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

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



Case Details (Reverse Sorted by Onset Date)

This is page 37 out of 8,010

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VAERS ID: 1761525 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Facial pain, Head discomfort, Headache, Hypoaesthesia, Pyrexia, Toothache, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Anaphylaxis to flu vaccine. At around age 18.
Other Medications: Verapamil 300 mg QD Vit D 5000 I.u. QD Loratidine 10 mg QD
Current Illness: None
Preexisting Conditions: HTN
Allergies: Sulfa Flu vaccine Amoxicillin
Diagnostic Lab Data: Per my employee health department, I will be getting Covid tested today or tomorrow
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Vomiting Bilateral hip pain Numbness in neck Fever - 101.2 Headache - like it?s being squeezed in a vice Upper teeth hurt Cheeks hurt Can?t move my head without vomiting


VAERS ID: 1761527 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Keppra, Zoloft, Seroquel, Zocor, aspirin, FeroSul, Neurontin
Current Illness:
Preexisting Conditions: Major depression, seizures, SDH, hyperlipidemia, PTSD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: given Pfizer in error of Moderna booster


VAERS ID: 1761542 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / UNK - / IM

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

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

Write-up: Patient came to clinic today and requested a third dose of covid vaccine. He stated that he had received two doses of Pfizer vaccine earlier in 2021. The Medical Assistant was not able to validate the previous covid vaccines received via database and she elected to proceed with the third dose. When the patient produced his vaccination card for the MA she realized that he had received Moderna previously (not Pfizer)


VAERS ID: 1761546 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-28
Onset:2021-10-04
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Balance disorder, Confusional state, Disorientation, Fall, Influenza A virus test, Influenza B virus test, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Arthritis (broad), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Influenza A/B, SARS CoV-2, PCR, Rapid, Varies 10/4/2021
CDC Split Type:

Write-up: Patient is a lovely 70 y.o. female who presents to the ED after a fall from standing height onto her living room floor while she was going to the bathroom this morning. She appears in pain, only complains of shoulder pain. She is confused and not oriented to time. She remembers getting up quickly and losing her balance. She is not sure if she hit her head or lost consciousness. She has a history of a few falls and she also suffers from breast cancer and has undergone radiation therapy. She complains of 10/10 shoulder pain since the fall. This patient denies any pertinent past medical or psychiatric history and additionally has a completely negative systems review including no nausea, vomiting, fever, chills, dysuria, diarrhea ,headache or any other symptoms of concern. Overall this patient appears well and has a reassuring presentation.


VAERS ID: 1761560 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-22
Onset:2021-10-04
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Condition aggravated, Hallucination, SARS-CoV-2 test positive
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: citalopram (CELEXA) 20 mg oral tablet insulin aspart, pen, (NOVOLOG) 100 units/mL SubQ pen insulin glargine, pen, (LANTUS) 100 unit/mL SubQ pen metFORMIN ER (GLUCOPHAGE XR) 500 mg oral extended release tablet 24 HR
Current Illness: ALCOHOL INTOXICATION, AUDITORY/VISUAL HALLUCINATIONS, HIGH BLOOD SUGAR 4/17/21
Preexisting Conditions: Alcohol withdrawal delirium Paranoia Alcohol dependence with alcohol-induced anxiety disorder
Allergies: Cranberry Pcn [Penicillins]
Diagnostic Lab Data: POSITIVE COVID TEST 10/4/21
CDC Split Type:

Write-up: ASYMPTOMATIC . ADMITTED FOR RECURRING HALLUCINATIONS


VAERS ID: 1761606 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benicar, Armour, Otezla, Fish Oil, NAC, glutamine, turmeric, B12, D, Multi-Vit, Alleve, V-A, V-C,
Current Illness: psoriatic arthritis, HBP, High Cholesterol
Preexisting Conditions: same as above
Allergies: Wheat sensitivity
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I had a metallic taste starting 6:30 it was gone when I woke up


VAERS ID: 1761619 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pre natal vitamin
Current Illness: none. Breastfeeding
Preexisting Conditions: none
Allergies: Bacitracin ointment
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Roughly around 10 pm on 10/04/2021, patient experienced severe chills and shivering which caused her to not nurse her baby. She reports she had a sustained fever of 102.1 degrees F from 2 am 4 am. She self-administered Tylenol 650 mg at 4 am which alleviated the fever and aches.


VAERS ID: 1761659 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Micardis HCT, Simvastatin, Fish Oil, Vit D3
Current Illness: None
Preexisting Conditions: Bicuspid Aortic valve, hypertension, high cholesterol
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I got a booster shot. My first vaccines were in January. My only symptom so far is pain and tenderness at the injection site. I do not have any redness or noticeable swelling.


VAERS ID: 1761678 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-10-04
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / UNK LA / IM

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

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

Write-up: breakthrough C19 infection and hospitalization


VAERS ID: 1761701 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-28
Onset:2021-10-04
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Mental status changes, SARS-CoV-2 test positive
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: a.fib, CHF
Allergies:
Diagnostic Lab Data: covid19 positive test - 10/4/202
CDC Split Type:

Write-up: altered mental status, increased oxygen requirements


VAERS ID: 1761718 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 UN / IM

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

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

Write-up: Patient received Pfizer booster shot accidentally after receiving 2 dose series with Moderna. Patient was not eligible to receive Pfizer booster shot. No adverse reactions occurred.


