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From the 5/7/2021 release of VAERS data:

Found 188,897 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 36 out of 1,889

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VAERS ID: 1211954 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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: Error: Incorrect Reconstitution


VAERS ID: 1211955 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Syncope, Vital signs measurement
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received vaccine and was asked to move to observation area. Shortly after sitting down the patient came back to pharmacy counter and stated he was feeling dizzy. Just as the pharmacist was telling him to sit back down he fainted and fell on the floor. He recovered rather quickly (matter of seconds?) and tried to sit up right away. Pharmacist asked him to stay on the floor for a moment, the store''s first responder (MIC) was called over to pharmacy. After a minute of sitting on floor the patient got up on his own accord and transferred to a nearby chair. His BP was taken twice per emergency protocol of pharmacy. Patient initially appeared calmmy and BP was 132/81, pulse 44, respirations 18 at 12:25p. BP was 142/89, pulse 48, respirations 16 at 12:35. Patient was given both a water and a Gatorade while he was seated. Patient stated he had not eaten anything yet for the day. Patient was repeatedly offered medical services (i.e. "Do you want a medic? Do we need to call an ambulance?") The patient repeatedly refused any further medical treatment. After further observation patient was able to stand, check out at the pharmacy and left the store on his own accord.


VAERS ID: 1211960 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dysphagia, Dyspnoea, Hypertension, Hyperventilation, Tachycardia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Dehydration (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Hypertension-Medium, Systemic: Hyperventilation-Medium, Systemic: Tachycardia-Medium, Additional Details: OSat: 92 Respiratory Rate: 22 Temperature: 97.5 F Blood Pressure: 135/93 Pulse 117


VAERS ID: 1211965 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Seizure-Medium, Additional Details: Patient presented with seizure like symptoms for 15 seconds. The health hub concierge noticed and called myself over. He was out of it for maybe 15-20 seconds. I asked him questions to see if he was coherent. He was able to tell me where he was and his name. Patient stated he has history of vasovagal syncope so no EMS was required. BP taken at 101/59 on right arm. He waited an hour before leaving with his mother.


VAERS ID: 1211970 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-13
Onset:2021-04-14
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chills, Headache, Hypersomnia, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamins D3, C, B12, zinc, albuterol as needed for asthma
Current Illness: none
Preexisting Conditions: asthma
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up at 12:30 am with 102 fever, chills, body aches and severe headache. Slept most of day and symptoms resolved by 4pm on Sunday of that day. Took Tylenol and drank gatorade to help symptoms.


VAERS ID: 1212147 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Dyspnoea, Pain in extremity, Platelet count normal
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin glargine
Current Illness: N/A
Preexisting Conditions: Diabetes
Allergies: No known drug allergies
Diagnostic Lab Data: None at the time of presentation. Noting platelet counts normal at the time.
CDC Split Type:

Write-up: Patient presented with leg pain and shortness of breath to the emergency department. Was subsequently found to have a DVT


VAERS ID: 1212289 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Emotional distress, Helplessness, Migraine, Photophobia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 20 MG Tablet daily morning, Fluticasone Prop 50 McG Spray daily x2, Sudafed 24 Hour Er 240 MG Tab daily in morning, Vienva-28 Tablet daily morning, Bupropion Hcl XL 300 Mg Tablet daily morning, Pravastatin Sodium 10 MG Tab dail
Current Illness: Ear infection, Mar-Apr 2021, presumed gone at time of vaccination.
Preexisting Conditions: Major depression disorder, generalized anxiety disorder, ovarian cysts.
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient (self) woke up the day after the vaccination with a light-sensitive migraine that lasted from 8am until approximately 10pm the same day. After the migraine resolved, patient experienced extreme anxiety (likely panic attack) accompanying by uncontrollable shaking of both legs and loud crying producing tears. Prescription medications were taken on schedule, but the vaccination event may have triggered breakthrough anxiety and/or feeling of helplessness ~36 hours after vaccine received.


VAERS ID: 1212333 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-01
Onset:2021-04-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Musculoskeletal stiffness, Pain in extremity
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Leg pain for the past two days my legs have been feeling stiff


VAERS ID: 1212396 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-04-06
Onset:2021-04-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / UNK UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / UNK UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Deep vein thrombosis, Erythema, Exposure during pregnancy, Muscle tightness, Ultrasound scan abnormal
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Dystonia (broad), Thrombophlebitis (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, Prozac 10mg
Current Illness: none
Preexisting Conditions: none
Allergies: No known allergies
Diagnostic Lab Data: Venous US Bilateral lower extremities ordered and revealed extensive DVT from calf to groin on the left.
CDC Split Type:

Write-up: Admitted 4/13/21at 39 weeks for planned primary low transverse Cesarean Section due to velamentous cord insertion. CS was uncomplicated. APGAARs 8 and 9, weight 6lbs, 10oz. On 4/14/21 patient got up to take a shower. After her shower she felt like her left leg felt ?tight? and was more red in appearance. She denied pain. She reports that leg got more swollen at one point in pregnancy as well. OBMD in to assess patient. Vascular US ordered and revealed extensive DVT from calf to groin on the left. Patient received her 2nd dose of Moderna 4/6/21.


VAERS ID: 1212410 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

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

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

Write-up: Hives started appearing days later and have not eaten anything different than the week before and have not changed shampoo, body wash, deodorant, etc or taken any medication


VAERS ID: 1212413 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-06
Onset:2021-04-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Blood test, Computerised tomogram, Dizziness, Electrocardiogram, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin
Current Illness: None
Preexisting Conditions: None
Allergies: Ambien, keflex, flagella, compezinr
Diagnostic Lab Data: Ct scan Blood work Ekg
CDC Split Type:

Write-up: Lightheaded, blurry vision off balance


VAERS ID: 1212461 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-12
Onset:2021-04-14
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Chest pain, Computerised tomogram thorax, Pain in extremity, Platelet count normal, Pulmonary embolism, Ultrasound Doppler, Ultrasound Doppler normal
SMQs:, Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium carbonate 500 mg po qHS, Kariva 1 tab po qHS, escitalopram 10 mg po daily, fexofenadine 180 mg po daily, and pantoprazole 40 mg po daily.
Current Illness: none
Preexisting Conditions: Hyperlipidemia, anxiety, and PCOS
Allergies: Codeine (hives, shortness of breath)
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 4/15/2021 patient presented with chest pain and left lower extremity pain, which started about 2 days prior to admission. CTA showed large volume multifocal bilateral pulmonary emboli throughout numerous right lower lobe, right middle lobe, right upper lobe, left upper lobe, and left lower lobe segmental branches. Left lower extremity venous ultrasound showed no evidence of deep or superficial vein thrombosis; the right lower extremity was not scanned. Patient denies personal or family history of VTE. She states that she does not smoke and has no history of smoking. Patient was treated with apixaban 10 mg po BID x7 d followed by 5 mg po BID. Platelets were 295 on admission.


