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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 38 out of 8,010

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VAERS ID: 1765056 (history)  
Form: Version 2.0  
Age: 76.0  
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 - / -

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Carvedilol 25mg Amlodipine 5mg Clopidogrel 75mg Low dose aspirin
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, lightheadedness ,cold sweats


VAERS ID: 1765107 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Arkansas  
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 1820095 / 1 LA / IM

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

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

Write-up: vaccine administered had expired 10/02/21


VAERS ID: 1765116 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Arkansas  
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 1820095 / 1 RA / IM

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

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

Write-up: vaccine administered had expired 10/02/21


VAERS ID: 1765120 (history)  
Form: Version 2.0  
Age: 64.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Fatigue, Lymph node pain, Lymphadenopathy, Pain in extremity
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On Sunday 10/3/21 got Pfizer booster at 1:00pm in left deltoid administered at a vaccination clinic. Came home and arm hurt a little bit and was tired. 10/4/21 her joints were hurting and felt very tired. Left side of chest also painful. Today 10/5 noticed swollen painful lymph nodes in left axilla.


VAERS ID: 1765126 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Arkansas  
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 1820095 / 1 LA / IM

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

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

Write-up: vaccine administered had expired 10/02/2021


VAERS ID: 1765127 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
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 050E21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, 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: None.
Current Illness:
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain and swelling in arm at injection site, warm to touch.


VAERS ID: 1765133 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Arkansas  
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 1820095 / 1 RA / IM

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

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

Write-up: vaccine administered had expired 10/02/21


VAERS ID: 1765138 (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: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 LA / IM

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

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

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


VAERS ID: 1765139 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
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 EW0179 / 3 RA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: alrex 0.2% drops, ascorbate calcium, aspirin, azelastine nasal spray, zyrtec, vitamin D, B-12, Colace
Current Illness: axillary lipoma
Preexisting Conditions: hypertension, asthma, dyspepsia, gastroesophageal reflux,
Allergies: amlodipine, clonidine, cephalosporins, Morphine, Lisinopril, Prilosec, Tramadol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient''s first 2 doses were Moderna. Patient did not have vaccination card and system to verify was down. Patient reported Pfizer first 2 doses.


VAERS ID: 1765149 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Arkansas  
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 1820095 / 1 LA / IM

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

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

Write-up: vaccine administered had expired 10/02/2021


VAERS ID: 1765160 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Arkansas  
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 1820095 / 1 RA / IM

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

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

Write-up: vaccine administered had expired 10/02/2021


VAERS ID: 1765227 (history)  
Form: Version 2.0  
Age: 46.0  
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 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given Moderna vaccine on 10/4/2021. The shelf life of the vaccine expired on 10/3/21. The vaccine was not expired


VAERS ID: 1765243 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-22
Onset:2021-10-04
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: On October 5th patient presented to the pharmacy stating that she has a warm, itchy, red area in the region of where she received her first Moderna shot. She states that she has been having this for several days.


VAERS ID: 1765250 (history)  
Form: Version 2.0  
Age: 26.0  
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 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

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

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

Write-up: Patient was given Moderna Vaccine on 10/4/2021. The self life of the vaccine expired on 10/3/21. The vaccine was expiration date is 10/10/2021.


VAERS ID: 1765254 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
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 EWO162 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Myalgia, Nausea, Oedema peripheral, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: pain in her thighs like muscle aches and then nausea and then bad swelling in her right axialla same arm of shot and had mammogram scheduled today and they could not do it with the swelling and pain


VAERS ID: 1765260 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Ohio  
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 FF2589 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Fatigue, Flushing, Headache, Hyperhidrosis, Hypoaesthesia, Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Lethargy, Nausea, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
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, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Headache-Medium, Systemic: Nausea-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Weakness-Medium


VAERS ID: 1765266 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-20
Onset:2021-10-04
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute coronary syndrome, Acute respiratory failure, Anticoagulant therapy, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Chest X-ray abnormal, Chronic respiratory disease, Condition aggravated, Dyspnoea, Electrocardiogram, Immunodeficiency, Inappropriate schedule of product administration, Interstitial lung disease, Laboratory test, Metabolic function test, Pneumonia, Procalcitonin, Productive cough, Pulmonary hypertension, Pyrexia, SARS-CoV-2 test positive, Troponin
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen-codeine (TYLENOL #3) 300-30 MG per tablet amitriptyline (ELAVIL) 10 MG tablet Ascorbic Acid (VITAMIN C PO) Cholecalciferol (VITAMIN D) 125 MCG (5000 UT) CAPS diphenhydrAMINE (BENADRYL) 25 MG tablet diphenhydramine-acetaminophe
Current Illness:
Preexisting Conditions: Hypothyroidism (acquired) Rheumatoid arthritis Mitral regurgitation History of alcohol abuse Age-related osteoporosis without current pathological fracture Rheumatoid lung Pure hypercholesterolemia Essential hypertension GERD without esophagitis Dilated cardiomyopathy Persistent atrial fibrillation Long term (current) use of systemic steroids Cardiac pacemaker in situ Peripheral vascular disease Pulmonary hypertension Generalized anxiety disorder Right heart failure due to pulmonary hypertension Pneumonia due to COVID-19 virus
Allergies: Tizanidine Hcl
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 10/4/2021; COVID-19 positive 10/04/2021; fully vaccinated HISTORY OF PRESENT ILLNESS: HPI Patient is an 84-year-old female with a past medical history of hypertension, interstitial lung disease, rheumatoid arthritis, pulmonary hypertension on 5 L at baseline who presents to the emergency department today via EMS for shortness of breath. Patient states she has had worsening shortness of breath over the last 3 days. She states that she is normally on 5 L of oxygen at baseline is had increase up to 9 L. patient states she has had a productive cough. She states she had a low-grade fever of 99. Patient has no signs of peripheral edema. Remainder of physical exam noncontributory. I ordered basic labs, troponin, EKG, COVID-19 PCR, BNP and chest x-ray. My working differential diagnosis included, but is not limited to congestive heart failure exacerbation, ACS, pneumonia, COVID-19 or worsening of her interstitial lung disease. As patient is taking her Xarelto as directed, I have low suspicion for pulmonary embolism and do not feel advanced imaging or lab work is warranted to pursue that diagnosis. COVID-19 PCR was positive. Chest x-ray shows acute airspace disease with superimposed chronic lung disease in the right lower chest. With the patient''s worsening respiratory status from her baseline and elevated BNP, patient is given a dose of IV Lasix. Due to her COVID-19 positive status, I gave the patient a dose of Decadron. Patient and her daughter were updated on lab and imaging results. We discussed her diagnosis of COVID-19 with likely worsening CHF. As patient has maxed out on her oxygen capabilities at home, we did discuss admission for this. CHIEF COMPLAINT Pneumonia due to COVID-19 virus ASSESSMENT AND PLAN Principal Problem: Pneumonia due to COVID-19 virus COVID-19 pneumonia -pt is vaccinated but immunocompromised, onset of increased oxygen demands 10/1/21 -s/p moderna vaccine 2/3/21 and 3/20/21 -CXR showed acute airspace disease superimposed on chronic lung disease in the right lower chest -start decadron and remdesivir acute exacerbation of chronic 5-8L O2 dependent interstitial lung disease, pulmonary hypertension -2/2 above, did not improve with prednisone 50mg qday 10/1 -follows up pt with pulmonologists as outpatient -pulmonology consult, await recommendations -continue home sildenafil and tyvaso -PRN albuterol -continuous pulse ox Note from 10/6/2021: ASSESSMENT/PLAN: Acute on chronic hypoxic respiratory failure COVID-19 PNA Interstitial lung disease -Patient reports she''s on 6 L oxygen at rest at baseline, goes up to 10 with exertion -currently on 6 L with rest but using NRB to ambulate. -Pulm consulted -continue dexamethasone -started remdesivir -started IV lasix, AM labs pending -continue PJP prophylaxis -hold cellcept Note from pulmonary on 10/6/2021: ASSESSMENT / PLAN: This is a 84 y.o. who has a past medical history significant for RA-ILD and PH on tyvaso and sildenafil, afib on DOAC admitted for hypoxic respiratory failure 2/2 covid-19. Assessment and Plan #acute on chronic hypoxemic RF #COVID-19 On baseline 3L, currently requiring 6L and more with exertion. Feels better today. - please start to wean O2 to keep sats $g90% - cont dexamethasone 6 mg daily - remdesivir 200 mg loading dose then 100 mg daily - procalcitonin 0.04 so will hold off empiric abx - continue lasix to 40 mg IV daily, can transition back to home PO dose once O2 requirement is decreasing - less likely PE in the setting of DOAC though please low threshold to get CTA chest if she has increasing O2 requirement - daily CMP while on remdesivir