VAERS ID: 1761724 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-10-04
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cyclobenzaprine (FLEXERIL) 10 MG tablet Take 1 tablet by mouth 3 (Three) Times a Day As Needed for Muscle Spasms. Sleepiness precautions Fluticasone-Umeclidin-Vilant (Trelegy Ellipta) 100-62.5-25 MCG/INH inhaler Inhale 1 puff Daily. gabapen
Current Illness:
Preexisting Conditions: Allergic Anxiety Backache Chronic airway disease Emphysema lung H/O cyst of breast Left Breast History of colonic polyps History of neck pain Hyperlipidemia Hypertension Insomnia Left knee pain Pain in joint involving lower leg Pap smear abnormality of cervix/human papillomavirus (HPV) positive Shortness of breath
Allergies: lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: breakthrough C19 infection and hospitalization


VAERS ID: 1761726 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Hyperhidrosis, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Throat tightness, headache, severe sweating


VAERS ID: 1761791 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Nausea, Paraesthesia, Pruritus, Tachycardia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Site: Bruising at Injection Site-Medium, Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Allergic: Itch Generalized-Mild, Systemic: Nausea-Mild, Systemic: Tachycardia-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium


VAERS ID: 1761799 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-26
Onset:2021-10-04
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM6202 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Fatigue, Headache, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol q6hrs calcium-vitamin D cetirizine 10mg daily cholecalciferol 400IU daily fexofenadine 180mg daily fluticasone-salmeterol BID fluticasone nasal daily simvastatin 40mg HS triamcinolone topical daily
Current Illness: None documented
Preexisting Conditions: smoker, rheumatoid arthritis, osteopenia, hypercholesterolemia, insomnia, prediabetes, COPD with exacerbation, environmental allergies, sensorineural hearing loss bilateral.
Allergies: iodine - swelling lisinopril - cough seafood - swelling
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated Cough, myalgia, fatigue, headaches, chills, congestion


VAERS ID: 1761829 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-07
Onset:2021-10-04
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/5 SARS/COV-2, NAAT Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1761835 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Mass, Pain
SMQs:

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

Write-up: Painful lump on left collarbone. Soreness under left arm.


VAERS ID: 1761838 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-25
Onset:2021-10-04
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Alendronate na Aspirin,
Current Illness: HTN, arthritis, hip replacement, hyperlipidemia
Preexisting Conditions: HTN, arthritis, hip replacement, hyperlipidemia
Allergies: NKA
Diagnostic Lab Data: rapid test
CDC Split Type:

Write-up: COVID positive


VAERS ID: 1761848 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-03
Onset:2021-10-04
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Type 2 diabetes, hypertension, Afib, PVD, abnormal liver function
Allergies:
Diagnostic Lab Data: PCR collected on 10-4-2021, resulted positive.
CDC Split Type:

Write-up: cough, nasal congestion, drainage


VAERS ID: 1761869 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

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

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

Write-up: Patient given COVID-19 vaccine Moderna dose 1 and 2 in past. COVID-19 Pfizer 3rd dose given. Patient denied any adverse affects at this time.


VAERS ID: 1761880 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-10-04
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Painful respiration, Pulmonary embolism, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Embolic and thrombotic events, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: AML post MUD SCT 6/2019
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: EC visit and subsequent admission for pain with breathing, cough, vomiting. Diagnosed with sub-segmental pulmonary emboli


VAERS ID: 1761884 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 4 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ativan, MTV, Vit D, Theodur, Desyrel
Current Illness:
Preexisting Conditions: Reflux esophagitis
Allergies: Peanuts
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt given 4 doses of Covid-19 vaccine


VAERS ID: 1761894 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anaphylactic reaction, Pharyngeal swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Client had received 1st dose of moderna on 8/27/21. Client reported afterwords that he had minor throat swelling when he arrived home and took expired Benadryl. Client had contacted health dept multiple times wanting to receiving the 2nd dose of Moderna. He told us about his "minor throat swelling" and we instructed that we would not give the 2nd dose of Moderna since he had a minor anaphylatic event . He could try J/J. Client came in on 10/4/21 and filled out his paperwork for 2nd dose of Moderna. He put on paperwork that he did not have an adverse reaction to the 1st dose and denied it when asked by staff. 2nd dose of moderna was given by staff because they did not know he had a previous reaction. Client hung around in clinic from 2:40pm until 4:04pm and then c/o throat swelling. Dr assessed patient. 99% on room air. EMS was called at 4:15pm. Client refused epi and benadryl. Pt stated he wantedf to sign a refusal for tx/transport to hospital. At 4:35pm pt denied shortness of breath or any problems swallowing. Discharged home.


VAERS ID: 1761919 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt had hives on arms 2-3 days after first dose of Moderna on 9/2/21
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Hives on arms 2-3 days after 1st Moderna Shot
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was at the clinic for his 2nd dose of Moderna. Pfizer was accidentally administered instead of Moderna.


VAERS ID: 1761923 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-29
Onset:2021-10-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood ethanol, Blood glucose, Diplopia, Disorientation, Dizziness, Ear discomfort, Electrocardiogram abnormal, Full blood count, Head discomfort, Magnetic resonance imaging head, Metabolic function test, Sensitisation, Tinnitus, Troponin I increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Ocular motility disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete Blood Count with Automated Differential; Comprehensive Metabolic Panel; Ethanol (alcohol); Medical POCT Glucose; Troponin I Sensitivity, 1 hour; EKG 12-lead Weakness; MR Head WO Contrast
CDC Split Type:

Write-up: Sudden onset profound Diplopia / double vision, followed by disorientation and dizziness, followed by pressure in head and ears with tinnitus. Diplopia and dizziness / disorientation lasted less than 30 seconds, but other symptoms persisted


VAERS ID: 1761926 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-10-02
Onset:2021-10-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3174 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mobility decreased, Vaccination site erythema, Vaccination site reaction, Vaccination site swelling, Vaccination site warmth
SMQs:, Parkinson-like events (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: emtricitabine-tenofovir disoproxil fumarate; cholecalciferol; acetaminophen, ibuprofen
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: sulfa medications
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Approximately 2 days after receiving the booster Covid Vaccine I noticed that the area below the vaccine site is swollen, tight, red, and warm to the touch. Lifting my arm is more difficult than normal and it feels as if may be in or spreading to my armpit.