VAERS ID: 1212470 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-04-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pleuritic pain, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Infective pneumonia (broad)

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

Write-up: 29yom with no significant medical history was diagnosed by CT with acute pulmonary embolism involving the branch vessel in the right lower lobe 14 days after receiving Johnson & Johnson vaccine. Symptoms of right pleuritic pain began 4 days prior to the diagnosis. Initiated therapy on oral anticoagulants.


VAERS ID: 1212515 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-04-06
Onset:2021-04-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Ultrasound scan
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Folic Acid, Prenatal multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Ultrasound
CDC Split Type:

Write-up: Patient was pregnant. Had a viable pregnancy confirmed on 3/17/2021 with a 9wk gestation fetus and + cardiac activity and no abnormalities noted. Patient returned for prenatal visit on 4/14/21 and was confirmed to have had a miscarriage with no cardiac activity noted and a fetus measuring 12wks 0 days gestation.


VAERS ID: 1212533 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-02
Onset:2021-04-14
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / IM

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

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

Write-up: RASH ON RIGHT ARM, BACK OF LEG, SMALL RAISED BUMPS


VAERS ID: 1212565 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Coeliac artery stenosis, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Splenic artery thrombosis, Splenic infarction
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Developed acute severe abdominal pain and found to have splenic infarct, splenic artery thrombosis, celiac artery stenosis on morning of 4/14/2021 on CT abd/pelvis with IV contrast and presented to ED for symptoms. Started on apixaban.


VAERS ID: 1212591 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-11
Onset:2021-04-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Chills, Decreased appetite, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received the J&J COVID vaccine at a state-run site. Chills and fever on day 1 post-vaccine. Vomiting and epigastric abdominal pain on day 3 post-vaccine. Continues with decreased appetite. Symptomatic care only at this time.


VAERS ID: 1212604 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-12
Onset:2021-04-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Abdominal discomfort, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asthma (symbicort 2X per day)
Current Illness: none
Preexisting Conditions: Asthma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Upset stomach Nausea for over 24 hours now


VAERS ID: 1212693 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-12
Onset:2021-04-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Computerised tomogram, Full blood count, Headache, Metabolic function test, Nausea, Tachycardia, Troponin, Urine analysis, X-ray
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), 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: cbc, urinalyses, cardiac troponin, metabolic panel, CT scan, x ray
CDC Split Type:

Write-up: Tachycardia, elevated BP, nausea, headache


VAERS ID: 1212814 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Carotid artery stenosis, Cerebral infarction, Dysarthria, Ear discomfort, Eye pain, Hypoaesthesia, Intensive care, Jaw disorder, Magnetic resonance imaging head abnormal, Muscular weakness, Tongue discomfort
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: complex migraines, menorrhagia and heart murmur since childhood smoked for 25y, quit in Jan 2021
Allergies: codeine
Diagnostic Lab Data: Patient underwent MRI and MRA of the brain which showed multifocal small acute infarcts along the right frontal and right parietal lobes, as well as punctate acute infarcts in the right occipital lobe. No evidence of intracranial bleeding. Also noted a filling defect in the right carotid bifurcation causing severe stenosis of the right ECA origin and moderate stenosis of the right ICA origin
CDC Split Type:

Write-up: Patient states that she had acute onset of left arm weakness, numbness, difficulty speaking and slurred speech that started at 22:50. Patient was seen as a code stroke, was FANG?D +. Patient underwent MRI and MRA of the brain which showed multifocal small acute infarcts along the right frontal and right parietal lobes, as well as punctate acute infarcts in the right occipital lobe. No evidence of intracranial bleeding. Also noted a filling defect in the right carotid bifurcation causing severe stenosis of the right ECA origin and moderate stenosis of the right ICA origin. Patient was not given TPA, and was started on heparin drip and admitted to the ICU. Patient did receive the Johnson & Johnson Covid?19 vaccine on 4/9. Patient also complained of right ear and right jaw discomfort, pain behind L eye and L aura, as well as burning discomfort of the back of her tongue for the past two days Started on heparin drip initially and then converted over to argatroban drip based on CDC guidance. No IVIG given as platelets are $g 500


VAERS ID: 1212889 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-12
Onset:2021-04-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Pain, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR20 generic, vitamin C, mens multi vitamins, vitamin D
Current Illness: None
Preexisting Conditions: raynaud''s syndrome
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling, redness, pain and tenderness to surface area of left pectoral area


VAERS ID: 1212944 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Balance disorder, Magnetic resonance imaging, Muscular weakness, Skin injury, Skull fracture, Suture insertion, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: Vaccine 130 pm. Lost contro of arms andlegs around 8 pm. Hit filing cabinet and tore skin off to my skull. Taken to trauma unit at campus. Received 13 stitches and a tetnus shot


VAERS ID: 1212954 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms, Pain in extremity
SMQs:, Dystonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carvedilol 25mg bid, losartan 25 mg qd, mometasone 50 mcg nasal spray qd, cetirizine 10 mg qd, loratadine 10 mg qd
Current Illness: none
Preexisting Conditions: hypertension, leaking heart valve (asymptomatic)
Allergies: nka
Diagnostic Lab Data: not known at this time
CDC Split Type:

Write-up: Patient called in complaining of left calf muscle cramping/ache. Told we would report to VAERS and for her to contact her primary care physician. She stated it started hurting on 4/14/21 upon awakening and it has continued to hurt as of 4/15/21.


VAERS ID: 1212967 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-04-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

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

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

Write-up: Reddened, tender, warm, raised abscess to injection site approx 4in diameter


VAERS ID: 1213025 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-07
Onset:2021-04-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray, Ear pain, Electrocardiogram, Head discomfort, Headache, Muscular weakness, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Tramadol, Methylene Blue, Ketotifen oral capsule
Current Illness: no active illness at time of vaccine
Preexisting Conditions: Lyme disease, possible MS, neuropathy, chronic pain syndrome, chronic fatigue syndrome, chronic headaches/migraines
Allergies: Sulfa drugs, Codeine, Prednisone, Latex
Diagnostic Lab Data: Neuro exam, 2vw chest radiograph, Urinalysis, EKG (all done at urgent care 4/14/21)
CDC Split Type:

Write-up: Atypical Headache 8 days post J&J vaccine. Woke up with headache at 7:30am and the headache got progressively worse throughout the day. Headache symptoms included head pressure, ear pain, and generalized full body weakness. Went to urgent care at 6:00pm. Due to ongoing health issues it was hard for the doctor to tell if it was a reaction to the vaccine or not at the time of exam. The doctor discharged me and recommend I go to ER if symptoms progress/get worse.


