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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 359 out of 6,867

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VAERS ID: 1487775 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-10
Onset:2021-07-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling cold, Feeling hot, Flushing, Malaise, Motion sickness, Nausea, Nervousness, Piloerection
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Became allergic to naproxen after malaria vaccine
Other Medications: LDN T3-T4 Citalopram
Current Illness: None
Preexisting Conditions: Asthma anxiety Hashimoto Thyroiditis
Allergies: Naproxen
Diagnostic Lab Data:
CDC Split Type:

Write-up: I felt perfectly fine until day 5 Ever since I feel very dizzy like motion sickness and nauseous most of the time. I am very nervous this will never go away. I get hot and flushed and then that goes away and I''m chilled with goosebumps. I feel ill most of the day


VAERS ID: 1488504 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-07
Onset:2021-07-15
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: patient developed sore throat and nasal congestion on 7/15/2021. She tested positive for COVID on 7/19/2021


VAERS ID: 1489549 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Connecticut  
Vaccinated:0000-00-00
Onset:2021-07-15
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 180978 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Fatigue, Hypersomnia, Injection site pain
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (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: Blood pressure high
Preexisting Conditions: Comments: Patient had no known drug allergies. Patient was taking multivitamins and multivitamins for the eye.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210738491

Write-up: STAY ASLEEP / REST LONGER; INJECTION SITE ARM PAIN; FEELING TIRED; LOSS OF ENERGY; This spontaneous report received from a patient concerned a 74 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included high blood pressure, and other pre-existing medical conditions included patient had no known drug allergies. patient was taking multivitamins and multivitamins for the eye. The patient was previously treated with lisinopril for high blood pressure, and amlodipine for high blood pressure. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 180978 expiry: UNKNOWN) dose was not reported, administered on 27-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-JUL-2021, the subject experienced stay asleep / rest longer. On 15-JUL-2021, the subject experienced injection site arm pain. On 15-JUL-2021, the subject experienced feeling tired. On 15-JUL-2021, the subject experienced loss of energy. Treatment medications (dates unspecified) included: menthol/methyl salicylate. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from injection site arm pain on 16-JUL-2021, and the outcome of feeling tired, loss of energy and stay asleep / rest longer was not reported. This report was non-serious.


VAERS ID: 1489556 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-07-15
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: Fatigue, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Back pain
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210738787

Write-up: MUSCLE SORENESS WHICH WAS WORSE IN HIS SIDES AND BACK; FATIGUE; This spontaneous report received from a patient concerned a 65 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included back pain. 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 14-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 15-JUL-2021, the subject experienced muscle soreness which was worse in his sides and back. On 15-JUL-2021, the subject experienced fatigue. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from fatigue, and had not recovered from muscle soreness which was worse in his sides and back. This report was non-serious.


VAERS ID: 1489626 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / UNK RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: post menopausal bleeding 3 hours and 45 minutes later; This spontaneous case was reported by a patient and describes the occurrence of POSTMENOPAUSAL HAEMORRHAGE (post menopausal bleeding 3 hours and 45 minutes later) in a 51-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027B21A) for COVID-19 vaccination. Concomitant products included BOTULINUM TOXIN TYPE A (BOTOX) and PROPRANOLOL for Migraine. On 15-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Jul-2021, the patient experienced POSTMENOPAUSAL HAEMORRHAGE (post menopausal bleeding 3 hours and 45 minutes later) (seriousness criterion medically significant). At the time of the report, POSTMENOPAUSAL HAEMORRHAGE (post menopausal bleeding 3 hours and 45 minutes later) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No medical treatment was reported. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested


VAERS ID: 1490253 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site bruising, Injection site induration, Injection site nodule, Injection site pruritus, Injection site rash, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (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: herbal supplements for Rheumatoid Arthritis, various prescription medications
Current Illness: none
Preexisting Conditions: "colon issues" Rheumatoid Arthritis, cataracts
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Nausea the evening of 7/15/2021. Took Nausea Medicine says she has a prescription due to "colon issues" 7/16-7/19 had nausea with intermittent vomiting. On 7/16/21, patient notices hard knot near injection site on left arm. Approximately 2 inches in length, 1.5-1 inch wide. Patient describes as football shape. Patient developed generalized rash at injection area on 7/17/21 with bruising. Patient reports that later the site become itchy. Called Pharmacy who administered vaccinations, advised to take benadry and tylenol continue to monitor. Advised patient to speak with PCP if injection site reaction does not resolve within 7-10 days after vaccination. Patient already has phone call in to PCP.


VAERS ID: 1490256 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 EW0181 / 1 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1490338 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-07-15
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive by PCR on 7/15/2021
CDC Split Type:

Write-up: The patient tested positive for COVID on 7/15/2021 after being exposed to family member(s) that were also positive. He came to the hospital on 7/19/2021 with symptoms of shortness of breath, hypoxia, and dyspnea.


VAERS ID: 1490467 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 RA / IM

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

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

Write-up: Administered the vaccine to patient under 18 years old


VAERS ID: 1490473 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 RA / IM

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

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

Write-up: Itchy hives developed on both hands ~24 hours after injection. Most bumps are on his hands and wrist with a few on his elbows.


VAERS ID: 1490479 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   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: 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: Rash
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Exhaustion, sore arm


VAERS ID: 1490526 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-14
Onset:2021-07-15
   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 EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Aphonia, Arthralgia, Chest discomfort, Dyspnoea, Headache, Influenza like illness, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (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: Influenza shots, noted similar side effects
Other Medications: Hydrochlorothiazide
Current Illness: N/A
Preexisting Conditions: HBP
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the Phizer 1st dose 07/14/2021, started to experience symptoms 07/15/2021 loss of voice, tightness in the chest, loss of taste, shortness of breath, fever (99.8), joint pain, and headache. Still experiencing continuous headache struggling with flu-like symptoms. Consulted with Pharmacists regarding still experiencing symptoms and was told to make a VAERS report. No primary visit noted.


VAERS ID: 1490572 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Public       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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna administered to a 12 yr old


VAERS ID: 1490583 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood glucose normal, Blood lactic acid, Blood magnesium normal, Body temperature increased, Chills, Dehydration, Differential white blood cell count, Electrocardiogram T wave abnormal, Full blood count, Influenza virus test negative, Lipase normal, Lymphocyte percentage decreased, Mean cell volume increased, Metabolic function test, Nausea, Neutrophil count increased, Neutrophil percentage increased, QRS axis abnormal, Red blood cell count decreased, SARS-CoV-2 test negative, Sinus tachycardia, Urine analysis normal, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Covid-19, unsure of issues
Other Medications: tamoxifen, oxybutynin chlorideXL, telmisaratan-hydrochlorithiazide, setraline
Current Illness:
Preexisting Conditions: Mitral Valve prolapse, hypertension, hyperlipidemia, malignancy (mastectomy with reconstructive augmentation), urge incontinence.
Allergies: Iodine, Penicillin, Latex, Natural Rubber
Diagnostic Lab Data: Physical exam 7/15 All 7/15 Lactic Acid 3.1 (HH) Magnesium 1.6 (L) Comprehensive metabolic panel - Glucose 136 (H) other values within range Lipase 56 CBC with Automated DIFF WBC 16.5 (H) RBC 3.89 (L) MCV 101.3 (H) Neutrophils 80 (H) Lymphocytes 15 (L) ABS Neutrophils 13.2 (H) All others within ref range EKG, 12 Lead Initial VR 121 AR 121 PR Interval 162 QRS 74 Q-T Interval 314 QTC Calculated 446 P Axis52 R Axis-27 T Axis66 sinus tachycardia corderline left axis deviation abnormal r wave progrssion borderline t abnormalities Covid, influenza, negative urinalysis normal
CDC Split Type:

Write-up: A few hours after receiving 2nd Covid vaccine patient began feeling nauseated then started vomiting. She denies blood in the emesis. She also endorses feeling "chilled to the bone." Triage temp is 103.1. Patient denies chest pain, shortness of breath, cough, numbness, tingling, falls, headache, abdominal pain, diarrhea, constipation, changes in diet, recent travel. No dysuria, hematuria, rashes, bruising or bleeding. She states she has had at least 6 or 7 episodes of emesis and is on her fourth emesis bag in the ER. She states she feels very dehydrated and week. I was informed that the patient was admitted and was under the care of a hospitalist who I could not reach.