VAERS ID: 1761949 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-29
Onset:2021-10-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Euphoric mood, Loss of personal independence in daily activities
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Zero, I am rarely ever sick and don''t remember the last time I even has a sign of illness.
Preexisting Conditions: Zero, I am a healthy individual.
Allergies: Only seasonal environmental allergies such as pollen.
Diagnostic Lab Data: None - only thing I have done is gotten this vaccine.
CDC Split Type:

Write-up: As of 12:30 PM on Monday 10/4/21 I am experiencing lightheadedness and dizziness at rest and with weight bearing activity. I''ve avoided the gym the last two days for this reason as I am not fit to be lifting weights or doing cardio. I thought I was okay to workout today, starting driving, and turned around to home. I am able to sleep and eat without issue. No other known symptoms, just the feeling of being high or in other words the feeling you get when you wake up from anesthesia after having surgery and are not fully awake. Symptoms have lasted for over 24 hours and started 5 days after injection into the left deltoid. A day after the shot I felt slightly weak but nothing significant. I avoided working out the day after the shot because of the slight weakness just to be safe. I rarely go to the MD so the next section does not really pertain to me. Unless I am dying, I will go; perhaps I am from this.


VAERS ID: 1761957 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-10-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BAWA / UNK - / SYR

Administered by: School       Purchased by: ?
Symptoms: Injection site discomfort, Injection site reaction, Injection site warmth, Rash erythematous, Rash papular, Rash pruritic, Vaccination complication
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: COVID arm. I woke 5 days after first injection to a red, golf ball sized, rash at the injection site. The rash was raised, red and warm to the touch. The rash also itches and is uncomfortable.


VAERS ID: 1761958 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-10-04
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1761964 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-06
Onset:2021-10-04
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, Diabetes Mellitus, Cardiovascular Disease
Allergies:
Diagnostic Lab Data: Positive SARS Antigen FIA 10/04/2021
CDC Split Type:

Write-up: Tested for Covid 19 on 10/04/2021


VAERS ID: 1761988 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Chills, Extra dose administered, Fatigue, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (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: January 9 2021, 35 years old. 2nd dose of Pfizer. Fever, chills, fatigue and rash for one week at injection site.
Other Medications: Tylenol, ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, headache, fatigue, severe all over body aches, pain under left armpit. Symptoms started about 17 hours after shot and continued throughout the next day, almost 48 hours. Fever was the last symptom early morning of day 2 but broke with Tylenol. The body aches were the worst symptom.


VAERS ID: 1761998 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Erythema, Nausea, Pruritus, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: itching after 1st dose
Other Medications: no
Current Illness: none
Preexisting Conditions: multiple allergies
Allergies: seasonal, bananas, seafood, certain fruits give me hives
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 1305: developed itching, 25mg Bendaryl given 1315: vomitted, red cheeks 1333: continued nausea, called rapid response 1345: Vitals stable. Cont. nausea but rapid response cleared CG to leave clinic 1400: Developed red arms, resolved by 0600 10/5/2021


VAERS ID: 1762016 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: chronic pain, presbyopia, thyroid disorder, HBP, DM, GAD
Allergies: sulfa antibiotics
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient given COVID-19 vaccine Moderna dose 1 and 2 in past. COVID-19 Pfizer 3rd dose was given. patient denies any adverse affects at this time.


VAERS ID: 1762017 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-22
Onset:2021-10-04
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Dyspnoea exertional, Positive airway pressure therapy, SARS-CoV-2 antibody test, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cloNIDine 0.2 mg/24 hour Patch Weekly Directions: 1 patch transdermal every Wednesday (Active) clopidogrel (Plavix) 75 mg Tablet Directions: 1 tablet oral daily (Active) hydrochlorothiazide 25 mg Tablet Directions: 1 tablet oral daily
Current Illness:
Preexisting Conditions: CAD, MI, CABG x2 in 2012, PAD s/p left SFA stent 2013, HTN, HLD, CVA , Tobacco abuse, non compliance with medication . left SFA stent 2013, CABG, neck fusion. Smoking Status Daily Smoker Cigarette Details Cigarette Amount 1 Cigarette Pack, Duration 35 Year. Alcohol Use Denies.
Allergies: NKDA
Diagnostic Lab Data: 10/4/2021 SARS-CoV-2 Antigen (-); SARS-CoV-2 PCR (++) 10/4/2021 SARS-CoV-2 IgM 0.28; IgG 0.02 and SARS-CoV-2 IgG2 QT-SPIKE Antibody 280.6
CDC Split Type:

Write-up: 68 year old male patient with PMH of CAD, MI, CABG x2 in 2012, PAD s/p left SFA stent 2013, HTN, HLD, CVA , Tobacco abuse, non compliance with medication who was brought to the ER for evaluation of shortness of breath. According to the wife the patient returned from Cruise yesterday and had dinner at home. Wife states around 8.30 pm he developed sudden onset of shortness of breath so decided to come to the hospital for further evaluation. Wife states patient is non compliance with medication. On arrival patient was having shortness of breath on exertion so placed on BIPAP with improvement.