VAERS ID: 1213104 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-10
Onset:2021-04-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A214 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: (14 April 2021) I started experiencing stomach discomfort which resulted in diarrhea . It has been constant for the past 24 hours. (15 Apr 2021) I contacted my healthcare provider at 8:10 am and selected the call-back option. The healthcare provider called me back at 8:17 am. The healthcare provider will start case file contact patient before the day is over. I took Imodium at 8:50 am. Got a call from the doctor''s office (10:19 am) with instructions: Take fiber and plenty of liquids. I informed them I took an Imodium, directions changed to drink plenty of liquids and let it run its course. There is nothing they can do because the vaccine was already administered.


VAERS ID: 1213233 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-06
Onset:2021-04-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Dizziness, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Blurry vision, dizziness, chills and throwing up, achey joints and overall feeling weak


VAERS ID: 1213252 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Aphasia, Chest pain, Decreased appetite, Discomfort, Vomiting
SMQs:, Acute pancreatitis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Aspirin Lipitor Lopressor Colace Dulcolax Lactulose Omeprazole Senna Synthroid Flomax
Current Illness:
Preexisting Conditions: CVA CAD DM PVD HTN PVD Dementia
Allergies: Shellfish Hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident ate a few small bites of pudding then refused. Resident then began with white, foul smelling emesis. Resident noted to be hunched over and clutching chest, unable to verbalize discomfort. BP 155/118 (manual) P 87 T 98.1 R 20. Out via 911 immediately.


VAERS ID: 1213259 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-07
Onset:2021-04-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

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

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

Write-up: Rash and skin bubbling on sides, arms, and upper legs at 10:10 p.m. on 4/14/21. By 6:30a.m. on 4/15/21, most of the rash had gone away.


VAERS ID: 1213260 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-07
Onset:2021-04-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood bilirubin, Blood fibrinogen increased, C-reactive protein increased, Differential white blood cell count normal, Fibrin D dimer increased, HIV test negative, Haemoglobin decreased, Hepatitis B surface antigen negative, Hepatitis B test negative, Hepatitis C virus test, International normalised ratio increased, Metabolic function test, Palpable purpura, Platelet count normal, SARS-CoV-2 test negative, White blood cell count normal
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Vasculitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: warfarin
Current Illness: no
Preexisting Conditions: History of Aortic valve replacement
Allergies: gabapentin ibuprofen
Diagnostic Lab Data: PendingBilirubin 3.2. Rest of CMP is normal.White blood cell count 5.5 thousand, hemoglobin 12.5, platelets 186,000, Normal manual differential, fibrinogen 581, INR therapeutic at 2.1, d-dimer 0.72. Blood type O+.SARS COV2 PCR negative HCV Ab and HBV SAg negative,HIV negative. C-reactive protein 83.
CDC Split Type:

Write-up: Patient presented to ED on 4/14/2021 with 24 h of progressive painful/pruritic palpable purpura of distal upper and lower extremities. No evidence of additional organ involvement.


VAERS ID: 1213299 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Peripheral swelling
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: Pain Cholesterol Asthma Vit D deficiency
Preexisting Conditions: Pain Cholesterol Asthma Vit D deficiency
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling and lump in the arm


VAERS ID: 1213349 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-02
Onset:2021-04-14
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Headache
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: Amlodapine
Current Illness: None
Preexisting Conditions: High blood pressure and asthma
Allergies: Bee stings and raspberries
Diagnostic Lab Data:
CDC Split Type:

Write-up: Non stop headaches. Taking Tylenol but not working very well.


VAERS ID: 1213377 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B12A / 1 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Pulmonary embolism, Pulmonary pain
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Osteo Bi-Flex One Per Day Tablet (Boswellia-Glucosamine-Vit D) Give 1 tablet by mouth two times a day for supplement Metoprolol Tartrate Tablet 50 MG Give 1 tablet by mouth two times a day for HTN Acetaminophen Tablet 325 MG Give 2 tab
Current Illness: cellullitis both le
Preexisting Conditions: ckd, muscle weakness, ra, anemia
Allergies: nkda
Diagnostic Lab Data: positive for PE
CDC Split Type:

Write-up: pt was vaccinated at 2pm on 4/13/2021 moderma vaccine lot 021b12a and on 4/14/2021 at 830 had sharp lung pain was sent to the hospital and was admitted with a PE


VAERS ID: 1213517 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-10
Onset:2021-04-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Muscle spasms, Pain in extremity
SMQs:, Dystonia (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: Advil Cold & Sinus, Bayer Aspirin 325 mg, Advil 200 mg, Vitron Iron pill, Life Extension brand of: Omega 3, One-Per-Day, Liver Efficiency, Balance Probiotic, Youthful Legs, Vitamin D3, Milk Thistle, CoQ10
Current Illness: None
Preexisting Conditions: A little overweight due to homecaring for my 95 year mother-in-law for the past 3 years. No time for myself so it shows on my Doctor''s records the weight gain the past 3 years.
Allergies: lortab, latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left Leg soreness. Woke up today, 04/15/2021 with Charley Horse in Left calf.


VAERS ID: 1214095 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-08
Onset:2021-04-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling, Thrombophlebitis, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin metoprolol
Current Illness: hx: htn, inc chol
Preexisting Conditions: as above
Allergies: NKDA
Diagnostic Lab Data: le doppler u/s
CDC Split Type:

Write-up: patient had pain and swelling in left leg - sent for doppler - positive for thrombiphlebitis


VAERS ID: 1214096 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-10
Onset:2021-04-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 cold like symptoms. later test positive for Covid (4/14/2021)


VAERS ID: 1214117 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-12
Onset:2021-04-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Guillain-Barre syndrome, Laboratory test, Pain in extremity
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Yellow Fever Vaccine/2014
Other Medications: Vitamin D, K, Vitamin B complex Multivitamin Fish Oil
Current Illness: None
Preexisting Conditions: None
Allergies: Yellow Fever Vaccine
Diagnostic Lab Data: He received IV Toradol to help out with his extremity pain. Labs were checked to rule out electrolyte disturbance, thrombocytopenia. The patient''s neurologic examination does not demonstrate classic signs of Guillain-Barre, there is no evidence of muscle weakness or paralysis and his deep tendon reflexes are normal. Acute pain has been described in acute Guillain-Barre, and so I gave the patient return precautions regarding progressive symptoms. At this point, there are not enough objective criteria to diagnose him with GBS, symptoms do not suggest the need for hospitalization for observation. Even so, it is clear the severe extremity pain is a result of the vaccine.
CDC Split Type:

Write-up: Patient developed mild case of Guillain Barre Syndrome 34 hours after injection of the Johnson and Johnson vaccine. Patient has severe extremity pains. The patient has a personal history of being diagnosed with Guillain-Barre after a yellow fever vaccination.


VAERS ID: 1214126 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-05
Onset:2021-04-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I am experiences pain in both my legs, in the calf musscle of both legs and palpatations int he calf muscle.


