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

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



Case Details (Reverse Sorted by Onset Date)

This is page 350 out of 6,867

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VAERS ID: 1489554 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
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: USJNJFOC20210738696

Write-up: DOSE GIVEN POST EXPIRY TIME; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 16-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 16-JUL-2021, the subject experienced dose given post expiry time. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of dose given post expiry time was not reported. This report was non-serious.


VAERS ID: 1489563 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (once a week.); Cigarette smoker (1 pack-per-day.)
Preexisting Conditions: Comments: The patient had no known drug allergies, no history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210739077

Write-up: VERY TIRED; HEADACHE (ABOVE THE EYE); LIGHTHEADEDNESS/DIZZINESS; This spontaneous report received from a consumer concerned a 59 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included cigarette smoker, and alcohol use, and other pre-existing medical conditions included the patient had no known drug allergies, no history of drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A, and batch number: 207A21A expiry: UNKNOWN) dose was not reported, administered on 15-JUL-2021 17:30 for prophylactic vaccination. No concomitant medications were reported. On 16-JUL-2021, the subject experienced lightheadedness/dizziness. On 17-JUL-2021, the subject experienced very tired. On 17-JUL-2021, the subject experienced headache (above the eye). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from lightheadedness/dizziness, very tired, and headache (above the eye). This report was non-serious.


VAERS ID: 1489565 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Alabama  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Influenza like illness, Injection site pain, Myalgia, Nausea, Pain, Pruritus, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LIDOCAINE 5%
Current Illness: Alcohol use (Socially); Arthritis (Med hx arthritis neck shoulders lidocaine 5%); Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies. The patient had no history of drug abuse or illicit drug use. Takes muscle relaxer and med to lose weight
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210739226

Write-up: ITCHING ALL OVER, DEEP ITCH ON THE HANDS, FEET, STOMACH, HEAD, LEGS; FLU LIKE SYMPTOMS; HURTING ALL OVER/ACHY; MUSCLE ACHES; FEVER (DID NOT TAKE TEMP); NAUSEA; TIRED; SORENESS TO LEFT ARM INJECTION SITE; LIGHT HEADED; This spontaneous report received from a patient concerned a 46 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included arthritis neck shoulders, alcohol use, and non-smoker, and other pre-existing medical conditions included the patient had no known allergies. the patient had no history of drug abuse or illicit drug use. takes muscle relaxer and med to lose weight.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1820095 expiry: UNKNOWN) dose was not reported, administered on 16-JUL-2021 for prophylactic vaccination. Concomitant medications included lidocaine for arthritis. On 16-JUL-2021, the subject experienced light headed. On 16-JUL-2021, the subject experienced flu like symptoms. On 16-JUL-2021, the subject experienced hurting all over/achy. On 16-JUL-2021, the subject experienced muscle aches. On 16-JUL-2021, the subject experienced fever (did not take temp). On 16-JUL-2021, the subject experienced nausea. On 16-JUL-2021, the subject experienced tired. On 16-JUL-2021, the subject experienced soreness to left arm injection site. On 18-JUL-2021, the subject experienced itching all over, deep itch on the hands, feet, stomach, head, legs. Treatment medications (dates unspecified) included: diphenhydramine hydrochloride/zinc acetate. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from muscle aches, fever (did not take temp), nausea, tired, light headed, itching all over, deep itch on the hands, feet, stomach, head, legs, soreness to left arm injection site, flu like symptoms, and hurting all over/achy. This report was non-serious.


VAERS ID: 1489625 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / UNK LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: blacking out; sweating; falling out of chair; spinning; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (blacking out) in a 30-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 054C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 16-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Jul-2021, the patient experienced LOSS OF CONSCIOUSNESS (blacking out) (seriousness criterion medically significant), HYPERHIDROSIS (sweating), FALL (falling out of chair) and VERTIGO (spinning). At the time of the report, LOSS OF CONSCIOUSNESS (blacking out), HYPERHIDROSIS (sweating), FALL (falling out of chair) and VERTIGO (spinning) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. It was reported that patient took Tylenol 1 hour before she got vaccination. Concomitant product included Birth control medication. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. No treatment information was provided by the reporter.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1489628 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-20
Onset:2021-07-16
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acoustic stimulation tests, Chills, Deafness, Dysaesthesia, Gait disturbance, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, Pyrexia, Tinnitus, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hearing impairment (narrow), Tendinopathies and ligament disorders (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METFORMIN ER; RYBELSUS; ATORVASTATIN
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Hearing test; Result Unstructured Data: 40 to 50 % of hearing loss on left side and mentioned that his right ear is also affected as well but not to the great extent.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: 40 to 50 % of hearing loss on left side/his right ear is also affected as well but not to the great extent; numbness on toes of his right foot; difficulty moving his right leg to use break pedal while driving his car; right foot was not going on the ground during his walk; left ear started buzzing with hollow sound which gradually increased every week; feeling tickling; Pain in hand; Numbness on fingers; started feeling that skin bellow his eye and right side of his face was falling; fever; pain in his right arm; shivering; This spontaneous case was reported by a consumer and describes the occurrence of DEAFNESS (40 to 50 % of hearing loss on left side/his right ear is also affected as well but not to the great extent), HYPOAESTHESIA (numbness on toes of his right foot), MUSCULAR WEAKNESS (difficulty moving his right leg to use break pedal while driving his car) and GAIT DISTURBANCE (right foot was not going on the ground during his walk) in a 44-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was provided by the reporter. Concomitant products included METFORMIN HYDROCHLORIDE (METFORMIN ER), SEMAGLUTIDE (RYBELSUS) and ATORVASTATIN for an unknown indication. On 20-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 16-Jul-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced DYSAESTHESIA (started feeling that skin bellow his eye and right side of his face was falling). On an unknown date, the patient experienced DEAFNESS (40 to 50 % of hearing loss on left side/his right ear is also affected as well but not to the great extent) (seriousness criterion medically significant), MUSCULAR WEAKNESS (difficulty moving his right leg to use break pedal while driving his car) (seriousness criterion medically significant), PARAESTHESIA (feeling tickling), PAIN IN EXTREMITY (Pain in hand) and HYPOAESTHESIA (Numbness on fingers). an unknown date, the patient experienced HYPOAESTHESIA (numbness on toes of his right foot) (seriousness criterion medically significant) and GAIT DISTURBANCE (right foot was not going on the ground during his walk) (seriousness criterion medically significant). an unknown date, the patient experienced TINNITUS (left ear started buzzing with hollow sound which gradually increased every week). an unknown date, the patient experienced PYREXIA (fever), VACCINATION SITE PAIN (pain in his right arm) and CHILLS (shivering). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. At the time of the report, DEAFNESS (40 to 50 % of hearing loss on left side/his right ear is also affected as well but not to the great extent), HYPOAESTHESIA (numbness on toes of his right foot), MUSCULAR WEAKNESS (difficulty moving his right leg to use break pedal while driving his car), GAIT DISTURBANCE (right foot was not going on the ground during his walk), DYSAESTHESIA (started feeling that skin bellow his eye and right side of his face was falling), TINNITUS (left ear started buzzing with hollow sound which gradually increased every week), PARAESTHESIA (feeling tickling), PAIN IN EXTREMITY (Pain in hand) and HYPOAESTHESIA (Numbness on fingers) outcome was unknown and PYREXIA (fever), VACCINATION SITE PAIN (pain in his right arm) and CHILLS (shivering) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Acoustic stimulation tests: abnormal (abnormal) 40 to 50 % of hearing loss on left side and mentioned that his right ear is also affected as well but not to the great extent.. After 24 hours of the second dose patient developed shivering, fever and pain in his right arm which lasted for 2 to 3 days. Patient could not get out of bed and had to take Tylenol to treat the symptoms. After 5 days, patient started feeling normal. Patient stated that 1 week after the second dose, his left ear started buzzing with hollow sound which gradually increased every week. Patient was referred to ENT specialist by his primary care doctor. ENT doctor performed hearing test and diagnosed the patient with 40 to 50 % of hearing loss on left side and mentioned that his right ear is also affected as well but not to the great extent. Patient stated that After 10 days (on 26/27May2021), his right foot was not going on the ground during his walk and started feeling tickling, numbness on toes of his right foot. Patient mentioned that the numbness kept going upwards and towards under his knee. One or two weeks ago, patient was having difficulty moving his right leg to use break pedal while driving his car. Patient stated that he is walking, running on treadmill and doing yoga daily. Patient''s walking got a little better but he still has numbness in his toes. Patient was told to get ABR test done and might need MRI test. Two weeks back from today (16Jul2021), Patient started feeling that skin bellow his eye and right side of his face was falling. Patient confirmed that he is still feeling the same. Patient informed his doctor about the symptoms and he was referred to a neurologist. Patient has an appointment with neurologist on 04AUG2021. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) was not applicable. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1490026 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210716; Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210738685

