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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 380 out of 8,010

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VAERS ID: 1654191 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Peripheral swelling, Pyrexia, Taste disorder
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, funny taste, fatigue and swelling in the arms still presist


VAERS ID: 1654192 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-16
Onset:2021-08-26
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 057620A / 1 LA / SC
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 LA / SC
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 3 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Lymphadenopathy, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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:
Other Medications: Metoprolol, Letrozole, alprazolam, cyclobenzaprin, mirtazipine, tramadol, and otc Tylenol.
Current Illness: None
Preexisting Conditions: Breasr Cancer, tachycardia, hypertension
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After receiving my second vaccine I just had the normal symptoms with some mild fever and pain at the injection site. After the THIRD injection I had no symptom until 8/262021 when the lymph nodes on the right swelled up and I developed a rash around my neck. I worked as an RN my whole life and know these things happen. I have an call in to my PCP and will try to get in tomorrow. I have been taking some Benadryl OTC and also loratidine once daily. I also have use benedryl cream. I was just shocked it took so long for these adverse events to happen


VAERS ID: 1654305 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control pill, women''s age 45+ vitamins
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: codeine
Diagnostic Lab Data: N/A- doctor has not returned my call
CDC Split Type:

Write-up: Rash on back, sides, back, upper legs to knees (both sides), upper arms (both sides)- bumpy, red and very itchy. Started 8/25- as of 8/29 still very itchy. Have been taking Benadryl and Claritin


VAERS ID: 1654309 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-08-26
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster
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: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles outbreak in multiple unilateral and linear areas on upper back and chest. This has never occurred before until reported. I had Mononucleosis in 1988.


VAERS ID: 1654319 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O17Z21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Cough, Fatigue, Gait disturbance, Headache, Oropharyngeal pain, Productive cough, Taste disorder, Throat irritation, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? No
Previous Vaccinations:
Other Medications: Metoprolol, flexaril, allopurinol, Celebrex, Lotomax eye drops, Hctz, vitamin D3, multi vitamin, calcium, lysine, losartan, oxybutnin, restasus eye drops, vitamin B-12 injection
Current Illness: None
Preexisting Conditions: No
Allergies: Pcn
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4 hrs after vaccine I had a scratchy throat and cough. I had chills and headache,next morning . Felt very fatigued. 2nd night I woke in middle of night with temp of 101, chills, stuffy nose and wheezy cough, Temp has not gone to normal since first night even with Tylenol. 3rd day severe sore throat, coughing up very thick and sticky phlegm. Fatigue, altered taste. I did not seek help bc I initially thought it was side effects associated with vaccine but after no real improvement in 3 days I decided to report. Will seek help from MD tomorrow


VAERS ID: 1654988 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-26
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Headache, Oropharyngeal pain, Pain
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (Occasionally); Smoker (Occasionally)
Preexisting Conditions: Comments: Patient had no known allergies and no drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210855780

Write-up: SORE THROAT; BODY ACHES; CHEST IS HURTING; HAVING DIFFICULTY BREATHING; HEADACHE; This spontaneous report received from a patient concerned a 24 year old male. The patient''s weight was 140 pounds, and height was 68 inches. The patient''s concurrent conditions included: alcohol use, and smoker, and other pre-existing medical conditions included: Patient had no known allergies and no drug abuse or illicit drug use. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 26-AUG-2021, the patient experienced sore throat. On 26-AUG-2021, the patient experienced body aches. On 26-AUG-2021, the patient experienced chest is hurting. On 26-AUG-2021, the patient experienced having difficulty breathing. On 26-AUG-2021, the patient experienced headache. The action taken with covid-19 vaccine was not applicable. This report was non-serious.


VAERS ID: 1655367 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

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


VAERS ID: 1655375 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Postural orthostatic tachycardia syndrome, Pyrexia, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Body Aches Generalized-Mild, Systemic: Fever-Medium, Systemic: Tachycardia-Medium, Additional Details: Patient has previous diagnosis of Potts, patient had fever of 103 for 2 days after injection, is still having issues with heart rate as of 08/28/2021. patient has not sought ER care at this time as her tachcardyia is not bad enough for her to go to ER


VAERS ID: 1655393 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Additional Details: Mild Lightheaded after 15 min of injection. Patient was monitored additional 15 minutes and recovered during that time; patient recovered and was able to leave the pharmacy on her own.