VAERS ID: 1214198 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-04-14
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 1802068 / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Deep vein thrombosis, Pain in extremity, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole 20 mg daily albuterol inhaler- 2 puffs q6 hrs prn shortness of breath daily multivitamin
Current Illness: N/A
Preexisting Conditions: obesity, post bariatric surgery asthma sleep apnea
Allergies: iodine, shellfish, hydrocodone
Diagnostic Lab Data: ER visit only. Venous ultrasouond revealing rights peroneal dvt and right lesser saphenous superficial venous thrombosis. Discharged on anticoagulation which just began yesterday.
CDC Split Type:

Write-up: Patient presented with acute onset leg pain and new diagnosis of DVT 5 wks post covid 19 J&J vaccine. 36 yo female with a history of a dvt in 2002 when she was on birth control (and became pregnant). Unknown if this is a true ADR or incidental finding


VAERS ID: 1214248 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-10
Onset:2021-04-14
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Deep vein thrombosis, Thrombophlebitis superficial, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (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: omeprazole 20 mg once daily multivitamin daily albuterol inhaler 2 puffs q6 hrs prn shortness of breath
Current Illness:
Preexisting Conditions: obesity sleep apnea asthma
Allergies: iodine shellfish hydrocodone
Diagnostic Lab Data: Venous ultrasound with right peroneal deep venous thrombosis and right lesser saphenous superficial venous thrombosis. diagnosed in visit to ER. discharged from ER on antocoagulant
CDC Split Type:

Write-up: Patient presented with new onset dvt 5 wks post covid 19 vaccination. 36 yr old female with solitary risk factor of previous history of DVT. Of note, pt had dvt in 2002 which occurred while on birth control (and pt became pregnant).


VAERS ID: 1214252 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-03-06
Onset:2021-04-14
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Chills, Fatigue, Myalgia, Pyrexia, Respiratory disorder, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? 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: Adderall XR
Current Illness: None
Preexisting Conditions: ADHD, Mild intermittent asthma, heart murmur (unknown type)
Allergies: Lactose
Diagnostic Lab Data: +COVID PCR on 4/14/2021
CDC Split Type:

Write-up: Breakthrough COVID case: patient received J&J vaccine on 3/6/2021. experienced fever, chills, myalgias, fatigue for 12-48 hours. Patient developed mild upper respiratory symptoms on 4/13/2021 and tested positive for COVID via PCR testing on 4/14/2021.


VAERS ID: 1214297 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-26
Onset:2021-04-14
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Brain natriuretic peptide, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Echocardiogram, Full blood count, Laboratory test, Metabolic function test, Pulmonary embolism, Troponin
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: fexofenadine, omeprazole, Breztri
Current Illness: no acute illnesses
Preexisting Conditions: asthma, gastroesophageal reflux, obstructive sleep apnea
Allergies: iodine (contrast agents), penicillin
Diagnostic Lab Data: Hospitalization, CTPE protocol, Echo, labs (including but not limited to CBC, CMP, Troponin, BNP), all testing occurred on 4/14-4/15/2021
CDC Split Type:

Write-up: patient was diagnosed with bilateral pulmonary emboli within 3 weeks of vaccine administration, developed dry cough within 1 week of vaccine that progressed to worsening shortness of breath.


VAERS ID: 1214309 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-07
Onset:2021-04-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Musculoskeletal discomfort, Pain, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: Full work and admission for observation. Elevated Troponin levels . Medication given.
CDC Split Type:

Write-up: Patient developed Chest pain at 0700. Came on suddenly. Pressure, squeezing and tightness that radiated up to his shoulder.


VAERS ID: 1214358 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-04-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CR8737 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CN020B / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary, Deep vein thrombosis, Pulmonary embolism, Thrombophlebitis superficial, Ultrasound Doppler, Varicose vein
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: Adalimumab 40 mg IM every 14 days Folic acid 3 PO mg daily Gabapentin 900 mg PO twice daily Methotrexate 15 mg PO weekly Prednisone 20 mg PO daily
Current Illness:
Preexisting Conditions: Rheumatoid arthritis depression insomnia hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data: 4/15 - venous duplex LE left, CTA pulmonary
CDC Split Type:

Write-up: 1. Acute left deep venous thrombosis in the popliteal, posterior tibial, peroneal, one branch of gastrocnemius veins. 2. Acute left superficial venous thrombosis in the great saphenous prox thigh to knee extending tinto a varicose vein at the proximal calf. 1. Pulmonary embolism with large thrombus burden bilaterally, right greater than left ASA/heparin gtt started


VAERS ID: 1214405 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-03
Onset:2021-04-14
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

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

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

Write-up: Pt received COVID Pfizer vaccine on 4/3/21. Pt tested positive for COVID on 4/14/21. Pt hospitalized on 4/14/21 for weakness d/t COVID


VAERS ID: 1214418 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-28
Onset:2021-04-14
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax, Pulmonary artery thrombosis, Pulmonary embolism
SMQs:, Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (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: prednisolone acetate 1% ophthalmic suspension - 1 drop each eye daily
Current Illness: lens transplants
Preexisting Conditions: none known
Allergies: NKDA
Diagnostic Lab Data: CT angio chest on 4/14/21
CDC Split Type:

Write-up: bilateral multiple pulmonary emboli (left and right main pulmonary arteries)


VAERS ID: 1214441 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-04-14
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received Pfizer COVID vaccine on 4/2/21. Pt became COVID + on 4/14 and hospitalized on 4/14 for COVID.


VAERS ID: 1214471 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-29
Onset:2021-04-14
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / UNK LA / 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received Moderna COVID vaccine on 3/29/21. Pt became positive with COVID on 4/6. Pt was hospitalized for COVID on 4/14/21.


VAERS ID: 1214573 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-08
Onset:2021-04-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Bone pain, Tenderness, X-ray normal
SMQs:, Osteonecrosis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flexeril, Zyrtec, escitalopram, trazodone, MiraLAX as needed, Flonase
Current Illness: None
Preexisting Conditions: past medical history of gastroesophageal reflux disorder, diverticulitis, depression, seasonal allergy, insomnia
Allergies: No known drug allergies
Diagnostic Lab Data: X ray right shin showed no fracture or malalignment no destructive osseous processes or aggressive periosteal reaction. No radiopaque foreign body or soft tissue gas.
CDC Split Type:

Write-up: Patient was seen in ER On 4/14/2021 with a complaint of right anterior hip pain. Patient denied any injury she received Johnson & Johnson vaccine on 4/8/2021 and has been worried about the side effects. Patient endorses a sharp pain which is worse with palpation right over the tibial bone. Right anterior shin x-ray showed no fracture or malalignment no destructive osseous processes or aggressive periosteal reaction. No radiopaque foreign body or soft tissue gas. Patient was discharged home to follow-up with her primary care. On today''s visit patient states that she continues to have her right shin pain overall it is getting better she has tried ibuprofen/Aleve, however still worried about Johnson & Johnson vaccine side effects. Denies recent fall or injury. No swelling on exam Duplex ordered