VAERS ID: 1765293 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

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

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

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


VAERS ID: 1765326 (history)  
Form: Version 2.0  
Age: 58.0  
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 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

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

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

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


VAERS ID: 1765370 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New Mexico  
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 / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D-3, Fish Oil
Current Illness: Osteoarthritis
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Intermittent paraesthesia and numbness outside of right thigh.


VAERS ID: 1765375 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Arizona  
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 - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Tongue ulceration
SMQs:, Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Large sore on tongue


VAERS ID: 1765376 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-13
Onset:2021-10-04
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

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

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

Write-up: Pt received Janseen COVID vaccine. Pt tested COVID + on 9/22/21 and admitted to hospital for COVID on 10/4/2021. Pt receiving remdesivir and dexamethasone.


VAERS ID: 1765411 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Ohio  
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 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Hyperhidrosis, Hypoaesthesia, Migraine, Nausea, Pain, Tremor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Migraine, body aches, exhaustion, nausea, vomiting, cough, chills, sweating, shaking, numbing of entire left arms


VAERS ID: 1765415 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
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 30155BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dry mouth, Erythema, Extra dose administered, Fatigue, Headache, Lymphadenopathy, Oedema peripheral, Oropharyngeal pain, Pruritus, Pyrexia, Respiratory tract congestion, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Dehydration (broad)

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

Write-up: Pt. states that after receiving the 3rd Booster of Phizer 10/04/2021, started experiencing symptoms of chills, headache, under arm swollen lymphoid (hot to the touch), red streak from under arm across the front of chest, itchiness under the arm, fever (100.1), dry mouth, sore throat, congestion, and fatigue. No noted Primary visit.


VAERS ID: 1765422 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Virginia  
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 30155BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: influenza 2019
Other Medications: baby aspirin, synthroid, estrace, lumigen, multivitamin, vitamin d3, gluatamine, vitamin c, probiotic, visobme,
Current Illness:
Preexisting Conditions:
Allergies: red dye in medication, ampicilon, cipro,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling in lower calves and feet after injection


VAERS ID: 1765452 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Alaska  
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 FD0809 / 3 LA / IM

Administered by: Other       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient requested booster dose of Pfizer. Patient did not bring vaccine cards to his booster appointment nor was he in the state vaccine database due to obtaining first vaccines out of State. The medical assistant gave the Pfizer booster based on the patient''s description and verbalized dates. Then the patient brought in his vaccine cards the next day and was found to have had Moderna vaccine for the first 2 doses. Patient had no adverse health events.


VAERS ID: 1765485 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-25
Onset:2021-10-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphemia, Tic
SMQs:, Dyskinesia (broad), Dystonia (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: Lexapro, Melatonin
Current Illness: Depression and Anxiety
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Unable to do MRI at this time because he cannot lay still long enough for the scan.
CDC Split Type:

Write-up: On Monday out of the blue patient started experiencing severe tics. His whole body is being thrusted and it is constant. He also is stuttering and saying words over and over. The symptoms mimic Tourette''s. He has never had any issues like this before and it was a sudden onset. Not saying it was the shot but the timeline is concerning. We took him to the doctor Tuesday and she ordered an MRI however he cannot have that done until he can be still for at least 30 minutes. She prescribed Baclofen for him in hopes that would ease the symptoms it has not. She said I should file a report. She did research and had not found anyone reporting these symptoms but there is a lot of uncertainty of the shot still. And Covid has effected so many in so many different ways and the vaccine has also. This is very unusual for patient as he has always been very healthy and has never had any issues before.


VAERS ID: 1765507 (history)  
Form: Version 2.0  
Age: 64.0  
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 30155BA / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache
SMQs:

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

Write-up: severe headache, temperature, chills, excessive tiredness.


VAERS ID: 1765518 (history)  
Form: Version 2.0  
Age: 52.0  
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 - / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Chills, Extra dose administered, Injection site erythema, Injection site pain, Injection site swelling, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone Propionate daily Rx for my allergy symptoms (runny nose & sneezing); OTC Amberen daily for my hot flushes; Tylenol 500 mg 2x/day since evening of 10/4/21 for booster site pain
Current Illness: Upper respiratory infection 9/15 - 9/17, s/p antibiotics
Preexisting Conditions: Chronic low back pain; on/off hypoglycemia
Allergies: No known allergy
Diagnostic Lab Data: Covid-19 rapid test this morning, 10/6/2021 at 0800 - Negative
CDC Split Type:

Write-up: Injection site pain, redness, swelling, chills & low grade fever. (Covid-19 Booster received on Monday, 10/4/2021 at 0850. At night, my right deltoid injection site started to be painful, Tylenol PM 100 mg at 2130 for pain and sleep. The following morning, 10/5/2021, more pain noted on injection site, +swelling and redness to the site, Tylenol 1000 mg taken at 0700 for pain before going to work. In the afternoon 10/5/2021, at around 1430 chills noted. Home by 1700 checked temperature at 1730 = T38.2, Tylenol 1000 mg taken for fever and pain). 10/6/21 morning-No more fever but will with pain, redness and swelling on the right arm/deltoid injection site.