VAERS ID: 1762055 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
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: Glyburide, Lisinopril, Simvastin, Lexapro, truliity, vit d3, aspirin, turmeric, cinammon, krill oil
Current Illness: N/A
Preexisting Conditions: Diabetes
Allergies: Penicillin
Diagnostic Lab Data: Prescribed Bactrim today
CDC Split Type:

Write-up: Red, hot, swollen at injection site


VAERS ID: 1762061 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Hypotension, Sluggishness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: patient says usually gets weak after shots
Other Medications: LORAZEPAM
Current Illness:
Preexisting Conditions:
Allergies: NONE KNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became very sluggish and a little disoriented. Blood pressure was severly low. Patient was monitored in urgent care. EMS was called. Patient refused treatment


VAERS ID: 1762126 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Dizziness, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: dizziness ,fainting cyanosis bluish discoloration. sweating . we injected Epipen . Patient recovered in 5 minutes


VAERS ID: 1762129 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-13
Onset:2021-10-04
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Eye pain, Fatigue, Photopsia
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Retinal 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: Wedge Weed, Barctin antibotic
Diagnostic Lab Data: none this is day two
CDC Split Type:

Write-up: I am experiencing lower abdomen stomach cramps. I have a flashing white and sharp blue light occuring over my left eye. It was so bright that it lights up my car. I can see it when I walk up my home stairs in the dark. all occurring on 10.4.21 8 hrs after the vaccine. It continues on day 2, Oct. 5th. It seems to be slower in frequency. It is dueler when I put my glasses on. I have a low grade headache on my right eye. Finally I have an fatigue body


VAERS ID: 1762130 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Lymphoedema
SMQs:, Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (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 40mg; Multivitamin; L-Arginine 1000mg; Fish Oil 1500mg
Current Illness: None
Preexisting Conditions: High cholesterol
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling in right armpit and fluid accumulation around/below armpit.


VAERS ID: 1762145 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Ageusia, Hypoaesthesia oral, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Taste and smell disorders (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: About an hour after the vaccine my tongue became swollen, numb and I lost my sense of taste


VAERS ID: 1762179 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-10-04
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 UN / IM

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

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

Write-up: Employee Health Services is required per policy to report all breakthrough cases of COVID-19 post vaccination.


VAERS ID: 1762246 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-18
Onset:2021-10-04
   Days after vaccination:290
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Respiratory tract congestion, Rhinorrhoea
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zolpidem; Ondansetron; Wellbutrin; Meloxicam; Lyrica; Sumariptan; Vitamin D3; Magnesium; MiraLax, Flonase,
Current Illness: none
Preexisting Conditions: alopecia; recurrent major depression, hyperlipidemial connective tissue disease; osteopenia
Allergies: Bactrim; Tetracycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lot numbers not documented for dose 1 and 2. Runny nose and congestion started 10/4/21


VAERS ID: 1762251 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: patient fainted 5 minutes after injection. after recovery, felt like he was going to faint again. pt had covid several months ago, if that matters as a statistic for fainting reaction


VAERS ID: 1762259 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-10-04
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762272 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-11
Onset:2021-10-04
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762273 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Fatigue, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Erythromycin, sulfa
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Body aches chills fever 100.2 tiredness exhausted


VAERS ID: 1762279 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 RA / IM

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

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

Write-up: Moderna COVID-19 Vaccine EUA inadvertently given instead of Pfizer BioNTech COVID-19 Vaccine EUA. No symptoms appeared during the 15 minute wait time after vaccine administered and currently no other symptoms at this time.


VAERS ID: 1762284 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: DIABETES MELLITUS TYPE 2
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Patient is an employee of the hospital and arrives to the vaccination area requesting to get the third dose PFIZER. Patient fills out the document. PFIZER vaccine is administered and when requesting the CDC card we realized that she had the first two doses of MODERNA. Patient reports not knowing that it was not PFIZER. We follow up by phone and she reports feeling good. Booster dose (third) PFIZER was administered to patient with MODERNA primary series without presenting adverse affects.


VAERS ID: 1762346 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dizziness, Electrocardiogram, Facial paralysis, Feeling cold, Feeling hot, Hyperhidrosis, Hypoaesthesia, Monoplegia, Pain in extremity, Paraesthesia, Renal pain
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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 (broad), Hearing impairment (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Pollen Allergy, Dust Allergy
Diagnostic Lab Data: EKG -10/4/2021
CDC Split Type:

Write-up: At around 11:30am, I received the first dose of the Pfiser vaccine on my left arm. I was told to sit in the waiting room with a nurse watching over us. About 10 minutes after the Pfizer vaccine, I started feeling dizzy while sitting in the waiting room. Seconds later, I started to sweat on my forehead and started feeling super hot all over my body. This is when the nurse watching over me told me to lay down on the floor. Right when I laid on the floor, I started feeling enormous tingling and numbness on my left hand which later became paralyzing where I couldn''t move my left forearm and hands at all. All my fingers on my left hand locked up together. The numbness spread to my legs and feet and later to my right hand and forearm, where my fingers also locked up. My right hand had only partial paralysis because I was able to move my pinky and ring finger. My forearms were not extended but close to my shoulders. In addition, I felt numbness around my diaphragm. My left facial muscles were droopy. The nurses placed ice packs on my forehead and the back of my neck. In addition, they placed an oximeter on my finger and tested my heart rate which was around 130. In a split reversal, my body started feeling super cold and I was shivering and had chills all over my body. I heard someone say to call for EMS at this point. The nurses who attended lifted my legs and placed sweaters and sheets on my body. After several minutes, I started to feel my right hand more and numbness and paralysis slowly going away. However, I started to get sharp random periodic pains around my left kidney area. Right when this happened, the EMS came and checked my blood sugar and blood pressure. The whole incident happened for about 45 minutes. EMS, transferred me to the hospital for evaluation. I got discharged from the hospital several hours later. After I left, the only thing I felt was soreness on my left arm.