VAERS ID: 1214577 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-08
Onset:2021-04-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Thrombophlebitis superficial, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: norethindrone, alprazolam, ubrogepant, citalopram
Current Illness:
Preexisting Conditions: Hx of DVT/PE not currently on anticoagulation
Allergies: penicillin
Diagnostic Lab Data: identified by duplex ultrasound
CDC Split Type:

Write-up: RLE thrombosis of greater saphenous vein


VAERS ID: 1214582 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-02
Onset:2021-04-14
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Angiogram, Dizziness, Fibrin D dimer increased, Nausea, Pulmonary embolism, Scan with contrast abnormal
SMQs:, Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81mg qd folic acid 1mg qd lisinopril 40mg qd metoprolol succinate 25mg qd simvastatin 20mg qd
Current Illness: Otherwise healthy
Preexisting Conditions: Congestive heart failure Coronary artery disease Aortic bovine valve replacement Hypertension
Allergies: Sulfa allergy
Diagnostic Lab Data: D dimer 1.93 mcg/mL FEU on 4/14/21 1253. CT angio chest identified pulmonary embolus within the intermediate pulmonary arteries bilaterally 4/14/21 1441.
CDC Split Type:

Write-up: Patient received Moderna vaccine initial dose at clinic on 4/2/21. Patient presented to the Emergency Department on 4/14/21 with complaints of dizziness and mild nausea. CT angio chest w& wout contrast identified pulmonary embolus within the intermediate pulmonary arteries bilaterally. Treatment started 4/14/21 with Eliquis (apixaban) patient admitted for observation overnight and discharged in stable condition on 4/15/21.


VAERS ID: 1214620 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Dyspnoea, Inappropriate affect, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: xyrem, escitalopram, gabapentin, sunosi
Current Illness:
Preexisting Conditions: asthma (mild), narcolepsy
Allergies: morphine/morphine- based
Diagnostic Lab Data:
CDC Split Type:

Write-up: brief shallow coughing with wheezing and slight inability to catch breath; brought on by episode of laughing- entire experience was singular


VAERS ID: 1214632 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / SYR

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

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

Write-up: Large area of rash over arms, thighs, calves, and buttocks. Rash at its peak about 6 hours after it started, then reduced overnight with only some rashes remaining.


VAERS ID: 1214735 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-26
Onset:2021-04-14
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram, Facial paralysis, Headache, Hemiparesis, Magnetic resonance imaging, Neurological symptom
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Montelukast 10mg, Ventolin HFA, PRN Albuterol nebulizer PRN
Current Illness: None noted
Preexisting Conditions: Intermittent asthma
Allergies: NKA
Diagnostic Lab Data: CT & MRI on 4/14/21 at Hospital.
CDC Split Type:

Write-up: Patient received Janssen vaccine on 3/26/21. States she had a headache on day one of receiving vaccine and progressive neuro symptoms afterwards. Went to UC 4/14/21 with facial drooping, left side weakness. Sent to ED and airlifted to hospital.


VAERS ID: 1214747 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-11
Onset:2021-04-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute myocardial infarction, Axillary pain, Catheterisation cardiac, Chest discomfort, Chest pain, Thrombosis, Troponin I increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 04/14/2021 Troponin I High Sens 0735 3288 and @0930 7616
CDC Split Type:

Write-up: Patient admitted 4/14/2021 with chest pain. Patient had received second Moderna vaccine on Sunday 4/11/2021 Patient had pain underneath both armpits. Patient was woken up around 4AM due to substernal pressure-like chest pain, left sided. Admitted through the ED. Cardiac Cath on 04/14/2021. Non-ST segment elevation myocardial infarction mostly likely secondary to maternal vaccine and acute thrombosis. 4/14/2021 Troponin I High Sens 3288 @ 0735 and 7616 @0930.


VAERS ID: 1214879 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-18
Onset:2021-04-14
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data: 1/23/2021 Covid 19 NAA detected 4/14/2021 Covid 19 NAA detected
CDC Split Type:

Write-up: Hospitalized on 4/14/2021 with respiratory distress - history of COPD


VAERS ID: 1215012 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I stood up and then blacked out (no dizziness beforehand). After I felt dizzy and sweaty (no nausea). The blackout was for less than 30 seconds. Did not seek medical treatment since did not injure self and felt back to normal after about 5 to 10 minutes.


VAERS ID: 1215017 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-10
Onset:2021-04-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (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: Coq10 And Turmeric
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe pain in lower left side of back


VAERS ID: 1215121 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Full blood count, Gait disturbance, Headache, Metabolic function test, Muscular weakness, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Chronic lower back pain
Allergies: Egg whites
Diagnostic Lab Data: CBC, CMP, UA, CK - all performed 4/14/21 afternoon
CDC Split Type:

Write-up: 15 min after vaccine administration, pt experienced frontal headache, diffuse subjective weakness of LE, and gait instability. Admitted to medical center for monitoring and workup.


VAERS ID: 1215340 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-08
Onset:2021-04-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Exposure during pregnancy, Pruritus, Rash, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Prenatal vitamin
Current Illness: Ear infection and slight sinus congestion a week prior
Preexisting Conditions:
Allergies: None known
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I am about 6 weeks pregnant. No known complications in this pregnancy, or any previous pregnancies. On 4/14, 6 days after receiving the Janssen vaccine, I started to break out in an itchy rash at about 5:30pm. It started on my left calf, and over the course of the next couple hours it spread to my left arm (bicep area), right arm (bicep area), right calf and knee, and left thigh. The areas were red, hot, and itchy, with some larger raised welts scattered through the area. It didn?t seem to respond to Benedryl, but I was able to sleep after liberally applying hydrocortisone cream. It seemed better in the morning, with a few lingering patches by the knees. However, at about 1:30pm it came back, this time mostly covering new places- lower back, shoulders, forearms, stomach.


VAERS ID: 1215814 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-12
Onset:2021-04-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topamax
Current Illness: Possible diagnosis of idiosyncratic intracranial hypertension
Preexisting Conditions:
Allergies: Penicillin family
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and swelling at injection site. Started 48 hours after injection, and is still there 72+ hours later. Contacted medical professional through a telehealth visit, who recommended Benadryl as to not impact the vaccine''s effectiveness, but suggested monitoring it incase it increased in severity.


