeling hot, Headache, Nasopharyngitis, Nausea, Pain, Pain assessment, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HYDROXYZINE
Current Illness: Abstains from alcohol; Allergic reaction to antibiotics; Allergic reaction to bee sting; Clot blood (The patient had family history of blood clot); Penicillin allergy; Smoker (occasional smoker)
Preexisting Conditions: Comments: The patient had no drug abuse or illicit drug use. Patient''s concomitant medication included: Cemoxazine100 mg twice a day for anxiety.
Allergies:
Diagnostic Lab Data: Test Name: Pain scale; Result Unstructured Data: Headache, Body ache and Bilateral ear ache had pain scale of 10/10
CDC Split Type: USJNJFOC20210708801

Write-up: FEVER; FELT NAUSEATED; FELT REALLY HOT; COLD; COUGH; BILATERAL EAR ACHE; FELT BURNING PAIN ON STOMACH MOSTLY ON THE MIDDLE AREA; SEVERE HEADACHE; BODY ACHE; This spontaneous report received from a patient concerned a 26 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included blood clot, non alcoholic, occasional smoker, penicillin allergy, allergic to amoxicillin, and bee sting allergy, and other pre-existing medical conditions included the patient had no drug abuse or illicit drug use. Patient''s concomitant medication included: cemoxazine100 mg twice a day for anxiety. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 206A21A, expiry: UNKNOWN) dose was not reported, administered on 02-JUL-2021 for prophylactic vaccination. Concomitant medications included hydroxyzine for anxiety. On 02-JUL-2021, the subject experienced body ache. On 02-JUL-2021, the subject experienced cold. On 02-JUL-2021, the subject experienced cough. On 02-JUL-2021, the subject experienced bilateral ear ache. On 02-JUL-2021, the subject experienced felt burning pain on stomach mostly on the middle area. On 02-JUL-2021, the subject experienced severe headache. On 03-JUL-2021, the subject experienced felt really hot. On 03-JUL-2021, the subject experienced felt nauseated. On an unspecified date, the subject experienced fever. Laboratory data (dates unspecified) included: Pain scale (NR: not provided) Headache, Body ache and Bilateral ear ache had pain scale of 10/10. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from severe headache, body ache, felt really hot, cold, cough, bilateral ear ache, felt burning pain on stomach mostly on the middle area, and felt nauseated, and the outcome of fever was not reported. This report was non-serious.


VAERS ID: 1453613 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-02
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Injection site pain, Neck pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (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: USJNJFOC20210709252

Write-up: NECK PAIN; ACUTE HEADACHE OR POUNDING HEADACHE; INJECTION SITE PAIN; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 02-JUL-2021 15:00:00 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 02-JUL-2021, the subject experienced injection site pain. On 03-JUL-2021, the subject experienced neck pain. On 03-JUL-2021, the subject experienced acute headache or pounding headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from injection site pain on 03-JUL-2021, and had not recovered from acute headache or pounding headache, and neck pain. This report was non-serious.


VAERS ID: 1453910 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Diarrhoea, Headache, Hyperhidrosis, Lymphadenopathy, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unithroid 112 mcg 2000 IU vitamin D 1000 mg fish oil
Current Illness: None
Preexisting Conditions: Graves? disease
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe body aches, joint pain, headaches, chills, diarrhea, sweating for 1.5 days. Severe headaches have continued but not as frequently. Swollen lymph nodes near right breast and under right arm (pain went away after 3 days).


VAERS ID: 1454191 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Chest discomfort, Chills, Dizziness, Fatigue, Headache, Heart rate increased, Pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins, prednisone started day after vaccine
Current Illness: None
Preexisting Conditions: Fibromyalgia, Trigeminal Neuralgia, Hyperlipidemia, Gastritis, Degenerative Disc Disease, Asthma, MGUS, Migraines, Sciatica, Protein C Deficiency, MTHFR, Reflux, Abdominal pain, Hematuria, Osteoarthritis
Allergies: Latex, Cipro, Ceftin, Iodine dye, Isovue, Lyrica, Sulfa drugs, Bactrim, Tramadol, Macrobid, Adhesive tape, Cholesterol lowering drugs
Diagnostic Lab Data: None - waited it out & within an hour or so, my heartrate returned to almost normal and chest started to feel a bit better.
CDC Split Type:

Write-up: Fast heartbeat (felt like I was having a heart attack), left chest discomfort, bad headache, dizzy, GI issues, body aches, chills, fatigue


VAERS ID: 1454422 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Throat irritation
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: depovera, robaxin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: itchy throat and difficulty swallowing less than 24 hours after vaccine given self treated with Benadryl symptoms resolved


VAERS ID: 1454469 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-16
Onset:2021-07-02
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cellulitis, Computerised tomogram, Full blood count, Metabolic function test, 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC, BMP, CT
CDC Split Type:

Write-up: unusual rash, cellulitis


VAERS ID: 1454486 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-24
Onset:2021-07-02
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Influenza like illness
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ocrecus x6months, Ursiduel 300mg, Gavapentin x3 day, Laraxipan 10mg, Oxybuten, Thevathoroxin, Ampyra, Cyanocobamin, Calcium B + C
Current Illness: N/A
Preexisting Conditions: MS
Allergies: Penicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. received Johnson & Johnson vaccine 05/24/2021 suffered flu-like symptoms following. Diagnosed with Shingles 07/02/2021. Doctor called in prescription for Shingles. Stating Physician informed her to let them "scab-up" and let them go away.