VAERS ID: 1765534 (history)  
Form: Version 2.0  
Age: 66.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Burning sensation, Headache, Hypophagia, Immunisation, Malaise, Nausea, Pain, Product administration error, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: "After previous COVID shot I didn''t feel great for a few days"
Other Medications: Levothyroxine, Prilosec, Statin Drug
Current Illness: None
Preexisting Conditions: None
Allergies: Aspirin, Advil
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patients report after receiving the vaccine. "Starting around 10pm started not feeling well, felt feverish. By 2am started vommiting, nausea, headache. Body feels achey and burning. Had a fever of ~102. After a couple of hours I was able to fall asleep. Had a fever throughout the day Tuesday but took Tylenol. I don''t have a fever today. Since then I have felt tired and have occasional nausea and headache. Haven''t been able to eat yet." "I woke up at 10:30am today, I''m feeling better than I was yesterday but still can''t eat" Describe Treatment/Outcome (See next page) Patient recieved their first 2 COVID-19 Vaccines 2/3/21 and 2/24/21. Patient came for their 3rd/Booster shot on 10/4/21 at the senior housing where they live. When the pharmacist went to inject the patient they pulled their arm away and stated that it felt like it hit a nerve. When injecting the first shot since the patient pulled their arm away no vaccine was injected into the patient. The pharmacist retrieved a new syringe and proceeded to inject the patient without incident. The following day the patient''s daughter contacted the pharmacy concerned that her moster was very sick. She was concerned about getting the extra dose. Pharmacist called the patient and their statement is in the information above. Patient said they didn''t feel well when they got their second shot. Patient thought they were getting better and haven''t looked for any additional care. Daughter wanted to make sure a report was made. We assured her we will fill out a VAERS report and we gave her information about V-Safe to also self-report any additional side effects or symptoms. Patient was told to keep an eye out for high fever or worsening symptoms and to call the PCP if anything progresses. We will follow up with the patient again tomorrow (10/7).


VAERS ID: 1765580 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Texas  
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 FF2587 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dizziness, Heart rate increased, Impaired driving ability
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Recovered from COVID-19 2 weeks prior
Preexisting Conditions: Minor heart issues: Enlarged aorta and Mitral Valve Prolapse
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nearly 24 hours after my 2nd Pfizer dose, I started experiencing a rapid heart rate, chest pains, and a sort of dizzy feeling. I took Adderall when I was younger, and it almost felt like a medicated stimulant type of feeling. This started on my way home from work, and I had to pull over a couple times to take deep breaths. I did not seek treatment, but thinking back, I probably should have. Things improved later in the evening, but even today (2 days later) I am still faintly feeling that stimulant-type feeling.


VAERS ID: 1765594 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-28
Onset:2021-10-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Polymenorrhoea
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrogen, testosterone, T3/T4, progesterone
Current Illness:
Preexisting Conditions: Ovarian failure
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Early menstrual cycle. This occurred also with the first dose.


VAERS ID: 1765651 (history)  
Form: Version 2.0  
Age: 34.0  
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 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       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: Administration error mixed series mRNA Pfizer and Moderna


VAERS ID: 1765655 (history)  
Form: Version 2.0  
Age: 57.0  
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 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       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: Administration error mixed series mRNA Pfizer and Moderna


VAERS ID: 1765681 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Idaho  
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 - / -

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
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: The covid vaccine vial was reconstituted with normal saline not with the diluent coming with the covid vaccine the one with pink top. This was not the right one. So the manufacturer stated that this is not valid and pt should do another dose in 6 months. Pt was receiving covid booster vaccine at that time.


VAERS ID: 1765688 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Idaho  
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 - / -

Administered by: Private       Purchased by: ?
Symptoms: Product preparation error
SMQs:, Medication errors (narrow)

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

Write-up: The covid vaccine vial was reconstituted with normal saline not with the diluent coming with the covid vaccine the one with pink top. This was not the right one. So the manufacturer stated that this is not valid and pt should do another dose in 6 months. Pt was receiving covid booster vaccine at that time.


VAERS ID: 1765708 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Idaho  
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 - / -

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
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: The covid vaccine vial was reconstituted with normal saline not with the diluent coming with the covid vaccine the one with pink top. This was not the right one. So the manufacturer stated that this is not valid and pt should do another dose in 6 months. Pt was receiving covid booster vaccine at that time.


VAERS ID: 1765713 (history)  
Form: Version 2.0  
Age: 72.0  
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 301308A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No prescriptions, supplements: multi-vitamin, magnesium, calcium, vitamin E, vitamin C, low dose aspirin, cetirizine hydrochloride, oil of oregano
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to sulfa, no other allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, fever, fatigue, sore arm lasting 18 hours


VAERS ID: 1765737 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
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 FF8841 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Breast swelling, Lymph node pain, Lymphadenopathy, Tenderness
SMQs:, Angioedema (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: Lisinopril, calcium, vitamin D, biotin
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None. Did report to the relevant department on 10/4/21.
CDC Split Type:

Write-up: Visible swelling in left clavicle appears to be fluid filled. Tender, slightly painful. Palpable swelling in left upper breast. This is more diffuse but not visible. Tender.


VAERS ID: 1765873 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-04
Onset:2021-10-04
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Brain natriuretic peptide increased, COVID-19, Cardiac failure congestive, Chest X-ray abnormal, Chronic kidney disease, Condition aggravated, Dyspnoea, Fatigue, Hyperkalaemia, Hypophagia, Hypoxia, Pleural effusion, Pneumonia, SARS-CoV-2 test positive, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet acyclovir (ZOVIRAX) 400 MG tablet apixaban (ELIQUIS) 2.5 MG tablet Calcium Carb-Cholecalciferol (CALCIUM + D3) 600-800 MG-UNIT TABS ferrous sulfate 325 (65 Fe) MG delayed release tablet folic acid (FOLV
Current Illness:
Preexisting Conditions: A-fib (HCC) Acute diastolic CHF (congestive heart failure) (HCC) Aortic valve insufficiency Arthritis CAD (coronary artery disease) Cancer (HCC) Colon cancer (HCC) Congestive heart failure (HCC) Coronary artery disease Detrusor instability of bladder Glaucoma History of blood transfusion HTN (hypertension) Hyperlipidemia Hypertension Laryngitis Macrocytic anemia Macular degeneration MD (muscular dystrophy) (HCC) Neck pain Nocturia Polymyalgia rheumatica (HCC) Severe tricuspid valve insufficiency
Allergies: Ivp Dye, Iodine, Tramadol and Vicodin (hydrocodone-acetaminophen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 10/4/2021; COVID-19 Positive 10/04/2021; fully vaccinated CHIEF COMPLAINT: COVID-19 Assessment/Plan HISTORY OF PRESENT ILLNESS: Pt is a 91 y.o. male who presented yesterday for evaluation of shortness of breath, fatigue and poor po intake. He was treated for pneumonia in September but recovered from that infection with antibiotics. He had several weeks of feeling well before starting to feel symptoms again the past week (not sure of date). Has family recently diagnosed with covid as well. Follows with cardiology for CHF and valvular heart disease. In the ER, Pt was hypoxic on RA. He required o2 via NC. Labs showed an elevated BNP, hyperkalemia, his known CKD and an elevated troponin. COVID-19 was positive. Chest xray showed CHF with a moderate right pleural effusion. He was started on Decadron and lasix with significant improvement. Initially, we did not have beds to accept him so he was pending transfer but was later admitted to HCF. Denies chest pain. Afebrile. Care Management note 10/6/2021: Plan/Reassessment: Plan Discharge Coordination/Progress: Pt plans to return home with family supports. He denies need for further services Plan: return home. Patient-Specific Goals (Include Timeframe): return home 1-2 days