VAERS ID: 1215930 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-12
Onset:2021-04-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Fatigue, Headache, Myalgia, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: Cetirizine HCI 10mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, coughing, muscle aches, fatigue, runny nose, changes in breathing ability


VAERS ID: 1216238 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: ROS: (10+) CONSTITUTIONAL: subjective fever, subjective chills, no night sweats EYES: No blurry vision, no loss of vision, no black spots, no curtain of lights. EAR, NOSE, THROAT ROS: (10+) CONSTITUTIONAL: subjective fever, subjective chills, no night sweats EYES: No blurry vision, no loss of vision, no black spots, no curtain of lights. EAR, NOSE, THROAT, MOUTH: No ear pain, no hearing loss, no ringing in the ears, no nasal discharge, no sore throat, no oral lesions, no dental pain. CARDIOVASCULAR: No chest pain, no syncope, no palpitations RESPIRATORY: No cough, no coughing blood, no shortness of breath GASTROINTESTINAL: yes nausea, no vomiting, no diarrhea GENITOURINARY: No dysuria, no hematuria, no discharge MUSCULOSKELETAL: No back pain, no limb pain, Full ROM to all extremities and joints. Nml gait. SKIN/BREAST: No rash, no lumps NEUROLOGICAL: No numbness, no weakness, no dizziness ALL SYSTEMS REVIEWED AND NEGATIVE EXCEPT AS NOTED ABOVE. PAST MEDICAL HISTORY: No significant medical history FAMILY HISTORY: No significant medical history SOCIAL HISTORY: No tobacco use yes alcohol use No recreational drug use PHYSICAL EXAM: (9 systems with 2 per system) CONSTITUTIONAL: No acute distress, A/O x 3, WDWN EYES: PERRLA, EOMI, No redness, no discharge, no vision change. EARS, NOSE, MOUTH, THROAT: TM clear and intact, no nasal discharge, pharynx normal, mucosa moist. NECK: Supple, non-tender, no meningismus CARDIOVASCULAR: RRR, no murmurs/rubs/gallops, peripheral pulses equal and strong bilaterally. RESPIRATORY: Lungs CTAB, no wheezes, rales, rhonchi. Breathing comfortably. CHEST/BREAST: no tenderness, no lumps/masses, no deformities. GASTROINTESTINAL: Soft, non-tender, non-distended, no pulsatile mass GENITOURINARY: exam deferred. LYMPHATIC: no lymphadenopathy, no edema MUSCULOSKELETAL: no deformities, no tenderness, nml gait NEUROLOGIC: CN 2-12 intact. nml UE and LE strength and sensation. No ataxia. Nml gait. No visual deficits. DERMATOLOGIC: No rashes, No open wounds. PSYCHIATRIC: No psychomotor abnormalities, no gaze avoidance.
CDC Split Type:

Write-up: migraine, fevers, body aches x 2 days after receiving J&J vaccine on 13Apr21; states max temp 100 at home; reports taking tylenol at home with minimal relief; last dose yesterday around 1200; denies any vision changes.


VAERS ID: 1216268 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-07
Onset:2021-04-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

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

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

Write-up: Chest Pain on 14 APR 2021 at 5 PM Chest Pain getting worse on 15 APR 2021 around 6 PM after dinner. Will visit to doctor office tomorrow 16 APR 2021 if appointment available.


VAERS ID: 1216382 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-08
Onset:2021-04-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, 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: Lysine and magnesium
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA 6 days after injection, starting having hive like bumps and redness in my upper torso. They seem to come and go.


VAERS ID: 1216429 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-01
Onset:2021-04-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Fatigue, Headache, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 10 mg Escitalopram 5 mg Vitamin D 2000 units
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, fatigue, nausea, upset stomach, overall feeling sick. This started on day 13 after injection in the morning when waking up.


VAERS ID: 1216443 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-12
Onset:2021-04-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / UN

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Dizziness, Headache, Muscular weakness, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, lightheaded, severe muscle weakness and back pain. Headache. Increasing rash on back of scalp over 24 hours later.


VAERS ID: 1216504 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-06
Onset:2021-04-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache
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: N-Acetyl Cysteine 1g (1000kmg)... 1x daily Vitex agnus-castus 400mg ... 2x daily Metformin hcl 500mg ... 2x daily Aspirin 81mg ... 1x daily Vitamin B6 100mg ... 1x daily Vitamin D3 50mcg ... 1x daily Cetirizine hydrochloride 10mg ... 1x
Current Illness:
Preexisting Conditions: Generalized anxiety disorder, chronic depression, chronic migraines (migraines typically occur for me right before my menstrual cycle)
Allergies: Seasonal allergies, mild allergies to hibiscus, papaya and passion fruit
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intense headache beginning 4/14 around 6pm. Despite rest, hydration, and acetaminophen the headache didn''t subside. Headache intensity decreased around 5pm on 4/15


VAERS ID: 1216579 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lithium, Propranolol, Prazosin, Hydroxyzine Hcl, Trazodone, multivitamin, fiber capsule, melatonin
Current Illness: none
Preexisting Conditions: hypertension, bipolar disorder
Allergies: erythromycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme itchiness and redness, started in my legs and moved to my arms (in the morning). By noon, it was full body. Called and set a telehealth appointment, and was advised to visit urgent care. At urgent care, I was examined and diagnosed with hives. I was given a dose of prednisone and a short prescription for hydroxyzine to help with the itching. I''m still extremely itchy. I''ve never had seasonal allergies, there have been no med, food or product changes, and the prednisone helped briefly but did not eliminate the itchiness. I was told to try an over-the-counter relief products, which I will be trying tomorrow.


VAERS ID: 1216600 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood test, Chest X-ray, Dizziness, Echocardiogram, Electrocardiogram, Headache, Heart rate decreased, Presyncope, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: April 14, 2021: EKG, chest xray, blood panels April 15, 2021: echocardiogram, blood panels
CDC Split Type:

Write-up: Near syncope 10 minutes after vaccine administered. Severe drop in heart rate. Transported by ambulance to the ER medical center. Overnight stay in hospital. Weakness, dizziness, headache, shaky.


VAERS ID: 1216606 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dysphagia, Throat irritation
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

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

Write-up: About 2-5 minutes after shot, I couldn?t swallow. My throat muscles just wouldn?t work, but it was really sporadic like once or twice every 30 seconds-2 minutes I was not able to swallow. After 30 minutes of no worsening and waiting at vaccine site, my throat became itchy on my drive home and i had to clear it often. Rarely this happens to me if I eat honeydew melon or drink soymilk. I went to Urgent Care, throat looked open and they told me to take Benadryl. I?m curious if you?ve had reports like this of sporadic throat inoperation and if it will happen worse with the second dose.


VAERS ID: 1216627 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site erythema, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirena IUD
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red splotchy area on upper left arm around the area of injection. It''s not itchy or painful, raised, bumpy, or warm to the touch. It''s just red. First noticed in the evening of the following day after the injection. The red area grew throughout the day of the 2nd day following injection. This occurred after the second dose of the moderna vaccine. I had no adverse effects after the first dose.