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient concerned a 40 year old White and Not Hispanic or Latino 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, route of admin not reported, batch number: 043A21A, expiry: UNKNOWN) dose was not reported, 1 total, administered on 02-APR-2021 to left arm for prophylactic vaccination. No concomitant medications were reported. On 16-JUL-2021, the patient was tested positive for COVID-19 (suspected COVID-19 infection and suspected clinical vaccination failure). The patient was close to someone who had COVID-19 with mild symptoms of a runny nose and cough. The symptoms were mild and patient got tested because she had children at home. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from suspected COVID-19 infection, and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210738685-covid-19 vaccine ad26.cov2.s-suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1490093 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Oropharyngeal pain, Respiratory tract congestion, Sputum discoloured
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Degenerative disc disease
Allergies: Lortab
Diagnostic Lab Data: Have not seen doctor
CDC Split Type:

Write-up: Fri night- stomach pain diarrhea Saturday till present--very sore throat and chest congestion with yellow phlegm. NO FEVER, NO LOSS OF TASTE OR SMELL


VAERS ID: 1490332 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C2119 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Sensation of throat tightening a few minutes after administration. Could still breathe and Went away after about 20 minutes. Swelling and redness and pain at injection site for 3 days. No medications were given for reactions.


VAERS ID: 1490349 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

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


VAERS ID: 1490353 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Asthma, Cough, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: Armour thyroid Coreg Red Yeast Rice Aspirin Call/mag/zinc Fish oil Turmeric Vit. D Multi-vitamin
Current Illness: None
Preexisting Conditions: High Blood Pressure No Thyroid due to Thyroid Cancer
Allergies: Erythromycin Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderate anaphylaxis, sneezing, very runny nose, coughing, asthmatic episode


VAERS ID: 1490365 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

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


VAERS ID: 1490366 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Blood glucose increased, Blood urea decreased, Carbon dioxide decreased, Coagulation test normal, Coagulopathy, Deep vein thrombosis, Electrolyte imbalance, Haematocrit increased, Haemoglobin increased, Injury, Liver function test normal, Metabolic function test, Platelet count increased, Respiratory rate increased, Skin discolouration, Skin warm, Testicular pain, Ultrasound Doppler normal, Vaccination complication, White blood cell count normal
SMQs:, Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Alprazolam, fish oil
Current Illness: None
Preexisting Conditions: Anxiety, History of petit-mal seizures 2010, hyperlipidemia
Allergies: None
Diagnostic Lab Data: Ultrasound venous duplex upper left extremity. Result Date: 7/17/2021 History (imported from Epic field): Discoloration to fingertips, concern for possible DVT. Findings: Grayscale and Doppler imaging is performed to the left upper extremity deep venous system. No evidence of deep venous thrombosis is seen within the jugular, subclavian, axillary, brachial veins. 1. No evidence of deep venous thrombosis within the venous structures of the left upper extremity.
CDC Split Type:

Write-up: Patient presented to provider office visit 2 days after 2nd dose of Moderna vaccine with testicular pain for last 2 days, bluish color on tips of left fingers. Was prescribed levofloxacin x 7 days to cover for possible epididymitis and was told to monitor the finger discoloration and return to PCP next week for recheck. The following day (7/17), he presented to the Emergency Department for evaluation of the fingertip discoloration. He reported that the testicular pain had improved. ED provider noted: Fingertips on 2 or 3 fingers of a few small thin lines that are purplish in color almost as if discoloration of the fingerprint itself. But it is no more than 1 or 2 lines to 2 or 3 fingertips. There is no erythema no swelling no tenderness. There is no muscle soreness. No axillary lymphadenopathy. No ascending lymphangitis. ED Course Differential Dx: Adverse reaction to Covid vaccine, DVT, electrolyte imbalance, coagulopathy, electrolyte imbalance, localized trauma Lab normal white count hemoglobin platelet count mildly elevated hematocrit of 51.3. CMP showed a low CO2 22 I suspect this is due to prior elevated respiratory rate he does admit that he slightly anxious. Glucose was elevated 142 BUN was 6. Liver function studies normal. Coags normal Did do ultrasound of his arm since he recently was vaccinated there is no evidence of DVT or any occlusion. Patient''s fingers are warm he has intact sensation I am not sure if this is an adverse reaction to the recent vaccine, some sort of unknown localized trauma. I suggested patient follow-up closely with primary care for reeval this week if no improvement and return if any acute worsening symptoms or problems.


VAERS ID: 1490377 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

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


VAERS ID: 1490386 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

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


VAERS ID: 1490433 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-08
Onset:2021-07-16
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Nasal congestion, Rhinorrhoea
SMQs:, Taste and smell disorders (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Runny Nose,loss of smell,nasal congestion,loss of taste


VAERS ID: 1490466 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Patient vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490508 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490525 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

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

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

Write-up: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490550 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490575 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490591 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Alieve, Turmeric Curcumin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hand tremors for a few hours after receiving the vaccine. Lasted approximately 12 hours


VAERS ID: 1490620 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-09
Onset:2021-07-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: About one week after the second dose, I started to experience a persistent numbness throughout my left arm. It is a "pins and needles" like feeling, mostly occurring in the left hand. However, if I use my arm for strenuous activity or let it sit the wrong way, the numbness persists in my arm as well. Soft and light movements generally ease the feeling, however it is not fully going away.