VAERS ID: 1454593 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-05
Onset:2021-07-02
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, Hypoxia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 1. Aspirin 81 mg po daily 2. Fluticasone 220 micrograms, 2 puffs BID 3. Glimeperide 2 mg po daily. 4. Losartan 100 mg po daily 5. Omeprazole 40 mg po daily 6. Tadalafil 5 mg po daily PRN 7. Albuterol 2mg/5 mL, 5mL 4x daily PRN.
Current Illness: 1. Type 2 Diabetes 2. Hyperlipidemia 3. Prior pneumonia and pericarditis. 4. Former Smoker
Preexisting Conditions: As above
Allergies: Listed as allergic to Aspirin
Diagnostic Lab Data: COVID 19 + on 7/2/2021
CDC Split Type:

Write-up: Patienyt vaccinated with Janssen product 5/5/2021, admitted to Medical Center on 7/2/2021 with hypoxemia and noted COVID 19 Positive. Treated with BiPAP, dexamethasone and remdesivir.


VAERS ID: 1454627 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / UNK - / IM

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

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

Write-up: Vaccine dose administered to be patient pertained to a vial that had been opened for over 6 hours.


VAERS ID: 1454682 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Booster dose was given 7 days early. Pt did not report any side effects.


VAERS ID: 1454714 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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 had a vasovagal episode following administration. Per - Pt stated that he faints during vaccines or anything of the sort. Patient fainted. Patient regained consciousness after about 2 mins. PA assisted PT with patient observation. Patient was observed for 30 minutes until stabilized.


VAERS ID: 1454805 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Dysphemia, Fall, Fatigue, Headache, Nasal congestion, Orthostatic intolerance, Peripheral swelling, Rash, Rash erythematous, Speech disorder, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin; ibuprofen; Excedrin Migraine; Maxalt/Rizatriptan
Current Illness:
Preexisting Conditions: Migraines; Myalgic Encephalomyelitis; Chronic Fatigue Syndrome; MECFF
Allergies: Egg Whites; egg yolks
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: Fifty nine minutes after the vaccine I started to get hives. I was red everywhere also had a rash especially on my neck face and arms. My legs were more like lumps. I took some enzymes that usually help with my symptoms with food allergies. I do not like to take Benadryl. The rash got better but I felt very congested in my nose for a couple of hours. The following day my arm was swollen and I had a headache and I was tired. I fell down because I lost my balance. I have a service dog because of my condition. Orthostatic intolerance is part of my condition and it was much worse than usual. It came so much quicker. For the next three days those symptoms persisted. Five days after the vaccine I started to have problems two hours after I got up in the morning. My speech is difficult and I am stuttering which happens to me a few times a year. It became very bad and it sounds like Stroke like symptoms. It has been five hours and it seems to be improving right now. It normally lasts about six hours. My Headache is much worse today and my Orthostatic intolerance is still causing me problems.


VAERS ID: 1454816 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Hallucination, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 102 fever, chills, headache, body aches, nausea, fatigue, and hallucinations. Fever stayed between 99.8 and 102 and lasted 32 hours. Ibuprofen and Tylenol was given every 4-6 hours.


VAERS ID: 1454831 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / SYR

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

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

Write-up: Nausea, stomach cramping and vomiting and dry heaving for several hours. Fatigue, body aches, fever of 100.7. Tylenol and ibuprofen given every 4-6 hours. 30 hours or so of feeling unwell.


VAERS ID: 1454888 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abscess, Pain in extremity, Paranasal sinus discomfort, Swelling face, Toothache, X-ray
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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: None
Current Illness: None
Preexisting Conditions: Diabetes II- Well controlled
Allergies: None
Diagnostic Lab Data: Dental x-ray
CDC Split Type: vsafe

Write-up: The day of I had sore arm, next day arm was more sore and started having toothache and sinus pressure. Saturday arm relieved, sinus was worse, swelling in my face, went to urgent care and got antibiotics and painkillers, Sunday I developed an abscess. Went to dentist today and they had to cut it open and drain it, will need root canal.


VAERS ID: 1454895 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt started having redness, skin rash all over her body, mild fever at the night after vaccination was done. Reports no breathing problems. pt came to consultation window at Wed 7/7/2021 at 7 pm with rash symptoms and temp 98.7 ''F. Was advised to take diphenhydramine 25 mg and follow up with PCP. Patient states there is no PCP. Was advised to go to emergency in case of worsening symptoms despite OTC recommendation.


VAERS ID: 1455119 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea
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: Tamiflu
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extremely painful menstrual cramps.


VAERS ID: 1455133 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / UNK UN / 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? 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: information given by pt stated that she was 12yr old to receive vaccine however she was 11. the 1st dose had already been administered at a previous date. Second vaccine was given.