VAERS ID: 1762385 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-15
Onset:2021-10-04
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762484 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C2114 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Muscle tightness, Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dystonia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal 200mg Avery morning Prilosec 30mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: Seafood, strawberries, bactrim , bee stings
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Tightness in throat and jaw, tongue swelling, shortness of breath., chest pain Treatment at the ER with Benadryl and Pepcid


VAERS ID: 1762498 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-02
Onset:2021-10-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient experienced headache, fatigue, chills and fever for a day and a half following the vaccination. Then those symptoms went away, she then noticed a red bump/bubble slightly lower on her arm than her injection site that appeared 2 days after vaccination. The red area was warm to the touch and the patient stated slightly painful to the touch and had grown since she had first noticed it.


VAERS ID: 1762525 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-04
Onset:2021-10-04
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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: Admitted to Hospital on Date of Adverse Event for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762532 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-10-04
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762691 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-10-04
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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: Admitted to Hospital on Date of Adverse Event [recorded in regulatory authority] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762712 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-10-04
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762714 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-10-04
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762716 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-10-04
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762857 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Dyspnoea, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: penicillin, augmentin, zinnat, septra, gabapentin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: shortness of breath, fever, headache, chills no treatment providers said symptoms will fade in 24 to 48 hours


VAERS ID: 1763091 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-02
Onset:2021-10-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Lymphadenopathy, Neck pain, Pain in jaw
SMQs:, Osteonecrosis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 0
Current Illness:
Preexisting Conditions:
Allergies: 0
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph node above clavicle, headache, neck and jaw pain, extreme fatigue. all symptoms for 2 days and ongoing.


VAERS ID: 1763104 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / UNK - / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312834 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: The patient (after making an appointment for and filling out all of the information for the appointment), told me that he already had gotten his Flu shot at a different store after I gave him the flu shot. I then gave him the covid shot, which he was also getting. The patient did not experience any adverse events as far as I can tell and did not seem concerned at all by this


VAERS ID: 1763105 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Cold sweat, Headache, Hyperhidrosis, Inappropriate schedule of product administration, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Vomiting, nausea, migraine, body aches. 28 years old, 09/03/2021, injection, Moderna first vaccine
Other Medications: Acyclovir, Bupropion, Omeprazole, Norgestimate, vitamin c, vitamin d, cranberry vitamin, calcium, vitamin D3, B-12, Biotin, Multi Vitamin
Current Illness: I had the flu the previous week before getting the vaccine
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nauseous, vomiting, body aches, cold and hot sweats, fever, headache, weakness, abdominal pain, can?t keep any food down, just keep vomiting.


VAERS ID: 1763119 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Arthropathy, Condition aggravated, Cough, Injection site pain, Musculoskeletal stiffness, Neck pain, Neuralgia, Pain in extremity, Secretion discharge
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: 1/10/2021 Pfizer COVID-19 vaccine
Other Medications: Flonase Azelastine
Current Illness: N/A
Preexisting Conditions: Pre-existing joint issues
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at injection site, sore arm -- 10/4 and beyond Difficulty managing secretions while sleeping, a lot of coughing on first 10/5 while in bed Flare in joint symptoms. Persisitent neck nerve pain. Hand stiffness. Flare in wrist pain.


VAERS ID: 1763676 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dizziness, Musculoskeletal chest pain, Pain, Pain of skin, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: TDap body aches and pain, RA flare. July2021
Other Medications: Allegra-D, spironolactone, Amlodipine, sertraline, probiotics
Current Illness: None
Preexisting Conditions: RA, Thoracic aortic aneurysm, HNT, Anxiety and depression.
Allergies: Tree nuts, wheat, some sea food, beans, soy, latex and a host of other things.
Diagnostic Lab Data: Nothing yet, waiting for my Cardiologist to call back or send a message.
CDC Split Type:

Write-up: Chest pain, heart palpitations, lightheaded lasted a few hours. Then soreness in the chest, ribs still having palpitations 24 hours later. Now adding body aches and pains and skin tenderness.


VAERS ID: 1763677 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia, Pharyngeal paraesthesia
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: Vitamin D Daily Multivitamin Amlodipine-Besylate Fenofibrate Hydralazine Atenolol-Chlorthalidone Adderall
Current Illness:
Preexisting Conditions: Hypertension Nonalcoholic Fatty Liver Disease ADHD Acute Kidney Injury Hypercalcemia Hypercholesterolemia Hyperaldosteronism Vitamin D Deficiency
Allergies: Red Dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling in left side of face and throat


VAERS ID: 1763706 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-01
Onset:2021-10-04
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Migrelief. Propranalol.
Current Illness: none.
Preexisting Conditions: chronic migraines. essential tremor. pre-diabetes.
Allergies: none known.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Initial response normal- injection site sore (as for first, two doses). Then, on day 5 (Monday, October 4), late at night, I was woken up by serious (level 3-5? out of 10) THROBBING pain: absolutely no swelling or redness (i.e. nothing visible). Throbbing has stopped but a consistent, low-grade pain, UNDER the skin (not external) persists. ?! (Everything I have read on internet suggestion symptoms should diminish and/or disappear after ~24 hours).