VAERS ID: 1490683 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

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


VAERS ID: 1490705 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

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


VAERS ID: 1490712 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Acute respiratory failure, Bilevel positive airway pressure, Culture negative, Dyspnoea, Fluid overload, Haemodialysis, Nausea, Pneumonia, Pyrexia
SMQs:, Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg PO CHEW Take 1 Tab by Mouth Once a Day. b complex-vitamin c-folic acid (VIRT-CAPS) 1 mg PO CAPS Take 1 Cap by Mouth Once a Day. clopidogreL (PLAVIX) 75 mg PO TABS Take 1 Tab by Mouth Once a Day. dilTIAZem (DILT-XR) 120 mg PO C
Current Illness: Chest Pain Elevated Troponin Nausea SOB
Preexisting Conditions: Unstable angina ? Chronic diastolic CHF ? Essential hypertension ? Dyslipidemia ? Chronically Elevated troponin ? DM2 with CKD on chronic dialysis ? Anemia in CKD, on chronic dialysis ? CAD hx of CABG and PCI with stent ? PVD (peripheral vascular disease) ? ESRD on dialysis
Allergies: Allergies Allergen Reactions Atorvastatin muscle/joint pain Lisinopril cough Metformin gi distress
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 7/16 c/o nausea and SOB , sent to the ER and admitted to hospital with: Acute hypoxic respiratory failure due to fluid overload and pneumonia. He was placed on BIPAP, received urgent HD and broad spectrum empiric antibiotics. He weaned off of BIPAP to NC, fever resolved and cultures were negative. On 7/20/21 Pt discharged from hospital and returned to Rehabilitation Center


VAERS ID: 1490769 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Budesonide, Albuterol, Aspirin, Atorvastatin, Azelastine, Bumetanide, Ipratropium, isosorbide mononitrate, linzess, lorazapam, nystatin, Omeprazole, prochlorperazine, trelagy, zofran, prednisone
Current Illness: loose stools, indigestion, neuropathy
Preexisting Conditions: CAD, HTN, HLD, Severe COPD , HTN, GERD, Dysphagia HFrEF ( EF 63), T2DM, CKD stage 3, PAD, HX Nstemi
Allergies: Codeine Penicillin G
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB, Nausea Sent to the ER on 7/16 2021 and remains there


VAERS ID: 1490806 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

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


VAERS ID: 1490824 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

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

Write-up: Dizziness vertigo and nausea. Ongoing but impact has lessened in last 2 days. Stayed immobile for 36 hours Headaches on going. Take ibuprofen or acetaminophen.


VAERS ID: 1490844 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / UNK - / IM

Administered by: Work       Purchased by: ?
Symptoms: Face injury, Fall, Head injury, Mouth injury, Nasal injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient sustained syncopal episode following vaccination administration, falling and striking head on the floor. Injuries to mouth, nose and left side of the face. Neurologic and vital signs stable. Transported for further evaluation to the ED.


VAERS ID: 1490859 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-28
Onset:2021-07-16
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: SARS-CoV-2 RNA Resp Ql NAA+probe~SARS-CoV-2, qPCR performed on 7/18/21. Test came back positive. Case investigation interview completed as of this note. Documentation from case manager mentions case experienced starting 7/16/21 cough, muscle aches, fever and fatigue.


VAERS ID: 1490878 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

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

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

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


VAERS ID: 1490906 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

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


VAERS ID: 1490986 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Pyrexia, Thirst, Tremor
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Uncontrollable shaking and teeth chattering, extreme weakness, fever starting at approximately 9pm the night of the injection. Shaking stopped when fever started. Fever broke by about 11am the following day. Weak and tired for 4 days following vaccine. Very thirsty.


VAERS ID: 1491229 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-13
Onset:2021-07-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM

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

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

Write-up: Pt received the 1st dose of Moderna and developed severe onset of vertigo 3 days later along with chest pain and shortness of breath. Shortness of breath and chest pain resolved but vertigo persisted until improved 7/21/21. Follow up visit 7/21/21 with his PCP. Vertigo has gradually improved.


VAERS ID: 1491869 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-13
Onset:2021-07-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: Patient reports redness at injection site, discomfort, and warmth to the touch


VAERS ID: 1491876 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / -

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

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

Write-up: Dreams every time i fall asleep (Day or Night) Reoccurring mild headaches and light headedness which last for a few seconds at a time


VAERS ID: 1492087 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Breast feeding, Chills, Fatigue, Headache, Injection site pain, Musculoskeletal stiffness, Pyrexia, Sleep disorder, Tonsillar hypertrophy
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (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: norethindrone
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After I received the vaccine, I began to experience pain and tenderness at the injection site almost immediately. Later that night I began to feel extremely tired so I went to sleep but woke up with chills a few hours later. A short time later I noticed that my neck was stiff and my tonsils began to swell a little. I also developed a slight fever of 100.6 and had headaches throughout the day. I called my doctor and asked if I could come in and if it is okay for me to continue breastfeeding my 5 month old. I was told that if my symptoms persisted or got worse, then I should come in but that I should take Tylenol, drink plenty of fluids and get as much rest as I can and that it was perfectly fine for me to continue to breastfeed my son. The effects lasted about 2 days the worst of it being within the 24 hours of receiving the vaccine.


VAERS ID: 1492881 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hyperhidrosis, Influenza like illness, Poor quality sleep, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cigarette smoker; Penicillin allergy; Social alcohol drinker
Preexisting Conditions: Comments: No drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210743244

Write-up: NOT SLEEPING WELL; ITCHING ALL OVER BODY; BROKE OUT INTO HIVES; FLU-LIKE SYMPTOMS (COLD CHILLS, ACHES); SWEATING QUITE A BIT; This spontaneous report received from a patient concerned a 58 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included penicillin allergy experienced it as a childhood reaction, alcohol user 2-3 beers every night around supper time, and cigarette smoker 10 cigarettes per day, and other pre-existing medical conditions included no drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: 07-AUG-2021) dose was not reported, administered on 15-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 16-JUL-2021, the subject experienced flu-like symptoms (cold chills, aches). On 16-JUL-2021, the subject experienced sweating quite a bit. On 19-JUL-2021, the subject experienced not sleeping well. On 19-JUL-2021, the subject experienced itching all over body. On 19-JUL-2021, the subject experienced broke out into hives. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from flu-like symptoms (cold chills, aches), and sweating quite a bit on 17-JUL-2021, had not recovered from broke out into hives, and itching all over body, and the outcome of not sleeping well was not reported. This report was non-serious.


VAERS ID: 1493724 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / N/A LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphonia, Headache, Lacrimation increased, Oropharyngeal pain, Sneezing
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Lacrimal disorders (narrow), Hypersensitivity (broad)

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

Write-up: sore throat, loss of voice, running eyes, sneezing, headache


VAERS ID: 1493902 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: 10 mins after vaccine the pt passed out. We were able to get him back but he passed out 2 more times. His BP was 80/61. EMS was contacted and the pt was monitored and recovered in about 20mins. The pt refused additional medical attention and was released. I contacted the pt Friday night and again on Sat. Pt stated he was feeling fine and would follow up with his MD.