VAERS ID: 1455928 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-07-02
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blister, Chest pain, Erythema, Herpes zoster
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin, omegas, lutein
Current Illness: None
Preexisting Conditions: Sciatica
Allergies: Meds only: Levaquin, macrobid, Ceftin.
Diagnostic Lab Data: Urgent care visit while out of town July 4, 2021. Still out town so much pain redness blistering. DX made by visual exam & H&P.
CDC Split Type:

Write-up: Severe right sided thoracic & chest pain. Onset of blister with redness, continued Rt sided pain 11/10. In first vacation since Covid and got sick, went to urgent care July 4, 2021, Dx with SHINGLES. Taking prednisone & valtrex but over next few days, blistering, redness spread between chest/breast to thoracic spine. Still with symptoms, while out of town on vacation! I am 55yo, healthy female, no underlying autoimmune disease or anything, no family history of shingles, so how did this happen? Possibly from Covid vaccine?


VAERS ID: 1456755 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-07-02
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METFORMIN; TRULICITY
Current Illness: Abstains from alcohol; COPD; Diabetic; Smoker (smoking since 13 years old - did not want to disclose the amount)
Preexisting Conditions: Comments: Patient had no known allergies and no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210710962

Write-up: SMALL AMOUNT OF PAIN AT THE INJECTION SITE THAT LASTED A FEW SECONDS/ARM PAIN; This spontaneous report received from a patient concerned a 72 year old male. The patient''s weight was 174 pounds, and height was 71 inches. The patient''s concurrent conditions included diabetic, copd (chronic obstructive pulmonary disease), smoker, and non alcoholic, and other pre-existing medical conditions included patient had no known allergies and no drug abuse or illicit drug usage.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 02-JUL-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. Concomitant medications included dulaglutide for diabetic, and metformin for diabetic. On 02-JUL-2021, the subject experienced small amount of pain at the injection site that lasted a few seconds/arm pain. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from small amount of pain at the injection site that lasted a few seconds/arm pain on 02-JUL-2021. This report was non-serious.


VAERS ID: 1457049 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / 1 RA / 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: Amlodipine, Omeprazole, Pro-Air, Trelegy, Venlafaxine
Current Illness: Headache, stomach upset, short of breath
Preexisting Conditions: Hypertension, COPD, Chronic right sided sciatica
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received vaccine on 7-2-21 @ 10:41am that was time expired. J&J vial was pierced on 7-1-21 @ 9:46am


VAERS ID: 1457141 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BA0180 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Cardiac stress test, Dizziness, Echocardiogram, Electrocardiogram, Myocardial necrosis marker increased, Palpitations
SMQs:, Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Tetanus shot, estimated 1998, grape-fruit size swelling in the injection site.
Other Medications: Fish oil, Levoxyn, Vitamin D, Cranberry capsule, Propion, Multivitamins, Calcium + Magnesium, Lisonporn
Current Illness: N/A
Preexisting Conditions: Athritis, Post-Head Injury, Heart Murmur PFO
Allergies: Maxfel, Allendroint, Anaprox, Vicodin, Sulfa, FDNC #2 Blue dye, Trichophyton rubrum, Biochloride, Peach, Dgt, Probply Gallahe, Corn/Corn family, Touluele, Saf flower, Rose Mary
Diagnostic Lab Data: EKG 07/02/2021 Echo 07/02/2021 Stress Test 07/02/2021
CDC Split Type:

Write-up: Pt. states received 07/01/2021 and 07/02/2021 started experiencing dizziness, laid down with pulse of 176 and lowering. Called hospital to inform and recommended to be transported by ambulance. Admitted and diagnosed with palpations A-phib, and high enzymes. Cardiologist visited and recommended several prescriptions. Appt. with Cardiologist in the future. Has since recovered with continuing use of prescriptions.


VAERS ID: 1457160 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Senior Living       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: Citalopram, Depo-provera injection
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Vaccination was administered to person aged 16 years old.


VAERS ID: 1457192 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-25
Onset:2021-07-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exfoliative rash, Rash, Rash erythematous, Rash pruritic
SMQs:, Severe cutaneous adverse reactions (narrow), 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: Aurovela birth control, multi-vitamin, biotin, salmon oil, vitamin D-3, probiotic, elderberry, olive leaf supplement, vitamin b12 spray.
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa meds
Diagnostic Lab Data: None. I did a telephone appointment and sent pics for review.
CDC Split Type:

Write-up: A week after the vaccine I developed a rash. It started on the lower inner left thigh and spread to the inside of my calf, then it spread to the same area on my right leg. It also showed up on both of my forearms. The rash is patchy and red, and it is itchy and scaly. Bumps also developed after a couple of days. It?s almost a week later, and I still have the rash.


VAERS ID: 1457242 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Pain
SMQs:

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

Write-up: Achiness, chills, headache over several days, resolved in part by Tylenol 1000mg, q 4 hr p.o. daily


VAERS ID: 1457273 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-03
Onset:2021-07-02
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: NA
Preexisting Conditions: smoking
Allergies: UK
Diagnostic Lab Data: Rapid antigen positive
CDC Split Type:

Write-up: became symptomatic 07/02/2021, rapid antigen positive 07/06.