VAERS ID: 1655397 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

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

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

Write-up: Moderna vaccine was thawed, frozen and given to patient


VAERS ID: 1655400 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 RA / IM

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

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

Write-up: Moderna vaccine thawed then frozen then thawed and given to patient


VAERS ID: 1655402 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / IM

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

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

Write-up: Moderna vaccine thawed then fron then thawed and given to patient


VAERS ID: 1655589 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / IM

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

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

Write-up: ON MAY 20, 2021 HE RECEIVED THE FIRST DOSE BY MODERNA LOT NUMBER 036C21A FROM A LOCAL DRUG STORE. ON 8/26/21 HE WAS AT A LOCAL NURSING HOME THAT WE WENT TO AND HE WAS GIVING PFIZER BRAND VACCINE. THE NURSING SUPERVISOR IS AWARE OF THIS, AND UNDERSTANDS THAT THE SERIES IS COMPLETE.


VAERS ID: 1655619 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-20
Onset:2021-08-26
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Abnormal faeces, Decreased appetite, Diarrhoea, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid shot #1; flu shots in the past
Other Medications: Tylenol, mini birth control pill
Current Illness: Feeling flu-like symptoms a 10 days prior
Preexisting Conditions: Celiac disease (autoimmune disorder)
Allergies: Wheat/Gluten
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Bad, continuous stomach pains, fowl-smelling and loose stool, nausea, and loss of appetite


VAERS ID: 1655736 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-21
Onset:2021-08-26
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN FC3183 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ709AA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (broad)

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

Write-up: 5 days after injection, Pt reports pain in shoulder. He feels this is SIRVA.


VAERS ID: 1655754 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-01
Onset:2021-08-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site nodule, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (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: Probiotic, vitamin D, B complex, multivitamin
Current Illness: Nine
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: A large, irregular shaped, raised red lump appeared at site of injection. About 1/2 the size of the palm of my hand. It became itchy the following day. It lasted about 4 days. No treatment.


VAERS ID: 1655769 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Condition aggravated, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Headache
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: none
Current Illness: Pt sick with fatigue, HA, Vision chages, COVID Exposure before vaccine
Preexisting Conditions: n/a
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT referred to ED for SOB , chest tightness PT reported covid exposure, fatigue, BA, HA before having vaccine- Pt says not asked if was sick before getting the dose and did not have to wait


VAERS ID: 1655780 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tobradex, Insulin Detemir, Crestor, Amaryl, Metformin, Kenalog
Current Illness:
Preexisting Conditions: Fatty liver, Diabetes Mellitus Type 2, Myopia, Varicose veins, Epicondylitis
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Consented to receive the Janssen vaccine, and confirmed on a legal form that he had not previously been vaccinated for Covid. Upon entering Janssen vaccine into it was discovered that he had completed the 2 dose Moderna series. (Moderna 026B21A on 04/01/2021 and Moderna 021C21A on 05/06/2021) did not answer his telephone on 08/27 or today. This RN spoke with his spouse on 08/27. She reported that had no adverse side effects and was feeling fine. She reported the family received the doses because they wanted to be "double vaccinated" to prepare for upcoming travel. spouse was instructed to call in morning of 08/30 if any adverse effects occurred over the weekend.


VAERS ID: 1655794 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: On 8/26/2021, the evening of the fourth day of receiving the vaccine injection, at 8:00pm patient began getting an itching sensation on the arms and in the armpit. By 8:15pm hives and a spreading rash of small bumps across the exposed arms and increased itching an pain in the armpits. 8:30 bumps and hives spread from arms to chest neck and back. 8:40pm patient s self administered 50mg of oral Benadryl and 400mg of Ibuprofen. 8:45pm Patient attempted to shower in case this was an allergic contact reaction to something . (Patient''s only allergy is to Penicillin). 9:00pm patient''s eyes and ears began to swell and was headed to ER. Airway was beginning to feel constricted at this time. 9:15pm patient was admitted to ER and seen by attending PA . Patient was treated with steroids (with Pepcid as an acid blocker) to impede the swelling at was monitored for 1/2 hour to see if this treatment was adequate. 10:15pm during consult with PA, patient was ordered to continue steroid treatment with acid blocker and oral Anti-histamine treatment for one week.


VAERS ID: 1655871 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient called on 8.30.21 complaining of swollen, sore glands under the armpit of her vaccinated (right) arm. She stated that it appeared on Friday, and got worse over Saturday and Sunday. She felt that it was slowly getting better as of Monday. Patient states she was taking ibuprofen to help with the pain and swelling.