VAERS ID: 1494047 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-18
Onset:2021-07-16
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Fatigue, Headache, Myalgia, Nasal congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Taste and smell disorders (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: The client contracted COVID-19 even after receiving both doses in a series of the vaccine. The client experienced a cough, muscle aches, loss of taste and smell, nasal congestion, headache and fatigue.


VAERS ID: 1494097 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Echocardiogram normal, Electrocardiogram normal, Fatigue, Lipids normal, Metabolic function test normal, Pyrexia, Tachycardia, Tremor, Troponin normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Troponin was normal on 7/18 and 7/19. Normal comprehensive metabolic panel, normal lipid panel, normal EKG and echocardiogram., all done on 7/19.
CDC Split Type:

Write-up: Developed fever, fatigue, shaking, and tachycardia. Required admission to the hospital for observation due to persistent tachycardia and concern of myopericarditis. He did not develop myopericarditis or end organ dysfunction of (Privacy). He was discharge in approximately 48 hours and is continuing to improve.


VAERS ID: 1494105 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Headache, Hot flush, Illness, Impaired work ability, Influenza virus test negative, Malaise, SARS-CoV-2 test negative
SMQs:, Guillain-Barre syndrome (broad), Arthritis (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: Balance of Nature Vitamins
Current Illness: Food poisoning July 11
Preexisting Conditions: Being monitored for an autoimmune disorder IBS
Allergies: Sulfa Amoxicillin
Diagnostic Lab Data: Covid and flu test both were negative
CDC Split Type:

Write-up: I have been sick since July 16 at 8:00 pm I have been unable to work I felt so ill my husband took me to the Doctor on July 22 . They test me for Covid and flu and both were negative. I have been having chills hot flashes headaches joint aches and very weak


VAERS ID: 1494123 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-25
Onset:2021-07-16
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Itchy site Swelling site


VAERS ID: 1494165 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Headache
SMQs:

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

Write-up: Severe headache persisting for 48 hours


VAERS ID: 1494223 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-07
Onset:2021-07-16
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 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? 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: Depressive disorder, hyperlipidemia, hypertension, GERD, joint disorder
Allergies: Aspirin, Cefaclor, Imipramine, Imitrex, Naproxen, Penicillin V Potassium, Prochlorperazine, Septra DS
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: A pt was vaccinated with the Pfizer COVID-19 vaccine on the 4th of July (I will look up and confirm the date she received it when I get back to work). I think the pt forgot that she received a dose already. We looked through the pt?s Vaccine Consent Form and she marked as no to question #6 ("Have you had the vaccine(s) you are receiving today before?"). One of our pharmacists had to look in the registry to find out that she had received the Moderna COVID-19 vaccine in March at a local fire department. And also when pts come in to get a COVID-19 vaccine, we verify with pts if it is the 1st or 2nd in order to choose the appropriate vaccines. At this time, no additional doses of either product are recommended if a pt received a mixed series of different mRNA COVID-19 vaccine products. We printed out the info from the CDC website and the pt will come in to get the info.


VAERS ID: 1494254 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Fatigue, Headache, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Body aches, fever, headaches, sore throat, shortness of breath, chest pain, fatigue x 6 days since having 2nd Pfizer vaccine.


VAERS ID: 1495663 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash erythematous, Rash pruritic, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None per mother of patient
Current Illness: None per mother of patient
Preexisting Conditions: None per mother of patient
Allergies: None per mother of patient
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient developed a full body rash from the neck down. Rash included redness, severe whelps, and itching. Patient woke up with rash 2 days after vaccine. He is being treated with diphenhydramine orally and this treatment has been effective so far. But as the medicine wears off the rash and its symptoms return.


VAERS ID: 1495687 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-01-01
Onset:2021-07-16
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Cardiac tamponade, Dizziness, Endotracheal intubation, Fall, Foaming at mouth, Hemiparesis, Pericardial effusion, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ISOtretinoin
Current Illness: none
Preexisting Conditions: none
Allergies: Sulfa Bactrim Cephalexin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has syncopal episode on 7/10 began "foaming at the mouth" and vomiting. was brought in to the hospital and intubated briefly. Six days later came back to the hospital for right sided weakness and dizziness that led to a fall. Patient was found to have a pericardial effusion on 7/16 that led to a cardiac tamponade and ultimately cardiac arrest on 7/21.


VAERS ID: 1496147 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Feeling abnormal, Heart rate increased, Oropharyngeal pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

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

Write-up: After my 1st dose?..I experienced severe arm pain at shot for several days. Headache within 4 hours from getting the shot which continued for up to two days after. Sore throat. Chest tightness and heart beating fast a few days after shot. Today is almost a week after getting first dose and I still feel off. Lightheaded now and them. Throat still killing me. Chest still feels like it has pressure . Not sure what is going on but after this one shot and I had reaction like this?.not sure I?ll get the 2nd dose.


VAERS ID: 1496307 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus, aches in the muscle near site of shot
Other Medications: Vitamin B6, E
Current Illness: none
Preexisting Conditions: allergies, seasonal
Allergies: have had random reactions to generic medications throughout the years
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe muscle aches all over body for about 36 hours


VAERS ID: 1496312 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / SYR

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

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

Write-up: Pt. had her 2nd Pfizer shot on July 14, 2021. Two days later, on July 16, 2021 approximately 4:58pm, she developed chest pain and light headache. She took 2 Tylenol pills and the 10- 15 mins the pain went away.


VAERS ID: 1496324 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Was treated at hospital for severe allergic reaction


VAERS ID: 1497192 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: influenza; hives, localized swelling, redness
Other Medications:
Current Illness:
Preexisting Conditions: asthma
Allergies: sulfa unknown food allergy that caused anaphylactic response in 2017
Diagnostic Lab Data: none
CDC Split Type:

Write-up: hives, itchiness; still present as of 7/23


VAERS ID: 1497923 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: Vaccine was given to patient that was 17 years old. No adverse effects noted


VAERS ID: 1497929 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-07-16
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: I came down with the shingles virus.


VAERS ID: 1497961 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / UNK UN / IM

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

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

Write-up: Doctor administered vaccine to a patient that didn''t meet age requirement. Pt under the age of 18 years old. Pt has reported no adverse reactions. Doctor spoke with patients mother as well and she has reported no adverse side effects.


VAERS ID: 1497979 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Chills, Cough, Feeling cold, Lacrimation increased, Laryngitis, Nasopharyngitis, Oropharyngeal pain, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Lacrimal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The night of the vaccine I felt like I was coming down with a cold, had chills, felt cold and my body temperature was 100.4. A week later I still have adverse symptoms such as laryngitis, sore throat, runny nose, watery eyes and cough.


VAERS ID: 1497996 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 LA / IM

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

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

Write-up: This dose was the patient''s third dose.


VAERS ID: 1498077 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-01
Onset:2021-07-16
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Dyspnoea, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), 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), 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: No
Current Illness: No
Preexisting Conditions: No
Allergies: Yes
Diagnostic Lab Data: COVID test
CDC Split Type: vsafe

Write-up: Caught COVID virus after being fully vaccinated. Fever, cough, congestion, no taste, no smell, can''t breathe and shortness of breathe.