VAERS ID: 1765884 (history)  
Form: Version 2.0  
Age: 73.0  
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 - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eye drops for glaucoma.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Wheat, almonds, chicken, tuna, bell pepper, orange, garlic, black tea.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 36 hours of: 100.2 fever Shivers Dizziness Fainted at the 30 hour mark


VAERS ID: 1766113 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
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 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Headache, Insomnia, Pain, Respiratory tract congestion, Upper respiratory tract infection, Vertigo
SMQs:, Vestibular 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: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Penicillin
Diagnostic Lab Data: Urgent care upper respiratory infection Vertigo
CDC Split Type:

Write-up: Headache;Congestion body aches and pains; Insomnia.


VAERS ID: 1766116 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pyrexia, Seizure, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever , convulsions, vomiting, shaking


VAERS ID: 1766454 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
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 - / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Herpes simplex
SMQs:, Opportunistic infections (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: Hsv-1
Allergies: Augmentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had hsv-1 flare up shortly after getting the covid vaccine. Unsure if related,has been more than 6 months since last flare up. Was diagnosed in 2015.


VAERS ID: 1767107 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms
SMQs:, Dystonia (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 known
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient called on evening of 10/05/2021 complaining of muscle spasms across the chest, but had no chest pains or breathing problems. The patient was asked if any reactions occured from the first dose and patient stated no reactions. Patient was referred to provider but patient said had no provider at this time. I tried calling patient to see if went to a provider and patient has not returned phone call.


VAERS ID: 1766842 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-10-04
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asymptomatic COVID-19, SARS-CoV-2 test
SMQs:, COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211001; Test Name: COVID-19 virus test; Result Unstructured Data: negative; Test Date: 20211004; Test Name: COVID-19 virus test; Result Unstructured Data: positive (twice)
CDC Split Type: USJNJFOC20211006301

Write-up: ASYMPTOMATIC COVID-19; This spontaneous report received from a consumer via a company representative concerned a 37 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: Unknown) dose was not reported, administered on MAR-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot number. No concomitant medications were reported. On 01-OCT-2021, Laboratory data included: COVID-19 virus test (NR: not provided) negative. On 04-OCT-2021, the patient experienced asymptomatic covid-19. Laboratory data included: COVID-19 virus test (NR: not provided) positive (twice). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of asymptomatic covid-19 was not reported. This report was non-serious. This report was associated with a product quality complaint: 90000195927.; Sender''s Comments: V0; Medical assessment comment not required as per standard procedure as case assessed as non-serious.


VAERS ID: 1766843 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-10-04
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 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: USJNJFOC20211006314

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a health care professional concerned a 40 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1816022, expiry: 29-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 expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious.


VAERS ID: 1766862 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Kansas  
Vaccinated:0000-00-00
Onset:2021-10-04
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 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: USJNJFOC20211009168

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 04-OCT-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 04-OCT-2021, the patient experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious.


VAERS ID: 1766867 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-10-04
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Headache
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Stroke; Comments: The patient had no known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211009427

Write-up: SORENESS FROM STOMACH DOWN AND BACK; HEADACHE; This spontaneous report received from a patient concerned a 63 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included: high blood pressure, and stroke, and other pre-existing medical conditions included: The patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1822809, expiry: 07-MAR-2022) dose was not reported, administered on 04-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-OCT-2021, the patient experienced soreness from stomach down and back. On 04-OCT-2021, the patient experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, and the outcome of soreness from stomach down and back was not reported. This report was non-serious.


VAERS ID: 1767138 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Inflammation, Pain, Pyrexia, Sputum discoloured, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: Vitamin B12
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12 hours after the second MODERNA application, I had chills for 6 hours, later I had fever, head pain. I vomited some clear green phlegm. After vomiting I felt a lot better but with some body pain but it went away the next day. I feel good now but after having chills, I feel chest inflammation on the left side and I still have that symptom.


VAERS ID: 1767277 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-10-04
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 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: USJNJFOC20211006371

Write-up: EXPIRED VACCINE USED; This spontaneous report received from a health care professional concerned multiple patients. 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: 204A21A 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 expired vaccine used. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine used was not reported. This report was non-serious. This case, from the same reporter is linked to 20211006668, 20211006798, 20211009653 and 20211009632.


VAERS ID: 1767628 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010D9A / 2 LA / UN

Administered by: Military       Purchased by: ?
Symptoms: Headache, Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: headache myocarditis