VAERS ID: 1216628 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Losathan, pravastatin; levothyroxine; provision; glucosamin chondrotin; calcium; vitamin c
Current Illness:
Preexisting Conditions: High blood pressure; thyroid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heavy nosebleeds-- 10 minutes, heavy blood loss. Daily since day of second shot


VAERS ID: 1216630 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-10
Onset:2021-04-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Eye pain, Headache, Hyperacusis, Nausea, Photophobia, Physical examination
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: n/a
Preexisting Conditions:
Allergies: CEPHALOSPORINS; SULFA MEDS; CELECOXIB
Diagnostic Lab Data: ROS: General: No fatigue, fevers/chills, malaise Eyes: light sensitivity; No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congest CV: No chest pain, palpitations, syncope, edema Pulm: No SOB, wheezes, cough, hemoptysis GI: No anorexia, abd pain, nausea, vomiting, diarrhea GU: No dysuria, hematuria, urgency, frequency MSK: No joint pain, edema, warmth, redness, deformity Neuro: HA; No seizures, weakness, numbness/tingling, vertigo, lightheadedness, AMS Skin: No rash, lesions, itching Heme: No easy bruising/bleeding, petechiae All systems reviewed and negative except as stated above. Physical Exam: Vital signs reviewed, no acute intervention necessary General: NAD, AOX3, cooperative Head: Normocephalic, atraumatic Eyes: PERRL, EOMI, no conjunctival injection, no scleral icterus; no photophobia on exam Ears: No edema/erythema of otic canal, no TM edema/erythema/dullness/bulging Nose: No nasal discharge Throat: No pharyngeal edema, erythema, tonsillar exudates, uvular deviation, asymmetric swelling, trismus, drooling, or voice changes Neck: No meningismus; normal ROM Lymph: No cervical lymphadenopathy Respiratory: Unlabored breathing, normal respiratory effort, LCTAB CV: Normal peripheral circulation, RRR, no m/r/g Skin: No rashes, petechiae, or purpura Neuro: Grossly intact, moves all extremities equally, gait normal MSK: No TTP, deformity, ecchymosis, or focal edema Psych: Normal mood, normal affect, appropriate responses
CDC Split Type:

Write-up: right-sided HA with pain around rightt eye x 5 days with dizziness and nausea coming on yesterday since receiving J&J vaccine on 10Apr21; denies any vision changes or vomiting; light and noise sensitivity present. 25 yo f c/o ongoing R sided post-orbital/temporal ha w/stated light sensitivity but w/o other visual changes x5d, states got J&J covid19 vaccine 10APR and sx''s started 2-3 hrs after that; Pt states ongoing nausea w/o vomiting; Pt states taking multiple doses of OTC ibuprofen w/o sig relief; Pt concerned for relation to J&J vaccine; Pt denies any fevers/ns/chills, neck pain, cp, sob, dyspnea, abd pain, diarrhea, rashes, prior hx of similar ha


VAERS ID: 1216655 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

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

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

Write-up: Had extreme chills for approximately one half hour, then was okay until following night had a mild fever for a few hours, was fine after and since then.


VAERS ID: 1216661 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-12
Onset:2021-04-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Chills, Disorientation, Feeling cold, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid, Inderal, Mirapex, Lipitor, Baclofen, Lipitor, Low Dose Naltrexone (4.5 mg), Vitamin D3, St. Johns Wort, CoQ10
Current Illness: Multiple Sclerosis
Preexisting Conditions: Multiple Sclerosis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received vaccine approx 11:20am, no issues until 10:30pm when I started to feel chilled. I took my temp with a forehead thermometer and it read 98.x. I put the thermometer on my nightstand thinking it prudent to have it handy. In bed under covers I kept feeling cold and started shivering/teeth chattering, within an hour or so my forehead thermometer read 102. My recollection of the time between midnight and 2 to 3am is vague as I was very disoriented, I recall taking my forehead temp several times during those hours - that took a lot of effort, and I saw several readings of 105 and I believe one over 106. I remember thinking I should be in the ER, then thinking how could I get there, then thinking I would call 911 but that I could probably not get my mind/body to be able to physically make a phone call. I believe that during this time span I had brief periods of consciousness when I was somewhat aware that I was having a high fever event, but that there wasn''t much I could do about it (I live alone). By 4am I was more aware, forehead temp reading was 102.something - I got up and made my way to the kitchen, I was unsteady on my feet and remember telling myself to be careful and not to fall. Temp gradually dropped throughout Tuesday, mostly back to normal on Wed.


VAERS ID: 1216675 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 LA / SYR

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

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

Write-up: About palm size red area around injection site. Slight itching.


VAERS ID: 1216682 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Eczema, Fatigue, Headache, Limb discomfort
SMQs:, Acute pancreatitis (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:
Current Illness:
Preexisting Conditions: Eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, stomach cramps, sever headache, fatigue, "dead arm"


VAERS ID: 1216683 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, 450mg
Current Illness:
Preexisting Conditions: Anxiety, depression, vulvodynia, insomnia
Allergies: Pollen, dust, cats, dogs, something in most lipsticks
Diagnostic Lab Data: none so far, going to call an audiologist tomorrow
CDC Split Type:

Write-up: I hear ringing in my ears that won?t stop. Sometimes it gets dimmer if i sit up, but it?s really bad when I lay down and when I?ve been trying to go to sleep. It?s like a whirring sound, the kind you?d hear from a machine whirring (like when you stand next to an ice cream machine?) There?s also this, like, chugging noise in the background.


VAERS ID: 1216688 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-08
Onset:2021-04-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: Swelling and redness at injection site, deltoid swollen to 2-3 times normal size Itching at injection site, slight rash Soreness in armpit on same side as injection site Joint pain and fatigue


VAERS ID: 1216693 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-05
Onset:2021-04-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A214 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache
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: Multi vitamin
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Budding headache , at night about 9pm, starting on April 14th, and again tonight the 15th at 9pm


VAERS ID: 1216697 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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: Dulaglitide, glimepiride,, Atorvastatin, Ergocalciferol
Current Illness:
Preexisting Conditions: T2DM HJTN
Allergies: NKDA
Diagnostic Lab Data: N ot seen-. Pt called
CDC Split Type:

Write-up: c/o feeling weak, sore, poor appetite, fever, chills


VAERS ID: 1216699 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Nervousness, Underdose, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Medication errors (broad), Hypoglycaemia (broad)

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

Write-up: Patient was injected with a new, unfilled/empty syringe. Patient was then injected with a new filled syringe with the appropriate dosage of the Moderna first dose vaccine. Patient was nervous, had blurry eyesight, and felt faint, vitals were checked by staff and by responding EMS. Patient felt better by the time EMS showed up after having some snacks. Patient has reported no adverse reaction other than initial blurriness and faintness as of 4/15/21


VAERS ID: 1216715 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA C32L20A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 30 mg Vyvanse 0.1 mg Clonidine Both once per day in the morning
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Skin Sensitivity, Fever, Chills, and Stomach Ache


VAERS ID: 1216762 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN0161 / 2 RA / SYR

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

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

Write-up: Huge swollen lymph node under armpit of arm that got injection.