VAERS ID: 1498101 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-24
Onset:2021-07-16
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lordapien, Norvax, Lipitor, Lanoxin, Elaquix, Farsega, Floroxifide, Potassium CLER, Steroid, Metoprolol, Tylenol
Current Illness: N/A
Preexisting Conditions: HBP, Thyroid, Hypertension, COPD, CHI
Allergies: Novocain, grass, mold
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states after receiving the 1st dose of J&J 06/24/2021, started experiencing symptoms 07/16/2021 of pain in the left of the head, Primary visit 07/202/2021 and diagnosed with active Shingles on the left side of the head. Treated with Tylenol for pain, recommend of anti-viral drug. Still continuing to develop.


VAERS ID: 1498145 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-04
Onset:2021-07-16
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein increased, Echocardiogram normal, Myocarditis, Pyrexia, Troponin increased, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Febrile viral infection, COVID negative
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data: 7/16/21 - CRP result 144, troponins up to 1.41
CDC Split Type:

Write-up: Patient presented to ED with fever, vomiting. Found to have elevated troponins with myocarditis. ECHO was normal, treated with indomethacin and colchicine and will follow up with Cardiology in a couple of weeks.


VAERS ID: 1498169 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Erythema, Feeling cold, Hypervigilance, Mechanical urticaria, Nervousness, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt was vaccinated at 10:02 and @10:16 patient reported severe itching tochest, neck, and BUE. Patient appeared to be anxious and hypervigilant upon assessment. Patient stated ""I sometimes get itchy when I am exposed to the cold."" Patient stated she was unsure if the itching was due to the vaccination or due to the exposure to the cold. Patient reported she was nervous getting the vaccination due to the side effects and as a result have delayed signing up for an appointment until today. Patient scratching at skin. Mild dermatographia on skin which appears to mostly be contributed to patient itching at skin. No visible hives or any uniform raised bumps on patient''s skin. Scratch marks/dermatgraphia and erythema/edema visible on left axilla, right forearm, and surrounding neck area. Patient denies any SOB or chest pain/tightness. Denies any angioedema, edema in in the throat, tongue swelling, throat itching. VS as follows 10:20 154/108, HR 85, RR 19, 97.0F, Sp02 99% on RA. LSCTA. 10:21 25mg PO Benadryl was administered to patient''s reports of purititis on skin. 10:30 145/85, HR 75 RR 17, 97.9F, 99% on RA. LSCTA 10:40 Patient reports less symptoms at this time, stated she felt good enough to go home. 10:45 143/85, HR 75, RR 17, 98.2F, 97% on RA. Patient advised to receive J&J for second COVID vaccination in 28 days. Patient was advised to follow up with PCP due to SBP of greater than 140 and family history of HTN. Patient verbalized understanding. Patient advised to seek immediate medical care if itching worsens or persists or any other symptoms manifest. Educated patient on S/S of allergic reaction including: hives, continued itching, SOB, throat itching, facial swelling, chest pain. Patient given written discharge instructions. Patient stable at time of discharge. Patient voiced no further questions or concerns at this time. Time of discharge: 1050 1758 Called to F/U with patient. Patient reported she was feeling better and did not have any further questions at this time."


VAERS ID: 1498199 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 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: Pt has an Epi Pen due to hx of anaphylaxis.
Current Illness:
Preexisting Conditions: PMH significant for anaphylaxis of unknown cause x1, allergic rhinitis and intermittent urticaria (possibly heat induced).
Allergies: Pt w/ no NKDA but with hx of anaphylaxis of unknown cause.
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt w/ no NKDA but with hx of anaphylaxis of unknown cause. PMH significant for anaphylaxis of unknown cause x1, allergic rhinitis and intermittent urticaria (possibly heat induced). Pt has an Epi Pen due to hx of anaphylaxis. Pt was vaccinated @10:00. At 10:15, pt c/o dizziness. BP 112/70, HR 49, RR 20. Pt indicates that he did not eat breakfast. Pt given orange juice and graham crackers. 10:30 pt stabilized and released from the vaccination site."


VAERS ID: 1498551 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 RA / SYR

Administered by: Public       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: no adverse outcome- patient had already received two pfizer and this was not caught in database prior to administration- investigation ongoing as to why this was not found


VAERS ID: 1498875 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood creatinine increased, Blood pressure increased, Burning sensation, Butterfly rash, Carbon dioxide decreased, Feeling hot, Glomerular filtration rate decreased, Heart rate increased, Metabolic function test, Muscular weakness, Myalgia, Pain in extremity, Rash, Rash erythematous
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu shot/Oct 2020 rash on arm
Other Medications: low dose naltrexone, HCQ, estradiol, pantoprazole, biotin, ketotifen, restasis, serum eye drops , vit c, salt
Current Illness: Sjogrens related dysautonomia, small fiber neuropathy, POTS, dryness (eyes, mouth), PCOS
Preexisting Conditions: Sjogrens related dysautonomia, small fiber neuropathy, POTS, dryness (eyes, mouth), PCOS
Allergies: sulfa, contrast media
Diagnostic Lab Data: Metabolic panel....Co2 low, creatinine high, GFR low
CDC Split Type:

Write-up: Hip and legs bone, muscle, muscle insertion extreme pain, increased heart rate, increased blood pressure, one episode of leg weakness, bright red lupus looking (malar) rash on face. It was hot to touch and burning. ER gave me toradol, steroids, and fluids. Facial rash and pain resolved that night. Bright red malar rash came back Saturday, Sunday, Monday.....comes back now when hot or out in the sun just on face.


VAERS ID: 1500562 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210742258

Write-up: PAIN ON THE ARM; TIREDNESS; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 16-JUL-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 16-JUL-2021, the subject experienced pain on the arm. On 16-JUL-2021, the subject experienced tiredness. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from pain on the arm, and tiredness on 19-JUL-2021. This report was non-serious.


VAERS ID: 1500582 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210716; Test Name: SARS-CoV-2 IgG antibody test; Result Unstructured Data: Negative (the value was less than 1.00)
CDC Split Type: USJNJFOC20210745802