VAERS ID: 1490675 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 LA / IM

Administered by: Unknown       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: Moderna vaccine vial must be discarded 12 hours since first puncture. Although the vial was kept in the refrigerator, patient received a dose from a punctured vials that was first opened past the 12 hour mark.


VAERS ID: 1490775 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-15
Onset:2021-07-15
   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: 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: 1490796 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-14
Onset:2021-07-15
   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 / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Full blood count, Inflammatory marker test, Metabolic function test, Myalgia, Peripheral swelling, Polyarthritis
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Normal inflammatory markers, CBC, BMP.
CDC Split Type:

Write-up: Patient developed ipsilateral arm swelling which progressed to polyarthritis on the elbow and wrist. Within a few days, similar symptoms developed on the ipsilateral leg including knee and ankle. Also with arthralgias and myalgia in this distribution. No real improvement with ibuprofen. Was admitted to hospital for these symptoms and arthritis resolved with NSAIDs, but still with significant arthralgias. No fevers throughout, but on NSAIDs.


VAERS ID: 1490828 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / UNK - / IM

Administered by: Work       Purchased by: ?
Symptoms: Lip pruritus, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling, itching lips, upper back and scalp. History of anaphylactic reaction to medications. Patient was given one dose of epinephrine, responded well and was transported to the ED for further observation.


VAERS ID: 1490998 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 FA7485 / 1 - / -

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: Received vaccine not stored according to manufacturer recommendations


VAERS ID: 1491002 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 FA6780 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Hypoaesthesia, Malaise, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: About 9pm on July 15, 2021, my daughter started to feel a tingling sensation on her face. Between 9:30pm-10:30pm she gradually begin to have mild to severe numbness in her face, legs, chest and arms and her heart was beating rapidly. She told us she feels that she?s going to die. We took her to the emergency room where heart rate rose as high as 175bpm and the numbness got worse


VAERS ID: 1491661 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-14
Onset:2021-07-15
   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 - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Head discomfort, Headache, Migraine, Nausea, Pain, Polymenorrhoea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Developed body aches, tiredness, fever, and headache. But the headache never went away, it?s more of a migraine. The headache and throbbing lessens but there is still some underlying pressure in my head and then it hurts again accompanied by nausea, and I haven?t suffered from migraines. The migraines seem to be lessening now. Also, I had just finished my period the week I got the shot and it restarted my period when I got the symptoms.


VAERS ID: 1492076 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-07
Onset:2021-07-15
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray, Chest pain, Dyspnoea, Headache, Palpitations, Tinnitus
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Dyshidrotic eczema. Seasonal Allergies
Allergies: None
Diagnostic Lab Data: On 07/19/2021 I had some tests done but nothing was found. Frontal and lateral radiographs of the chest did not find anything notable. Heart rate has some palpitations but is mostly normal. Blood tests didn''t find anything.
CDC Split Type:

Write-up: Day 2 after getting the vaccine I went to the hospital over headache, tinnitus, chest pain and breathing problems. The pain never went away but it slowly got worse over time. 5-6 weeks and I am severely suffering from chest pain and shortness of breath. Airways feels very tight. Went to the doctors and got perscribed prednisone and an inhaler. I''ve never needed or used an inhaler before. I''ve never had breathing problems other than nasal congestion during flu season. Neither the prednisone or the inhaler help at all. The prednisone and inhaler do not help the breathing even a tiny bit and this is after using them for all 5 days that they were perscribed. Breathing never feels satisfying. I am constantly breathing deep breaths through the mouth for air but it never feels like I''m getting enough air. Whether it be stress, allergic reactions, or exercise, I have never had breathing problems like this before and I have not done anything else that could have brought these problems on.


VAERS ID: 1492079 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Disturbance in attention, Dysphemia, Feeling hot, Hypoaesthesia, Nausea, Pain, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (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: Cozaar 100mg, 2000 iu vitamin D, iron, sodium bicarbonate 2 pills
Current Illness:
Preexisting Conditions: Stage 4 kidney disease, hypothyroidism, hypertension
Allergies: Lisinopril - dry cough
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Started feeling hot about 19 hours later 07/15/21 around 2:30pm, then both forearms and hands felt tingly/numb sensation on and off for about 7 hours. Started feeling confusion in the brain with stuttering lightly, trouble concentrating, inside brain kept feeling not as aware around 4:30PM for 2 hours, then started feeling like throwing up lightly around 6:30PM on and off for 3 hours, body ached all over starting at 8:30PM for about 4 hours towards end of night. I took 2 aspirin and 4 Tylenol around 10:00PM, then felt better at 3:30am.


VAERS ID: 1493590 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-11
Onset:2021-07-15
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 PCR Positive 07/15/2021
CDC Split Type:

Write-up: Patient fully vaccinated with Pfizer x 2 doses. Developed COVID-19 and hospitalized at Medical Center for same.


VAERS ID: 1493658 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 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:
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: 1493664 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-14
Onset:2021-07-15
   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 ER8736 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Balance disorder, Cough, Ear congestion, Headache, Influenza like illness, Injection site pain, Lacrimation increased, Malaise, Oropharyngeal pain, Productive cough, Pyrexia, Sluggishness, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Lacrimal disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine - many years ago - back in the early 1990''s. Bad reaction and have never had a flu vaccine since.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got vaccine by 5pm on Wednesday 7/14/2021, went to bed feeling fine, woke up the next morning feeling as sick as could be. I was feverish, sluggish, full of flu like symptoms (terrible sore throat/coughing/wheezing/headache/phlegm/ears blocked/ eyes watering/balance problems) My arm at the injection site was painful to the touch. I have had absolutely no taste or smell sensation at all. Today(07/22/2021) is day 8 of these symptoms and I am finally able to say that I may be over the hump(so to speak) of all this as I am starting to feel a little bit better. I am still coughing up phlegm, but not as bad.


VAERS ID: 1493704 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-07-08
Onset:2021-07-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site hypoaesthesia, Injection site pain, Injection site paraesthesia
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: patient states gets flu from flu vaccine for 6 months
Other Medications: amlodipine 5 mg daily aspirin 81 mg daily
Current Illness: none acute
Preexisting Conditions: fibromyalgia
Allergies: morphine/oxycodone/codeine penicillin and other antibiotics
Diagnostic Lab Data: none reported
CDC Split Type:

Write-up: About a week after her second shot in left arm, patient developed burning/numbness/tingling in right arm then in left arm. Patient reports that it is very painful. Patient states can''t tolerate any pain relievers and does not have a primary care provider to see, even though the pharmacist suggested it.


VAERS ID: 1493738 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Deafness, Pyrexia, Shock
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 2 mins after receiving the vaccination began to lose vision and hearing, fever. Went into shock and was admitted to the hospital.