VAERS ID: 1767629 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-12
Onset:2021-10-04
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Chest pain, Cough, Diarrhoea, Dyspnoea, Haematochezia, Haemorrhoids, Lung consolidation, Lung infiltration, Nausea, Oropharyngeal pain, Pneumonia, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL) 500 MG tablet atorvastatin (LIPITOR) 10 MG tablet B Complex Vitamins (VITAMIN-B COMPLEX PO) Cholecalciferol (VITAMIN D-3 PO) escitalopram (LEXAPRO) 20 MG tablet finasteride (PROSCAR) 5 MG table
Current Illness:
Preexisting Conditions: Hospital Benign prostatic hyperplasia without lower urinary tract symptoms Hypothyroidism (acquired) Hyperlipidemia Prostate cancer (cT1c low risk adenocarcinoma of the prostate gleason 3+3=6 in 5/12 cores);P3P no email MUSIC COVID-19 Hypoxia Benign essential HTN BMI 37.0-37.9, adult Non-Hospital Osteoarthritis, unspecified laterality, unspecified, unspecified osteoarthritis type, unspecified site, unspecified spinal region, unspecified spinal osteoarthritis complication Depression Elevated PSA Bleeding hemorrhoids Finger lesion Prostate cancer
Allergies: No Known Allergies
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time DR CHEST SINGLE VIEW [344856482] Resulted: 10/04/21 1950 Order Status: Completed Updated: 10/04/21 1952 Narrative: EXAMINATION: Single View Chest EXAM DATE: 10/4/2021 7:11 PM TECHNIQUE: Single view chest INDICATION: Covid COMPARISON: 7/31 2018 ENCOUNTER: Not applicable _________________________ FINDINGS: An abnormal focal area of consolidation is demonstrated in the right lower lung consistent with pneumonia. The left hemidiaphragm is not well visualized on this exam which could be due to the heart obscuring detail or airspace disease in the left lower lung. The mediastinum and pulmonary vasculature are normal. No pleural effusion is present. There is no pneumothorax. _________________________ Impression: There is abnormal infiltrate in the right lower lung consistent with pneumonia. Consider follow-up imaging to document resolution and exclude a mass. Procedure Component Value Ref Range Date/Time COVID-19 PCR - Rapid BL and Regionals [344696226] (Abnormal) Collected: 10/04/21 1618 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 10/04/21 1641 COVID-19 PCR Detected Abnormal Not Detected Comment: COVID-19 (SARS-CoV-2) test is positive. Clinical correlation with patient history and other diagnostic information is necessary to determine infection status. This test has received Emergency Use Authorization (EUA) by the FDA, but performance has not been evaluated for asymptomatic patients. Testing was performed using a nucleic acid amplification method. The specimen source may have been changed from the original order per patient situation or symptoms. Covid 19 Result Comment See Comment Comment: COVID-19 results reported as "detected" means COVID-19 positive. Positive patients should self-isolate for 10 days or 24 hours after fever resolves and other symptoms are improving, whichever is longer: - Stay home except to get medical care and wear a facemask if you must leave - Separate yourself from other people in your home, known as home isolation - Cover your coughs and sneezes - Wash your hands often - Avoid sharing household items - Clean high-touch surfaces everyday - If you have a medical emergency and need to call 911, notify dispatch personnel that you may have COVID-19 and put on a facemask before emergency medical services arrive. If the result is "inconclusive" or "invalid" and you have not been contacted by a medical professional about your result or if you have questions about COVID-19, your symptoms, or need a return to work/school note, please contact your primary care provider (PCP).
CDC Split Type:

Write-up: History and physical obtained using telehealth technology with the assistance of the bedside nurse. a 72 y.o. male who presents to hospital. The patient states that he developed shortness of breath, coughing and fevers. The symptoms started about 10 days ago. It all started with sore throat and then symptoms progressively worsened with nasal discharge and burning feeling in his lungs. + slight fever in the first 4 days which progressively worsened. Highest was 103.7. No vomiting. + nausea but only with severe coughing spells. + diarrhea x 2 days. No black or bloody stools that he knows of recently. However, about 3 weeks ago he had some blood stools but does have hemorrhoids. He came in today because the triage nurse convinced him to come in when he was scheduling his wife for COVID testing. His SOB was not severe, he was able to walk out to the mailbox. He was vaccinated back in febrauary/march x 2 vaccinations.


VAERS ID: 1767725 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-10-04
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: Patient had no pre existing medical condition and no usage of any medications. No known allergies. No illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211009191

Write-up: SWELLING IN ARM; STABBING PAIN IN THE ARM SLIGHTLY LOWER THAN THE INJECTION SITE (MILD IN NATURE); STRESS HEADACHE AT THE TEMPLES; This spontaneous report received from a patient concerned a 22 year old male. The patient''s weight was 135 pounds, and height was 72 inches. The patient''s concurrent conditions included: non-alcoholic, and non-smoker, and other pre-existing medical conditions included: Patient had no pre existing medical condition and no usage of any medications. No known allergies. No illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 212A21A, and batch number: 212A21A expiry: UNKNOWN) dose was not reported, administered on 04-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-OCT-2021, the patient experienced swelling in arm. On 04-OCT-2021, the patient experienced stabbing pain in the arm slightly lower than the injection site (mild in nature). On 04-OCT-2021, the patient experienced stress headache at the temples. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from swelling in arm, stabbing pain in the arm slightly lower than the injection site (mild in nature), and stress headache at the temples. This report was non-serious.


VAERS ID: 1767770 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-09-01
Onset:2021-10-04
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNK / 2 - / SYR

Administered by: Military       Purchased by: ?
Symptoms: Extra dose administered, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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: Weapons Grade Anthrax
Other Medications: No prescriptions Over the counter eye drops and Alegra for seasonal allergies. Multi vitamin.
Current Illness: Numerous due to Agent Orange, Benzine, Dust And Burn pits in war. Physical trauma from combat.
Preexisting Conditions: Granulomas in lungs, neuropathy, Sleep Apnea Small mass on liver
Allergies: Angora Cats .. swollen eyes Seasonal weed allergies Weapons Grade Anthrax vaccination during military service caused red, swollen injection site rash
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 3 days after after second dose ? lots of itching , body rash for a month until I took Benadryl. 4 days after 3rd dose minor itching starting


VAERS ID: 1767947 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 34135BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: trouble breathing after the nasal flu vaccine
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Nasal Flu immunization
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea and vomiting x3 days Body Aches Fever (low grade) Diarrhea x3 days


VAERS ID: 1767979 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest discomfort, Chest pain, Electrocardiogram, Headache, Heart rate increased, Impaired work ability, Lymphadenopathy, Pain in extremity, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu Shot, last year, the month of October
Other Medications: Prednisone, Mycophenalate, Lisinopril and Metropolol
Current Illness: Autoimmune Pancreatitis Type 1 and Hyper Ig4 Schlerosing disease
Preexisting Conditions: Autoimmune Pancreatitis Type 1
Allergies: No
Diagnostic Lab Data: EKG and Chest Xray on Tuesday 10/5 and having a echocardiogram on 10/7. She also ordered blood work on 10/5
CDC Split Type:

Write-up: The first dose I had no problems at all. The second dose was given on 10/1/21, my legs started swelling on 10/3 around 10pm, woke up on 10/4 at 7am with a weird feeling in my chest and a mild pain underneath my right arm. During my drive to work my chest started feeling like a balloon was under my chest cavity. By the time i arrived at work i started having mild chest pains and pressure in my chest. Had to leave work early, while im driving from work, i started hearing my heartbeat in my ears followed by a headache. Later that day my skin started to itch on my chest and back and legs. Called my doctor she brought me in Tuesday at 11am. After taking my Lisinopril and Metoprolol at 7am, my blood pressure at the doctor office was and my pulse. I informed my doctor about the pain underneath my right arm and she could feel the lymph node under my arm was swollen. She made the decision to put me off work until further notice.


VAERS ID: 1767994 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Eructation, Fatigue, Gastrooesophageal reflux disease, Hyperhidrosis, Nausea, Oral discomfort, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 10/01/21 11pm, fever chills 4 hours, fever sweats till morning, tired, achy, left arm extremely painful. 10/02/21 fever sweats morning, Epson salt bath, took 1 Tylenol, 1 Motrin, ok a few hours, no appetite, 3-4 pm fever chills till roughly 7pm, fever sweats several more hours. 1 Tyenol, 1 Motrin before bed, arm still very sore. 10/03/21 very tired, achy, no appetite, arm still sore. 10/04/21 tired woke up very nauseous bad acid reflux burn/mouth taste no appetite, took 1 Tums very burpy 10/05/21 woke up little nauseous, bad acid reflux, hungry at lunch, took 1 Pepcid to be able to eat, not really hungry at dinner. 10/06/21 no nausea, still refluxy pepcid taken ate breakfast, ate lunch, ate dinner. Feeling better. 10/07/21 Woke up a little acid refluxy but was ok till ate breakfast. Took 1 Omeprazole.