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a health care professional concerned a 58 year 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, route of admin not reported, batch number: Unknown and expiry: Unknown) dose was not reported, 1 total administered on 13-MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. After receiving the vaccine, the patient underwent antibody test ((SARS COV 2 AB IgG Spike Semi quantitative (SARS-CoV-2 IgG) antibody test )) conducted on 16-JUL-2021 which was negative (the value was less than 1.00). The patient experienced confirmed immunological vaccine failure (therapy non-responder). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition). The report was associated with product quality complaint: 90000186856; Sender''s Comments: V0-20210745802-Covid-19 vaccine ad26.cov2.s- CONFIRMED IMMUNOLOGICAL VACCINE FAILURE. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1500606 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Angioedema, Chest discomfort, Insomnia, Lymphadenopathy, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (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: CLARITIN-D; PANTOPRAZOLE; BACLOFEN; SINGULAIR; LORAZEPAM
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Swelling of the lymph nodes in neck-on the right side; Face started to swell; woke up in the middle of the night; Angioedema/lips started to swell after the injection/face started to swell; Felt pressure on the chest; This spontaneous case was reported by a patient and describes the occurrence of ANGIOEDEMA (Angioedema/lips started to swell after the injection/face started to swell) in a 55-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included LORATADINE, PSEUDOEPHEDRINE SULFATE (CLARITIN-D), PANTOPRAZOLE, BACLOFEN, MONTELUKAST SODIUM (SINGULAIR) and LORAZEPAM for an unknown indication. On 16-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Jul-2021, the patient experienced ANGIOEDEMA (Angioedema/lips started to swell after the injection/face started to swell) (seriousness criterion medically significant). 16-Jul-2021, the patient experienced CHEST DISCOMFORT (Felt pressure on the chest) and INSOMNIA (woke up in the middle of the night). On an unknown date, the patient experienced LYMPHADENOPATHY (Swelling of the lymph nodes in neck-on the right side) and SWELLING FACE (Face started to swell). The patient was treated with METHYLPREDNISOLONE ACETATE (DEPO-MEDROL) for Adverse event, at an unspecified dose and frequency; DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Adverse event, at an unspecified dose and frequency and CIMETIDINE HYDROCHLORIDE (TAGAMET [CIMETIDINE HYDROCHLORIDE]) for Adverse event, at an unspecified dose and frequency. On 16-Jul-2021, CHEST DISCOMFORT (Felt pressure on the chest) had resolved. On 17-Jul-2021, INSOMNIA (woke up in the middle of the night) had not resolved. At the time of the report, ANGIOEDEMA (Angioedema/lips started to swell after the injection/face started to swell), LYMPHADENOPATHY (Swelling of the lymph nodes in neck-on the right side) and SWELLING FACE (Face started to swell) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The patient experienced angioedema her lips started to swell 30 minutes after the injection, and her face started to swell 2 days after vaccination. The patient experienced swelling of the lymph nodes in her neck ? on the right side. The patient woke up in the middle of the night and felt pressure on the chest, but it lasted a couple of seconds and then went away. The patient went to the rheumatologist and was given a Depo-Medrol shot. The patient was also taking Benadryl and Tagamet. Very limited information regarding this events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information has been requested.


VAERS ID: 1500866 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-05
Onset:2021-07-16
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling, Sensory disturbance, Skin discolouration, Spontaneous haematoma, Ultrasound Doppler
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan; Lexapro; famotidine; Brilinta - twice a day; Aspirin - baby; Klonopin; cholesterol lowering pill - Atorvastatin
Current Illness: No
Preexisting Conditions: High blood pressure - for 20 years
Allergies: Codeine; Penicillin; Dramamine; Benadryl; Crestor and Lisinopril
Diagnostic Lab Data: 7/16/2021 Ultrasound ER and another test some kind of a doppler thing. And they diagnosed as a Spontaneous Hematoma the capillaries in my hand had burst.
CDC Split Type: vsafe

Write-up: I was on my computer and I felt a burst in my left hand. My left hand had swelled to the size of baseball bat and it hurt really bad. I called my doctor and couldn''t get ahold of him and went to ER. From wrist to knuckles had turned completely black. They lowered my blood thinner - from two doses of Brilinta to one dose of the generic form of Epient. I had a follow up visit with cardiologist - he is the one that changed my medication. Note: I''m estimating the dates of the vaccines for COVID and my second dose of the Shingles vaccine - I had it Pharmacy-and it was three weeks after the first dose of the COVID vaccine; and three weeks before the 2nd dose of the vaccine.


VAERS ID: 1500868 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthma, Chest discomfort, Condition aggravated, Dyspnoea, Respiratory tract congestion, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: Asthma - no acute exacerbations in past 4 years
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Asthma exacerbation. Difficulty breathing, dyspnea at rest, chest pressure and chest congestion, feeling of throat closing up. Symptoms started approximately 36hrs after vaccine was given. Was taking albuterol inhaler every 4hrs. After 1 week of no improvement, was treated with PO prednisone and a new long-acting, everyday inhaler.


VAERS ID: 1500881 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Fatigue, Myalgia, Nausea, Peripheral swelling, Ultrasound Doppler normal, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamins
Current Illness: None
Preexisting Conditions: Factor V Leiden Latent celiac
Allergies: Pennicilkin, IVP dye
Diagnostic Lab Data: Went to hospital ER 7/23/21 upon concern of blood clot due to symptoms experienced & being a factor V Leiden carrier. Ultrasound performed on legs & confirmed no clot.
CDC Split Type:

Write-up: Lower back pain beginning day after vaccine. Vertigo & nausea beginning days after vaccine, lasting 2-3 days. Fatigue beginning day after vaccine and is improved, but still present. Leg muscle pain and slight swelling beginning 5 days post-vaccine.


VAERS ID: 1500902 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Fatigue, Headache
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (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: Actemra, cyclobenzaprine, metoprolol, duloxetine, prednisone, aripriprozole
Current Illness:
Preexisting Conditions: Hypertension, rheumatoid arthritis, osteosarthritis, sjogrens, bells palsy
Allergies: Buspar, isordil
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fatigue and headache with backache and joint pain


VAERS ID: 1501012 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Antibody test negative, Antinuclear antibody positive, Asthenia, Blood creatine phosphokinase normal, Blood thyroid stimulating hormone normal, Borrelia test negative, Computerised tomogram head normal, Dysstasia, Gait inability, Guillain-Barre syndrome, Immunoglobulin therapy, Magnetic resonance imaging head normal, Magnetic resonance imaging spinal normal, Muscular weakness, Red blood cell sedimentation rate normal, Vitamin B12 normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT head negative, MRI brain and C/T/L spine normal. CPK, ESR, TSH, B12 all normal. Lyme negative, ANA +, reflex AB''s all negative.
CDC Split Type:

Write-up: Patient experienced diffuse muscle weakness in all 4 extremities, beginning 2 days after the 2nd dose of the Pfizer COVID-19 Vaccine. It progressed equally in upper and lower extremities. 4 days after vaccination, he was unable to walk and couldn''t stand from a seated position. Presented to the ER and had a 5 day hospital stay. His upper extremities graded 4/5 strength, his lower extremities graded 3/5. Initially throught to be Guillan-Barre Syndrome, he received 5 doses of IV IG over 3 days. Reflexes preserved throughout his stay. He was treated by physical therapy and occupational therapy throughout his hopsital stay. He improved dramatically over the last two days of his stay and was discharged home with home PT.


VAERS ID: 1501203 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, Ear discomfort, Nystagmus, Seizure, Tinnitus, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (narrow), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 80mg, Carvedilol 3.25mg, low dose aspirin, multivitamin
Current Illness: None
Preexisting Conditions: Heart attack in 2005, kidney stones,
Allergies: None known
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: Stuffy ears, tinnitus, hearing loss, severe vertigo attack on 7/24/21 with vomiting, nystagmus and involuntary convulsions in both legs, primarily on the left.