VAERS ID: 1655897 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Breast cancer female, Central nervous system lesion, Headache, Metastases to central nervous system, Radiotherapy
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Breast malignant tumours (narrow), Non-haematological malignant tumours (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: Breast cancer with metastatic disease to brain, complaints of headaches, received vaccine and admitted for brain lesions, radiation, currently admitted


VAERS ID: 1655916 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Muscle spasms, Pain, Palpitations, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I received my 2nd dose of Moderna on 08/26/21 at 10:40 am. By 7:00 pm on 08/26/21 I had intense body aches, fever, headache, racing heart rate, back spasms, chills, and pain on injection site in my right arm. On 08/27/21 (I had to call into work) I had a fever, chills, headache, and body aches and nausea. On 08/28/21 I had a headache, and body aches. On 08/29/21 I had a mild headache, and no other symptoms.


VAERS ID: 1655919 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-25
Onset:2021-08-26
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Solifenacinsuccinate 10mg, Valacyvoler 1g, Vitamin D, Clonidine .2mg Patch, Hydrochlorothiazide 12.5mg, Metoprolol 50mg, Denazetril 10mg, Nifeditine 60mg
Current Illness: N/A
Preexisting Conditions: HBP
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving both doses of Phizer 03/25/2021, tested Positive for Covid-19 08/26/2021 ,


VAERS ID: 1655944 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye swelling, Facial paralysis, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: About 3 hours after getting vaccine, patient started having swelling in corner of left eye. She went to ER & it was noted that left side of face was drooping some, and tongue was pulling to left side as well. She chose not to be admitted to ER, and instead went home & took some Benadryl. Woke up with similar problem next morning, continues to get a little better each day, even today 8/30/2021. Not completely recovered, but doing better


VAERS ID: 1655950 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-11
Onset:2021-08-26
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anaemia, Atrial fibrillation, Blood gases normal, COVID-19, Chest X-ray abnormal, Condition aggravated, Cough, Dyspnoea, Electrocardiogram abnormal, Lung opacity, SARS-CoV-2 test positive, Sick relative, Systemic inflammatory response syndrome, Tachycardia, Tachypnoea, Troponin increased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (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: hypertension, COPD on 3 L nasal cannula, osteoporosis, and peptic ulcer disease cirrhosis liver; decompensated; (outpatient paracentesis) -CHF -coronary artery disease -mitral valve ring -hypertension -atrial fibrillation; paroxysmal (warfarin) -chronic anticoagulation (Coumadin)
Allergies: DIGOXIN,ENTRESTO, PENICILLIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: 86-year-old male past medical history: -cirrhosis liver; decompensated; (outpatient paracentesis) -CHF -coronary artery disease -mitral valve ring -hypertension -atrial fibrillation; paroxysmal (warfarin) -chronic anticoagulation (Coumadin) -echocardiogram; 02/03/2021: LVEF: 50%; severe tricuspid regurg; -received a Johnson & Johnson vaccine in February Presents to the hospital with cough, difficulty breathing. Onset roughly 2 weeks ago. Reports that he was diagnosed with COVID-19. States that everyone in his household was tested (+) for COVID-19. Recently had wife passed away from COVID-19. On admission patient was found to be atrial fibrillation with RVR (122). Hemodynamically stable. Met sirs criteria infectious source (tachycardia; tachypnea; (+) COVID-19). ABG showed no hypoxia. Patient was started on 2 L. as he was struggling using accessory muscles for breathing. Identified mild anemia; elevated troponin (40); EKG showed no ST segment changes or T-wave inversions; atrial fibrillation identified. Chest x-ray showed elevation of right hemidiaphragm. Streaky right basilar opacities. Additionally, patient reports that he gets outpatient paracentesis roughly every 2 months. It has been 2 months since his last paracentesis.