VAERS ID: 1493742 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-13
Onset:2021-07-15
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Cough, Diarrhoea, Dyspnoea, Fatigue, Myalgia, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CKD Stage IV, HTN, hyperparathyroidism, T2DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria review with +COVID test $g14 days post vaccination series. Presented to ED with shortness of breath, myalgias, fatigue, nausea, abdominal pain, cough, vomiting, diarrhea


VAERS ID: 1493802 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Contusion, Erythema, Induration, Neck pain, Pain in extremity, Skin warm
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN 325 MG ORAL TABLET 240 A 05-07 05-07 2 30 ALCOHOL PREP PAD 100 A 06-29 06-29R 11 30 BUPRENORPHINE-NALOXONE 8 MG-2 MG SUBLI E 06-01 06-01 0 30 90 CAPSAICIN 0.025% CREAM 60 A$g 05-18 05-18 5 15 HYDROXYZINE 25 MG ORAL TABLET 56 A
Current Illness:
Preexisting Conditions: alcohol abuse tobacco anxiety Type 2 DM asthma depression ptsd opioid abuse
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bruised, red, lump, warm to touch, sore/achy arm, neck hurts


VAERS ID: 1493858 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-25
Onset:2021-07-15
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL92601 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Melaena, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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: Metorprolol, Synthroid, Omega 3, Zocor, multivitamin, vit. D, Prolia, CoEnzyme Q10,
Current Illness: COPD, GERD, hypothyroidism, pulmonary emphysema, dyslipidemia, diverticulosis, colon polyps, arthritis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COV pos. 7.15.21 on admission
CDC Split Type:

Write-up: Nausea, vomiting, black tarry stools,


VAERS ID: 1494112 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-08
Onset:2021-07-15
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Lateral position, Pyrexia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (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), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin 20mg po q day, Bumetanide 0.5mg po qod, Carvedilol 25mg po bid, Famotidine 40mg po bid, Isosorbide Mononitrate SR 120mg po q am, Levothyroxine 100mcg po q day, Warfarin, Amlodipine 2.5mg po bid, Glipizide 2.5mg po q day, Hyd
Current Illness: Pt had fall on 6/10 and came in with head lacerations which were repaired with staples.
Preexisting Conditions: Cardiac Pacemaker, GERD, CAD, DM2, Hx of MI, pSVT, Erectile Dysfunction, Emphysema, Senile purpura, Atherosclerosis of Aorta, Hyperlipidemia, Bilat nonexudative age related macular degeneration, Hx of artery embolism, systolic Heart Failure, Constipation
Allergies: Ibuprofen - rash Lisinopril - Hyperkalemia Flomax - Stomach upset
Diagnostic Lab Data: CORONAVIR PAN 2019-NCOV, NAA, QL SARS-COV-2, QUALITATIVE, NAA (COVID-19), KP LAB Collected: 07/17/21 1109 Result status: Final Value: COVID DETECTEDAbnormal Comment: Nasopharynx/Oropharynx source.
CDC Split Type:

Write-up: 86 year old pleasant gentleman with a history of coronary artery disease (noted on MPS in 2003, unclear if prior intervention), hx of SSS with PPM, type 2 DM, ischemic CM with EF of 41%, chronic kidney disease with a baseline Cr 1.5 - 1.9, hx of popliteal artery embolism felt to cardioembolic in origin (in setting of cardiomyopathy) on lifelong coumadin, and chronic thrombocytopenia with baseline plts of 100s. He has been admitted for acute respiratory failure due to COVID pneumonia. There may also be a component of pulmonary edema given elevated BNP. Plan: 1. Acute Resp Failure/COVID-19 Disease - - Symptom onset on 07/15. COVID positive on 07/17. Last fever on 07/15 o Pt has been started on Remdesivir on 07/20. He is to have a 5 day course. o Continue decadron 6 mg daily - started on 07/20, will continue for 10 days o Trend LFT''s and chemistry daily as he is on remdesivir. Hold Remdesivir if ALT $g10xULN or CrCl<30 o Continue awake proning: 2 hrs prone, 1 hr left, 1 hr right and back to prone. Limit the hrs supine. Explained in detail to patient who understands and is agreeable. o May use MDIs as needed for bronchospasm o Check d-dimer, ferritin, ESR, and CRP every other day. If rising will need to consider CTA/LE doppler o Monitor I/O and make sure patient is net negative. Continue bumex home dose for now per patient request. Will increase tomorrow UOP not adequate. o Continue Coumadin for prophylaxis active bleeding o Nasal Cannula 3 liters. Goal SpO2 $g92%. Consider ICU evaluation if requiring $g40LPM and 60% FiO2 for SpO2 $g/= 90% o Pepcid for GI prophylaxis o Continue isolation in hospital per Regional/Local ID guidance.


VAERS ID: 1494173 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-13
Onset:2021-07-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 - / -

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

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

Write-up: PT DEVELOPED HIVED 2 DAYS AFTER 2ND SHOT... WENT TO DR AND THE HIVES HAVE WENT AWAY


VAERS ID: 1494248 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 EW0181 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Disorientation, Hallucination, Headache, Hypoacusis, Laboratory test, Loss of consciousness, Urinary incontinence
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), Dementia (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: Still waiting for results
CDC Split Type:

Write-up: Hallucinated after 1st shot then blacked out. Lost control of bladder functions. Disoriented and unable to speak or hear for several minutes. Transported to emergency room. Still have hearing issues and headache a week later.


VAERS ID: 1494415 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-08
Onset:2021-07-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site warmth, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: After a week skin around vaccination area is red, warm and etchy. After another week petechiae appeared in that area.


VAERS ID: 1495660 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 2 RA / IM

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

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

Write-up: Patient had RX from Dr.''s office to get the Janssen. She had an anaphylactic reaction to Pfizer. J+J consulted patient and said it was ok to still get the Janssen vaccine. Therefore, patient got an RX from doctor. Patient tolerated the vaccine with two benadryl tablets.


VAERS ID: 1496331 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207AZ1A / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Malaise, Nausea, Palpitations, Tachycardia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu
Other Medications: Plavix, asprin synthroid zedia
Current Illness: Surgery
Preexisting Conditions: Hashimotos
Allergies: Avocado demerol singular
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 days later nausea, vomiting, diarrhea, palpitions, tachycardia, fatigue, general malaise. Still have occassional palpitations.


VAERS ID: 1497185 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-15
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210744480

Write-up: DEEP DRY COUGH; FEVER; 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: Unknown) dose, start therapy date were not reported 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 15-JUL-2021, the subject experienced deep dry cough. On 15-JUL-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from fever, and had not recovered from deep dry cough. This report was non-serious.


VAERS ID: 1497945 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-01
Onset:2021-07-15
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 010M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Epi EZ Pen as directed IM hs Triamcinolone Acetonide Topical 0.1% cream 1 app applied topically twice a day prn dermatitis Fluticasone Propionate 50 mcg/inh spray as directed intranasally once a day Amlodipine Besylate 10 mg tablet
Current Illness:
Preexisting Conditions: Anxiety- citalopram previously. Kidney stone. Obstructive sleep apnea - using cpap. Vitamin D def. Hypertension. Hypogonadism. Hemorrhoids.
Allergies: Fire ants: swelling, hives - Allergy
Diagnostic Lab Data: Tested ER- PCR- positive. 7/16/2021
CDC Split Type:

Write-up: 39 y/o W M with COVID. Daughter brought it home from camp. He started with symptoms over late last week and was tested on Friday. He was treated by doctor through his insurance. He is on day 4 of Ivermectin. He c/o cough disrupting his sleep. He has not has SOB, but his wife has been mildly. Tested ER- PCR- positive. 7/16/2021 Doctor also prescribed Zpack, Symbicort, and prednisone.


VAERS ID: 1498020 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-22
Onset:2021-07-15
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2316 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Fatigue, Headache, Myalgia, Oropharyngeal pain, Pyrexia, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: COUGH,RUNNY NOSE,LOSS OF TASTE AND SMELL,SORE THROAT,MUSCLE ACHES,FEVER,HEADACHE,FATIGUE


VAERS ID: 1498093 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-17
Onset:2021-07-15
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site warmth, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin Humalog/Lantus ozempic Prinz ide Lipitor Wellbutrin
Current Illness: no
Preexisting Conditions: diabetes
Allergies: Prozac
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Covid Arm, on Wed 21st, red to touch, itchy and blotchy. On July 23, it has spread down to crook of elbow, still warm to touch and itchy.