VAERS ID: 1767996 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-30
Onset:2021-10-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Erythema, Joint swelling
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 3 days after vaccination, he developed L elbow redness, pain, swelling. no injury or previous hx of arthritis or joint complaints in the past.


VAERS ID: 1768005 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH L: FF2588 E:12/ / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH L: 30155BA E: 1 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Condition aggravated, Fatigue, Headache
SMQs:, Neuroleptic malignant 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: Cialis for BPH
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the first dose, I was just fatigued. For the first 2 days after the second dose, it was just fatigue. On the 3rd day, I started spiking temperatures as high as 103 off and on all night. Then I had uncontrollable shakes/chills for about 1 1/2 hours as well as horrible headache.


VAERS ID: 1768017 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dysphonia, Headache, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alendronate 70mg weekly Calcium 1200 daily Fish Oil 1000mg daily D3 50mcg daily Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, fever (100.1), muscle pain in legs and arms, chills, and hoarseness. Took 1 ibuprofen every four hours. All conditions gradually improved over next two days. Back to normal on third day


VAERS ID: 1768037 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-22
Onset:2021-10-04
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: finasterie, furosemide, gabapentin, losartan, lovastatin, metFORMIN, metoprolol succinate , nitroglycerin, tamsulosin
Current Illness:
Preexisting Conditions:
Allergies: Vytorin 10-80 [Ezetimibe-simvastatin]
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted under observation on 10/04/2021 due to Acute respiratory failure with hypoxia 2/2 COVID pneumonia. Patient was tested for COVID-19 and was positive on 10/04/2021.


VAERS ID: 1768147 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Restlessness, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: fluoxetine calcium vitamin D
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Woke up in the early morning hours after receiving the shot midday with extreme chills, teeth chattering and feeling feeling totally drained. Went back to bed, could not stop shivering and teeth chattering but eventually fell back asleep, albeit fitfully. That morning, I woke and the chills had gone but I still felt totally drained and spent the remainder of the day -- until about 3 pm -- in bed, sleeping on and off. Felt better -- though still weak. Took two days, but am now feeling pretty normal.


VAERS ID: 1768153 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Chills, Cough, Pain, Paraesthesia, Pyrexia, Respiratory tract congestion, Urinary incontinence
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Wife calling for pt who received his Johnson and Johnson COVID19 last Friday, 10/1/21. On Sunday he developed a cough and on Monday chills and a fever. Temp on Tuesday was 102 and Wednesday was 100.4. She states no fever today, 10/7/21, and his cough has lessened. Pt also on call and reports having tingling in his LLE and R foot, generalized body aches, constant abdominal pain in the last 24 hours, feeling slightly congested and some bladder control problems. Pt denies any chest pain, leg swelling, blurry vision or headache. Pt sent to the ED.


VAERS ID: 1768190 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LA / IM

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

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

Write-up: Arm pain( muscle pain) and body ache.


VAERS ID: 1768244 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Abdominal pain, Chills, Erythema, Headache, Injection site pruritus, Myalgia, Nausea, Pain in extremity, Pyrexia, Skin warm, Swelling, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: losartan,metformin,
Current Illness: none
Preexisting Conditions: DM2, HTN
Allergies: lisinopril
Diagnostic Lab Data: none
CDC Split Type:

Write-up: severe arm pain redness swelling and heat, Itching at injection site . Nausea began aprox 1 hr after injection then severe headache, fever of 100.1 and chills progression aprox 5 hr after injection. Nausea with 2 x emesis aprox 9 hr after injection. continuing muscle acheing and abdominal pain aprox 14 hr after injection


VAERS ID: 1768283 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-23
Onset:2021-10-04
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810, EN6202 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dyspnoea, Nausea, Productive cough, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

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

Write-up: SOB, cough with clear sputum, nausea and diarrhea, subjective fevers and chills.


VAERS ID: 1768284 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-17
Onset:2021-10-04
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 LA / IM

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

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

Write-up: Patient had a positive COVID PCR test on 10/04/2021 after receiving both vaccines


VAERS ID: 1768318 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Attendee had an Adverse reaction to first Pfizer Covid 19 vaccine. Became dizzy and sweaty approximately 13 minutes after vaccine. Laid down on cot with legs up. V/S taken every 5 minutes. After 10 minutes, given cold Gatorade. Did not eat earlier in day. (Was high on Marijuana). Left after 30 minutes with friend. Ambulated by self.


VAERS ID: 1768354 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-21
Onset:2021-10-04
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Electrocardiogram, Inflammation, Laboratory test, Pain, Painful respiration, X-ray
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: On 10/4/21 in the afternoon patient reported sharp pains when breathing and tightness/heaviness/burning in upper left chest area. On 10/5/21 patient went to urgent care where they informed him reaction may due to vaccine. Patient prescribed prednisone 20mg twice daily for 5 days and instructed to go to emergency room if symptoms worsened. That night patient checked into emergency room due to severe pain. Labs, X-ray and EKG performed. Patient discharged with acute chest pain and inflammation in the chest (or chest wall? patient unsure) and asked to follow-up with primary doctor.


VAERS ID: 1768388 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-20
Onset:2021-10-04
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Lethargy, Rhinorrhoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium Carbonate, Plavix, Claritan, Zocor, losartan, Trusopt, Xalatan, metoprolol succinate, Fish oil, Probiotic, Timoptic, Vit D
Current Illness: None known
Preexisting Conditions: CKD Stage 3, Hypertension, S/P CVA, GERD, Insomnia, Urge incontinence, Osteopenia, thoracic aortic aneurysm without rupture
Allergies: Contrast Dye, Cephalexin, Oxybutyin
Diagnostic Lab Data: Covid 19 PCR test completed 10/5/21- tested positive
CDC Split Type:

Write-up: Cough, runny nose, lethargy, loss of taste and smell


VAERS ID: 1768408 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Body temperature increased, Burning sensation, Dizziness, Fatigue, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nifidepine 40 mg daily, Quinapril 25 mg /12.5 HCTZ daily, Metoprolol XL 25mg daily, Metformin 500 mg daily, Rotarvastin490 mg at HS
Current Illness: HTN, DM 2
Preexisting Conditions: HTN , DM x 6months
Allergies: None Known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Received dose at approx. 9:45 am , returned to work and end her shift 3:30 pm went home tired, went to bed until 6pm woke up and had a tem of 101 F temporal , took Aleve went back to sleep and woke up around 12 am feeling fatigue and dizzy took water and went back to sleep, woke up at 5am the following day and notice rashes on trunk area, looking red and burning , also felt swelling and sore on injected site area feels warm and applied cold compress no relief. Took Aleve and Benadryl itching was relieved and burnins sensation minimize but painful to touch. The next few was very uncomfortable with pain on injected site with no temporary relief on OTC meds. She then seek help from Covid clinic nurse for further evaluation. Upon assessment, L deltoid area appears reddened with swelling and warm to touch with moderate pain