VAERS ID: 1763952 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / UNK LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Heart rate increased, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hemorrhoids
Allergies: None
Diagnostic Lab Data: EKG 4 Oct 2021 - normal
CDC Split Type:

Write-up: 4:30 PM same day, sudden near syncope, rapid heartrate, chest pain


VAERS ID: 1763970 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-10-04
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211006246

Write-up: EXPIRED JANSSEN COVID-19 VACCINE ADMINISTERED; This spontaneous report received from a health care professional concerned a 20 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A expiry: 21-SEP-2021) dose was not reported, administered on 04-OCT-2021 to Right Arm for prophylactic vaccination. No concomitant medications were reported. On 04-OCT-2021, the patient experienced expired janssen covid-19 vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired janssen covid-19 vaccine administered was not reported. This report was non-serious.


VAERS ID: 1763975 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Kansas  
Vaccinated:0000-00-00
Onset:2021-10-04
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211006386

Write-up: ADMINISTRATION OF VACCINE PAST EXPIRATION DATE; This spontaneous report received from a health care professional concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, and batch number: 203A21A expiry: 21-SEP-2021) dose was not reported, administered on 04-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-OCT-2021, the patient experienced administration of vaccine past expiration date. The action taken with covid-19 vaccine was not applicable. The outcome of administration of vaccine past expiration date was not reported. This report was non-serious.


VAERS ID: 1763981 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Kansas  
Vaccinated:0000-00-00
Onset:2021-10-04
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211006486

Write-up: ADMINISTERED AN EXPIRED DOSE OF VACCINE; This spontaneous report received from a health care professional concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1820095 expiry: 02-OCT-2021) dose was not reported, administered on 04-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-OCT-2021, the patient experienced administered an expired dose of vaccine. The action taken with covid-19 vaccine was not applicable. The outcome of administered an expired dose of vaccine was not reported. This report was non-serious.


VAERS ID: 1763983 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Iowa  
Vaccinated:0000-00-00
Onset:2021-10-04
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient didn''t experience any adverse event after the vaccination
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211006624

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 38 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient didn''t experience any adverse event after the vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808982 expiry: 21-SEP-2021) dose was not reported, administered on 04-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-OCT-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious.


VAERS ID: 1764328 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (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: 2nd shot but it subsided in 6-8 hours.
Other Medications: buprenorphine for pain tylenol for pain
Current Illness: Fully disabled, so...EDS T3 ....Vascular spectrum disorder (aneurysm, clots, fistula in my spine) POTS, gastroparesis
Preexisting Conditions: all above
Allergies: tramadol, macrodantin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Extreme body pain, aches fatigue and mild fever that have been lasting now 3 days. The second dose I had a worse reaction but it lasted about 6-8 hours and stopped. This one is continuing on. I am reporting so you have this as information. I am not seeking medical care yet...hopefully it subsides.


VAERS ID: 1764332 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Loss of consciousness, Pain, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (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: On the day of the vaccine, I passed out in a store and puked in the parking lot. I also experienced extreme chills and headache. My entire body ached for the rest of the day. On the day after the vaccine I felt much better, but I did have diarrhea.


VAERS ID: 1764336 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Lymphadenopathy, 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: Sore arm
Other Medications: Humira Crestor Norvasc Probiotics Multi vitamin
Current Illness: Crohns Disease
Preexisting Conditions: Crohns Disease
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue Chills Body aches (shoulders, back, hips, knees) Fever Swollen lymph node in left armpit


VAERS ID: 1764345 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: Patient received the J and J vaccine on 10/1/21. He noticed on 10/4/21 that his right side of his face was drooping. He presented to a walk in clinic on 10/5/21 and diagnosed with Bells Palsy. He denies any other complications or side effects. He was prescribed prednisone and advised to follow up with his primary care doctor in 2-3 days.


VAERS ID: 1764531 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Lymphadenopathy, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: Aches and pain, fatigue, tiredness, swollen armpit lymph node, headache


VAERS ID: 1764614 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / UNK RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site swelling, Pain, Pain in extremity, Pyrexia, Vertigo
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (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:
Other Medications: Losartan for high blood pressue
Current Illness: None
Preexisting Conditions: High blood pressure. Maintained through medication
Allergies: None
Diagnostic Lab Data: None This has not been reported to any doctors. I thought it important to advise the cdc on my personal side effects. If the vertigo does not go away, I will seek advise from healthcare.
CDC Split Type:

Write-up: Date of vaccine. Evening head ache and arm pain. Approximately 8pm symptoms started. Headache progressed and worsened through night. Pain in arm also increased. In the more I experienced body aches, feverish chills, head ache and arm pain. I took Motrin and pain, headache subsided (6am). Approximately 2pm day after my symptoms returned with increased body ache, headache, feverish chills, and vertigo. I took more Motrin at 8pm and went to bed. 10/6/21 I woke up with all symptoms gone besides the vertigo and golf ball sized spot from infection site. I have never experienced Vertigo until yesterday.


VAERS ID: 1764624 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-29
Onset:2021-10-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ecchymosis, Erythema, Pain, Rash papular, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prempro Ibuprofen
Current Illness: none
Preexisting Conditions: Venous Insufficiency
Allergies: Kelp
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large localized left upper arm from acrominal space to elbow and into axilla with redness, heat, swelling, pain, papular rash and ecchymosis.


VAERS ID: 1764626 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Axillary pain, Headache, Injection site pain, Menstruation normal
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: Flu vaccine, Received Oct 2020 , soreness at injection site
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies: Seasonal allergies, dust, animal dander,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, injection site soreness, pain in left armpit 3 days after receiving vaccine. Onset of period.