VAERS ID: 1498281 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site induration, Injection site pain, Injection site pruritus, Injection site swelling, Ultrasound scan
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: High Blood Pressure
Allergies: Sulfer
Diagnostic Lab Data: Sonogram
CDC Split Type:

Write-up: Pain at sight, hard and swollen around the area of sight, itchiness, area is still swollen today


VAERS ID: 1498296 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-20
Onset:2021-07-15
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, COVID-19, SARS-CoV-2 test positive
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, Aspirin, Cinnamon bark, Plavix, liraglutide, lisinopril, claritin, metformin, metoprolol, multivitamin, omega-3 fatty acids, crestor, saw palmetto, sour cherry extract
Current Illness: None
Preexisting Conditions: Hypertension, hyperlipidemia, DM2, gout, obesity, Coronary artery disease
Allergies: Thimeresal (reports he had this in contact solution, it cause irritation to his eyes), Penicillins, Proton Pump Inhibitors, Seafood, Sulfa drugs, Losartan
Diagnostic Lab Data: Positive COVID PCR on 07/15/21.
CDC Split Type:

Write-up: Fully vaccinated patient who tested positive for COVID upon admission screening to hospital. Admitted through ED for STEMI. No fever, cough, or loss of taste or smell. No s/s of COVID throughout stay. Discharged on 07/17/21. Of note - patient recovered from COVID in 11/2020.


VAERS ID: 1498369 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-03
Onset:2021-07-15
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Other chronic diseases
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1498380 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 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: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: The patient recieved the Pfizer vaccine as her first dose on 6/24/21. On 7/15/21 we administer the incorrect second Covid vaccine as Moderna instead of Pfzier. We followed CDC guidelines with educating the patient their were considered fully vaccinated after reciving two mRNA vaccines.


VAERS ID: 1498393 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Cold sweat, Dizziness, Hyperhidrosis, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: no
Preexisting Conditions: Authorities, had heart attack
Allergies: walnuts, banana, strawberries, and onions
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: I went home got something to eat felt dizzy and nausea. I went to sleep woke up clammy and sweating. I slept 13 hours and woke up with a fever . I took IB-profrin and the fever continued for about 3 days. I still have chest pains


VAERS ID: 1498534 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 FA6780 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Headache, Lip discolouration, Lip exfoliation, Lip swelling, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swollen lips after 4-6 hours Discoloration of top lip (purple in color) with redness on skin above. Started peeling 2 days after, still with purple discoloration of top lip but improved. vomiting for 2 days after - vomiting that evening. With headaches which also resolved after 2 days.


VAERS ID: 1498537 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-01
Onset:2021-07-15
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, Citroma, guaifenesin, albuterol, milk of magnesia, carbidopa-levodopa, escitalopram, hydrochlorothiazide, methenamine, acetaminophen, amantadine, bisacodyl, multivitamin with minerals, gabapentin, hyoscyamine, ropinirole
Current Illness:
Preexisting Conditions: CKD, HTN, hypertensive heart disease, major depression disorder, hypothyroidism, Parkinson''s disease, neuromuscular, dysfunction of the bladder
Allergies: No known medication allergies
Diagnostic Lab Data: SARS CoV test outpatient 7/12/2021
CDC Split Type:

Write-up: Hospitalization due to COVID-19 infection 7.21.21 - patient discharged to a facility.


VAERS ID: 1498584 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-04
Onset:2021-07-15
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, Cough, Dyspnoea, Influenza A virus test negative, Influenza B virus test, Intensive care, Respiratory failure, SARS-CoV-2 antibody test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), 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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: Proctitis, raidiation, hx Hep C, microcytic anemia, vag cancer-distant.
Allergies: Amlodipine, Floxin, hydralazine, losartan, sulfa drugs
Diagnostic Lab Data: Coronavirus 2019 Influenza A, B PCR was positive for SARS CoV 2 PCR COVID 19 on 7/15/2021. SARS CoV2 Total Ab COVID 19 was nonreactive.
CDC Split Type:

Write-up: Patient had Moderna Vaccines on 1/4/2021 and 2/1/2021. No reactions developed after both vaccinations. Patient came into the ED on 7/15/2021 with complaints increasing dyspnea and a cough that started 9 days ago. She tested positive for COVID 19 and was admitted to ICU for hypoxemic respiratory failure on BIPAP. She is now on heated high flow NC at 100% FIO2 40L oxygen. Patient was started on ceftriaxone, doxycycline and remdesivir. 7.23.21 - patient is still admitted at the time of this form submission.


VAERS ID: 1498585 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-22
Onset:2021-07-15
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 - / -

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

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

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


VAERS ID: 1498589 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-01-26
Onset:2021-07-15
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood fibrinogen increased, Blood lactate dehydrogenase normal, C-reactive protein increased, COVID-19, Cough, Dyspnoea, Fibrin D dimer, SARS-CoV-2 test positive, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: levothyroxine 125 mcg daily Lialda 1.2 gm daily Mirtazapine 15 mg bedtime Clonazepam 1 mg bedtime
Current Illness: none noted
Preexisting Conditions: hypertension, depression with anxiety, hyperlipidemia, history of remote PE but not on anticoagulation, hypothyroidism, history of prostate cancer status post prostatectomy
Allergies: none
Diagnostic Lab Data: 7/22 COVID PCR positive WBC 5.5, LDH 167, C reactive protein 4.47, dDimer 0.38 with fibrinogen 580
CDC Split Type:

Write-up: Received his Pfizer vaccinations 1/26/21 and 2/16/21; he started to have a dry cough on 7/15/21 which has progressed to shortness of breath. He does admit to eating with friends who were not vaccinated while on vacation sometime prior to this. He had a positive COVID test at his PCP office on 7/18 and another positive COVID PCR at our hospital 7/22


VAERS ID: 1498606 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-04
Onset:2021-07-15
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Eye infection, Eye pain, Inappropriate schedule of product administration, SARS-CoV-2 test positive
SMQs:, Glaucoma (broad), Ocular infections (narrow), Medication errors (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Type 2 diabetes, chronic kidney disease, hyperlipidemia
Allergies: No known drug allergies
Diagnostic Lab Data: patient tested positive for COVID on 7/17/2021 upon admission patient tested positive for COVID-19 upon admission on 7/17/21. Please note: Patient received First dose of Pfizer COVID-19 vaccine on 3/22/2021, followed by the second dose 22 days later, on 4/12/2021 (confirmed from health department)
CDC Split Type:

Write-up: Patient is a 66-year-old female with a past medical history of diabetes mellitus, vertigo, hyperlipidemia, fall, syncope who presents to the hospital with right eye pain/infection that started about 3 days ago. Patient tested positive for COVID-19 upon admission on 7/17/21; but was asymptomatic. Please note: Patient received First dose of Pfizer COVID-19 vaccine on 3/22/2021, followed by the second dose 22 days later, on 4/12/2021 (confirmed from health department)


VAERS ID: 1499083 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Extra dose administered, Feeling hot, Interchange of vaccine products, Pain in extremity, Wrong product administered
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: Pt.received a Pfizer Covid vaccination but was supposed to receive a Shingrix vaccine. He received his Covid series (Moderna) 1/22/21 and 2/19/21. This was a third Covid vaccine and unnecessary. He experienced a sore arm for approximately 2 days. He did not experience fatigue or headache. He did experience chills and hotness (fever?) for 3 days. His doctor was notified by me, pharmacist and he recommended the shingrix shot 2 weeks after this Covid shot. He is not currently experiencing side effects.


VAERS ID: 1500718 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1500784 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-20
Onset:2021-07-15
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acne, Burning sensation, Facial pain, Herpes zoster, Neuralgia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Magnesium; birth control pill; riboflavin; L-lysine; I am pretty sure I was taking Allegra and Flonase and Asselstine
Current Illness: no
Preexisting Conditions: Pre-clampsia when pregnant
Allergies: Black pepper; crab meat and rye and seasonal allergies
Diagnostic Lab Data: no - visual exam
CDC Split Type: vsafe

Write-up: Woke up the morning I went to the doctor - felt a really bad burning sensation in my right nostril - like I was breathing fire. And a weird pain on the right side of my face. I made an appt to go to dr. and she saw all my lesions and my bumps in my lower chin and she said that I had shingles. I thought it was just acne. I had been treating it like acne and that made it worse. She diagnosed me with Shingles. I got on Prednisone and Valtrex (anti-viral) and a med for nerve pain - Gabapentin (as needed for the nerve pain). My bumps in my face are 95% better. I''m on my last two days of Prednisone. Mostly recovered - I still get the nerve pain.


