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

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



Case Details (Reverse Sorted by Onset Date)

This is page 35 out of 8,010

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VAERS ID: 1779159 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-10-05
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: type 2 diabetes, obesity, COPD, hyponatremia, tobacco use, CAD
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received COVID vaccines on 03/16/21 and 04/06/21. While admitted to the hospital, pt developed a fever. Pt was tested for COVID on 10/05/21 and was found to be COVID positive.


VAERS ID: 1779184 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-10
Onset:2021-10-05
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Dyspnoea, Dyspnoea exertional, Headache, Nasal congestion, Respiratory symptom, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient has a past medical history of diabetes, high cholesterol, cardiac stents depression, colon cancer, and anemia. First COVID vaccination given on 2/10/2021 and second vaccination on 3/10/2021. (Second dose of Moderna vaccine given on 3/10/2021, lot number 026A21A)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to the hospital on 10/9/2021 for upper respiratory symptoms which began on Tuesday, generalized weakness, shortness of breath at rest, headache and dyspnea on exertion. Nasal congestion, runny nose, and wet nonproductive cough began on Tuesday. Patient developed generalized weakness, shortness of breath at rest, and shortness of breath on exertion. Patient was previously tested twice for COVID and the results came back negative. Patient tested positive for COVID-19 on 10/9/2021.


VAERS ID: 1779252 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-29
Onset:2021-10-05
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid positive church contact


VAERS ID: 1779270 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-23
Onset:2021-10-05
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Nasal congestion, Peripheral coldness
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient with a history of dialysis, CHF, hypertension, seizures, angioplasty, CABG, and cardiac stents. (Patient received second dose of Pfizer-BioNTech COVID-19 vaccine on 4/14/2021, Lot #ER8729. Both dose one and two were given at the Immunization Clinic. )
Allergies: Celecoxib, Cephalexin, Ciprofloxacin, Hydrocodone, Lisinopril, Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted to the hospital on 10/5/2021 for evaluation of cough and nasal congestion. Patient also reports bilateral foot coldness.


VAERS ID: 1779331 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-03
Onset:2021-10-05
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), 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? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient with a history of hypertension, diabetes, GERD, and hyperlipidemia. (Patient''s second dose of Moderna COVID-19 vaccine was given on 10/2/2021, Lot #061E21A. Both doses given at store/pharmacy
Allergies: Aspirin, Diazoxide, Hydrochlorothiazide, Sulfa drugs, Triamterene
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presents to the ER for evaluation of fever and reports that the second dose of the vaccine was given 3 days prior to admission. Patient endorses cough and congestion since that time. Patient reports onset of fever the day of prior to admission.


VAERS ID: 1779355 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3O135BA / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Angiogram, Blindness, Blood pressure abnormal, Blood test, Chest X-ray, Computerised tomogram, Electrocardiogram, Intraocular pressure test, Laboratory test, Magnetic resonance imaging, Urine analysis, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Hypertension (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NO
Current Illness: NO
Preexisting Conditions: NO
Allergies: CAT DANDER, ERTHROMYCIN, SULPHUR, CODEINNE, SEASONAL
Diagnostic Lab Data: MRI/MRA, EKG, BLOOD WORK, CT SCAN, HEART XRAY, OTHER TEST URINEAYLSIS AND OTHER TEST. I HAD A FLU VACINNE ABOUT 10 DAYS PRIOR TO RECEIVNG 3RD PFIZER. SHOT IN MY FOOT
CDC Split Type: vsafe

Write-up: I LEANED DOWN TO TIE MY SHOE AND I LOST VISION IN MY EYE. I WENT TO THE OPHTHALMOLOGIST HE PERFORMED SEVERAL TESTS. BLOOD PRESSURE WAS 137/100 WHICH ISNT NORMAL FOR ME. 41 WAS MY EYE PRESSURE AT THE EYE DOCTOR. AT THE ER IT WAS 17. A 4MM ANEURYSM BUT ITS BEETN THERE SINCE BIRTH. I SEEN A FEW DOCTORS AND NURSES. MY VISION HAS RETURNED BUT MY VISION IS STILL HAZY


VAERS ID: 1779392 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Full blood count normal, Influenza virus test negative, Laryngitis, Metabolic function test, Oropharyngeal pain, Paranasal sinus discomfort, Pruritus, Pyrexia, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: None
Preexisting Conditions: Congenital heart anomaly absent right SVC with persistent left SVC Global anhidrosis
Allergies: Latex
Diagnostic Lab Data: 10/11/2021 negative for COVID, influenza, strep 10/11/2021 CBC, CMP unremarkable
CDC Split Type:

Write-up: Symptoms started 4-6 hours post vaccination. Chills, sinus pressure, headache, fatigue, itching to soles of feet. Symptoms progressed over next several days to include fever 102.3, sore throat, dry cough, laryngitis. Symptoms still present today, 7 days post vaccination. No treatment except for supportive measures to include pushing oral hydration, and alternating Tylenol and Advil.


VAERS ID: 1779497 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

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

Write-up: PATIENT MADE AN APPOINTMENT ONLINE REQUESTING PFIZER VACCINE...HE DID NOT BRING THE CARD AND CONCEALED THE FACT THAT HE GOT MODERNA VACCINE EARLIER.....PT RECEIVED THE PFIZER BOOSTER VACCINE WHERE THEY SHOULD NOT HAVE, AS MODERNA IS NOT INDICATED FOR A BOOSTER DOSE AS OF NOW.....IT IS A MIX UP OF TWO DIFFERENT VACCINE MANUFACTUERS ?. PT BROUGHT THE CARD AFTER FEW DAYS ONLY THEN, THE PHARMACY REALIZED THAT THE PATIENT RECEIVED PFIZER BOOSTER WHERE THEY SHOULD HAVE NOT .


VAERS ID: 1779553 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Ear pain, Rhinorrhoea
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: First Covid 19 dose 1
Other Medications: Participant insist on: See previous record Dose 1
Current Illness: None
Preexisting Conditions: RSD
Allergies: Vicodin
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: Ear pain, needed antibiotics, running nose and dizzy.


VAERS ID: 1779601 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-08
Onset:2021-10-05
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0717 / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Myocardial necrosis marker increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: chest pain, shortness of breath, elevated cardiac enzymes.


VAERS ID: 1779602 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE 3590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Diarrhoea, Fatigue, Peripheral swelling, Pyrexia, Rash, Rash pruritic, Swollen tongue
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st Shingles shot
Other Medications: Levoxyl 1.25, Vit B, Probiotic, Magnesium, Calcium,
Current Illness: None
Preexisting Conditions: Hip issue, no co-morbidities
Allergies: Many antibiotics but the form is about to time out so no time to enter them. I have not had any recently. 1st Shingles shot reaction.
Diagnostic Lab Data: None. Ferry system not working well to get off the island, and I didn''t think I could drive safely.
CDC Split Type:

Write-up: 10/5/21 Tuesday Tuesday 10:30am Felt very tired almost immediately. Went home, slept until 3pm. Ate something for dinner, went back to bed. COVID Booster 10/6/21 Wednesday 9am Woke up with a rash and a 101.3 fever, joints and back ache. 1 Benadryl, and 2 Tylenol for fever Wednesday 10am Rash all over my chest, abdomen, arms, back, and tops of legs, arches of feet. Loose stools. 2 Prednisone 10mg each ? 20mg total Wednesday 2pm Rash slightly better. Fever gone. 1 Benadryl Wednesday 6pm Rash slightly better Took 1 Benadryl Wednesday 10pm Rash improved but not gone which is unusual for me. 2 Prednisone 10mg each ? 20 mg total and 1 Benadryl 10/7/21 Thurs. 10am Rash slightly better 1 Benadryl, and 1 Prednisone 10 mg Thurs. 3pm Rash slightly better 1 Benadryl Thurs. 5:40pm Teleconference. Provided photos. Got a new prescription for Prednisone. Rash still present but not as bad as Wednesday. Thurs. 8pm Legs swollen, tongue swollen, drank lots of water, 1 Benadryl Thurs. 2am Went to bed late 1 Benadryl 10/8/21 Fri. 9am Rash improved but not gone which is unusual for me. Why the persistent rash? 1 Benadryl 10/9/21 Sat. 9am lingering rash but no fever, extremely tired in the morning. Checkin call from Doctor. Slept and finally felt better. 10/10/21 Sun. Rash getting better. Not as visible on arms, torso, upper legs. Fairly itchy. 10/11/21 Mon. Fairly itchy finally. Applied topical soothing oil. Rested. 10/12/21 Tuesday (today) no rash visible but itchy and tired today.


VAERS ID: 1779619 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Injection site pain, Injection site warmth, Mobility decreased, Musculoskeletal stiffness, Neck mass, Neck pain, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), 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), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), 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: Lisinopril, Atorvastatin, Metformin, Zyrtec, Bioastin.,womens probiotic, famotidine Stopped 81 mg aspirin and centrum silver womens multivitamin after vaccine. 2 weeks prior had flu vaccine in left arm.
Current Illness: Sore throat chronic since 7/2021 after viral sinusitis/rhinitis. Negative strep, negative COVID, CBC levels clear. Multiple MD visits. Unknown why chronic. Completed 2 step Pfizer Covid vaccine 2/2021.
Preexisting Conditions: DM2 ( controlled diet and Metformin), HTN, congenital ventricular Septal Defect.
Allergies: Sulfa, dust, tetracycline
Diagnostic Lab Data: No tests as no fever, just edema and pain posterior R neck. Prior to vaccine CBC negative. Bloodwork normal. Only slight elevated Vitamin D with d/c Centrum Silver multivitamin.
CDC Split Type:

Write-up: About day after booster Pfizer dose, neck stiffness Right side only, 3 days slight heat and muscular pain at right deltoid/injection site, then slight edema supraclavicular right side. Did not check axilla as never had lymphatic involvement after other vaccinations. Concern is more accumulation of fluid at ipsilateral side only of booster shot 5+ days after injection posterior neck and base of occiput. At peak very noticeable as could feel mass/edema Limiting cervical extension. As of today, base of occiput edema slowly going down after some lymphedema MLD massage. Another healthcare co-worker reported headaches.


VAERS ID: 1779669 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-10-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Extra dose administered
SMQs:, Hearing impairment (broad), Medication errors (narrow)

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

Write-up: Patient developed Bell''s Palsy 1 week after 3rd dose of vaccine.


VAERS ID: 1779707 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 RA / IM

Administered by: Work       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: Hypertension, asthma
Allergies: No known allergies
Diagnostic Lab Data: This was reported to the manufacturer Moderna. Case number CEA0843 Their response: Thank you for your unsolicited inquiry: Pharmacist states that 4 patients received their 3rd doses of the Moderna Covid-19 Vaccine 33 days after the vial was moved to refrigeration. She wants to know how to proceed. Lot number(s): 040C21A. Number of doses/vials: 1 vial/4 doses. Date the vial was initially stored in the refrigerator: 2Sep2021. Date(s) of administration of vaccine: 5Oct2021. Did the vial undergo any temperature excursions? No Our team can conduct an analysis to determine if the vaccine administered past the expiry date provided the necessary protection against a COVID-19 infection. Due to the nature of your event, a LOT assessment will be conducted to determine the activity level of the vaccine. This assessment can take 8 to 10 business days. Your case number is CEA-0843. Following the conclusion of that assessment you will be contacted and provided with a product stability determination and instructions.
CDC Split Type:

Write-up: The vaccine was administered 3 days after the beyond use date. The dose was administered on 10/5/2021 when the beyond use date was 10/2/2021. The expiration date of the vial was 10/31/21. The expiration date was used instead of the beyond use date.


VAERS ID: 1779887 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 - / IM

Administered by: Work       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: Unknown.
Current Illness:
Preexisting Conditions: Hypertension, Arthritis, Dyslipidemia.
Allergies: Allergy-Morphine.
Diagnostic Lab Data: This was reported to the manufacturer Moderna for a recommendation if the dose should be repeated. Moderna case #CEA0843 There response: Thank you for your unsolicited inquiry: Pharmacist states that 4 patients received their 3rd doses of the Moderna Covid-19 Vaccine 33 days after the vial was moved to refrigeration. She wants to know how to proceed. Lot number(s): 040C21A. Number of doses/vials: 1 vial/4 doses. Date the vial was initially stored in the refrigerator: 2Sep2021. Date(s) of administration of vaccine: 5Oct2021. Did the vial undergo any temperature excursions? No Our team can conduct an analysis to determine if the vaccine administered past the expiry date provided the necessary protection against a COVID-19 infection. Due to the nature of your event, a LOT assessment will be conducted to determine the activity level of the vaccine. This assessment can take 8 to 10 business days. Your case number is CEA-0843. Following the conclusion of that assessment you will be contacted and provided with a product stability determination and instructions.
CDC Split Type:

Write-up: The vaccine was administered 3 days after the beyond use date. The dose was administered on 10/5/2021 when the beyond use date was 10/2/2021. The expiration date of the vial was 10/31/21. The expiration date was used instead of the beyond use date. No outcome or adverse event occurred at this time


VAERS ID: 1779890 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 - / -

Administered by: Work       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: Hypertension, osteoarthritis, bronchitis, diabetes, hypothyroidism, hyperlipidemia
Allergies:
Diagnostic Lab Data: This was reported to the manufacturer Moderna for a recommendation if the dose should be repeated. Moderna case #CEA0843 There response: Thank you for your unsolicited inquiry: Pharmacist states that 4 patients received their 3rd doses of the Moderna Covid-19 Vaccine 33 days after the vial was moved to refrigeration. She wants to know how to proceed. Lot number(s): 040C21A. Number of doses/vials: 1 vial/4 doses. Date the vial was initially stored in the refrigerator: 2Sep2021. Date(s) of administration of vaccine: 5Oct2021. Did the vial undergo any temperature excursions? No Our team can conduct an analysis to determine if the vaccine administered past the expiry date provided the necessary protection against a COVID-19 infection. Due to the nature of your event, a LOT assessment will be conducted to determine the activity level of the vaccine. This assessment can take 8 to 10 business days. Your case number is CEA-0843. Following the conclusion of that assessment you will be contacted and provided with a product stability determination and instructions.
CDC Split Type:

Write-up: The vaccine was administered 3 days after the beyond use date. The dose was administered on 10/5/2021 when the beyond use date was 10/2/2021. The expiration date of the vial was 10/31/21. The expiration date was used instead of the beyond use date. No outcome or adverse event occurred at this time