VAERS ID: 1764628 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-02
Onset:2021-10-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Malaise, Oropharyngeal pain, Paraesthesia, Pyrexia, Troponin increased
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 10/5/2021: Troponin = 5.5, then 9.77 10/6/2021: Troponin = 4.17
CDC Split Type:

Write-up: The following day, he started developing low grade fevers, and was not feeling too well. One day prior to admission, he started developing some difficulty breathing, with sore throat as well. Around 3:30AM on morning of admission, he felt some chest tightness (described as pressure like, with a tingling sensation) without any worsening difficulty breathing.


VAERS ID: 1764646 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-31
Onset:2021-10-04
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Gastrointestinal disorder, Nucleic acid test, SARS-CoV-2 test positive, Upper respiratory tract infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: uri/gi sx X 2d + abbott test m10/4


VAERS ID: 1764661 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-30
Onset:2021-10-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Deep vein thrombosis, Joint swelling
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
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 hospitalized with knee swelling and was dx with DVT


VAERS ID: 1764669 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA8016 / 2 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB decreased, Chest pain, Myoglobin blood increased, Pain, Painful respiration, Troponin I increased
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No known meds
Current Illness: Major depressive disorder, anxiety
Preexisting Conditions:
Allergies: Morphine
Diagnostic Lab Data: POC CK-MD: 2.6 POC Myoglobin: 96.0 POC Troponin I: <0.05 Troponin I: 0.20 (H)
CDC Split Type:

Write-up: Patient awoke at 4:00 AM on October 4th with complaints of sharp, stabbing pain localized to the left side of his chest. No radiation of pain. Pain made worse with movement and deep inspiration. No fevers, cough, SOB, abdominal pain, nausea, vomiting, anosmia, aguesia. Played soccer the day prior.


VAERS ID: 1764679 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-04
Onset:2021-10-04
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Respiratory viral panel, 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: Respiratory Panel PCR w/ COVID-19: collected 10/5/21: COVID19 Detected
CDC Split Type:

Write-up: Patient positive for Covid on 10/04/21 and is now hospitalized.


VAERS ID: 1764713 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-14
Onset:2021-10-04
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/5 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1764734 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2285 / 3 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Breast swelling, Injection site erythema, Injection site swelling, Lymphadenopathy
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: keflex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Redness/swelling at injection site, enlarged axillary lymph nodes, and swelling at the breast.


VAERS ID: 1764742 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 - / IM

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

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

Write-up: Patient received Pfizer for a booster dose and had Moderna for the 1st and 2nd. dose


VAERS ID: 1764743 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Body temperature increased, Extra dose administered, Headache, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Medication errors (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: Second Pfizer Covid, same reaction as recent booster
Other Medications: Alpha Lipoic Acid, Aspirin Low Dose, Calcium with D, Fluticasone Propionate, Lisinopril, Metoprolol Tartrate, Levothyroxine, Rosuvastatin Calcium, Super B-Complex, Tamoxifen, Vitamin D-3, Xyzal
Current Illness: no
Preexisting Conditions: Had breast cancer, still on Tamoxifen Asthma Hypothyroidism
Allergies: Sulfa, Penicillin, Biaxsam, Atorvastin, lots of foods
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Slight rise in temperature (1 or so degrees), headache, aching of entire body. Began about 12 hours after injection. Took Advil and slept. Lasted about 12 hours.


VAERS ID: 1764755 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-19
Onset:2021-10-04
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Computerised tomogram head, Dizziness, Electrocardiogram, Full blood count, Metabolic function test, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, pramoxine
Current Illness:
Preexisting Conditions: anxiety. hypertension,
Allergies: NKA
Diagnostic Lab Data: CBC, CMP, CXR, EKG, CT HEAD
CDC Split Type:

Write-up: Dizziness, weakness, nausea


VAERS ID: 1764773 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: escitalopram 10mg
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: nkda
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt was given a dose of the Pfizer/COVID-19 Vaccine, in place of a 2nd dose of the Moderna/COVID-19 Vaccine


VAERS ID: 1764842 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Dizziness, severe full body aches, fever, diarrhea


VAERS ID: 1764874 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angioedema, Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 10/4/21 @ 10 am she developed significant angioedema of her lips (and slightly to her left infraorbital region), but no other allergic reaction symptoms. Apparently she had filler injected into both her lips a couple weeks ago and less filler, longer ago to her left infraorbital region. We spoke with her plastic surgeon and came up with a plan to properly treat her reaction. No hospitalization required, but was seen by our emergency dept, Of note, the patient was not eligible for a third booster dose yet, and she was not immunocompromised and in otherwise good health. She is a healthcare professional.


VAERS ID: 1764915 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-10-04
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Vaccination complication
SMQs:

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

Write-up: breakthrough case


VAERS ID: 1764928 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet Take 2 tablets (650 mg total) by mouth every 6 (six) hours as needed (MILD PAIN). albuterol (PROVENTIL) 2.5 mg /3 mL (0.083 %) nebulizer solution Take 3 mLs (2.5 mg total) by nebulization 4 (four) times
Current Illness: ONCOLOGY TREATMENT Adenocarcinoma of lung, stage 4, right (Recurrent) C34.91 6/19/2013 - Present More... INFUSION TREATMENT Adenocarcinoma of lung, stage 4, right (Recurrent) C34.91 6/19/2013 - Present 2/25/2 Other Cerebral arteriosclerosis with history of previous cerebrovascular accident I67.2, Z86.73 2004 - Overview Signed 2/25/2021 left-sided weakness Essential hypertension / Hyperlipidemia I10 4/15/2013 - Present 2/25/2021 More... Benign prostate hyperplasia N40.0 4/15/2013 - Present 2/25/2021 More... COPD (chronic obstructive pulmonary disease) J44.9 4/15/2013 - Present Overview Signed 2/25/2021 J43.9 Unknown - Present 2/25/2021 More... Glaucoma suspect of both eyes (Chronic) H40.003 8/2/2017 - Present 2/25/2021 Thyroiditis, autoimmune E06.3 10/9/2018 - Present 2/25/2021 Chronic congestive heart failure I50.9 1/24/2019 - Present 2/25/2021 More... Fracture of proximal humerus with malunion-right S42.209P 2/2019 - Present 2/25/2021 Overview Signed 2/25/2021 9:05 AM comminuted and impacted proximal right humerus fracture Traumatic compression fracture of L1 lumbar vertebra S32.010A 1/21/2021 - Present 2/25/2021 Traumatic compression fracture of L2 vertebra S32.020A 1/21/2021 - Present 2/25/2021 Class 2 obesity due to excess calories with body mass index (BMI) of 39.0 to 39.9 in adult E66.09, Z68.39 Unknown - Present Anxiety F41.9 Unknown - Present Chronic low back pain M54.50, G89.29 Unknown - Present 2/25/2021 Depression F32.A Unknown - Present 2/25/2021 Sleep apnea G47.30 Unknown - Present 2/25/2021 Overview Signed 2/25/2021 8:32 AM Traumatic compression fracture of L5 vertebra 32.050A 2/25/2021 - Present 2/25/2021 Hypothyroidism E03.9 Unknown - Present 2/25/2021 by Venous stasis dermatitis of both lower extremities I87.2 Unknown - Present 2/25/2021 by Overview Signed 2/25/2021 8:53 AM with stasis dermatitis Very heavy cigarette smoker (40 or more per day) F17.210 Unknown - Present 2/25/2021 Overview Signed 2/25/2021 9:23 AM 100 pack yr hx, 2004 reduced to 0.25 ppd Osteopenia of lumbar spine M85.88 2/25/2021 - Present 2/25/2021 Periumbilical abscess L02.216 8/18/2021 - Present 8/18/2021 More...
Preexisting Conditions: see #11
Allergies: NKA
Diagnostic Lab Data: PCP was notified of event, pt was monitored for over a hour, no ill effects were observed.
CDC Split Type:

Write-up: Patient came in for covid booster, received 2 doses of Moderna, pt report received Pfizer, did not have vaccine card to confirm, wife also presented for covid booster, reported Pfizer was given for the first 2 doses, had card to confirm. It was discovered after administering Pfizer booster the patient received Moderna.


VAERS ID: 1764931 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2020-12-23
Onset:2021-10-04
   Days after vaccination:285
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol Advil
Current Illness: headache body ache Soar throat Fever Chilingp
Preexisting Conditions: Hyper tension
Allergies: Chlorantiazide
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills Headache Body ache


VAERS ID: 1764949 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

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

Write-up: Patient was given 3rd dose of Covid-19 vaccine, had said she had Pfizer with prior 2 doses. After receiving immunization, RN noted on vaccine card that patient had received Moderna vaccine for first 2 doses. RN called Pfizer to advise, was instructed no further action to be taken. Patient has been notified.


VAERS ID: 1764955 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, body aches, chest pain, chills


VAERS ID: 1764958 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Lymphadenopathy, Mobility decreased, Pain, Pain in extremity
SMQs:, Parkinson-like events (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Extremely swollen lymph nodes in right arm pit. Same arm that I received the vaccination. This occurred within 8 hours of getting the vaccination. My entire right arm is in pain, I cannot use my arm normally without causing extreme pain in my arm pit. Also within 8 hours of receiving the shot, my joints in my entire body hurt. I had nothing wrong with me, no pain anywhere when I went to get the vaccination.


VAERS ID: 1764986 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Anxiety, Dysphonia, Enlarged uvula, Hypersensitivity, Pharyngeal swelling, Salivary hypersecretion
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Brilinta Aspirin Atorvastatin Lisinopril
Current Illness: Aortic Valve Disorder(Mild aortic insufficiency (AI) with normal aortic valve, asymptomatic, stable.
Preexisting Conditions: Aortic Valve Disorder
Allergies: NKDA
Diagnostic Lab Data: No test performed on the day of the ER visit.
CDC Split Type:

Write-up: Service member had symptoms of an allergic reaction about 45 minutes after his first dose of Pfizer vaccine. He began having a sensation of swelling in the throat. His voice deepened, but did not had difficulty breathing nor with his air way, he did experience an increase amount of saliva in his mouth. EMS was called on the scene to access his vital and his air way, he later was transported to the hospital as precautioning measures. On arrival to hi did not appear to be in acute distress. He had some mild swelling over the uvula in the posterior pharynx. He had a feeling that his voice was deeper, he was anxious and with no.n toxic appearance and not in acute distress. The degree at onset was minimal, he was given Decadron 10mg, IV Push once, Pepcid 20mg IV push once, Diphenhydramine 25 mg. After the above treatment service member was feeling much better and was discharged from ER, with a follow up with his primary care physician .


VAERS ID: 1765002 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Exposure during pregnancy, Pain
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pre-natal vitamins, low-dose aspirin, allergy medications (Zyrtec, Flonase, Zaditor)
Current Illness: None
Preexisting Conditions: Allergic rhinitis
Allergies: Sulfa, amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Full body ache beginning the night of injection, continuing into the next day; resolved by the morning after that. Received injection at 16 weeks of pregnancy; estimated due date 3/16/22.


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