VAERS ID: 1500799 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: had surgery on L elbow in 6/14/2021
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: a few hours after getting vaccine pt developed swelling and tenderness along L lateral scapula and extended under L arm. Along latissimus dorsi. I saw patient on 7/19/21 and pt was still complaining of mild swelling and tenderness. No redness or induration. No signs of infection.


VAERS ID: 1500835 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-21
Onset:2021-07-15
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / IM

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

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

Write-up: unknown


VAERS ID: 1501065 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-04-10
Onset:2021-07-15
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Oropharyngeal pain, SARS-CoV-2 test positive, Sinus congestion, Sinus operation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: spironolactone 25 mg tablet (spironolactone) loratadine 10 mg tablet (loratadine) lisinopril 20 mg tablet (lisinopril) Aspirin Low Dose 81 mg tablet,delayed release (aspirin) atorvastatin 10 mg tablet (atorvastatin calcium) Vitamin C 500 mg
Current Illness: None
Preexisting Conditions: Systolic heart failure, GERD, Hyperlipidemia, Essential Hypertension, Takotsubo cardiomyopathy
Allergies: Erythromycin
Diagnostic Lab Data: 07/22/2021: Rapid Coronavirus test collected, tested in urgent care: POSITIVE. 07/22/2021: Coronavirus PCR test collected and sent to lab for confirmation. Resulted on 07/23/2021 as POSITIVE.
CDC Split Type:

Write-up: Seen in clinic on 07/22/2021 for upper respiratory infection symptoms x1 week. Symptoms started 07/15 and consisted of sore throat, sinus congestion, sinus drainage, headache, dry cough. Symptoms initially mild, and worsened throughout the week with sinus symptoms more prominent. Patient presented to believing he had a sinus infection. Rapid test was positive and patient notified. He was frustrated as he thought he was protected by vaccine status. We collected a second sample for confirmatory Coronavirus PCR testing and sent this out later in the day. Patient was notified of the positive confirmatory test on 07/24. No current information on his recovery.


VAERS ID: 1501786 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-01
Onset:2021-07-15
   Days after vaccination:105
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: COVID-19, Chills, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A - unknown
Current Illness: N/A - Unknown
Preexisting Conditions: Diabetes mellitus type II and hypertension
Allergies: Hives allergy to Penicillins
Diagnostic Lab Data: COVID PUI LIAT via nasopharingeal swab. 7/18/21 - positive
CDC Split Type:

Write-up: 85 yo M with past medical history significant for diabetes mellitus type II and hypertension, received Pfizer vaccine in April/May. He presented to the hospital with fever and chills x 2 days but reports no other symptoms. He was found to be COVID positive and with RLL pneumonia on imaging


VAERS ID: 1501959 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-14
Onset:2021-07-15
   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 EW0186 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood test, Facial pain, Impaired work ability, Injection site pain, Injection site pustule, Injection site swelling, Injection site warmth, Joint contracture, Mobility decreased, Neck pain, Pain in extremity, Red blood cell sedimentation rate increased
SMQs:, Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin
Current Illness:
Preexisting Conditions: Neuropathy left side
Allergies: Shellfish and iodized salt
Diagnostic Lab Data: Dr visit + Blood work 7/16 sed rate 32 ER visit 7/23 sed rate 47
CDC Split Type:

Write-up: Puss filled bubble at the injection area, Hot to touch and very puffy and painful. Sharp pain spreading throughout my arm and leg and where my fingers and wrist knee and ankle bend also under my chin the side of my face and back of neck all on my right side from July 14 to date. I''m still in pain to this date. I have to speak to text just to write this. I can''t turn my steering wheel without my right wrist and fingers locking up in pain. I have to type for a living so this is preventing me from working and I''m right handed.


VAERS ID: 1502053 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 EW0198 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Nausea, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Felt nauseous and broke out into a sweat. Reported lightheadedness and dizzy. Felt like she would pass out. Reported tingling in fingertips. Laid down for an hour. Tingling subsided and felt lightheadedness subsided; however, continued to feel nauseous. Denies vomiting, chest pain, SOB, et.c


VAERS ID: 1502074 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 EW0198 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Dyspnoea, Panic attack
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: SOB and chest tightness after vaccine. Pulse and RR within normal limits. Gave albuterol - examined by physician in office. Felt to be of anxiety or panic attach related and the albuterol was maybe more of a placebo effect.


VAERS ID: 1502550 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-17
Onset:2021-07-15
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abscess, Abscess drainage, Cyst
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: Levothyroxine, Viactiv, Fish oil.
Current Illness: None
Preexisting Conditions: Cyst, Partial Thyroidectomy, Ovariectomy, Knee surgery (Torn ACL)
Allergies: NKA
Diagnostic Lab Data: Only treatment, no test or labs done.
CDC Split Type: vsafe

Write-up: (07/15/2021) A cyst infection appeared while on vacation and was getting worse for 4 days and at Clinic the abscess was lanced and drained. Antibiotics prescribed. Follow up with Dr. for care and further treatment.


VAERS ID: 1502761 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 LA / IM

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

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

Write-up: After receiving COVID-19 vaccine 5 days ago, this employee developed pain in her left arm. This pain has continued to increase to become ?severe?. She was advised to see a provider asap.


VAERS ID: 1505248 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-08
Onset:2021-07-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Swelling face, 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: ibuprofen, Neurontin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: a week after treatment started breaking out in hives and face swelling; experience on and off for last two weeks


VAERS ID: 1505454 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-07-15
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal tenderness, Acute kidney injury, COVID-19, Cough, Immunodeficiency, Malaise, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (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: Congenital kidney disease s/p renal transplant, HTN, HLD, gout, osteoporosis
Allergies:
Diagnostic Lab Data: Novel Coronavirus PCR- SARS-COV-2 detected (7/15/2021)
CDC Split Type:

Write-up: 42 yo male with history of congenital kidney disease s/p renal transplant in 1990; stable on myfortic, Neoral, and prednisone. He developed COVID symptoms on 7/15 and tested positive that day with cough, fevers, but no hypoxia or work of breathing. He completed his full Pfizer COVID-19 vaccination:first dose 2/18/21, second dose 3/11/21. He presented and was admitted to the hospital on 7/20 for abdomen tenderness and AKI. Due to his immunocompromised state, he was started on remdesivir for COVID-19.


VAERS ID: 1505779 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-01
Onset:2021-07-15
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN NA / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Feeling abnormal, Laboratory test, Muscle spasms, Skin infection, Skin laceration, Thirst, Type 1 diabetes mellitus, Vision blurred, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Hospitalized with weight loss, thirsty, blurry vision, leg cramps, cuts on arm with skin infection and generally feeling bad. Diagnosis: Type 1 Diabetes


VAERS ID: 1505788 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-09
Onset:2021-07-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flecanide, Bupropion, Esopmeprazole, Loratidine, Gabapentin, Trazodone, Singulair, Atorvastatin, Estradiol, Stool Softner, Famotidine,
Current Illness:
Preexisting Conditions: Crohn''s, IST, Errosive gastritis, Depression, Seasonal Allergies, RLS, Insomnia
Allergies: Avelox, Codeine, Shellfish, Tree nuts, Beans
Diagnostic Lab Data: Office Visit 07/26/21, labs, received steroid shot, started on oral steroids and itching medication
CDC Split Type:

Write-up: Itching that started all over body a few days after injection, spontaneous rashes that start a week after injection


VAERS ID: 1505821 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-03
Onset:2021-07-15
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Chest pain, Cough, Diarrhoea, Dyspnoea, Feeling abnormal, SARS-CoV-2 test positive, Vomiting, Weight decreased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Tested positive for COVID in ER on 7/24/2021
CDC Split Type:

Write-up: Breakthrough case after full vaccination. Per report from the prison, patient reported he felt awful and was having trouble breathing. Reports onset 9 days prior. Reports vomiting. Weight loss of 12lbs since 7/8/21. Reported diarrhea x 7 days. Reports cough and chest pain with coughing. Patient was transported to local ER via EMS.