VAERS ID: 1779899 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 - / IM

Administered by: Work       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: unknown
Current Illness:
Preexisting Conditions: seizures
Allergies:
Diagnostic Lab Data: This was reported to the manufacturer Moderna for a recommendation if the dose should be repeated. Moderna case #CEA0843 There response: Thank you for your unsolicited inquiry: Pharmacist states that 4 patients received their 3rd doses of the Moderna Covid-19 Vaccine 33 days after the vial was moved to refrigeration. She wants to know how to proceed. Lot number(s): 040C21A. Number of doses/vials: 1 vial/4 doses. Date the vial was initially stored in the refrigerator: 2Sep2021. Date(s) of administration of vaccine: 5Oct2021. Did the vial undergo any temperature excursions? No Our team can conduct an analysis to determine if the vaccine administered past the expiry date provided the necessary protection against a COVID-19 infection. Due to the nature of your event, a LOT assessment will be conducted to determine the activity level of the vaccine. This assessment can take 8 to 10 business days. Your case number is CEA-0843. Following the conclusion of that assessment you will be contacted and provided with a product stability determination and instructions.
CDC Split Type:

Write-up: The vaccine was administered 3 days after the beyond use date. The dose was administered on 10/5/2021 when the beyond use date was 10/2/2021. The expiration date of the vial was 10/31/21. The expiration date was used instead of the beyond use date. No outcome or adverse event occurred at this time


VAERS ID: 1779924 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM

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

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

Write-up: patient received Moderna on 06/17/2021. No adverse effects from receiving this dose


VAERS ID: 1779932 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient received Moderna on 07/14/2021& 08/13/20212, then received Pfizer as booster on 10/05/2021. No side effects reported at this time.


VAERS ID: 1780126 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-02
Onset:2021-10-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chills, Dyspnoea, Fatigue, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flu vaccine day before, vitamin d3, calcium, iron, anastrozole, testosterone, tadalafil, pantoprazole, clomiphene
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: COVID test on Weds - Negative
CDC Split Type:

Write-up: 99.5 fever started on Tuesday, Weds through Thursday sustained 102.6 fever, body aches, chills, tiredness, tightness in chest, slight shortness of breath


VAERS ID: 1780314 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Lymphadenopathy, 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: XARELTO; SYNTHROID; CARDIZEM; Lisinopril; CALTRATE; Vitamin D; Pantoprazole; EMGALITY; NURTEC
Current Illness:
Preexisting Conditions: Atrial Fibrillation; Hypertrophic Cardiomyopathy; High Pressure; No Thyroid
Allergies: Cephalosporin; MACROBID; Clindamycin.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: High fever, intense head pain, (sensation of pounding in head) tiredness, enlarged neck nodules.


VAERS ID: 1780460 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-23
Onset:2021-10-05
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Pregnancy test negative
SMQs:, Fertility 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: None
Current Illness: none
Preexisting Conditions: Asthma
Allergies: Shellfish
Diagnostic Lab Data: Negative urine HCG pregnancy test 10/11.
CDC Split Type:

Write-up: Amenorrhea as of due date 10/5 until present.


VAERS ID: 1780473 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-14
Onset:2021-10-05
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: fluticasone furoate disk inhaler, levothyroxine, phentermine, topiramate, tramadol, triamterine-hydrochlorothiazide
Current Illness:
Preexisting Conditions: chronic respiratory failure on home 2L, asthma, morbid obesity, OSA, hypertension, chronic lymphedema, migraine, depression, hypothyroidism
Allergies: Augmentin, morphine, green pepper
Diagnostic Lab Data: COVID status positive 10/5/21.
CDC Split Type:

Write-up: Patient received Janssen COVID vaccine on 3/14/21. On 10/5/21, patient admitted to our facility with acute on chronic hypoxic respiratory failure and COVID pneumonia (COVID positive). As of 10/12/21, patient is still admitted in med/surg unit on higih flow oxygen and dexamethasone. She already received tocilizumab.


VAERS ID: 1780475 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-26
Onset:2021-10-05
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Endotracheal intubation, Intensive care, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby aspirin, atorvastatin, metoprolol succinate, nitroglycerin SL tab PRN, telmisartan
Current Illness:
Preexisting Conditions: history of MI/TIA/CAD, hypertension, hyperlipidemia
Allergies: ACE Inhibitors
Diagnostic Lab Data: COVID status positive on 10/5/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 3/1/21 and 3/26/21. On 10/5/21, patient was admitted to our facility with acute hypoxic failure due to COVID pneumonia (COVID positive). Patient received tocilizumab (10/9), remdesivir (10/5-10/6), and dexamethasone (10/5-current). Patient transferred to CCU on 10/9 and intubated today (10/12).


VAERS ID: 1780618 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-10-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Respiratory tract congestion, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Atorvastin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tickley throat/ congestion


VAERS ID: 1780808 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-11
Onset:2021-10-05
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL EXTRA STRENGTH) 500 MG tablet albuterol (VENTOLIN HFA) 108 (90 BASE) MCG/ACT HFA inhaler atorvastatin (LIPITOR) 40 MG tablet B Complex Vitamins (B COMPLEX 1 PO) calcium, as calcium carbonate, (CALTRATE) 600 MG tablet
Current Illness: None known
Preexisting Conditions: Hypercholesteremia Chronic bilateral low back pain without sciatica Pes planus Osteoarthritis of hip Psoriasis Impaired fasting glucose Fracture, finger, middle right hand, base of the proximal phalanx Essential hypertension Allergic rhinitis Primary osteoarthritis of both hips Low testosterone Bipolar depression Polyp of transverse colon Wasp sting-induced anaphylaxis, undetermined intent, sequela Spondylosis of cervical region without myelopathy or radiculopathy Hypersomnia Erectile dysfunction, unspecified erectile dysfunction type Moderate persistent asthma with acute exacerbation Prostate cancer metastatic to bone History of supraventricular tachycardia
Allergies: None known
Diagnostic Lab Data: COVID-19 test positive on 10/5/2021 and patient reported positive on 9/14/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 10/1/2021 for worsening shortness of breath. He was found to be COVID-19 positive on 9/14/2021 during a vacation where he was hospitalized and treated with remidesivir. He was discharged on home oxygen and returned home. His symptoms worsened and he presented to hospital and was admitted for further management. He was found to be positive on PCR test on 10/5/2021 for COVID-19. Patient''s condition improved and was discharged home on 10/9/2021.


VAERS ID: 1782205 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3592 / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Chills, Diarrhoea, Faeces discoloured, Feeling cold, Headache, Impaired work ability, Insomnia, Mobility decreased, Myalgia, Neck pain, Pain, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid 19 dose 1. Extreme fatigue, chest pains, hemorrhoids and change of menstrual cycle. 36 Pfizer
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Around 7pm my stomach was hurting and I had diarrhea. There was a greenish yellowish liquid coming out after there was no more stool to pass. Around 11pm my body started aching and I was feeling cold and had chills. My head started pounding from the front to back of my head. I was unable to lift my right arm up. Around 12:45am 10/6/21 I had a fever of 101.2. My muscles in my back and neck and lower legs got painful. I was shaking the entire night and was unable to rest. I took an advil and was able to fall asleep around 4 in the morning. I attempted to work and clocked in that morning but the body pain made it unbearable. I contacted my jobs clinic to report the adverse symptoms. My job instructed me to take off and rest. I am currently experiencing pain in my neck, upper back and back of the head that will not go away. I am currently seeking a specialist.