VAERS ID: 1457301 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Fall down stairs, right parietal and temporal SDH, rib fractures
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After patient was screened as eligible and J&J COVID vaccine administered, patient''s family identified that patient had previously received 2 doses of Moderna on 4/15/21 and 5/14/21 from another healthcare system. This information was not present in state database when queried as part of screening process. It was later determined that patient has 2 profiles in the state system. Patient recovering from traumatic brain injury. No harm to patient identified from vaccine administration.


VAERS ID: 1457350 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Loss of consciousness, Visual impairment
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), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: High cholestrol
Allergies: None
Diagnostic Lab Data: Once, arriving at the ER on 7/2/2021 patient was given fluid via IV and blood was drawn.
CDC Split Type:

Write-up: Within 5 minutes of receiving vaccine, patient was seeing spots and passed out. 911 was called and patient was treated by EMTs. Epi-Pen and two shots of Benadryl were administered and patient was transported via EMTs to ER for further medical treatment and monitoring.


VAERS ID: 1457463 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Dyspnoea, Electrocardiogram, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Advair, Zyrtec
Current Illness: none
Preexisting Conditions: Asthma
Allergies: none
Diagnostic Lab Data: Chest x-ray, blood enzyme test. ECG
CDC Split Type:

Write-up: Fever within 3 hours of receiving vaccination. Chest pain and difficulty breathing


VAERS ID: 1457532 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hypotonia, Seizure
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Within minutes of patient receiving her first dose on Pfizer Covid-19 she became limp and her head fell on her mother''s shoulder. Her mother stated she was having a seizure. When the pharmacist came to her, she was conscience and alert. She stated she felt weak and she was given some water. EMS then arrived and she did not leave with EMS. She left with her mother who stated the next day that she immediately took her to ER where it was determined she had "an allergic reaction."


VAERS ID: 1457551 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-25
Onset:2021-07-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Pruritus, 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: I got my Moderna Covid Vaccine on 06/25/2021. after two hours my arm where I got injection started sore and pain, it lasts about 2 days and pain has gone. and I notice my upper arm started itchy and I scratched, it had a big bump after s
Current Illness: No
Preexisting Conditions: no
Allergies: unkown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore ,pain after 2 hours later of the injection. in about one week, my upper arm started to get itchy and has some rash


VAERS ID: 1457649 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Photopsia
SMQs:, Retinal disorders (narrow)

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

Write-up: Flashing lights like fireworks going off


VAERS ID: 1457673 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient did not mention
Current Illness: Cardiovascular diseases
Preexisting Conditions: Cardiovascular diseases
Allergies: NO
Diagnostic Lab Data: Does not apply.
CDC Split Type:

Write-up: At the moment the patient does not present with any adverse event, It''s reported now that the second dose was administered before the required 21 days. In this occasion what is being reported is a vaccination error.


VAERS ID: 1457865 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Women''s multi-vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: mango
Diagnostic Lab Data: I called and talked to the pharmacist who gave me the shot. This call was made on 7/8/2021. I also called and talked to our local pharmacist to get advice right after the first call on 7/8/2021. Pharmacist said to try Tylenol. She said that she could have hit a nerve or tendon or ligament. She said that if it persists for more than a month, then I should see my personal physician. The pharmacist at our local pharmacy, said that it might have something to do with the sirva or bursa tissue. He said to contact my doctor if it persists more than a couple weeks.
CDC Split Type:

Write-up: Soreness in left arm began the next day after the shot. It has continued for over a week now. There is and never was any outward sign of bruising or swelling. The soreness continues on the inside of the arm just below the shoulder through the bicep area. When I stretch the arm in any direction, there is a twinge of pain that extends from the lower shoulder area down to almost the elbow.


VAERS ID: 1457877 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-20
Onset:2021-07-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Dyspnoea, Heart rate increased, Menstruation irregular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Fertility disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MMR
Other Medications: Larissia 0.1 mg
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rapid heartbeat, dizziness, chills, irregular period, difficulty breathing


VAERS ID: 1458136 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-10
Onset:2021-07-02
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Senior Living       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: Coreg, lisinopril,sotalol, coumadin,atorvastatin, hztz
Current Illness: None
Preexisting Conditions: Heart, vascular
Allergies: None
Diagnostic Lab Data: Abbott Binax Now Ag rapid test. 7/8/2021
CDC Split Type:

Write-up: I had the 2nd booster shot on 01/31/2021. Began having covid symptoms on 07/202021. Rapid Ag Binax Now home test self administered today, 7/8/2021, was positive for covid. Thus making me sick with a breakthrough covid. The vaccine did not help. Contact tracing has not provided a source for the infection. Please mark my case as a vaccine failure.


VAERS ID: 1458370 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Divalproex, Oxcarbazepine, Topiramate, Quetiapine, Clonidine, Olanzapine
Current Illness: None
Preexisting Conditions: Generalized tonic-clonic seizures, Autism spectrum
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving his first Pfizer COVID19 shot and waiting 15 minutes at the pharmacy, the patient and his parents left the store. They came back shortly thereafter and said he was having a seizure in the parking lot. The pharmacist went out to investigate, and found the patient alert and responsive in the back of their vehicle. He said he was okay several times and his father also said he was okay. Later in the afternoon, his doctor sent in a prescription for Lorazepam for breakthrough seizures. The pharmacist called the next day and his father repeated that he was okay.