VAERS ID: 1655952 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-23
Onset:2021-08-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Alpha 1 globulin normal, Angiogram pulmonary abnormal, Anion gap, Anion gap normal, Anticoagulant therapy, Aspartate aminotransferase normal, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine increased, Blood glucose normal, Blood potassium decreased, Blood sodium normal, Blood urea nitrogen/creatinine ratio, Blood urea normal, Carbon dioxide normal, Chest X-ray normal, Chest pain, Computerised tomogram thorax abnormal, Dizziness, Dyspnoea, Electrocardiogram normal, Fibrin D dimer increased, Globulin, Glomerular filtration rate, Hepatic steatosis, Nausea, Palpitations, Pancreatic atrophy, Protein total normal, Pulmonary embolism, Pulmonary mass
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion 300 mg
Current Illness: N/A
Preexisting Conditions: Depression
Allergies: Hazelnuts
Diagnostic Lab Data: 1. Right upper lobe and right lower lobe subsegmental pulmonary thromboemboli. 2. Superior segment left lower lobe 7 mm pulmonary nodule. Recommend: 6 month follow-up CT scan of the chest to document stability of the pulmonary nodule. Electronically Signed: 8/29/2021 2:11 PM Diagnostic Imaging Narrative EXAM DESCRIPTION: CT ANGIO CHEST W CONTRAST COMPLETED DATE: 8/29/2021 1:47 PM COMPARISON: None available. CLINICAL INFORMATION: PE suspected, intermediate prob, positive D-dimer TECHNIQUE: After the administration of 100 cc of Isovue-370, contrast enhanced CT angiography of the chest is performed with sagittal and coronal reconstructions. FINDINGS: 1. A 7 mm posterior segment left lower lobe pulmonary nodule is demonstrated. The lungs are otherwise clear. 2. The base of the neck and axilla structures are normal. 3. Right upper lobe and right lower lobe subsegmental pulmonary thromboemboli are demonstrated. The hilar and mediastinal structures are otherwise intact. 4. There is diffuse pancreatic atrophy. Diffuse fatty infiltration of the liver seen. The visible upper abdominal organs are otherwise intact. 5. The bony structures are intact. 08/29/2021 Component Your Value Standard Range Flag Na 141 mmol/L 136 - 145 mmol/L K 3.1 mmol/L 3.5 - 5.1 mmol/L L Cl 103 mmol/L 98 - 107 mmol/L CO2 29 mmol/L 21 - 31 mmol/L Anion Gap 12 mmol/L 5 - 20 mmol/L Glucose 90 mg/dL 74 - 109 mg/dL BUN 12 mg/dL 7 - 25 mg/dL Creatinine 1.29 mg/dL 0.7 - 1.3 mg/dL BUN/Creatinine Ratio 9 Calcium 9.9 mg/dL 8.6 - 10.3 mg/dL Protein, Total 7.7 g/dL 6.0 - 8.3 g/dL Albumin 4.8 g/dL 4.2 - 5.5 g/dL Globulin 2.9 g/dL 1.3 - 4.9 g/dL A/G Ratio 1.7 1.0 - 2.4 BILIRUBIN, TOTAL 0.6 mg/dL 0.3 - 1.0 mg/dL ALK PHOS 53 U/L 34 - 104 U/L AST 15 U/L 13 - 39 U/L ALT 18 U/L 7 - 52 U/L Estimated GFR $g60 mL/min/1.73m2 $g60 mL/min/1.73m2 Component Your Value Standard Range Flag DDIMER 657 ng/mL 0 - 400 ng/mL HH CRITICAL RESULT CALLED TO: READ BACK BY RN 1328 08/29/2021 Testing performed at Medical Center General Information Ordered by DO Collected on 08/29/2021 12:38 PM (Blood) Resulted on 08/29/2021 1:25 PM Result Status: Final result
CDC Split Type:

Write-up: I was vaccinated on Monday August 23, started having shortness of breath midday on Thursday, heart palpitations midday on Friday, and midday Sunday I went to the ER for chest pains, dizziness, nausea, and shortness of breath. Chest xrays came back clean, EKG was normal, bloodwork was normal except for low potassium (3.1) and DDIMER at 657. Doctor ordered a CT scan which showed two small clots in my right lung. Diagnosed with accute pulmonary embolism with unspecified cause. Sent home after 3 hours with Apixaban 5mg (two pills twice daily for the first week) and told to follow up with PCP and Hematology clinic within 10 days.