VAERS ID: 1782273 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Insomnia, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: About 3 hours after I received the shot, I started having pain deep in my left armpit. Pain in armpit became worse as the night progressed, making it very difficult to sleep on left side. The next day I awoke with continued pain in my armpit and with swelling present in my armpit. 2 days post shot, deep armpit pain remained and swelling became worse. It is now 8 days post shot, swelling remains but at about 25% of what it was. Pain in armpit is still present but could be defined as slight. Ibuprofen had decent effect on armpit pain but did not decrease swelling.


VAERS ID: 1782287 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest pain, Chills, Discomfort, Dizziness, Dizziness postural, Feeling abnormal, Feeling cold, Hyperhidrosis, Limb discomfort, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: At 11pm, 10/5/21 I woke up uncomfortable, achy and feeling cold and continued to progress throughout the night. By 5am 10/6/21, I woke up with severe chest and back pain, sweats and chills. When I stood up, I began to feel dizzy and light headed. I took 600mg of Motrin shortly after and symptoms started to subside after about 30-40mins. The morning of 10/6/21, I started having tingling sensations in my neck, upper to mid back, left tricep, left forearm and left hand. Tingling was intermittent throughout the day, along with Brain Fog. These symptoms lasted a few days and started to subside by Saturday 10/9/21, lingering symptoms only in left leg and foot and Brain Fog. Symptoms in left leg and foot continued until Monday 10/11/21, nearly 100% gone, still lingering discomfort in left big toe. Contacted Primary Care Physician on 10/11/21 to discuss these symptoms at 7:17pm. Dr. recommended to keep an eye on symptoms and to contact back if symptoms re-present themselves or worsen. As of 10/12/21, symptoms seem to be improving, continued feeling of brain fog and left foot/toe discomfort.


VAERS ID: 1782349 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-14
Onset:2021-10-05
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207AZIA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Cardiac telemetry, Chest X-ray, Computerised tomogram, Contusion, Dizziness, Electrocardiogram, Facial paralysis, Laboratory test, Magnetic resonance imaging, Pain in extremity, Vertigo
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hearing impairment (broad), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cymbalta 20mg/day Vit C Vit B12 Vit D3 turmeric
Current Illness: none
Preexisting Conditions: osteo arthritis and migraine
Allergies: Latex, bananas. penG, Keflex, Erythamycin, Sulfa ,codeine
Diagnostic Lab Data: Oct 6 ER visit labs and CT scan Oct 11-12 hospitalized labs, CT, MRI, chest xray, EKG, tele monitoring
CDC Split Type:

Write-up: initial bruising and sore arm. 7 weeks later vertigo and then bells palsy chronic dizziness and left sided facial paralysis


VAERS ID: 1782375 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-17
Onset:2021-10-05
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anxiety, Blood creatine increased, Blood gases abnormal, Blood potassium increased, COVID-19, COVID-19 pneumonia, Condition aggravated, Dyspnoea, Endotracheal intubation, Fibrin D dimer increased, Headache, Intensive care, Laboratory test, Malaise, Positive airway pressure therapy, Respiratory distress, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Pneumonia Due To COVID-19 Chronic Obstructive Pulmonary Disease Exacerbation (HCC) Cachexia (HCC) Pneumonia C
Allergies: NKA
Diagnostic Lab Data: 10/6 home covid test positive 10/9 EXT SARS Coronavirus-2, PCR POSITIVE
CDC Split Type:

Write-up: Briefly, Patient is a 79 y.o. male vaccinated current smoker with a 60 pack year history of tobacco use who is admitted with acute hypoxemic respiratory failure secondary to COVID-19 pneumonia. His past medical history is notable for COPD, CAD, CKD Stage 3, prostate cancer, brain aneurysm s/p coiling, hypertension, depression and anxiety. He initially developed symptoms consisting of headache, shortness of breath and malaise on 10/5/21. Home COVID test was positive on 10/6. He presented to the ED on 10/9/21 with dyspnea and had oxygen saturations in mid 90s on room air. COVID-19 test was positive and he was started on prednisone 40mg daily and azithromycin. Home bronchodilators were continued. On 10/10/21, he re-presented to the ED with anxiety and was prescribed lorazepam. Oxygen saturations at that time were $g95% on room air. Today, he re-presented to the ED with respiratory distress with respiratory rates in the 60s and oxygen saturations 80% on room air and was initially placed on BIPAP. Labs notable for D dimer 5400, ABG 7.19/50/86, WBC 20, K 5.8, Cr 2.3. He continued to have increased work of breathing. Goals of care discussions were had with patient and wife and they requested preference to be full code and he was intubated by anesthesia. He received 1L NS, dexamethasone 20mg, ceftriaxone 2g, fentanyl, versed and rocuronium. BP 126/90 following intubation and oxygen saturations were 100% on FiO2 100%. He was transported to hospital via air. On arrival to the Hospital, he is intubated, normotensive with oxygen saturations 100% on FiO2 1.0 and we have been able to wean FiO2 to 0.35. Additional information for Item 12: Hospital Pneumonia Due To COVID-19 Chronic Obstructive Pulmonary Disease Exacerbation (HCC) Cachexia (HCC) Pneumonia Community Acquired Tremor Hyperreflexia Depression Anxiety


VAERS ID: 1782570 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-06
Onset:2021-10-05
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1782582 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dysphagia, Mouth swelling, Pain, Pyrexia, Speech disorder, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, achiness, swelling of the mouth and neck, unable to swallow and talk properly, was prescribed antibiotics for 3 days.


VAERS ID: 1782608 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Headache, Hypertension, Ultrasound Doppler, Visual field defect
SMQs:, Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Hypertension (narrow), Optic nerve disorders (broad), Retinal disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Had chills, fever, and vertigo after Pfizer COVID dose #2
Other Medications: Trikafta, concerta
Current Illness:
Preexisting Conditions: Cystic fibrosis, history of Reversible Cerebral Vasoconstriction Syndrome after C-section delivery in 2010, 2015
Allergies: Sulfa
Diagnostic Lab Data: Transcranial doppler, 10/6/21 MRI scheduled 10/20/21
CDC Split Type:

Write-up: 18 hours after 3rd dose of Pfizer vaccine, developed visual field loss lasting 30 minutes, followed by headache and hypertension. This was a recurrence of symptoms experienced postpartum as part of reversible cerebral vasoconstriction syndrome (RCVS). Was evaluated by neurology the next day and abnormal transcranial doppler testing results were obtained. Symptoms have almost completely resolved as of this report filed 9 days after dose.


VAERS ID: 1782723 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BUD 1730 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Pruritus, Throat irritation, Tryptase, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Itching on her trunk and arms, itchy throat, had chest pain and dyspnea. Reports she was wheezing 10/7/21 and used her daughter''s inhaler.


VAERS ID: 1782756 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-29
Onset:2021-10-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Culture, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, liothyroninr, rosuvastatin, Preservision AREDS2, CoQ10, Vitamin D, Emergen-C, chia seeds
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Penicillin, sulfa,cashews, mangoes, poison ivy
Diagnostic Lab Data: Culture of blister contents
CDC Split Type:

Write-up: Swollen, itchy inflamed feet an d hands. Severe blisters on right foot, less so on left foot and hands


VAERS ID: 1782847 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-30
Onset:2021-10-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Condition aggravated, Injection site erythema, Injection site pruritus, Neuropathy peripheral, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Neuropatia
Other Medications: metoprolol tartrate 25 mg, vitamin C
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: penicillin, aspirin, Decadron, Fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: The second dose of Pfizer vaccine was place in my right arm September 30, October 1st Arm area turned reddish and itchy, and on day 5 I started with pain in my feet ,burning , stinging, burning, and pain in my hands. I called my doctor and he told me that it was Neuropathy, and he sent me to take Generic Neurontin.