VAERS ID: 1216768 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Chills, fever, slight headache, tiredness


VAERS ID: 1216902 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-31
Onset:2021-04-14
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Eyelid disorder, Magnetic resonance imaging
SMQs:, Periorbital and eyelid disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: COPD/Lung Issues
Allergies: n/a
Diagnostic Lab Data: As above
CDC Split Type:

Write-up: 04/14/2021 Noticed around 1:00 p.m. that my left eyelid was sagging. Concerned it may be a symptom of a stroke, I rushed to the emergency room at Hospital. They admitted me and ran a variety of tests, one of which was an MRI which concluded that I had not had a stroke. The neurologist stated that it appeared to be similar to a wrinkle. Not sure what caused that sudden event. Possibly a side affect of the COVID `19 shot. Therefore the report. I returned home the next day, 04/15/2021.


VAERS ID: 1216906 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-04-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site rash, Rash papular
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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, welbutrin XL, birth control, Claritin
Current Illness:
Preexisting Conditions: Re-occurring mononucleosis, delayed sleep phases disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8 days after the vaccine I noticed a rash around the injection site. The area is slightly raised and red, it is not itchy but feels a little tender to touch. It covers an area about the size of a larger bandaid.


VAERS ID: 1217055 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 1 LA / IM

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

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

Write-up: Allergy, red and itchy and hives


VAERS ID: 1217057 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-07
Onset:2021-04-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: I had 0 adverse symptoms for the week following my vaccination. On the evening of the 7th day, I developed a rash around my ankles and on my arm around the injection site. That has spread into a full-body rash which is extremely itchy. Antihistamines have helped (Benedryl) but only provide temporary relief. Significant discomfort.


VAERS ID: 1217214 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-04-10
Onset:2021-04-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Women?s multivitamin DIM supplement
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Lab work April 15,2021
CDC Split Type:

Write-up: Hives and welts not controlled with Benadryl Cream or oral tabs. Went to ER as spread was significant and had IV solumedrol. Hives led up. Within an hour of discharge they started coming back and were not controlled with Benadryl still. Hives were apprearing in new locations and spreading rapidly again. Went back to ER for further treatment.


VAERS ID: 1217225 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Headache, Immediate post-injection reaction, Nausea, Pain, Pain in extremity, Pyrexia, Restlessness, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 100mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: My right arm was sore almost immediately after being vaccinated, but it wasn?t bad. Then later at night when I was trying to get to sleep I was horribly restless, shaking, and feverish. I had to bundle up in blankets because I was so cold. My whole body ached terribly, and I had a headache. It lasted a few hours and I couldn?t get to sleep. At one point I felt extremely nauseous and ran to the bathroom, barely holding back vomit, but then it went away and never came back. The day after that (April 15th) I was extremely fatigued and still had body aches and a headache. I took my temperature at 5 am on April 15th and it was 99.4. I mostly just slept a lot and didn?t have much of an appetite. My arm was still a little sore during this whole time. As I?m writing this at 5 am on April 16th, I still have a headache.


VAERS ID: 1217268 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Axillary pain, Chills, Cough, Decreased appetite, Fatigue, Headache, Injection site pain, Limb discomfort, Musculoskeletal discomfort, Nausea, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: SHINGLE VACCINE- had most of the adverse effects that were listed . Sick for three days. Treated myself, got better after 3 day
Other Medications: Sertraline --- Atorvastatin ---Atenolol ---Aspirin ---Calcium-Magnesium-Zinc ---Vitamin D3 ---Lutein ---Omega 3fish oil ---Senior Womens Multi-Vitamin ---Miralax --- Prevacid
Current Illness: COVID-19 for most of January 2021 and hospitalized Jan.11 for 4 days.
Preexisting Conditions:
Allergies: Erythromycin---Rash Septra---Severe Heartburn
Diagnostic Lab Data:
CDC Split Type:

Write-up: Awakened at 1:30am 4-14-21 with intense pain in both of my upper arms and some back and leg discomfort. Pain at injection site in left arm. Started having chills and fever ranging from 99.8 to 100.8 Slight nausea later in the day. Fatigue throughout duration. Headache. Loss of appetite. occasional cough. Treated symptoms with rest and Tylenol. 416/21 I am having pain in my arms and pains in my armpits but most of my other symptoms have subsided.


VAERS ID: 1217272 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site pain, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fatigue, slight fever, chills same day and next. Itchy arm starting around 5 days after with on and off pain.


VAERS ID: 1217355 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-24
Onset:2021-04-14
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (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: Elanzopine
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: ER visit for possible stroke
CDC Split Type:

Write-up: Bells Palsey


VAERS ID: 1217634 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-31
Onset:2021-04-14
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Sleep disorder, Tenderness
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: Woke up around 2:00 am on 4/14 with leg pain on left side of lower left leg above the ankle in the calf area. Felt like pain was moving up leg. Pain was strong enough to wake me up and was something I never experienced before. Leg is still tender in that spot but there is no bruising or discoloration.


VAERS ID: 1217899 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Syncope, Tinnitus
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topamax, Mirena, questran
Current Illness: Sinus/allergy issues month prior. Took mucinex & Benadryl
Preexisting Conditions: Migraine, arthritis, IBD, orthostatic hypotension, asthma
Allergies: Sulfa, corn, sorbitol, dextrose, glucose
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fatigue - days 2-7 after vaccine Prolonged dizziness - comes and goes - not only from standing up too quickly - starting 4/14 - can be anything from momentary to 30 minutes. Occasionally fainting. Fainting - starting 4/14 - following dizziness - has happened 4 times Tinnitus - starting 4/14 - comes and goes - severity/loudness increases before dizziness


VAERS ID: 1218047 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-10
Onset:2021-04-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Echocardiogram, Heart rate increased, Laboratory test, Magnetic resonance imaging head, Nausea, Vertigo, X-ray
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Dehydration (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Erythromycin
Diagnostic Lab Data: Full lab work was done at the ER as well as an MRI of brain x-ray and echocardiogram of the heart.
CDC Split Type:

Write-up: 72 hours after receiving the shot I had debilitating vertigo and nausea, as well as rapid heartbeat. I went to the ER and was admitted for 2 days. I am still currently experiencing dizziness on Friday April 16th 2021.


VAERS ID: 1218067 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: severe headache, dizziness and blurry vision
Preexisting Conditions: migraines, restless leg syndrome
Allergies: Bactrim
Diagnostic Lab Data: sent to ER
CDC Split Type:

Write-up: severe headache, dizziness and blurred vision


VAERS ID: 1218124 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-01-18
Onset:2021-04-14
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 9264?? / 2 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Staff member received the vaccination on 1-18-2021 (first dose) and 2-8-2021 (second dose). On the morning of 4-14-21, she experienced abdominal pain. She took herself to the ER. while she in the ER she was tested for COVID, the results of the test was posiitve for COVID. She was tested again on 4-15-21, the test results for this test were positive. Hospital, She was there for 2 days.


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