VAERS ID: 1505850 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-09
Onset:2021-07-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest pain, Dyspnoea, Ear pruritus, Electrocardiogram normal, Feeling abnormal, Laboratory test, Malaise, Urine analysis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dementia (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Buspar, Zoloft, Medroxyprogesterone, Polyethylene glycol, Hydrocortisone, Prazosin.
Current Illness: No.
Preexisting Conditions: Depression, Anxiety
Allergies: Latex.
Diagnostic Lab Data: Lab work, Urinalysis, EKG(normal results)
CDC Split Type: vsafe

Write-up: I don''t know if any of his adverse events are related I wanted the CDC to be aware. He started feeling uneasy, unwell, vomiting, itchy ears (both), upper chest pain, upper back pain and difficulty breathing. We went to the ER at 17:00 - 22:00 on 7/18 was discharged couldn''t figure out what was happening was given medication for migraine, Benadryl, Loratadine.


VAERS ID: 1505972 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 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? 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: Vaccine was administered to a 14 year old. No adverse outcome.


VAERS ID: 1505985 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 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? 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: Vaccine was administered to a 15 year old. No known adverse outcome.


VAERS ID: 1506742 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-07-03
Onset:2021-07-15
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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: TEGRETOL 200 mg at night
Current Illness: Epilepsy
Preexisting Conditions:
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right side facial paralysis, without evolution. 50 mg Prednisone. Physical Therapy.


VAERS ID: 1507889 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-01-19
Onset:2021-07-15
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / OT

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, 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: Medical History/Concurrent Conditions: Acute gastritis
Allergies:
Diagnostic Lab Data: Test Date: 20210719; Test Name: Covid 19; Test Result: Positive; Test Date: 20210719; Test Name: Nasal Swab/Lumiradx Sars-Cov-2 AG; Test Result: Positive
CDC Split Type: USPFIZER INC202100918004

Write-up: I tested positive for Covid19 on 19Jul2021/COVID-19 confirmed by positive COVID-19 test; I tested positive for Covid19 on 19Jul2021/COVID-19 confirmed by positive COVID-19 test; This is a spontaneous report from a contactable consumer (patient) reported for himself. A 28-years-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number: EL3247, Expiration date: 31May2021) intramuscular, administered in left arm on 19Jan2021 at 13:15 pm (age at vaccination was 28 years) as dose 1, single for COVID-19 immunization and received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number: EL3247, Expiration date: 31May2021) intramuscular, administered in right arm on 08Feb2021 at 11:45 am (age at vaccination was 28 years) as dose 2, single for COVID-19 immunization. The patient''s medical history acute gastritis. The patient had no allergies. The other medications the patient received in two weeks included Once a day Men''s Multivitamin. The facility where the most recent COVID-19 vaccine was administered was Workplace clinic. The patient did not receive any other vaccine in four weeks. Prior to vaccination, the patient was not diagnosed with COVID-19. On 15Jul2021 at 12:00 pm, the patient developed symptoms of congestion, cough, runny nose, head and muscle aches and loss of smell and taste) of COVID-19 which got worsened on 16Jul2021. The symptoms started to decrease each day after but the patient tested positive for COVID-19 on 19Jul2021. Since the vaccination, the patient has been tested for COVID-19. The patient underwent lab test Lumiradx Sars-Cov-2 AG, nasal swab: positive and COVID-19 test: positive on 19Jul2021. No treatment was received for the adverse events. On Document 20Jul2021, the report from Quality Complaints was reported. As part of the LOE simplification process, the following Complaint Records were classified as Product Use Attributes // Lack of Effect and have been moved to Closed (No Investigation) state referencing a previously completed investigation for the same product and lot as per the ''One and Done'' business process according to in PQS Q1215 and/or Q1252. Product Description (CR): Compound BNT162 Covid-19 Vaccine Suspension for Intramuscular 2ml Multiple Dose Vial X 1. The complaint for lack of effect of the PFIZERBIONTECH COVID-19 VACCINE Lot EL3247 was investigated. The investigation included a review of manufacturing and packaging batch records, deviation investigations, and an analysis of complaint history for the reported lot. The final scope included the reported finished goods lot EL3247, fill lot EL3230, and the formulated drug product lot EL3223. A complaint sample was not returned, and photographs were not received. No related quality issues were identified. Fill Date: This is the date the formulation product is filled into the primary container 05Dec2020. Package Date: This is the start date when the finished product is packaged into the commercial presentation 07Dec2021. (Parent) evaluation comment included Pfizer (site name) reviewed this complaint and agrees with the site assignment, investigation decision, classification, sub-classification, and priority. The reported lot number is valid and an investigation will be performed. QA Review & Rationale included this is a complaint for lack of effect of lot EL3247 of product PFIZER-BIONTECH COVID-19 VACCINE INJECTABLE. The complaint and its classification have been reviewed. No immediate containment action is required. The complaint, its priority, and its classification have been reviewed and determined to be appropriate. The initial scope of this investigation is limited to EL3247 pending review of lot genealogy to determine other in-scope lots. The investigation will include a include a review of the returned complaint sample (if received) and reserve samples, if necessary. A full investigation will be performed. Reviewed on: 01Mar2021. Investigation findings: Summary of Investigation included the initial scope of the investigation was limited to the reported finished goods lot. The final scope was expanded to include the reported finished goods lot EL3247, fill lot EL3230, and the formulated drug product lot EL3223. Manufacturing and packaging batch records were reviewed for the reported complaint lot. Pfizer (Site name) QO did not receive photographs or a complaint sample for examination. The complaint was not confirmed. There were no planned or unplanned deviations recorded during the manufacture of the complaint lot and associated manufacturing lots that may have caused a complaint of this nature. A review of the manufacturing records confirmed processing steps were performed within pre-established parameters. All raw materials and amounts used in the manufacture of the batch were of the correct weight and identity. The drug product is stored at controlled refrigeration throughout the manufacturing process and a log is maintained documenting the elapsed time out of refrigeration. A review of the logs confirmed that all times were within allowable limits. The product also requires storage in ultra-low temperature freezers following the packaging of the product. A review of the freezer temperature log for the reported batch confirmed that all freezer temperatures were within allowable limits. The results of all analytical tests performed at the time of lot release confirmed that the batch continues to meet potency specifications. Root Cause Analysis/Identified included Pfizer (Site name) Quality Operations could not indicate a probable root cause for the complaint to be related to the production process of the involved batch. Review of the manufacturing and packaging batch records and release test results confirmed that the batch continues to meet potency specifications. It is unknown how the product was handled, stored, or administered after it left the Pfizer (site name). Impact Analysis included based on the results of this investigation, the manufacturing and packaging batches remain acceptable and the reported complaint is not representative of the lot. No regulatory notification is needed. Corrective/ Preventive Action included there were no corrective actions as a result of this complaint investigation. The results of all tests, inspections, and in-process controls have been reviewed and all results met the established requirements prior to the release of the reported batch for distribution. Conclusion included the complaint for lack of effect of the PFIZER-BIONTECH COVID-19 VACCINE lot EL3247 was investigated. The investigation included a review of manufacturing and packaging batch records, deviation investigations, and an analysis of complaint history for the reported lot. The final scope included the reported finished goods lot EL3247, fill lot EL3230, and the formulated drug product lot EL3223. A complaint sample was not returned, and photographs were not received. No related quality issues were identified during the investigation. There is no impact to product quality. No root cause or corrective/preventative actions were identified as the complaint was not confirmed. All release testing performed prior to the release of the reported batch was within specifications. Batch/Process record review: Scope of Compl. Investigation included the scope of this investigation included the reported finished goods lot EL3247, fill lot EL3230, and the bulk formulated drug product EL3223. Acceptable review of related documentation, including manufacturing batch records and review of release test results at the time of lot release confirmed that there were no issues which may have resulted in a complaint of this nature. There was one deviation recorded that was related to the in-scope lots. Event report # was initiated after a process engineer discovered a warped vent filter on the Bioburden Reduction (BBR) pathway. There is no quality impact as a result of this incident because there is downstream bioburden reduction filtration and 2x sterile filtration from this point in the process. Additionally, Bioburden results from the sample taken post BBR and pre-dilution were acceptable. The batch remains acceptable for use. Manufacturing Batch Records: Complete-Acceptable. The bulk manufacturing batch record for the complaint batch was reviewed as part of this investigation and found to be acceptable. All processing steps were performed within pre-established parameters. The review of the manufacturing record confirmed that all in process checks, all line startup and end of batch challenges, and all line clearance and cleaning activities were completed satisfactorily. All raw materials used in the complaint batch were of the correct weight and identity. All the manufacturing temperatures mix speeds and mixing times were within acceptable ranges. In-process appearance and specific gravity test results were all within acceptable ranges. A review of the solution filtration documentation confirmed that all materials, filters and Water for Injection (WFI) were used within their expiration dates, and that all the filtration times, pH results, and pressure specifications were met. The manufacturing processes of raw material usage, solution formulation and filtration were all found to be acceptable. All manufacturing parameters met established requirements. A log is maintained throughout the manufacturing process of the amount of elapsed time that the product is out of refrigeration. A review of the elapsed time tracking logs confirmed that all times were within allowable limits. Packaging Batch Records: Complete-Acceptable. The review of the packaging record confirmed that all in process checks, all line startup and end of batch challenges, and all line clearance and cleaning activities were completed satisfactorily. Audits are performed on the finished packaged units by Packaging Operations personnel at regular intervals throughout the final packaging process. This is done in order to ensure that all required labeling and packaging is present, complete, and meets all establishments requirements. During the audits, inspectors visually check the appearance of the finished product for defects. The Pfizer-BioNTech COVID-19 Vaccine vials are loaded into trays containing 195 vials each. Five trays are then banded together into a bundle. The vaccine requires ultra-low temperature freezer storage. Prior to loading, freezer temperatures were verified to between -67 degree C and -73 degree C. Freezer shelves were then loaded with bundles of product. During the freezing phase, which occurs 60 hours after loading, the temperature of the freezers is monitored. If the temperature is warmer than the expected freezer temperature, supervision is notified. A review of the log for the reported batch confirmed that all freezer temperatures were acceptable. Samples are then stored until the product is released for distribution. There were no issues recorded during the packaging or storage process which may have impacted the quality of the batch and potency of the drug product. Lot History: Complete-Acceptable. The results of all tests and inspections met required specifications at the time of release for distribution on 10Jan2021. Rsrv. Sample Eval. Rationale included visual examination of a reserve sample would not be expected to indicate the potency of the drug product. A reserve sample was not sent to the QC-lab to determine the amount of active ingredient since the complaint was received within six months of the release date of the involved batch. The results of all analytical tests performed at the time of lot release were confirmed to be within registered specifications. All available stability results for this product were within registered specification and stability studies (including accelerated studies) are ongoing for this product. Lot Trend Assmt. & Rationale included the complaint history for the reported PFIZER-BIONTECH COVID-19 VACCINE lot EL3247 was reviewed. As of 12Mar2021, there were a total of four complaints for this lot and classification. No lot specific trend was identified. Lot trend actions taken included there were no lot trend actions as a result of this investigation. The outcome of the events was resolving. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1509196 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021900835