VAERS ID: 1458473 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Hypoaesthesia, Nausea, Pain, Painful respiration, Palpitations, Paraesthesia, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: crestor 10 mg q day, pantoprazole 40 mg daily, fluoxetine 30 mg daily, seroquel 10 mg daily, tylenol. Mother gave him 1 promethazine 25 mg of hers on July3rd.
Current Illness: anxiety, depression, Aspergers syndrome, GERD, Hyperlipidemia
Preexisting Conditions: anxiety, depression, Asperger''s syndrome
Allergies: sulfa=hives,rash, hallucination dextromethorphan= hallucinations
Diagnostic Lab Data:
CDC Split Type:

Write-up: ON jULY2ND-jULY 4TH FEVER, CHILLS, NAUSEA, VOMITING, BODY ACHES,. OVER THE NEXT FEW DAYS HE DEVELOPED CHEST PAIN, PALPITATIONS. CHEST PAIN WITH DEEP BREATH., LEFT HAND AND ARM WITH NUMBNESS, TINGLING


VAERS ID: 1458774 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-07-02
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Contusion, Fall, Headache, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (Once a week); Non-smoker
Preexisting Conditions: Comments: The patient had no known health issue, no known allergies and no drug abuse or illict drug usage, patient was not pregnant at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210708727

Write-up: SWOLLEN LEG; BRUISE GREEN PURPLE BRUISE, IT HURTS UPON TOUCHING, ON THE INNER THIGH , LEFT SIDE , BIG SIZE, ABOVE THE KNEE AND ALL THE WAY TO THE TOP; HEADACHE (BUT SHE THINKS IT WAS HANGOVER FROM LAST NIGHT''S DRINKS); FELL DOWN ON BACK NOT RELATED TO SIGHT OF PROBLEM; This spontaneous report received from a patient concerned a 29 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included alcohol user, and non smoker, and other pre-existing medical conditions included the patient had no known health issue, no known allergies and no drug abuse or illict drug usage, patient was not pregnant at the time of vaccination.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 02-JUL-2021 07:00 for prophylactic vaccination. No concomitant medications were reported. On 02-JUL-2021, the subject experienced fell down on back not related to sight of problem. On 03-JUL-2021, the subject experienced bruise green purple bruise, it hurts upon touching, on the inner thigh, left side, big size, above the knee and all the way to the top. On 03-JUL-2021, the subject experienced headache (but she thinks it was hangover from last night''s drinks). On an unspecified date, the subject experienced swollen leg. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from bruise green purple bruise, it hurts upon touching, on the inner thigh , left side , big size, above the knee and all the way to the top, and headache (but she thinks it was hangover from last night''s drinks), and the outcome of swollen leg and fell down on back not related to sight of problem was not reported. This report was non-serious.


VAERS ID: 1459691 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Error: Improper storage (temperature).


VAERS ID: 1459693 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

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


VAERS ID: 1459898 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-29
Onset:2021-07-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain natriuretic peptide normal, C-reactive protein increased, Chest X-ray normal, Chest pain, Decreased appetite, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram ST segment elevation, Enterovirus test negative, Fibrin D dimer increased, Full blood count normal, Headache, Human rhinovirus test, Hypophagia, Immunoglobulin therapy, Immunology test, Influenza virus test negative, Insomnia, Left ventricular dysfunction, Magnetic resonance imaging heart, Malaise, Metabolic function test, Myocardial oedema, Nausea, Pain, Pleuritic pain, Respiratory syncytial virus test negative, SARS-CoV-2 test negative, Troponin T increased, Troponin increased, Ultrasound chest, Ventricular extrasystoles
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Myocardial infarction (narrow), Ventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Infective pneumonia (broad), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: D-Dimer 1.82, 1.01 mcg/mL Troponin T - peaked at 1.7 ng/mL Adenovirus PCR and culture - negative SARS-CoV-2 POCT - negative Influenza A/B POCT - negative hMPV PCR - negative RSV PCR and PCOT - negative Rhinovirus PCR - negative Enterovirus PCR - not detected Lyme Ab Total - 0.16 negative Cardiac MRI:? Normal biventricular size and systolic function. No regional wall motion abnormalities. ? Myocardial late gadolinium enhancement of the left ventricle. ? Evidence for left ventricular myocardial edema. ? No significant valvular dysfunction. ? No coronary artery aneurysms. ? Small pericardial effusion. ''ECHO No structural abnormalities identified. ? No coronary artery aneurysms detected. ? Normal valvular function. ? Normal left ventricular size. Borderline depressed left ventricular systolic function. ? Qualitatively normal right ventricular size and systolic function. ? No pericardial effusion.
CDC Split Type:

Write-up: Patient reports onset of chest pain three days after his second Pfizer COVID vaccine. In the following three days after his vaccine, he had headache, decreased appetite, and mild nausea. However was still taking in fluids, decreased solid food intake. He also experienced insomnia and generalized malaise. At midnight on 07/02 he began to experience 9/10 substernal chest pain that was sharp, burning in sensation and located in the middle of the chest, non-radiating, pleuritic which lasted for several hours. Patient has had no fevers, vomiting, diarrhea, congestion, sore throat or cough. Denies any SOB, dizziness, syncope, palpitations, edema, orthopnea. There has been no trauma to the chest. No recent URIs. He was seen at a hospital where he was found to have a trop of 1251 ng/L (converting to ~1.5 in our system) then one hour later up to 1500mg/L. His EKG at the hospital demonstrated lateral ST elevations. Had a normal CXR. He was given Maalox which was not helpful. He was transferred to another medical facility after 3 hours at the hospital. Upon presentation to the emergency department, his vitals were stable. He had elevated CRP to 7.69, troponin was 1.0. CBC and Chem were normal. BNP normal at 15. Bedside ultrasound showed no pericardial effusion. Cardiology was consulted and ECHO showed mild left ventricular dysfunction with EF 47%. Repeat EKG here showed ongoing ST elevations in lateral leads, though mild. His pain has since improved to a 2/10. He has not required any medication for his pain. He is COVID/flu/RSV negative. On arrival to the floor, his chest pain had completely resolved. Patient reports the pain was pleuritic, worse with exertion and improving on rest. PMH: idiopathic urticaria Allergies: NKDA Family history: none reported, no cardiac disease or sudden cardiac death Hospital Course: Patient was admitted to the cardiology floor for continued monitoring of his troponin levels and EKG. He was then treated with IVIG 2g/kg and started on methylprednisolone IV x 2 doses. He initially had some very mild chest discomfort that improved by day 2 of admission. An echocardiogram was performed which showed improvement in his EF to 54%. Given his dysfunction, he was started on Enalapril 2.5mg twice daily. He was transitioned over to PO steroids which he tolerated well. On day of discharge, his troponin levels were trending down, and EKG was WNL. Cardiac MRI was performed and showed late gadolinium enhancement in the left ventricle. He had occasional PVCs but no arrhythmias. Viral myocarditis studies were sent and all negative. By time of discharge, patient was well-appearing, vitals stable, demonstrating good PO intake. Prescriptions sent to preferred pharmacy. Follow up with cardiology in place. Discharge instructions and return precautions reviewed with patient and parent, who expressed good understanding and agreement with plan. Patient will follow up in cardiology clinic next week with a repeat MRI 3-6 months.


VAERS ID: 1459919 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Alanine aminotransferase increased, Antibody test negative, Anticoagulant therapy, Aspartate aminotransferase increased, Blood alkaline phosphatase normal, Blood lactate dehydrogenase increased, Brain natriuretic peptide increased, C-reactive protein increased, Chest X-ray normal, Chest discomfort, Chest pain, Cytomegalovirus test negative, Echocardiogram normal, Electrocardiogram ST segment elevation, Electrocardiogram ambulatory, Enterovirus test, Enterovirus test negative, Epstein-Barr virus test negative, Fatigue, Fibrin D dimer, Gamma-glutamyltransferase normal, Haemoglobin normal, Headache, Human herpes virus 6 serology negative, Human metapneumovirus test, Human rhinovirus test, Immunoglobulin therapy, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Intervertebral disc degeneration, Laboratory test, Liver function test abnormal, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart, Myalgia, Mycoplasma test negative, Myocarditis, Pericardial effusion, Pyrexia, Red blood cell sedimentation rate normal, Respiratory syncytial virus test negative, SARS-CoV-2 antibody test negative, SARS-CoV-2 test negative, Troponin, Troponin T increased, Troponin increased, Vaccination complication, Ventricular extrasystoles, Ventricular tachycardia, Viral test negative, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: D-Dimer < 0.27 mcg/mL Troponin T 3.15 ng/mL - 0.73 ng/mL CRP 3.01 mg/dL Adenovirus PCR - negative Cytomegalovirus PCR - negative SARS-CoV-2 PCR - negative Influenza A/B PCR - negative hMPV PCR - negative Parainfluenza 1-4 PCR - negative RSV PCR - negative Rhinovirus PCR - negative EBV, Enterovirus, HHV6 PCR - negative Lyme Ab Total by ELISA 0.44 - negative Mycoplasma IgG 0.2 units/L (H) Mycoplasma IgM 0.06 units/L SARS-CoV-2 Total Antibody - nonreactive
CDC Split Type:

Write-up: 15 yo M with no PMH p/w 1 day of chest pain and elevated troponin and lateral ST segment elevations. On Wednesday 6/30 he had his second dose of Pfizer COVID vaccine. There after he had headache, tactile fever, fatigue and myalgias which resolved by Friday 7/2. On Friday at midnight, he awoke with 7/10 sharp substernal chest pain, non radiating. No recent trauma to the chest. He took Tylenol at home which did not relieve the pain. No recent URI sx over the last month. The last time he remembers having URI sx was 1.5 years ago. He does endorse "one or two sneezes" over the past month, which he attributes to allergies. Today 7/3, he presented to urgent care center where he got an EKG, which was concerning for ST elevations. He was given ASA which did not relieve the pain. He was sent to hospital for further work up where he had a Troponin to 1.59, CRP to 36, AST to 79, ALT to 64, Alkphos to 74, BNP to 119, ESR to 10, and WBC to 13.4. EKG showed ST elevation in I, II, precordial leads V4 V5 V6. CXR wnl. He was given IV toradol at hospital, which alleviated his CP. He was transferred to ED for further evaluation. On arrival to the ED on 7/3, he was HDS afebrile, with BP 111/69, HR of 80, and satting 100% on RA. His CP had resolved to a level of 0/10. Additional labs were obtained including repeat CBC (with WBC 10K, Hgb of 14), normal ESR of 20, normal D-dimer of less than 0.27, BMP wnl, elevated LFTs with AST 103, ALT of 61, elevated LDH to 293, normal GGT and alk phos, normal BNP to 28, elevated CRP to 3, and an extremely elevated troponin of 3.15. NP swab for COID, Influenza A/B, and RSV were negative. CXR wnl but did note findings consistent with degenerative disc disease at one level in the mid-distal thoracic spine. Hospital Course: Patient was admitted to the cardiology floor for continued monitoring of his troponin levels and EKG. He was then treated with IVIG 2g/kg and started on methylprednisolone IV x 8 doses. His chest discomfort improved by day 2 of admission. An echocardiogram was performed which did not show any cardiac dysfunction. His troponin downtrended while on IV steroids, therefore he was transitioned over to PO steroids which he tolerated well. On day of discharge, his troponin levels were continuing to trend down, and EKG was WNL. Cardiac MRI was performed and showed late gadolinium enhancement in the left ventricle. He had occasional NSVTs/PVCs; he was started on Bisoprolol 2.5mg daily to prevent arrhythmias after discharge. He was discharged home with a Holter monitor to be worn for 4 days. Viral myocarditis studies were sent and all negative. By time of discharge, patient was well-appearing, vitals stable, demonstrating good PO intake. Prescriptions sent to preferred pharmacy. Follow up with cardiology in place. Discharge instructions and return precautions reviewed with patient and parent, who expressed good understanding and agreement with plan. Patient will follow up in cardiology clinic next week with a repeat MRI 3-6 months. Of note, CXR from 7/3 with incidental findings suspicious for degenerative disc disease at one level in the mid-distal thoracic spine. This should be followed by his primary care physician as an out patient. Reasons for new, changed, and discontinued medications: - Bisoprolol 2.5mg daily (for prevention of NSVT) - Prednisone 30mg BID (myocarditis) - Famotidine 20mg daily (while on steroids) Reasons for new, changed, and discontinued equipment: NA Relevant Diagnostic Images/Studies: Cardiac MRI (7/7): ? Normal biventricular size and systolic function. ? No regional wall motion abnormalities. ? Suggestion of increased T2 signal intensity/edema. ? Positive myocardial late gadolinium enhancement without functional correlate. ? No significant valvular dysfunction. ? No coronary artery aneurysms. ? Small pericardial effusion. Echocardiogram (7/3): ? Normal valvular function. ? Normal left ventricular size and systolic function. ? Normal diastolic function indices. ? Reduced longitudinal strain with normal circumferential strain. ? Normal appearing proximal coronary arteries. ? Qualitatively normal right ventricular systolic function. ? No pericardial effusion present. ? A comprehensive anatomic survey was not performed at this time. Tests Pending Enterovirus PCR QuaL, Stool Miscellaneous Test Arup These tests will be followed after Discharge Vitals and Discharge Physical T: 36.5 ?C HR: 64 (Monitored) RR: 20 BP: 131/59 SpO2: 98% HT: 168 cm WT: 76.4 kg BMI: 27.1 Discharge Physical Exam General: NAD, lying in bed, sleepy, but conversational HEENT: atraumatic, normocephalic, no icterus, no conjunctivitis; extraocular muscles intact; moist mucous membranes CV: RRR, S1/S2, no murmurs, gallops or rubs noted; dp pulses 2+; capillary refill <2 seconds. Resp: unlabored respirations; symmetric chest expansion; clear breath sounds bilaterally Abd: soft, nontender, nondistended; bowel sounds normal Ext: no clubbing, cyanosis, or edema; normal upper and lower extremities Neuro: no atrophy, normal tone; moves all extremities equally; no focal deficits Skin: no rash or erythema Diagnosis List 1. Myocarditis, 07/04/2021 2. COVID-19 mRNA vaccine adverse reaction, 07/04/2021


VAERS ID: 1459939 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Dizziness, Limb discomfort, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Pt c/o dizziness, anxiety, tingles in feet/legs 5 mins after vaccination. Breathing normally. Pt developed leg heaviness (40mins after vaccination). Pt notes that she did not eat after breakfast @10AM. @13:54 BP 158/110, HR 80, O2 Sat 99% -- $g @14:00 148/96 -- $g @14:40 126/76, 80, 99%. Pt given water, juice, snacks and symptoms improved. Pt stable and released from the vaccination site @15:10.