VAERS ID: 1768428 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-10-04
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Diarrhoea, Dyspnoea, Headache, Pain
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)

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

Write-up: SOB, Chest Pain, body aches, headache, diarrhea


VAERS ID: 1768444 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-10
Onset:2021-10-04
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Fatigue, Headache, Respiratory tract 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen 1000 q4hr prn for pain calcium-vitamin D daily diazepam 5mg daily prn for anxiety escitalopram 15mg daily ibuprofen 600mg q6hr prn for pain lysine 500mg daily prn meloxicam 15mg daily CBD oil nitroglycerin 0.4mg pramipexole 0
Current Illness: None documented
Preexisting Conditions: Degeneration of lumbosacral intervertebral disc, osteopenia, chronic low back pain, history of colon polyp, restless legs, anxiety, ovarian cyst, diverticulosis of colon, history of adenomatous polyp of colon, history of shingles, metatarsalgia,
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated headache, runny nose, congestion, chills, cough, fatigue


VAERS ID: 1768467 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 RA / IM

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

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

Write-up: PATIENT RECEIVED THE MODERNA VACCINE FOR DOSES 1 AND 2 AND THEN RECEIVED A BOOSTER OF PFIZER


VAERS ID: 1768492 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: itching, swelling and redness of the injection site within 4 hrs of injection; generalized hives within 12 hrs of injection


VAERS ID: 1768514 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-27
Onset:2021-10-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: alprazolam 0.5 mg
Current Illness: none
Preexisting Conditions: none
Allergies: latex , eggs
Diagnostic Lab Data: none
CDC Split Type:

Write-up: one week after the shot patient had warmth , itching and a hard knot at the injection site , Dr . called it Covid arm


VAERS ID: 1768519 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, Maternal exposure during breast feeding, Pain in extremity
SMQs:, Neonatal exposures via breast milk (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: No noted reaction on 10/04 0655 I saw employee getting on elevator and asked how she did with the booster "just a sore arm is all" Employee signed up for Covid Pfizer Booster vaccination- had Moderna vaccines x 2 doses . She sent me an text on 10/06 that " she she received moderna dose originally and received a phizer dose for booster. I just received an email that states they are not supposed to be given together. I asked her why she signed up for the Pfizer booster if she knew she received Moderna " I wanted the booster so just signed up, im breastfeeding, had children and work in the ER"


VAERS ID: 1768550 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Dizziness, Heart rate increased, Injection site pain, Nasal congestion, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Varicella, 54, arm swelled up to elbow
Other Medications: Loestrin FE 1-20, 1x/day Allegra - 180 mg, 1x/day Lisinopril - 10 mg, 1x/day Mucinex - 600 mg, 1-2x/day Baclofen -20-30 mg/day Claritin - 10 mg, 1x/day Montelukast Sodium - 10 m NeilMed Saline Nasal Rinse, 2x/d
Current Illness: None
Preexisting Conditions: Multiple Sclerosis Hypertension
Allergies: Percocet Banana Cherry Coconut Cantaloupe Pineapple Peas Lettuce Onion Cucumber Mushroom Eggplant Green pepper Mozzarella Brie Swiss Ricotta Almond Cashew Peanut Pignoli Black pepper Sesame Green olive Cinnamon Rice
Diagnostic Lab Data:
CDC Split Type:

Write-up: Light headed Heart rate increased Throat tightening Shoulders/back achy Headache Stuffy Slight chest pain Injection site pain


VAERS ID: 1768551 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levoxyl Levothyrinine Sertraline Omeprazole Vit D
Current Illness: NA
Preexisting Conditions: Hoshimotos hypothroid
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Massive full body pain all joints, all muscles. 101.1 fever last from 10 pm 10/4/21-@12:00AM 10/6/21


VAERS ID: 1768579 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-28
Onset:2021-10-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Aspartate aminotransferase increased, Atrial fibrillation, Blood albumin decreased, Blood potassium normal, Blood sodium decreased, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Cough, Dizziness, Dyspnoea, Fibrin D dimer, Full blood count, Haemoglobin decreased, Intensive care, Lung opacity, Lymphocyte count decreased, Metabolic function test, N-terminal prohormone brain natriuretic peptide increased, Nausea, Platelet count decreased, Procalcitonin, Pyrexia, Red blood cell sedimentation rate increased, SARS-CoV-2 test positive, Troponin increased, Vomiting, Wheezing
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, clopidogrel, Advair, lisinopril, metoprolol succinate, simvastatin
Current Illness:
Preexisting Conditions: COPD, tobacco abuse, severe obesity (class 3), obstructive sleep apnea
Allergies: NKA
Diagnostic Lab Data: 10/7/21 COVID-19, rapid: positive CBC: platelets 133; HBG 13.4; lymphocytes 15 Sed rate: 62 Chest X-ray: right lateral mid-field opacity; bibasilar opacities d-dimer: 1.37 Pro-BNP: 1137 CMP: sodium 130; potassium 3.6; AST 49; albumin 3.4 CRP: 129.7 Procalcitonin: 0.14 troponin (high sensitivity): 36 Chest CT: bilateral opacities
CDC Split Type:

Write-up: On approximately 10/4/21 the patient began experiencing nausea and vomiting, cough, and shortness of breath. On 10/7/21 the patient began feeling associated dizziness and lightheadedness with his shortness of breath. Per EMS report, the patient''s O2 sats were in the high 80s with bilateral wheezing when they arrived. The patient received a Duoneb treatment in the field. Patient was found to have A-fib with RVR in ED (HR in the 150s on initial presentation) and patient has no known history of A-fib. Patient was febrile to 103 F. Patient was started on anticoagulation, fluids, and a diltiazem drip. Patient is requiring high flow O2. Patient is positive for COVID-19 by rapid test. The patient will be admitted to ICU.


VAERS ID: 1768634 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-10-04
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

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

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

Write-up: Patient had a positive COVID test on 10/4/2021


VAERS ID: 1768640 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-10-04
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

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

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

Write-up: Patient had a positive COVID test on 10/4/2021


VAERS ID: 1768648 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-30
Onset:2021-10-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, atorvastatin, exenatide microspheres, glipizide, linagliptin, metformin, singulair
Current Illness:
Preexisting Conditions: DM2, sleep apnea, dyslipidemia
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient complains of wheezing, beginning on 10/4/21. He has had to use his inhaler 2-3 times per day after not having used it for months


VAERS ID: 1768682 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 RA / 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? 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 completed the Moderna vaccine series and received a Pfizer Booster.