Write-up: slight chest tightness like little bit of chest pain like patient chest was still tight when patient breathe; slight chest tightness like little bit of chest pain like patient chest was still tight when patient breathe; This is a spontaneous report from a contactable consumer (patient). A patient received of unspecified age and gender received unknown dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot Number and expiration date were unknown), via an unspecified route of administration, on 15Jul2021 13:00, as single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not provided. Patient had the Pfizer Vaccine at 1 o''clock on 15Jul201 and experiencing like slight chest tightness like little bit of chest pain like patient chest was still tight when patient breathe if that make sense. Outcome of the events was not recovered. Information about lot/batch number has been requested.


VAERS ID: 1509231 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-25
Onset:2021-07-15
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dizziness, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid positive after screening on 7/15/2021
CDC Split Type:

Write-up: Nausea and vomitting, dizzy


VAERS ID: 1509234 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

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


VAERS ID: 1509254 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 RA / IM

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

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

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


VAERS ID: 1509268 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

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


VAERS ID: 1509594 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 EW0196 / 1 RA / IM

Administered by: Unknown       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: Pfizer vaccine was administered after being discovered the vaccines were in the freezer for 11 days after the two-week standard time.


VAERS ID: 1509616 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-07-15
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 - / -

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

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

Write-up: Patient hospitalized with positive COVID Sepsis secondary to COVID


VAERS ID: 1509630 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 EW0196 / 1 RA / IM

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

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

Write-up: Pfizer vaccine was administered after being discovered the vaccines were in the freezer for 11 days after the two-week standard time. Patient notified and given the option for an additional dose.


VAERS ID: 1509651 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 EW0196 / 1 RA / IM

Administered by: Unknown       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: Pfizer vaccine was administered after being discovered the vaccines were in the freezer for 11 days after the two-week standard time. Patient notified and given the option for an additional dose.


VAERS ID: 1509864 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

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


VAERS ID: 1509892 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 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:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1509902 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

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


VAERS ID: 1509930 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

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


VAERS ID: 1509934 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 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:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1509944 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-15
   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 EW0196 / 1 LA / IM

Administered by: Unknown       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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer vaccine was administered after being discovered the vaccines were in the freezer for 11 days after the two-week standard time. Patient notified and given the option for an additional dose.


VAERS ID: 1509961 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Arthritis, Inflammation, Mast cell activation syndrome, Pain
SMQs:, Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Arthritis (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Assessment & Plan: Pt is here to discuss post covid vaccination symptoms after vaccine was given 5/7/21. Reviewed information. Additional research done prior to seeing patient. While ivermectin may be used in the clinical trial setting it is not currently recommended for outpatient treatment howevver, it has been shown to decrease time of symptoms by about 2 days. Given taht we are so far from the vaccine I am more thinking that this might be continued elevated body inflammation. She also has joint pains and arthritis, thus we discussed using mobic which given its NSAIDs category is generally not recommended immediately after vaccines due to decreased antibody response. Given she is still having these global inflammation symptoms, with joint pains/body aches, will start mobic 7.5mg bid for around a month. If no benefit, could consider low dose prednisone burst to help diminish any further inflammation. However if the mobic does not help the symptoms, I do not suspect continued improvement in symptoms with prednisone but could try 5-10mg QD x 5 days. Other options which may be helpful if it is suspected to be mast cell activation would lbe antihistamines +/- montelukast. She will f/u in 1 month or sooner should condition worsen


VAERS ID: 1511569 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-15
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210715; Test Name: COVID-19 virus test; Result Unstructured Data: positive
CDC Split Type: USJNJFOC20210755671

Write-up: COVID-19 TEST POSITIVE; This spontaneous report received from a patient via a company representative concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 15-JUL-2021, the subject experienced covid-19 test positive. Laboratory data included: COVID-19 virus test (NR: not provided) positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of covid-19 test positive was not reported. This report was non-serious. This report was associated with product quality complaint: 90000187269.; Sender''s Comments: V0-Medical Assessment Comment is not required as per standard procedures, as the case was assessed as non-serious.