VAERS ID: 1783171 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Chest discomfort, Disturbance in attention, Feeling abnormal, Feeling hot, Hypoaesthesia, Hypoaesthesia oral, Nausea, Palpitations, Rash, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: hives, rashes, nausea, entire body dumb, body gets hot, daily outbreak of hives, tightness in chess, heart pounding, numbness around mouth, difficulty focusing, not feeling like myself


VAERS ID: 1784837 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-14
Onset:2021-10-05
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: My period started and it was abnormally heavy compared to how it has been most of my life. The blood no longer was clotted and I was saturating my pants after about an hour of changing my cup. It was very strange to have this happen and my body change after having my vaccine.


VAERS ID: 1784908 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pharyngeal swelling, Sinusitis, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amour thyroid, cytomel, benadryl, vit d, vit c, epi pen
Current Illness: none
Preexisting Conditions: Hypothyroid, IBS, Immunsuppression, kidney stones, migraine headache with aura
Allergies: latex, avocado, banana, PCN, Erythromycin, Clindamycin, Vancomycin, Gentamycin, Tobramycin, Sulfa, Mold, Pollen, Oak, Pine, cats
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling of throat, nasal passages, and tongue within 10 minutes of dose administration benadryl and steroids given


VAERS ID: 1785018 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-10-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: breakthrough COVID-19 case


VAERS ID: 1785019 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH D8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac discomfort, Chest discomfort
SMQs:, Anaphylactic reaction (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: Chest discomfort/pressure around the heart area began within 24 hours of the injection and has persisted through day 10 post injection.


VAERS ID: 1785080 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-10-05
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: breakthrough COVID-19 case


VAERS ID: 1785148 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-10-05
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Back pain, COVID-19, Coronavirus test positive, Faeces discoloured, Neck pain, Oesophagogastroduodenoscopy abnormal, Varices oesophageal
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific inflammation (broad), Arthritis (broad), Noninfectious diarrhoea (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Hemorrhage Gastrointestinal Non-Hospital Aftercare Feeding Tube Long Term Use Of Insulin Active Diabe Additional information for Item 12: Hospital: Hemorrhage Gastrointestinal Non-Hospital Aftercare Feeding Tube Long Term Use Of Insulin Active Diabetes Mellitus Type 2 Hemochromatosis Hereditary Weakness General Chronic Diastolic (Congestive) Heart Failure Osteoporosis History Of Falling Diabetes Mellitus Type 2 Hyperglycemia Hypertension Portal Thrombocytopenia Primary Malnutrition Moderate Protein-Calorie Long Term (Current) Anticoagulant Treatment Heart Failure NOS Pancreatic Cancer (Primary) NOS Depression Anxiety Cerebral Hemorrhage Hypertension Essential Primary Ascites Chronic Other Cirrhosis Of Liver Failure Liver Adjustment Disorder Mixed Reaction Anemia Cancer Pancreas Primary Personal History Bacteremia Bloodstream Infection Due To Central Venous Catheter Initial Infection Urinary Tract Hyperglycemia Postpancreatectomy Hyperglycemia Tachycardia Supraventricular Tumor Posterior Fossa Intracranial Hypotension Secondary Malignant Neoplasm Of Lung Laterality Unknown Hyperkalemia Failure Renal Acute (Acute Kidney Injury) Vancomycin Resistant Enterococcus Colonization Abdominal Pain Colitis Infection Urinary Tract Acute Rotator Cuff Disorder Left Polyp Colon Adenomatous Personal History Positive Cologuard Stool Deoxyribonucleic Acid Test Swelling Leg Ulcer Gastric Acute With Perforation Wound Abdominal Wall Open Subsequent Herniorrhaphy Ventral Status Post Home Enteral Nutrition Atrial Fibrillation Obesity Body Mass Index 30-39.9 Adult Hypermagnesemia Hypoalbuminemia Acute Respiratory Failure With Hypercapnia Hepatic Encephalopathy With Coma Peritonitis Spontaneous Bacterial Embolus Pulmonary Personal History Thrombosis Deep Vein Personal History Hyponatremia Inferior Vena Cava Filter Secondary Esophageal Varices Without Bleeding Pain Low Back Chronic Issue Renewal Prescription Hypertensive Chronic Kidney Disease (CKD) Stage 3a Glomerular Filtration Rate (GFR) 45 To 59
Allergies:
Diagnostic Lab Data: 10/5/2021 Coronavirus 2 PCR Detect, V Asymptomatic DETECTED
CDC Split Type:

Write-up: CHIEF COMPLAINT/REASON FOR VISIT Weakness - Generalized HISTORY OF PRESENT ILLNESS Patient is a 74 y.o. female presents with generalized weakness. Patient describes that she has been feeling generally weak for the past week which is been associated with COVID. Patient also describes that for the past 3 weeks she has been having intermittent black stools. Last 1 that was abnormal was last night. She describes that today her stools were almost back to normal. Chronic back and neck pain which are unchanged. No abdominal or chest pain. No difficulty breathing. No pain with urination. No fevers or chills. No nausea or vomiting. EGD 07/17/2019 showed grade 1 varices in the lower 3rd of the Additional information for Item 18: CHIEF COMPLAINT/REASON FOR VISIT Weakness - Generalized HISTORY OF PRESENT ILLNESS Patient is a 74 y.o. female presents with generalized weakness. Patient describes that she has been feeling generally weak for the past week which is been associated with COVID. Patient also describes that for the past 3 weeks she has been having intermittent black stools. Last 1 that was abnormal was last night. She describes that today her stools were almost back to normal. Chronic back and neck pain which are unchanged. No abdominal or chest pain. No difficulty breathing. No pain with urination. No fevers or chills. No nausea or vomiting. EGD 07/17/2019 showed grade 1 varices in the lower 3rd of the esophagus. PMH includes insulin-dependent diabetes, general weakness, CHF, portal hypertension, malnutrition, heart failure, pancreatic cancer with Whipple procedure, cerebral hemorrhage, ascites, cirrhosis, bacteremia, colitis, AFib, PE on Eliquis, gastric ulcer, AFib, IVC filter, soft feel varices, COVID.


VAERS ID: 1785278 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-10-05
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: On 10/11/2021- PCR positive Covid test
CDC Split Type:

Write-up: Patient tested positive for COVID $g 14 days after completion of Pfizer vaccine series


VAERS ID: 1785545 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-06
Onset:2021-10-05
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Patient seen at Clinic 10 days after administration of Moderna vaccine. Vaccine given at pharmacy and as per patient symptoms of SOB/Chest discomfort started 2 to 3 days after second dose of vaccine 10/5/2021 and has not improved. Patient was instructed to follow up at Emergency room for re-evaluation of her symptoms.


VAERS ID: 1785546 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Fatigue, Pain in extremity, Pyrexia, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: Type 1 diabetes
Allergies: None.
Diagnostic Lab Data: Rapid Test - POSITIVE PCR - NEGATIVE
CDC Split Type:

Write-up: 10 hours after receiving shot - low grade fever, sore arm, extreme fatigue, no smell or taste.


VAERS ID: 1785570 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diplopia, Fatigue
SMQs:, Ocular motility disorders (broad), Hypoglycaemia (broad)

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

Write-up: Double vision, fatigue.