VAERS ID: 1655962 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Cardiac pacemaker insertion, Crying, Facial paralysis, Headache, Hypoaesthesia oral, Injection site erythema, Injection site swelling, Lip swelling, Lymph node pain, Lymphadenopathy, Migraine, Pruritus, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hearing impairment (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: 2nd Covid shot moderate reaction in Feb. 10th 2021
Other Medications: No
Current Illness:
Preexisting Conditions: POTF - Postural Orthostatic Tachycardia Syndrome; BP issue and some other related issue
Allergies: Codeine; anti cholinergic; Bactrim; contrast dye; shellfish
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: 1st 24 hrs., I had a headache and left side of my face from my eye to my chin went numb. Partial facial Paralyses. My lips were swollen, my tongue was partially numb. The injection was red and swelling. Lymph nodes under my left armpit started to swell. The next day everything got much worse and Lymph nodes under my left armpits to the size of a walnut. There was a rash. Swollen red, has rash and itches from my shoulder to my left arm. It''s the worst it has been today. I took one Advil every 6 hours. We have been isolated 19 months to avoid Covid. Temp 100.4 - 2nd and 3rd days. 4th day went down to 99. Day 4 I had a migraine. I had a pacemaker implanted. The lymph nodes and chest are tight and very painful. The lymph nodes are pushing to my implant. Arm in a sling and I was crying. I spoke to my doctor''s cardiologist and aware of my medical condition. virtual healthcare visit. I could get up at all.


VAERS ID: 1655963 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-20
Onset:2021-08-26
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Nasal congestion, Paranasal sinus discomfort, Pulmonary congestion, Pyrexia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LORATIDINE, HYDROXYZINE, LOSARTAN, POTASSIUM, OMEPRAZOLE, ESCITALOPRAM, BUSPIRONE, ATENOLOL
Current Illness: NONE
Preexisting Conditions: HTN, DEPRESSION, ALCOHOL ABUSE, GERD, ANXIETY
Allergies: KNA
Diagnostic Lab Data: 08/26/21: POSITIVE SARS-COV-2 RNA
CDC Split Type:

Write-up: NASAL CONGESTION, SINUS PRESSURE, FEVER, CHEST CONGESTION, COUGH


VAERS ID: 1655979 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-30
Onset:2021-08-26
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Fatigue, Oropharyngeal pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID+ PCR test on 8/28/2021
CDC Split Type:

Write-up: She was seen at urgent on 8/28/21 for increasing shortness of breath and chest congestion for the past 2 to 3 days. Her baseline oxygen is around 93. She came into the Urgent Care using the nasal cannula 3 L with the saturation over 90. She states that she has fever and she has sore throat. She is coughing. She feels fatigued and tired. Over-the-counter cough medication including Robitussin was used with very minimum help. Upon arrival to the hospital, the patient was found to be febrile with the temperature over 100. Her heart rate is around 100, blood pressure stable, and her saturation is 95% on 2 L nasal cannula.


VAERS ID: 1655981 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-19
Onset:2021-08-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Headache, SARS-CoV-2 RNA
SMQs:, Anaphylactic reaction (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OMEPRAZOLE, FERROUS SULFATE, METFORMIN, NOVOLOG, LEVEMIR, PROPRANOLOL
Current Illness: NONE
Preexisting Conditions: TYPE 2 DM, OBESE, ALLERGIC RHINITIS, PRESBYOPIA, THROMBOCYTOPENIA, CIRRHOSIS OF LIVER, LUNG NODULES, ASTIGMATISM, PERIPHERAL NEUROPATHY, ESOPHAGEAL VARICES, HX ALCOHOL ABUSE
Allergies: NSAID
Diagnostic Lab Data: 8/30/21: POSITIVE SARS-COV-2 RNA
CDC Split Type:

Write-up: COUGH, HEADACHE


VAERS ID: 1655985 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-08-26
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: COVID swab
CDC Split Type:

Write-up: Swab collected/ positive COVID. Came to ED with Cough / SOB/ fever/chills


VAERS ID: 1655990 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 2 RA / IM

Administered by: Other       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: none listed
Current Illness: none listed
Preexisting Conditions: none listed
Allergies: none listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt previously received 1 dose of Moderna on 02/19/2021 at another facility


VAERS ID: 1656029 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient was vaccinated with Moderna that expired on 8/11 from Refrigerator. Moderna was place in the refrigerator on July 12th from freezer stock


VAERS ID: 1656068 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 LA / IM

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

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

Write-up: We were told to report this incident to Vaers in reference to not qualifying for the booster shot. Pt claimed he had emphysema, which is not a qualifying condition


VAERS ID: 1656094 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-18
Onset:2021-08-26
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 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: The patient takes: FLUoxetine (PROZAC) 10 mg oral Capsule FLUoxetine (PROZAC) 20 mg oral Capsule acetaminophen (TYLENOL) 500 mg oral Tablet alum-mag hydroxide-simeth (MAALOX) 200-200-20 mg/5 mL oral Suspension famotidine
Current Illness:
Preexisting Conditions: The patient has a history of: Heart failure Mixed hyperlipidemia Primary angioplasty with coronary stent Coronary artery disease Ischemic cardiomyopathy GERD Lumbar fusion Hypertension Obstructive sleep apnea
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID TEST


VAERS ID: 1656103 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Headache, Mobility decreased, Painful respiration
SMQs:, Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient stated that she can provide a list of medication
Current Illness:
Preexisting Conditions: Chronic Bronchitis Asthma
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: On the first day of the vaccine Patient had headache and could not move her arm. Patient also started having chest pains;. She had to lay down. She started having the normal chest pains. The next day patient stated that the chest pains became mild. The chest pains have lighten up but her chest sore every time that she would breathe.