VAERS ID: 1501301 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-06
Onset:2021-07-16
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-07-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood culture negative, COVID-19, Chills, Cough, Dyspnoea, Exposure to SARS-CoV-2, Hypoxia, Interleukin level, Oxygen saturation decreased, Pyrexia, Rash, SARS-CoV-2 antibody test negative, SARS-CoV-2 test positive, White blood cell count normal
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, atorvastatin, lostart-HCTZ
Current Illness: None
Preexisting Conditions: Hypertension and Hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data: 7/16: COVID test positive 7/21: COVID test positive Blood cultures negative Antibody: negative IL-6: 419 IL-8: 55 WBC: 5.2, 5.1, 4.8, 6.1
CDC Split Type:

Write-up: Patient was exposed to a family member who was COVID-19 positive and tested positive on 7/16. Symptoms start on 7/16 with cough, fever, chills and SOB. Primary care doctor recommended he go to ED and receive casirivimab/imdevimab. Patient received the infusion on 7/21 morning. Then came back to the hospital in the evening due to worsening SOB and was admitted for hypoxia requiring oxygen. Patient was started on remdesivir (7/22) and steroids and lovenox (7/21). No longer febrile starting 7/23. Asymptomatic rash noted on patient''s chest on 7/25 and no longer requiring oxygen.


VAERS ID: 1501513 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

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


VAERS ID: 1501514 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

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

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

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


VAERS ID: 1501537 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-06
Onset:2021-07-16
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Asymptomatic COVID-19, Blood creatinine increased, Chest X-ray abnormal, Chest pain, Dyspnoea, Electrocardiogram T wave abnormal, Lung disorder, Pulmonary embolism, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: lisinopril
Current Illness:
Preexisting Conditions:
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7/18/2021 Patent presemted to ED with a chief complaint of chest pain for the last 3 days associated with shortness of breath. Refers has been using ibuprofen achieving minimal relief. Received COVID 19 vaccinate in April (Johnson & Johnson). Upon initial evaluation on ED VS: stable. Laboratories revealed elevated creatinine and COVID 19 TEST Positive. EKG: Sinus rhythm, T wave abnormalities. A chest x ray: IMPRESSION: Left lower lung airspace disease. CT angio showed Acute pulmonary embolism, left lower lobe, nonocclusive. COVID-19 infection considered asymptomatic and no treatment required for this. Discharged home on 7/19/21.


VAERS ID: 1501820 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Chills, Dizziness, Fatigue, Headache, Myalgia, Pain, Pyrexia, Rhinorrhoea, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine 1996 and 2012
Other Medications: Metformin Vitamin c
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: No
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Soreness, swelling, headache, chills, fever, body aches, joint pain, muscle pain, runny nose, fatigue, upper and middle back ache, chest pain, and dizziness.


VAERS ID: 1502035 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-09
Onset:2021-07-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot over 20 years ago, cellulitis.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Burning rash on the face and elbows; softball-size redness/hard painful at the site.


VAERS ID: 1502066 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Epilepsy, Immediate post-injection reaction, Muscular weakness, Nystagmus, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methadone. KEPPRA sans compliance.
Current Illness: Substance abuse. Epilepsy.
Preexisting Conditions: Substance abuse. Epilepsy.
Allergies: Avocado severe.
Diagnostic Lab Data: None known.
CDC Split Type:

Write-up: Patient experienced S/S of epileptic episode immediately after administration of Pfizer COVID-19 vaccine. Disclosed history of SA and Rx Methadone for cessation therapy. Undisclosed history of epilepsy and non-compliance with Rx KEPPRA. According to field reports and verbal debrief, patient had: brief unresponsiveness + nystagmus + upper extremity contraction. During episode, patient''s partner disclosed to nurses her PMHx epilepsy and non-compliance with KEPPRA. After a minute or so, S/S ceased and patient was AOX4. No concern by RN after VS measurement and monitoring. Paramedics summoned for second-eye assessment. No concern by paramedics. Patient verbalized feeling OK. Released after a further 30minute observation.


VAERS ID: 1502227 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-05
Onset:2021-07-16
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Nasal congestion
SMQs:

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

Write-up: Nasal Congestion


VAERS ID: 1502280 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Electrocardiogram, Pericarditis, Troponin
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: bupropion XL 150m daily
Current Illness: None
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: ECGs (suggestive), troponin (negative)
CDC Split Type:

Write-up: acute pericarditis, symptoms developed within 24 hours. have persisted for 10 days


VAERS ID: 1502287 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-04-11
Onset:2021-07-16
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Chest pain, Computerised tomogram thorax abnormal, Dyspnoea, Pulmonary embolism, Pyrexia, Surgery, Tachycardia, Tibia fracture
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Escitalopram, 10mg/day
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: chest CT 07/22/2021
CDC Split Type:

Write-up: June 14th I had surgery to set broken tibia/fibia. Friday July 16th I began to suffer severe chest pain, shortness of breath, difficulty breathing and tachycardia. Went to a local ER but symptoms decreased as I waited and eventually they sent me home. Mild chest pain, shortness of breath, difficulty breathing, tachycardia and fever lasted until Thursday the 22nd when I saw Dr. He ordered a chest CT and as a result I was diagnosed with pulmonary embolism. I was prescribed Eliquis to help the clots clear.


VAERS ID: 1502315 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: We were notified by the state health department that he is believed to have received 3 doses of the covid shot, at our facility on 7/16 and 6/25 as well as an earlier shot on 4/17 per the state immunization registry. We have called the patient numerous times and he has not returned our calls so it is unknown if he experienced any adverse effects.


VAERS ID: 1503125 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Dyspnoea, Fatigue, Influenza, Nausea, Syncope, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

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

Write-up: About 4 to 5 minutes after inoculation, I suddenly fainted and was wheezing(my husband said). When I began to come to, a minute or two later, it was a extremely violent rushing back. I was gasping for breath. I had cold sweat and felt like I was weak and in shock and nauseous. After a time of gaining strength I went home and was fine except for feeling like I had the flu and fatigue for about 24 hours.


VAERS ID: 1505045 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Bell's palsy, Headache, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Bell''s Palsy-Severe, Systemic: Headache-Severe, Systemic: Visual Changes/Disturbances-Severe, Additional Details: wife came to the pharmacy and explained that after the shot the patient had one side weakness went to er and the er stated that the covid shot was the cause of bells palsy severe headaches, and visual changes. she states that it isnt resolving and they are going for more doctors visits


VAERS ID: 1505395 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: High cholesterol; asthma; TBI.
Allergies: Processed shellfish; bee; pollen; Zocar; naproxen; gabapentin
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: 07/16/2021 that evening when I went to take a shower I had a large rash around my right breast, looked like red blisters also on chest area and right side of my back that looked like a rash. After taking a shower the bumps did go down, but there in the front the blister do hurt and the rash on the back hurts. Still ongoing today, but I am going to my doctor.


VAERS ID: 1505408 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-24
Onset:2021-07-16
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

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

Write-up: Fever (101.8 degrees) for 24 hours Ongoing chronic headaches that happen spontaneously over several days.