VAERS ID: 1785614 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Nasopharyngitis, 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: Covid PCR - positive on 10/13/21
CDC Split Type:

Write-up: Cold symptoms


VAERS ID: 1785653 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Inflammation, Lymphadenopathy, Mammogram normal, Pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Covid vaccine 1st dose causing arm pain, and rash, and Vaccine 2nd lymph node swelling.
Other Medications: l-thyroxine 25mcg tablets, proproninal 10mg tablets half morning and half at night, nascobal spray due to vitamin b-12 deficient, 50,000 unit vitamin D capsule, atorvastatin 10mg once daily, alprazolam 0.125 mg when unable to sleep,
Current Illness: dysautonomia POTS hx for 14 years
Preexisting Conditions: dysautonomia POTS hx for 14 years, I cannot take blood thinners due to significant bleed prior. Stopped getting cycle in July due to being taken off of birth control in June
Allergies: N/a
Diagnostic Lab Data: Mamogram due to lymph node swelling after second vaccine no malignancy.
CDC Split Type: vsafe

Write-up: 1/7/2021 Moderna lot 012L20A 2/5/2021 Moderna Lot 007M20A 10/05/2021 Moderna Lot 022C21A Arm cream: fluocinonide cream USP 0.1% after receiving rash on arm site, 46% inflammation due to immune system response. Immediately after an hour severe headache and, fever, sore arm. Could not get fever down below 101 for three days. Took Tylenol and liquid iv to combat fever and dehydration.


VAERS ID: 1785692 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

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

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

Write-up: Patient fainted shortly after 2nd pfizer dose and was unresponsive for a period of about 10-15 minutes, 911 was called, cold compress applied to back of neck, patient laid onto ground, BP was monitoring by vaccine administering nurse and reported as 98/58 and 98/52 for the 2 readings. EMTs arrived about 15mins later, by which time patient had just become responsive and was sitting upright, EMT performed their own evaluation/assessment of patient and was cleared by them, she sat in pharmacy waiting room for additional 15 minutes prior to leaving pharmacy.


VAERS ID: 1785720 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-28
Onset:2021-10-05
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: cefzil
Diagnostic Lab Data: none
CDC Split Type:

Write-up: left sided tingling of arm and leg


VAERS ID: 1785760 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, 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:

Write-up: Patient was administered vaccination on 10/01/21 at 230 PM; she reported that her arm was sore on 10/5. No further information of adverse events, treatments or negative outcomes have been reported since.


VAERS ID: 1785933 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Rash, Rash maculo-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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Parkinson''s disease Multinodal goiter HTN RLS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: developed macular papular rash over his left leg that is non-blanching extensive, mildly itchy


VAERS ID: 1785949 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: PMH: Neurofibromatosis, type 1
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received second dose of Moderna and was instructed to be monitored for 30mins by provider. Within 20mins, pt c/o dizziness. VSS. Pt waited an additional 10mins. Pt was stable and stated that they felt ok at the end of the intended observation time. Pt stable and released from the vaccination site. Medications: unknown to this writer PMH: Neurofibromatosis, type 1 Allergies: none


VAERS ID: 1786352 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-17
Onset:2021-10-05
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: Numerous
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: I got the first Covid shot and got tinnitus approximately 2 1/2 after. I?ve never had any issues with tinnitus.


VAERS ID: 1786566 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / SYR

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

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

Write-up: I start to notice the next day after the shot my arm swelled. Now the following week, my menstrual is late when the month prior and before they were on time.


VAERS ID: 1773227 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-05
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: KRJNJFOC20211014738

Write-up: DIZZINESS; VOMITING; MUSCLE PAIN; HEADACHE; This spontaneous report received from a health care professional via a Regulatory Authority concerned a 5 decade old female. 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, intramuscular, batch number: 212A21A and expiry: 21-DEC-2021) dose was not reported, frequency 1 total, administered on 29-SEP-2021 to deltoid for an unspecified indication. No concomitant medications were reported. On 05-OCT-2021, the patient experienced dizziness, vomiting, muscle pain and headache and was hospitalized (date unspecified) and inpatient treatment was administered. The number of days hospitalized was not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vomiting, muscle pain, dizziness and headache was not reported. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20211014738-Covid-19 vaccine ad26.cov2.s -Dizziness. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). V0: 20211014738-Covid-19 vaccine ad26.cov2.s -Vomiting, Muscle pain, Headache . This event(s) is labeled per regulatory authority and is therefore considered potentially related.


VAERS ID: 1780602 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8222 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Anaphylactic reaction, Chest discomfort, Dizziness, Dyspnoea, Inappropriate schedule of product administration, Oropharyngeal pain, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Medication errors (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20201119; Test Name: COVID-19 virus test; Test Result: Negative ; Comments: No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC202101334708

Write-up: dizziness; chest tightness; sore throat; abdominal pain; SOB; Anaphylaxis; Inappropriate schedule of vaccine administered; This is a spontaneous report from a contactable pharmacist received from the regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202110060934125840-2KQA0. Safety Report Unique Identifier GB-MHRA-ADR 26042328. A 17-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on 05Oct2021 at the age of 17-years-old (Lot Number: FF8222) as dose 2, single for COVID-19 immunisation. Concomitant therapy was none. Patient has not had symptoms associated with COVID-19. Patient is not pregnant. Patient is not currently breastfeeding. Patient is not enrolled in clinical trial. The patient previously received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 on 19May2021 for COVID-19 immunisation. The patient has no medical history and concomitant medications. The patient experienced dizziness (hospitalization, life threatening) on an unspecified date with outcome of not recovered, chest tightness (hospitalization, life threatening) on an unspecified date with outcome of not recovered, sore throat (hospitalization, life threatening) on an unspecified date with outcome of not recovered, abdominal pain (hospitalization, life threatening) on an unspecified date with outcome of not recovered, anaphylaxis (hospitalization, life threatening) on 05Oct2021 with outcome of recovering, sob (hospitalization, life threatening) on an unspecified date with outcome of unknown, inappropriate schedule of vaccine administered on 05Oct2021 with outcome of unknown. The patient underwent lab tests and procedures which included COVID-19 virus test: negative on 19Nov2020, No - Negative COVID-19 test. Patient has not tested positive for COVID-19 since having the vaccine. Therapeutic measures were taken as a result of dizziness, chest tightness, sore throat, abdominal pain, anaphylaxis, sob includes 2 doses of adrenaline 500mcg given - 15:30 and 16:20, Taken via ambulance to acute hospital, given stat dose of hydrocortisone 100mg IV, remained on emergency assessment unit overnight for observation. Discharged with 3 days of oral steroids 06Oct2021. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1757645 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-13
Onset:2021-10-04
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / SYR

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

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

Write-up: No issue until 3 weeks later. Sudden pain in chest. Hurts if any pressure is applied. Worse when lay down or take deep breaths. Seems to be worse right behind sternum.


VAERS ID: 1757880 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Cold sweat, Dizziness, Dysstasia, Feeling cold, Headache, Pain
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: 1:00am headache body and joint pain dizziness cold and clammy temperature 100.2 weakness unable to stand.