VAERS ID: 1656155 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B/P med & thyroid med
Current Illness: N/A
Preexisting Conditions: M/S & Cancer
Allergies: Pen, asp,codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: 103.5 for 4 hours. Then 104 for 8 hrs. Shortness of breathe & rash on neck. Husband had to submerse into ice cold tub to break fever. Tylenol did NOT work. Only happened with Booster


VAERS ID: 1656201 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-08-26
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -

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

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

Write-up: Hospital 8/26/21


VAERS ID: 1656206 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-20
Onset:2021-08-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 002F21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 - / -

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

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

Write-up: Covid 19 positive 08/25/21 with onset of symptoms 08/26/2021


VAERS ID: 1656239 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-08-26
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Activated partial thromboplastin time, Adrenal mass, Anaemia, Angiogram, Blood magnesium, Chest X-ray, Chest pain, Computerised tomogram abdomen, Differential white blood cell count, Dizziness, Electrocardiogram, Fibrin D dimer, Full blood count, Gastrointestinal haemorrhage, Influenza virus test, International normalised ratio, Lipase, Metabolic function test, Occult blood, Prothrombin time, Pulmonary embolism, Respiratory syncytial virus test, SARS-CoV-2 test, Scan with contrast, Tachycardia, Troponin
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: on 8/30/21: CMP, D-Dimer, occult blood, CBC with differential, lipase, magnesium, PT/INR, PTT, sars/flu/RSV, troponin CT abdomen pelvis with contrast, CTA chest, EKG, Xray Chest portable
CDC Split Type:

Write-up: chest pain, multiple subsegmental pulmonary emboli without acute cor pulmonale; anemia, massive GI bleed, tachycardia, lightheadedness, midepigastric abdominal pain, bilateral adrenal masses.


VAERS ID: 1656263 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-14
Onset:2021-08-26
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chlorthalidone 25 mg daily Diovan 320/25 daily Symbicort 2 puffs BID
Current Illness: None
Preexisting Conditions: High blood pressure seasonal allergies
Allergies: None known
Diagnostic Lab Data: No labs or tests. Aug. 26 awoke with swollen eyes, itching on ears and hands. By end of work day lips were 5x normal size, swollen cheeks. Went to Urgent care on the way home and received 60 mg Prednisone with script to take 50 mg daily for 5 day.s. August 28 with Hives from head to toe and returned to urgent care. Received Atarax.
CDC Split Type:

Write-up: angioedema, Hives


VAERS ID: 1656274 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1077 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
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: Tenex
Current Illness:
Preexisting Conditions: Developmental delay, ADHD, Oppositional Defiant Disorder
Allergies: Adderall, Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: mother consenting to the administration of a Covid vaccine. She indicated on a legal signed form that had not received a Covid vaccine. Upon entering the vaccine into IRIS, it was discovered that he had already completed the Pfizer series. (Pfizer EW0173 on 05/28/2021 and Pfizer EW0181 on 06/18/2021). This RN spoke with mother on 08/27 and 08/30. Mother denies side effects and reports that he is feeling fine. Mother reports that she wanted the family "double vaccinated" for upcoming travel. Mother instructed to call SCPH with any adverse effects that occur. Mother verbalized understanding.


VAERS ID: 1656276 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Muscle tightness, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Shortness of breath Heart palpitations Chest pain Tight muscles


VAERS ID: 1656291 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Discomfort, Facial pain, Feeling abnormal, Headache
SMQs:, Dementia (broad), Glaucoma (broad)

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

Write-up: Immediate headache. I was in a fog for several hours after vaccine. My left side of my face has felt weird ever since getting the vaccine 4 days ago. I felt pain and pressure on the let side of my face starting the same day I received the vaccine.