VAERS ID: 1459970 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Current medications: Lisinopril 10mg PO Daily Amlodipine 5mg PO Daily Unknown if additional medications
Current Illness:
Preexisting Conditions: PMH significant for HTN and anxiety.
Allergies: Pt w/ allergy to bovine collagen (SOB) and Glucosamine-chondroitin (SOB).
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt w/ allergy to bovine collagen (SOB) and Glucosamine-chondroitin (SOB). PMH significant for HTN and anxiety. Pt vaccinated @10:46. At 11:20, post-vaccination, pt was brought to the triage area due to complaints of lightheadedness and slight HA. Pt stated that she has hx of anxiety and HTN. V/S @1120AM - BP: 170/99, HR: 88 NP further assessed pt and instructed pt to take her Amlodipine med, as prescribed. Pt was offered and given fluids, placed on recliner chair. Continued to monitor. V/S @1140AM - BP: 186/96, HR: 86 Per pt, she did not eat breakfast this morning before appt. Pt was given crackers. Per pt, had taken her prescribed Lisinopril med in the AM. Continued to monitor. V/S @1200PM - BP: 152/92, HR: 82 Pt verbalized improvement to sx and denied experiencing any new/abnormal sxs. NP cleared pt to be released from clinic. ED precautions given. Pt left with daughter with stable gait, AxOx4. Current medications: Lisinopril 10mg PO Daily Amlodipine 5mg PO Daily Unknown if additional medications"


VAERS ID: 1459992 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-29
Onset:2021-07-02
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood pressure increased, Burning sensation, Chills, Cough, Laboratory test, Myalgia, Nausea, Oropharyngeal pain, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, vitamin C, zinc
Current Illness:
Preexisting Conditions: Thalassemia, high blood pressure (started about three months ago)
Allergies: Dust, pollen
Diagnostic Lab Data: lab work; covid test; negative
CDC Split Type: vsafe

Write-up: I started with a cough, sore throat which progressively worsened over the days. On 07-02-2021, I had a cough attack, cough spasms, felt very nauseated in which I tried to vomit but I could not and also my sore throat was getting worse. My blood pressure also went up and an ambulance was called to my home. I was admitted to the ER by 12:00pm and at the hospital, lab work was performed, did a Covid test which was negative. While in the hospital I had three episodes of spasmic cough attacks and I continued to feel nauseated, had chills, muscle aches and I was discharged at 11:30pm that day. A few days later I went to see my doctor who again performed lab work and my results came back normal. I also feel pain to the back of my knees, pain associated with a hot sensation that does not go away. Today I still continue with cough spasms and muscle aches and the hot sensation to the back of my knees. I do not have lot# to provide, 2nd dose.


VAERS ID: 1460063 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

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


VAERS ID: 1460065 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

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


VAERS ID: 1460070 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Error: Improper storage (temperature).


VAERS ID: 1460076 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

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


VAERS ID: 1460079 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

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


VAERS ID: 1460177 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Malaise, Mobility decreased, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (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: Lisinopril and Propanolol
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache chills body-aches generally unwell couldn?t get out of bed. No energy. Felt like a really bad flu.


VAERS ID: 1460305 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Periorbital swelling, Swelling face, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: For blood pressure and 3 weeks prior, was taking Acyclovir 400 mg. The doctor had recommended discontinuing med 3 weeks prior to receiving MODERNA vaccine.
Current Illness: Hypertension; Prolapsed valve; Thalassemia
Preexisting Conditions: Same as aforementioned
Allergies: Codeine; Aspirin; Gluten
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On 7/02/2021, the patient received the first dose of the MODERNA vaccine. Included in the questions was patient history- patient was allergic to various medicines including aspirin, codeine and foods containing gluten. Included in conditions were hypertension, prolapsed valve and thalassemia, as immunologic conditions. In the interview, she stated she had BENADRYL in her purse but had not taken anything and I, Pharmacy immunizer, told her to wait 30 hours in observation and that we had IV BENADRYL and EPI PEN in case of any emergency and would activate any protocol in the event of. After informing her of possible side effects such as fever, headache, nausea, vomiting, diarrhea, fatigue and to use some ice in the event of inflammation around the area of injection; we proceeded to vaccinate the patient in her left arm. On 7/09/2021 her husband came by in the morning and informed us of that the patient had vomiting that night and days 4-5 after the vaccination. Patient had facial swelling and around her eyes and took 25mg of BENDARYL x 2days. On 3pm, I proceeded to call Doctor to inform them of the incident but they did not answer. I called the patient''s husband and he told me she was fine and I asked him if he had another phone or cell number to the doctor who had given the authorization for the vaccination, because I couldn''t find it. To this, the patient''s husband told me that the doctor was not in today and that the patient was due to see her the following Monday (7/12) or Tuesday (7/13) and would notify her.


VAERS ID: 1461487 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site reaction, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: supplemental information, January 2021 Tested positive for COVID-19
CDC Split Type:

Write-up: Low grade fever of 100.5 chills muscle pain other than injection site fatigue Symptom duration ended approximately 20-24 hours after onset.


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