VAERS ID: 1757919 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Feeling hot, Hot flush, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta 30mg qd Atenolol 25 mg qd
Current Illness: Fibromalgya
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath, hot flashes, feeling hot from the inside, having to breath fast, tired, sleepy


VAERS ID: 1758573 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-11
Onset:2021-10-04
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Lisinopril, Multivitamin, Keppra
Current Illness: N/A
Preexisting Conditions: Seizures
Allergies: NKA
Diagnostic Lab Data: Positive COVID-19 RT-PCR Test
CDC Split Type:

Write-up: Positive COVID-19 when fully vaccinated


VAERS ID: 1758575 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Migraine Hearing loss hip pain bilateral knee pain hypertension GERD Sleep apnea Fibromyalgia neuropathy
Allergies: Shellfish, peanuts
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt had received two Moderna vaccines and I gave the pt Pfizer vaccine as a booster. Pt did not have any adverse events at the time.


VAERS ID: 1758578 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness:
Preexisting Conditions: n/a
Allergies: seasonal allergies
Diagnostic Lab Data: 11:11am: hr:78, r 17, bp 120/80/ sat 99%.
CDC Split Type:

Write-up: Within ten minutes of receiving first dose of pfizer patient reported itchiness of both arms and spread to neck.


VAERS ID: 1758613 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Needle was not properly connected to syringe, which resulted in some leakage from the injection site. More than half was administered to the patient.


VAERS ID: 1758617 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

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

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

Write-up: The patient got the Moderna vaccine on 9/11/2021. She got J&J vaccine today from our office. She did not report she got the Moderna before got the J&J. We found it from system. Per the patient, she had adverse reactions from the Moderna and she did not want to get the Moderna 2nd dose. However, her workplace required COVID 19 vaccine. That''s why she got J&J today per patient.


VAERS ID: 1758627 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, 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: empagliflozin (JARDIANCE) 10 MG tablet Take 1 tablet by mouth daily (before breakfast). nitrofurantoin, macrocrystal-monohydrate, (MACROBID) 100 MG capsule Take 1 capsule by mouth 2 times daily for 10 days. AMIODarone (PACERONE) 200 MG tabl
Current Illness: none
Preexisting Conditions: Coronary atherosclerosis of unspecified type of vessel, native or graft Essential hypertension, benign Hyperlipidemia Status post abdominal aortic aneurysm repair PVD (peripheral vascular disease) (CMS/HCC) Atrial fibrillation with RVR (CMS/HCC) Wide-complex tachycardia (CMS/HCC) Endocrine and Metabolic Type II or unspecified type diabetes mellitus without mention of complication, not stated as uncontrolled Eye Exophthalmos Myopia Old retinal detachment, partial Presbyopia Genitourinary and Reproductive Elevated PSA Impotence of organic origin
Allergies: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient recieved 1.3ml pfizer vaccine instead of the 0.3ml thus far patient has not had any adverse reaction to the increased dose given


VAERS ID: 1758633 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-26
Onset:2021-10-04
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Public       Purchased by: ?
Symptoms: Blindness, Imaging procedure, Retinal artery occlusion
SMQs:, Embolic and thrombotic events, arterial (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol
Current Illness: Asthma Centronuclear Myopathy
Preexisting Conditions: Asthma Centronuclear myopathy
Allergies: NKDA
Diagnostic Lab Data: Ophthalmology Consultations, Imaging
CDC Split Type:

Write-up: Acute eye stroke - loss of vision


VAERS ID: 1758649 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Ear discomfort, Mouth swelling, Pharyngeal swelling, Throat clearing, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levonorgestrel Ulipristal Ibuprofen Cyclobenzaprine
Current Illness: none indicated by pt
Preexisting Conditions: endometriosis scoliosis
Allergies: Ceftriaxone Dilaudid Naproxen Shell fish per pt
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt reported that "within 5 seconds" of receiving her 1st Pfizer (30155BA) vaccine she developed "itching to my throat" but denied any swelling to her mouth or throat. Pt ambulated with very steady gait to monitoring area and continued to speak full and clear sentences. Within 3 minutes of monitoring, pt began having persistent clearing of her throat and coughing", pt also indicated that she was having a burning sensation to her bilateral ears. Call out to ER MD and verbal orders obtained for Cetirizine 10mg po now. Pt was medicated and tolerated very well. Approximately 10 minutes post medication, pt reported "feeling much better" with her itching and burning decreasing. Lung sounds remained clear to auscultation bilaterally. Pt was -stridor or wheezing. No rash or swelling noted on physical exam. She remained calm and very cooperative. Within 30 minutes of monitoring pt, her symptoms continued to get better, minimizing to a 2-3/10 from initially a 6/10 itching to her throat. She was speaking full and very clear sentences with no other complaints upon discharge.


VAERS ID: 1758669 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness transient, Gastrointestinal disorder, Hyperhidrosis, Skin warm
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient reported that he could not see five minutes after administration of second dose of Moderna. Upon examination, patient was profusely sweating, warm to the touch and hunched over grabbing his stomach. He was conscious but could not communicate to me what he felt. I administered 25mg (10ml) of Benadryl 12.5mg/5ml and applied a cold compress to the neck. Paramedics arrived and transported the patient.


VAERS ID: 1758688 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 292R2 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxicillin (10th day) Fluconazole EpiPen 2-Pk
Current Illness: Strep throat and yeast infection
Preexisting Conditions: None
Allergies: tree nuts and peanuts
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient present with mother for second dose of covid pfizer vaccine. Patient has allergies to peanuts and tree nuts - was waiting 30 minutes. Vaccine administered at 1054. At 1115 patient called RN over to bedside for itchiness and hives developing on chest. Denies difficulty breathing at this time. Dr. called to bedside and put orders for 5ml of benadryl. 1120 Benadryl administered. Mother decided to stay additional 10 minutes for observation. 1127 patient stated she was having minimal difficulty swallowing her saliva. Denied difficulty breathing at this time. Vital signs were taken with continuous o2 sats. Dr. notified and additional orders placed. Benadryl 37.5mg (15ml) given to patient. Dr. prescribed prednisone 60mg at 1211. Patient took medication in office and observed for 30 additional minutes.


VAERS ID: 1758721 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-02
Onset:2021-10-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Limb mass, Neck mass
SMQs:

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

Write-up: Lump on neck and shoulder.


VAERS ID: 1758748 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chills, Dizziness, Dysgeusia, Feeling cold, Feeling hot, Flank pain, Hypoaesthesia, Limb discomfort, Mobility decreased, Muscle contracture, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No known medications.
Current Illness: No known illnesses noted.
Preexisting Conditions: No known chronic conditions.
Allergies: Allergy to pollen.
Diagnostic Lab Data: No known medical tests or laboratory results.
CDC Split Type:

Write-up: Patient first stated that he felt dizzy around 11:40AM and was moved to the floor to lay down. Vital signs were initiated. Patient stated feeling "tightening" in his chest and both upper extremities and was experiencing contractions and unable to move his fingers. The patient stated feeling numbness and tingling in his left fingers and feet. Patient stated feeling hot when experiencing numbness and tingling. Patient stated tasting metal on his tongue. Patient stated feeling sharp pain in his left flank area. Patient turned to his side and started shivering and stated feeling cold and having chills. Patient reported improvement in mobility in lower extremities and left hand. EMS was called at 11:47AM and arrived onsite 25 minutes later. Assessment was initiated and patient was taken to the nearest hospital. Patient left the vaccine site at 12:18PM via EMS.