VAERS ID: 1656431 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Vaccine was mixed with smaller dose of saline than 1.8 ml , no reaction to report as of today


VAERS ID: 1656465 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysarthria, Heart rate decreased, Movement disorder
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

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

Write-up: slurred speach, unable to move legs, heart rate down,


VAERS ID: 1656485 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: no event other than patient being underage


VAERS ID: 1656492 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 60 mg Prozac 10 mg Metoprolol 20 mg Atorvastin Calcium Multivitamin Calcium 81 mg Baby Asprin
Current Illness: Wisdom Tooth Pulled
Preexisting Conditions: Stent, Gastric Bypass
Allergies: No
Diagnostic Lab Data: none
CDC Split Type:

Write-up: beginning Thursday, 8/26/2021 Difficulty breathing , Lightheaded, dizzy, loss of balance, rapid heart Symptoms went into 8/28/2021, No issues 8/30/2021


VAERS ID: 1656513 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-23
Onset:2021-08-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Gave blood sample at doctors office.
CDC Split Type:

Write-up: Various body parts started feeling itchy on Thursday, 8/26. Thought initially it may have been mosquito bites. The next day, my arms and legs were covered in red bumps and patches. Took Benadryl that night but symptoms became worse the next morning. Irritated areas included my arms, legs, back and feet. Went to my primary care doctor on Saturday, 8/28. Doctor told me it was urticaria (hives). Prescribed Zyrtec and Prednisone which I began taking that day.


VAERS ID: 1656518 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-18
Onset:2021-08-26
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Thrombosis, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: shrimp / shellfish
Diagnostic Lab Data: ultrasound
CDC Split Type:

Write-up: blood clot left leg - thrombosis left gastronomies'' vein


VAERS ID: 1656523 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Oedema peripheral, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: Had syncope minutes after receiving first HPV vaccine and influenza booster on 12/20/17
Other Medications: Motrin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Morning after vaccine had pain and swelling to axilla of the same side he received the vaccine. that swelling subsided but over the next few days developed swelling to his right chest wall and flank area. No redness or pruritis, does have some pain with movement. Swelling is improving but not completely gone.


VAERS ID: 1656541 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Interchange of vaccine products, Product administration error
SMQs:, Medication errors (narrow)

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

Write-up: PFIZER-BIONTECH COVID-19 VACCINE EUA. ADMINISTRATION ERROR- MIXED DOSE SERIES. It is unclear what patient received for 1st dose of Covid-19 vaccine. Immunization database shows patient received 1st dose of Moderna on 4/21/21. Provider of 1st immunization is saying patient received Johnson & Johnson. Nursing facility doctor states patient is immunocompromised and needs an additional dose. Due to exceptional circumstances, patient cannot leave nursing facility and having trouble determining what they actually received for 1st dose. Patient vaccinated with Pfizer on 8/26/21 for 2nd dose to complete series or provide additional dose.


VAERS ID: 1656551 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown Denies allergy to a component of a COVID-19 vaccine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No adverse event. This is a medication administration error. She is 17 and received Moderna.


VAERS ID: 1656555 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-29
Onset:2021-08-26
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet Take 1,000 mg by mouth every 6 hours as needed for Pain. alendronate (FOSAMAX) 70 mg tablet Take 1 tablet by mouth every 7 days. Patient taking differently: Take 70 mg by mouth every 7 days Wednes
Current Illness: ? Arthritis ? Atrial fibrillation ? Collar bone fracture 02/2019 ? Colon polyp ? Edema ? High cholesterol ? History of colonoscopy ? Hyperlipidemia ? Malignant neoplasm of upper-outer quadrant of left female breast (HCC) 8/17/2017 ? Motion sickness ? Rheumatoid arthritis(714.0)
Preexisting Conditions: See section 11
Allergies: NKDA
Diagnostic Lab Data: SARS-CoV-2 RNA Resp Ql NAA+probe POSITIVE Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Ordered Test Codes: 94500-6 (LN LOINC)/ Status: Final Accession Number: 822485241 Specimen Source: SOFT TISSUE SAMPLE Specimen Site: Nasopharynx(Nasopharynx) Specimen Collection Date/Time: 2021-08-26 11:06:00.0
CDC Split Type: 908495

Write-up: Case completed 2 dose Covid vaccine series on 3/29/21, and ws subsequently hospitalized for Covid pneumonia on 8/26/21.


VAERS ID: 1656561 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown no allergy reported to COVID-19 vaccine components
Diagnostic Lab Data: none
CDC Split Type:

Write-up: No adverse event occurred. This is a report of a vaccine administration error as she received Moderna at age 17.