VAERS ID: 1768707 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-19
Onset:2021-10-04
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 LA / 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Sofia Antigen COVID-19 test with a positive result
CDC Split Type:

Write-up: Patient was vaccinated on 12/30/20 and 1/19/21, so was fully vaccinated when testing positive for COVID-19 on 10/4/21.


VAERS ID: 1768729 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-10-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Myocarditis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: Fever, diarrhea and headache.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting, shortness of breath, chest pain and myocarditis.


VAERS ID: 1768732 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: Knee surgery 9/22/21. Acl reconstruction and meniscus tear repair
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None. Spoke to doctor who reports rash is unlikely the result of vaccine. Which can?t possibly be true as there isn?t a single thing that has changed in my life.
CDC Split Type:

Write-up: Recurrent full body hives. Scalp, palms of hands and soles of feet with persistent itch. Unrelieved after 2 days of Benadryl. Started prednisone taper yesterday 2nd dose taken today. Hives and itching continues intermittently.


VAERS ID: 1768733 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-05
Onset:2021-10-04
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / IM

Administered by: Private       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? 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 of covid


VAERS ID: 1768752 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Paraesthesia oral
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: "tingling tongue"


VAERS ID: 1768786 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-03
Onset:2021-10-04
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Appetite disorder, Chills, Cough, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Respiratory tract congestion, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: Metoprolol; Sertraline; Furosemide; Eliquis
Current Illness: none
Preexisting Conditions: depression, irregular heartrate
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: congestion, difficulty breathing, wheezing, tired, not very hungry, some coughing, chills, SOB. starting 10/4/21. Patient lives with daughter who recently tested positive. Patient had 3rd Pfizer booster on 10/1/21. Lot # for all vaccines are NOT available, done at another location.


VAERS ID: 1768848 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-24
Onset:2021-10-04
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eczema, Pain, Periorbital swelling, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Periorbital and eyelid disorders (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D supplement
Current Illness: n/a
Preexisting Conditions: eczema
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme flare-up of eczema around eyes. The other day when I noticed it began I couldn''t open my eyes when I first woke up; since then every morning I''ve had puffy eyes with a ring of eczema around both eyes. I currently have blurry and foggy vision. The last time I had eczema around my eyes was Fall 2016, but it was nowhere near as painful and prominent as this. I was mandated by my college to get the vaccine, to which I was very much personally against getting, even after my doctor wrote a letter to the college stating I do not need the vaccine, supporting my belief not to get the covid vaccine. The school did not agree with me, I was told to take a sort of leave of absence, or get vaccinated. I am not sure that the vaccine is directly responsible for this recent painful flare-up of eczema on my face, but it is the only thing recently that has been out of the ordinary. I am cautious with products I use, as I often get eczema on my hands. The eczema on my face currently is the worse case of eczema I have ever experienced.


VAERS ID: 1768849 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-30
Onset:2021-10-04
   Days after vaccination:278
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: PATIENT HAD PFIZER VACCINE ON 12/30/2020, and 01/20/2021, AND TESTED POSITIVE TO COVID.


VAERS ID: 1768861 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NONE GIVEN / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Eating disorder, Fatigue, Headache, Laryngitis, Malaise, Nausea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer shots 1,2
Other Medications: Vitamin D, verapanil
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, malaise/fatigue, GI nausea unable to eat, headache, cough, laryngitis. Severe arm soreness


VAERS ID: 1768873 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-10-04
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Computerised tomogram, Echocardiogram, Electrocardiogram, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: BIRTH CONTROL, MULTIVITAMIN, MAXALT, SAXENDA
Current Illness: NO
Preexisting Conditions: ARTHITIS
Allergies: CLOMID, PROTONIX
Diagnostic Lab Data: ECHO, EKG, CT
CDC Split Type:

Write-up: CHEST PAIN/ PULMONARY EMBOLISM


VAERS ID: 1768911 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-02
Onset:2021-10-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Back pain, Herpes zoster, Neck pain, Neuritis
SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Arthritis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Etodolac, 300mg morphine sulfate 15 mg, amlodipine besylate 5mg, simvastatin 20mg, atenolol 25mg.
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: None
Diagnostic Lab Data: None I''m staying in bed
CDC Split Type:

Write-up: I have symptoms of shingles the inflammation of the nerves excessive pain in the lower back and hip left side and back of the neck.


VAERS ID: 1768986 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Lymphadenopathy, Pain, Skin mass
SMQs:, Extravasation events (injections, infusions and implants) (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: elder berry 50mg, zinc gummies, cod-liver oil capsule, vitamin d3, hydrochlorothiazide, losartan, methimazole, methenamine
Current Illness: codeine
Preexisting Conditions: lactose intolerant
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, swollen lymph nodes, chills, sore, tiredness, knot on arm


VAERS ID: 1769017 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-29
Onset:2021-10-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Rash, Rash papular
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Betahistine, fosamax, magnesium, B-12, and women''s multi-vitamin
Current Illness: urinary tract infection
Preexisting Conditions: none
Allergies: Sulfa, augmentin
Diagnostic Lab Data: My internist reviewed the pictures I took of the rash and thought it could be related to getting the booster vaccine. So I reported it.
CDC Split Type:

Write-up: I woke up with raised white bumps covering my arms, upper legs and behind. They were most pronounced on my thighs and behind but they also lightly covered by arms and torso. There were NO other symptoms - NO fever, NO itching, NO problem swallowing, etc. Just a lot of raised white bumps . My internist saw the pictures I took of it and thought it could be related to getting the booster vaccine.


VAERS ID: 1769057 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ataxia, Fatigue, Headache, Hunger, Hypertension, Pyrexia, Urinary incontinence, Vaccination site pain
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypertension (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 40Mg, Metoprilol Succinate 25 Mg, Omega -3 900 Mg, Aspirin (enteric) 325 Mg (1 AM 1 PM), Atorvastatin 20 Mg
Current Illness: none
Preexisting Conditions: Coronary Artery Disease
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The day of vaccination just site pain. The next day lack of control of bladder. lack of control of muscles aiding getting out of bed and/ or up from chairs, headache, fever, elevated blood pressure, fatigue. adverse reactions lasted two days with strength, then the third day slight headache persisted, tiredness continued (less than fatigue level). The fourth day after vaccination hunger started to return.


VAERS ID: 1769076 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

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

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

Write-up: On 10/4/21 a patient came in and requested to get the Covid Booster. They indicated that they had Pfizer and it had been more than 6 months since their 2nd dose. The patient did not have their immunization card with them. We did not give the previous doses so we attempted to verify the previous series on database and there was no record. We had the patient sign the attestation form and gave the Booster dose of Pfizer. Today on 10/7/21 the patient came back in with his card for us to add the Booster to it and we discovered he had Moderna not Pfizer. I called the patient later in the day to ask if he wanted us to call his primary care doctor and he said he had already contacted them.


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