VAERS ID: 1758754 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

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

Write-up: Patient states " it feels a little itchy where I got my shot" approximately 15 minutes after immunization. Denies any adverse effects after first 2 doses. Site and surrounding skin assessed and no redness, no swelling, and no rashes noted. Denies any shortness of breath, difficulty breathing, chest pain/palpitations, difficulty swallowing, throat irriatation, dizziness, or nausea. Patient remained in clinic for an additional 15 minutes and site reassessed prior to patient leaving clinic with no redness, rash, or swelling noted. No rashes, swelling, or redness noted to other visible parts of skin. Patient states that itching has resolved prior to discharge from clinic. Discussed with patient should she develop any shortness of breath, difficulty breathing, difficulty swallowing, swelling of tongue/throat, chest pain, or dizziness to call 911 as this may indicate a severe allergic reaction requiring immediate medical attention. Patient alert and oriented x 4 and ambulatory with steady gait when leaving clinic.


VAERS ID: 1758756 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect product formulation administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type: 23A

Write-up: Client seen for COVID-19 Pfizer vaccine, RN inadvertently gave Janssen & Janssen and not 3rd booster of Pfizer COVID-19 vaccine. Client had no adverse reaction or signs/symptoms of adverse reaction.


VAERS ID: 1758793 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Eructation, Rash, Rash erythematous, Rash pruritic, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), 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 (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:
Preexisting Conditions:
Allergies: pneumovax, thimerosol, sucralfate
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 minutes after vaccination the patient started to get a red itchy rash on forearm of the arm that it was administered. She Took 50mg of benadryl to treat the symptoms. Symptoms progressed into difficulty swallowing, belching, and vomitting. An ambulance was called for the patient''s further care.


VAERS ID: 1758803 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu Vaccine
Other Medications: Omeprazole 40 PRN Nortrel Goody powder PRN
Current Illness: No
Preexisting Conditions: NA
Allergies: Flu shot Augmentin Adhesive on bandaids Ortho-evra
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient was c/o menstrual bleeding at 11 am today 10/04/21. She did state she was having pain at the injection site at 3 am today--10/04/21


VAERS ID: 1758895 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 - / -

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

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

Write-up: Small bumps around the injection site, hives on chest and neck.


VAERS ID: 1758923 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-06
Onset:2021-10-04
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Dizziness, Electrocardiogram, Feeling hot, Hyperhidrosis, Immediate post-injection reaction, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: At the hospital, I did blood work, EKG, and Xray on chest/lungs.
CDC Split Type:

Write-up: Immediately after the shot, I sat down and became hot, sweaty and dizzy. After a few moments, I had a seizure in the waiting room of the pharmacy while sitting in the chair. Pharmacists and former EMT were in the vicinity to help immediately. I was then taken by ambulance to the hospital.


VAERS ID: 1758925 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-30
Onset:2021-10-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Fatigue, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: none
CDC Split Type:

Write-up: patient is having elevated BP readings (without history of BP issues), weakness (generalized), fatigue (severe) and nausea/vomiting.


VAERS ID: 1758990 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Fainted, pale, skin felt cold and clammy, patient reported nausea, BP was 107/73, pulseox: 98%, Pulse: 65 bpm. Patient given a lollipop, cookies, and water as well as an ice pack. Patient sat and rested for approximately 20 minutes after event after which he reported feeling much better and left.


VAERS ID: 1759022 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK - / IM

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

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

Write-up: Sweating, dizziness


VAERS ID: 1759023 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-05
Onset:2021-10-04
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

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

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

Write-up: positive for covid 10/4/2021


VAERS ID: 1759033 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent HFA, fluticasone propionate, ProAir HFA
Current Illness: none
Preexisting Conditions: Asthma
Allergies: Ibuprofen
Diagnostic Lab Data: Not medically necessary at this time.
CDC Split Type:

Write-up: Patient came in to receive COVID 19 vaccination. Grandmother asked for patient to receive Moderna, as that was the vaccine she received. After administration of the vaccine, it was realized that patient was not 18 years old.


VAERS ID: 1759034 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

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

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

Write-up: Third dose of Pfizer COVID vaccine given earlier than 6 months since second dose.


VAERS ID: 1759035 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-25
Onset:2021-10-04
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: positive for covid today


VAERS ID: 1759045 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-09
Onset:2021-10-04
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: positive for covid


VAERS ID: 1759050 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 4 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, 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: unknown
Current Illness: none known
Preexisting Conditions: Multiple Sclerosis
Allergies: Amantadine, Aspirin, Ibuprofen, Naproxen
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Covid third dose clinic for pfizer vaccine was held 10/4/2021 at Nursing Home for residents. Facility Director of Nursing took Public Health Nursing staff room to room to administer vaccine. Director of Nursing already had paper forms made out ahead of time. This resident had already had three doses of the covid vaccine and was inadvertently given a fourth dose today. This was not caught until entering the vaccines in the registry later in the day. No adverse effects reported at this time. Primary Care physician notified of incident.


VAERS ID: 1759057 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-24
Onset:2021-10-04
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: positive for covid


VAERS ID: 1759058 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-30
Onset:2021-10-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle spasms, Neck pain
SMQs:, Dystonia (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:

Write-up: The patient has extremely painful charley horse like pain in his neck, beginning this morning. He has tried to resolve the pain by taking a steam shower, taking ibuprofen, and drinking plenty of water. He has been alternating hot and cold, additionally.


VAERS ID: 1759067 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Wrong patient
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: Wrong Patient (documentation in EMR)-


VAERS ID: 1759072 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-10-04
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient received Pfizer vaccine with 1st dose on 01/20/2021 and 2nd dose on 02/12/2021. Covid + on 10/04/2021 and hospitalized Per ED Note: Patient is a pleasant 77year old male presented today to emergency department for evaluation of shortness of breath. He has been feeling this way for the past 2 days. He does admit to fevers and cough at home. He took Tylenol prior to coming in. Patient denies any chest pain, abdominal pain, vomiting, focal paresthesias or weakness, headache, change in bowel or bladder habits, dizziness, leg pain or edema or history of blood clots, or changes in medications. He denies any other modifying precipitating or relieving factors.


VAERS ID: 1759075 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / N/A RA / IM

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

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

Write-up: Patient had come in for second Moderna vaccine. Incorrectly administered Pfizer vaccine instead.


VAERS ID: 1759085 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Headache-Mild, Systemic: Weakness-Medium, Additional Details: pt mentioned that she do faint after vaccins usually. we called the mom she was nearby location (she came in 5 min). blood pressure was10.05/5.6. we made her lie flat. then she drink water and eat salty chips. she was all right after 15 min.


VAERS ID: 1759088 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered, 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: unknown
Current Illness: unknown
Preexisting Conditions: Patient Self-Attests to being immunocompromised.
Allergies: no known allergies
Diagnostic Lab Data: none currently
CDC Split Type: N/A

Write-up: None currently - Patient received moderna booster dose on 10/04/21 Intramuscularly in the Left Arm. Moderna Vaccine expired 10/03/21.


VAERS ID: 1759099 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt was administered Moderna instead of Pfizer. Pt was in with mother and both were receiving the vaccine. Mother received Moderna and pt was to receive Pfizer but given Moderna in error.


VAERS ID: 1759147 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-02
Onset:2021-10-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Headache, Injection site swelling, Neck pain, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Pain in calves, feet, quads, hamstrings, lower and upper back, neck and head ache. Swelling in the shot location.


VAERS ID: 1759167 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-02
Onset:2021-10-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Fatigue, Nausea, Pyrexia, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Nausea, vomiting, vertigo, cold sweat, fever, fatigue


VAERS ID: 1759210 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       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? 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: Swollen left axilla lymph node same side as vaccine


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