VAERS ID: 1511630 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Dyspepsia, Headache, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood cholesterol abnormal (Verbatim: Cholesterol); Blood pressure high (Verbatim: High Blood Pressure)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100917679

Write-up: fever; stomach pain/his stomach hurts; stomach burning; he experienced a bad headache/head hurt really bad; This is a spontaneous report from a contactable consumer or other non hcp (Daughter) reporting for father (patient). A 55-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number and Expiry date are unknown), via an unspecified route of administration on 15Jul2021 between 16:00-18:00 at the age of 55-years-old as dose 2, single for COVID-19 immunisation. Patient''s medical history including any illness at time of vaccination and concurrent conditions included ongoing High Blood Pressure and ongoing Cholesterol from unspecified date. There were no concomitant medications. The patient previously took first dose of historical vaccine, bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE) on an unspecified date as dose 1, single for COVID-19 immunisation. Additional vaccines administered on same date of the pfizer suspect were none. Prior vaccinations within 4 weeks were none. AE(s) following prior vaccinations were none. Family medical history relevant to AE(s) was none. Relevant tests were none. Patient age at time of vaccination was 55 years. On 15Jul2021, the patient experienced headache, head hurt really bad, stomach hurts and burns and on 18Jul2021, experienced fever. Caller was a caregiver calling on behalf of her 55-year-old father. The caller reports that he received his second dose of the Pfizer BIONTECH COVID-19 vaccine on 15Jul2021. Afterwards he experienced a bad headache and a fever, those symptoms have since resolved. He was now experiencing stomach pain, stomach burning and diarrhea. The case was reported as non-serious. The patient took received Tylenol as treatment for headaches and pyrexia. The outcome of event headache was recovered on 15Jul2021 and fever was recovered on 18Jul2021 while other events were not recovered. Information about lot/batch number has been requested.


VAERS ID: 1512044 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, Dizziness postural, Fear, Malaise
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: Medical History/Concurrent Conditions: Blood pressure high; Diabetes; Disability (am little a disabled, have hard time walking)
Allergies:
Diagnostic Lab Data: Test Name: blood pressure; Result Unstructured Data: Test Result:121/60; Comments: My blood pressure right now because I got scared 121/60(Not clarified hence not captured in tab).
CDC Split Type: USPFIZER INC2021902676

Write-up: When I get up to go to bathroom everything was like going round and round I was very dizzy; I got scared; I don''t feel good; This is a spontaneous report from a contactable consumer (patient). A 57-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Right on 14Jul2021 11:20 (Batch/Lot number was not reported, at age of 57 years old) as single dose for COVID-19 immunisation. Medical history included high blood pressure and diabetes, patient was a little disabled, she had hard time walking. Concomitant medications included unspecified medications and patient took it every day. On 15Jul2021, when the patient got up to go to bathroom everything was like going round and round she was very dizzy the only time she had no weakness, the patient had no pain nothing else just that very dizzy. The patient just got disabled 4 O'' clock in the morning on 15Jul2021. She was fine all day. She didn''t get nothing. The patient''s blood pressure because she got scared 121/60 on unknown date. The patient didn''t feel good to talk. The patient underwent lab tests and procedures which included blood pressure: 121/60 on unknown date. The patient did not receive any treatment for events, she didn''t get nothing. The outcome of events was unknown. The patient had not received second dose yet, second one in 04Aug2021. The lot number for the vaccine BNT162B2 was not provided and will be requested during follow up.


VAERS ID: 1512205 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2001-04-06
Onset:2021-07-15
   Days after vaccination:7405
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow)

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

Write-up: Venous sinus thrombosis - with JJ vaccine


VAERS ID: 1512528 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-25
Onset:2021-07-15
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Pneumonia, SARS-CoV-2 test
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Recent NSTEMI, hypertension, hyperlipidemia, chronic kidney disease stage 3, moderate COPD, coronary arteriosclerosis, and osteoarthritis.
Allergies: No known drug allergies
Diagnostic Lab Data: COVID-19 (PCR-CEPHEID)
CDC Split Type:

Write-up: Patient presented with weakness, dizziness, and light-headedness. Patient does not have any respiratory symptoms and is being treated for community acquired pneumonia (CAP). Patient was started on Azithromycin and Ceftriaxone to treat his CAP, as well as other supportive care. Patient status improved and he was discharged.


VAERS ID: 1512558 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dysphagia, Hypoaesthesia, Musculoskeletal stiffness, Palpitations, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: none
Current Illness: no
Preexisting Conditions:
Allergies: peanuts eggs milk shellfish soy wheat / gluten
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Throat Swelling internally, Stiff neck, Trouble swallowing, Facial numbness, Rapid heart, tight chest


VAERS ID: 1512657 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-28
Onset:2021-07-15
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Decreased appetite, Dyspnoea, Dyspnoea exertional, Fatigue, Headache, Pain, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 MG Oral Tablet Take 10 mg by mouth daily aspirin 81 MG Oral Tablet Delayed Release Take 81 mg by mouth. atorvastatin (LIPITOR) 40 MG Oral Tablet Take 40 mg by mouth nightly at bedtime. buPROPion HCl (WELLBUTRIN XL
Current Illness:
Preexisting Conditions: ? Asthma ? CAD (coronary artery disease) ? CHF (congestive heart failure) (CMS-HCC: 85) ? COPD (chronic obstructive pulmonary disease) (CMS-HCC: 111) ? Diabetes mellitus ? Hypertension
Allergies: Bactrim (not specified)
Diagnostic Lab Data: SARS-COV-2, , Detected 7/16/21
CDC Split Type:

Write-up: Patient hospitalized for breakthrough COVID infection on 7/15/21. Left facility on 7/16/21. Patient received dose #1 of Moderna on 3/31/21 and dose #2 on 4/28/21. Below is copied from report upon admission: Patient is a male with past medical history of COPD, DVT (not currently on AC), DM, and HTN who is being admitted for evaluation of fatigue. He has been feeling tired, low energy, headache and decreased appetite for the last 2 weeks. Also has been feeling SOB mostly on exertion. The pain is sharp, non radiating, worse with coughing. Patient tested positive to COVID19. Per ED, he was sating 89% on RA, placed on 2LPM and sats improved to 98%. Patient denies fever, chills, hemoptysis, leg swelling or pain.


VAERS ID: 1512677 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-20
Onset:2021-07-15
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Chills, Decreased appetite, Diarrhoea, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test, Sepsis, Tachycardia, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (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), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 MG Tablet Take 1 tablet by mouth daily. aspirin 81 MG Tablet Chewable Chew 1 tablet daily. butalbital-acetaminophen-caffeine (FIORICET, ESGIC) 50-325-40 MG Tablet Take 1 tablet by mouth every 4 hours PRN headaches.
Current Illness:
Preexisting Conditions: ? Hypertension ? Osteoarthritis ? Morbid obesity (BMI 46)
Allergies: Ampicillin (not specified)
Diagnostic Lab Data: SARS-COV-2, NAA, Detected 7/15/21
CDC Split Type:

Write-up: Patient hospitalized for breakthrough infection from 7/15-7/19/21. She completed Moderna series: vaccine #1 on 2/20/21 and dose #2 on 3/20/21. Below is copied from discharge summary: "This is a 74-year-old female who presents to the hospital with fever chills sore throat diarrhea and loss of appetite. COVID-19 virus infection Patient has already been vaccinated for COVID-19 (Moderna). No need to continue dexamethasone No need for abx at this moment Sepsis-fever, tachycardia in setting of COVID-19 virus infection- obtain blood cultures, no antibiotics for now. Acute hypoxic respiratory failure secondary to COVID-19 virus infection albuterol MDI as needed Breathing RA Essential hypertension- resume outpatient blood pressure medications Patient is discharged in stable condition with stable vital signs. All questions regarding hospital course and plan of care after discharge have been answered to satisfaction."


VAERS ID: 1512733 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21Q / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

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

Write-up: Systemic: Patients blood pressure increased directly after receiving injection-Medium, Systemic: Hypertension-Medium, Additional Details: patient said she could tell directly after injection that her blood pressure increased. We monitored at store for 30 minutes. about 15 minutes after receiving her bp was 140/80 pulse 58. 30 minutes post injection she was 157/94. she decided to go home. i asked her to call and update me later in the day. i never heard from her again and we don''t have a current phone # on file.


VAERS ID: 1512746 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-01-29
Onset:2021-07-15
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Exposure to SARS-CoV-2, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Specimen Collection Date: 07/26/2021 Specimen Source: nasopharyngeal swab Test Performed: SARS-COV-2 RNA TMA Result: Detected Lab:
CDC Split Type:

Write-up: Sx onset 7/15/21 with cough, chills & muscle aches. Visited son, his wife & newborn. Son and DIL are both + cases. Tested on 7/26/21 which resulted as positive.


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