VAERS ID: 1505452 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chemotherapy, Cough, Dyspnoea, Lethargy, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Arthritis, CAD, DM, elevated liver function tests, GERD, HTN, iron deficiency, anemia, MI (2010), obesity, osteoarthit Additional information for Item 12: if knee, trochanteric bursitis, DLBCL, hyperlipidemia,
Allergies:
Diagnostic Lab Data: Novel Coronavirus PCR- SARS-COV-2 detected (7/16/2021)
CDC Split Type:

Write-up: 58 yo female with diffuse large B cell lymphoma was admitted to the hospital on 7/17 for fever and cough and found to be COVID+. She is s/p cycle 2 of R-CHOP chemotherapy, last given on 7/8. She is also s/p full Pfizer COVID-19 vaccination: First dose 6/10/21, second dose 7/1/21. Treated initially with 5 day course of remdesivir, dexamethasone and Levaquin, however on day 5 of treatment, patient developed new oxygen requirement up to 4L. Pt left hospital against medical advice on day 6, discharged on dexamethasone and oxygen. Readmitted to the hospital on 7/22 with complaint of shortness of breath and lethargy.


VAERS ID: 1505705 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-05-26
Onset:2021-07-16
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood thyroid stimulating hormone increased, Mood altered, Thyroxine free increased, Thyroxine normal, Tri-iodothyronine normal
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Depression (excl suicide and self injury) (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: I received my comprehensive physical exam around the time of my second Moderna shot on May 26, 2021. I received my first Moderna shot on April 30, 2021. My blood was drawn the day before my second shot, on May 25, and I had a TSH reading of 8.06, higher than it had ever been before (my TSH was tested 5 times since September 2016). My blood was drawn again 6 weeks later, on July 16, and the TSH reading was 15.03! T3 and T4 levels were normal: T3 uptake 32, free T4 index 2.1, T4 total 6.5. I seem to feel decreased energy and possibly a change in mood associated with hypothyroidism.


VAERS ID: 1505740 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 3 RA / IM

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

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

Write-up: Patient indicated he needed his second shot in the series--however he had already had a complete (2 shots) series -we did not know this per his registration information..he had misunderstood the process and got a third Pfizer vaccine --previous completed series was Pfizer


VAERS ID: 1505745 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Petechiae, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (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: None
Preexisting Conditions: None
Allergies: Nickel, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Petechiae looking rash showed up on the inside ankles of each leg. Rash worsened after 24 hours. Red and spread up the side of calf from ankle. No other symptoms with rash. No itching, no swelling. Took over a week for rash to start getting better. 1.5 weeks later rash is still present, but almost gone.


VAERS ID: 1505782 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 OT / IM

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, 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: Acetaminophen, Al/Mg/Simethicone, Aspirin, Eflornithine, cont.
Current Illness: Abdominal pain, Anxiety, Dyspepsia, Elevated prolactin level,
Preexisting Conditions: Gender identity dysphoria, Mood disorder, Hx of syphilis.
Allergies: Chorpromazine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received 1st dose of Pfizer vaccine on 2/19/21. On 7/16/21, patient accidentally received one dose of Moderna vaccine. Patient had no adverse reaction to the vaccine after 15 minutes of monitoring. Patient is a transgender individual, in the process of transitioning to female.


VAERS ID: 1505791 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-22
Onset:2021-07-16
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Nasal congestion
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: The patient contracted COVID-19 even after being fully vaccinated. The client had nasal congestion and loss of taste and smell.


VAERS ID: 1506260 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-12
Onset:2021-07-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Balance disorder, Chest discomfort, Chest pain, Clumsiness, Computerised tomogram, Electrocardiogram, Eye pain, Fumbling, Headache, Hyperacusis, Hypoaesthesia, Laboratory test, Magnetic resonance imaging, Muscular weakness, Neck pain, Pain, Peripheral swelling, Photophobia, Tic, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Arthritis (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: propranolol, albuterol prn
Current Illness: Chronic HA (migraine)
Preexisting Conditions: intermittent asthma
Allergies: NKDA
Diagnostic Lab Data: CT''s, MRI, EKG, labs
CDC Split Type:

Write-up: - presents with a cc of left sided numbness arm and leg and left leg weakness - on friday she was seen at a local hospital, given tPA, have neg CVA eval in terms of her imaging but did not have a MRI (documentation is unclear why this was not offered to her); her symptoms somewhat improved but never resolved; returned today - reports HA; she always has HA but since Friday the HA became stronger; pain around her left eye, worse with light and certain sounds and head movements; better with laying down in the dark; pain feels like a throbbing sensation and radiates around her head and into her neck; denies vision changes - she states the neck pain is unusual for her HA, but usually she does have left eye and entire head throbbing - denies fevers - denies URI symptoms - denies n/v - reports CP, also started on Friday; chest pain is sharp at times, pressure other times, heavy other times; comes and goes; when she has it is lasts a couple minutes; denies back or abd pain; she has the pain multiple times during the day; she has had this pain before, occurs off and on for months; denies leg swelling, travel, hx of cancer, recent surgeries - denies estrogen/birth control use - denies hx of blood clotting disorder in the family or personal hx - she reports her right foot (mainly the bottom) which is new today, no trauma, and also with standing-$gthe top part of the right foot seems to bulge and the veins pop out, this has been ongoing for a few months - feels like her legs are going to give out with walking, this has been ongoing for months; left hand more so then right, she sometimes drops things/feels clumsy; sometimes her hand seems to hit things without her intending to - denies family hx of neurologic disease or autoimmune disease - she reports she is vaccinated against COVID-$gmoderna, second dose was july 12th, first dose was June 14th - she reports she has always been shaky with walking, tics with her hands, clumsy in her hands all seemed to start when she was shot in the head with bebe pellet years ago


VAERS ID: 1507847 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Paraesthesia, SARS-CoV-2 test, Upper respiratory tract infection
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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:
Current Illness: Alcohol use (Patient consumes only socially on vacation maybe a few days/week.); Iodine allergy; Non-smoker
Preexisting Conditions: Comments: The patient had no past medical history, no history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data: Test Date: 202107; Test Name: SARS-CoV-2 PCR test; Result Unstructured Data: No results; Test Date: 202107; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: Negative; Test Date: 20210724; Test Name: SARS-CoV-2 PCR test; Result Unstructured Data: No results; Test Date: 20210724; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210755504

Write-up: SYMPTOMS OF UPPER RESPIRATORY INFECTION (COLD SYMPTOMS); TINGLING TO BACK WHICH SPREAD TO BOTH ARMS, HANDS AND LEGS; MILD HEADACHE; This spontaneous report received from a patient concerned a 46 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included alcohol use, non-smoker, and iodine allergy, and other pre-existing medical conditions included the patient had no past medical history, no history of drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 203A21A, and expiry: UNKNOWN) dose was not reported, administered on 05-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On JUL-2021, Laboratory data included: SARS-CoV-2 PCR test (NR: not provided) No results, and SARS-CoV-2 rapid diagnostic test (NR: not provided) Negative. On 16-JUL-2021, the subject experienced mild headache. On 22-JUL-2021, the subject experienced tingling to back which spread to both arms, hands and legs. On 24-JUL-2021, the subject experienced symptoms of upper respiratory infection (cold symptoms). Laboratory data included: SARS-CoV-2 PCR test (NR: not provided) No results, and SARS-CoV-2 rapid diagnostic test (NR: not provided) Negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from tingling to back which spread to both arms, hands and legs, and mild headache, and the outcome of symptoms of upper respiratory infection (cold symptoms) was not reported. This report was non-serious.


VAERS ID: 1509239 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

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

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

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


VAERS ID: 1509241 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

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


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