VAERS ID: 1656610 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Interchange of vaccine products, Product administration error
SMQs:, Medication errors (narrow)

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

Write-up: PFIZER-BIONTECH COVID-19 VACCINE EUA. ADMINISTRATION ERROR- MIXED DOSE SERIES. Patient received Moderna series for 1st and 2nd dose on 3/10/21 and 4/7/21 respectively. Nursing facility and/or patient attests is immunocompromised and needs an additional dose. Due to exceptional circumstances, patient cannot leave nursing facility to obtain Moderna for 3rd dose. Patient was vaccinated on 8/26/21 with Pfizer for additional dose for immunocompromised.


VAERS ID: 1656612 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-04-21
Onset:2021-08-26
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Biopsy soft tissue, COVID-19, SARS-CoV-2 RNA
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 MG tablet TAKE ONE TABLET BY MOUTH ONCE DAILY (DOSE INCREASE) 6/1/21 atorvaSTATin (LIPITOR) 10 mg tablet Take 1 tablet by mouth nightly. 8/19/20 Cholecalciferol (VITAMIN D3) 5000 units TBDP Take 1 tablet by
Current Illness: ? Arthritis ? Essential hypertension 2/2/2018 ? Hypogonadism 7/22/2012 ? Pure hypercholesterolemia 3/2/2018
Preexisting Conditions: See section 11
Allergies: ? Bactrim [Sulfamethoxazole-Trimethoprim] Hives ? Tamiflu [Oseltamivir] Hives
Diagnostic Lab Data: SARS-CoV-2 RNA Resp Ql NAA+probe POSITIVE Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Ordered Test Codes: 94500-6 (LN LOINC)/ Status: Final Accession Number: 697736084 Specimen Source: SOFT TISSUE SAMPLE Specimen Site: Nares(Nares) Specimen Collection Date/Time: 2021-08-20 09:41:00.0
CDC Split Type: 128637

Write-up: Case completed Pfizer Covid vaccine series on 4/21/21, then was admitted to hospital for Covid treatment on 8/26/2021.


VAERS ID: 1656619 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: a black spot came in my hand and feel dizzy and i feel choose
Current Illness: i feel dizzy
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1656996 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Headache, Hypoaesthesia, Musculoskeletal stiffness, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: (possible case of Bell''s Palsy), tingling numbing on right side of face, numbing of the right side of neck , stiffness of the neck, numbing of right arm, pressure behind the right ear, mild fever, mild headache


VAERS ID: 1657009 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initially I only had a bad headache and sore arm the day after I got my vaccine. Then a couple days later I started to get really tired and dizzy. That continued so I went to the doctor today (a week after injection). My resting heart rate was over 100. For context, when I was donating blood last month it was 64. Over 100 is very high for me. My doctor advised me that all I can do is rest, and I am not allowed to exercise for the time being.


VAERS ID: 1657021 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Burning sensation, Chest pain, Dyspnoea, Fatigue, Feeling hot, Gait inability, Headache, Muscle contractions involuntary, Myalgia, Pain, Pain of skin
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: I started having back pain, feeling light headaches. at 9 pm start feeling hot like my body was burning. All my body was painful , my joints, muscles, and skin were very painful, mild chest pain. unable to walk due to a mild SOB and feeling tired. the symptoms were like when I had COVID virus infection back in December. the difference was that I did not had cough. the symptoms were for about 3 days. after those days, i still feel tired and my arm where the vaccine was given feel like the muscles are contracting on and off.


VAERS ID: 1657025 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Diarrhoea, Headache, Musculoskeletal stiffness, Nausea, Oropharyngeal discomfort, Sneezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Arthritis (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Omeprazole
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, stiffness, scratchy throat, coughing, sneezing, headache, diarrhea, nausea.


VAERS ID: 1657241 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Episcleritis, Eye pain, Headache, Ocular hyperaemia, Pain, Photophobia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Scleral disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, zyrtec, vitamin d, zinc, neurontin
Current Illness: Nothing
Preexisting Conditions: Asthma, allergies, hypertension
Allergies: Amoxicillin, tb skin test, iodine, ibuprofen
Diagnostic Lab Data: Nothing to date
CDC Split Type:

Write-up: Hr12 after injection headache started. Hr24- fever max 100.8, severe headache, chills, body ache. Hr 48 right eye pain started, headache in temple. Hr 60, full right eye red, extreme light sensitivity, pain. Hr 72- sought urgent medical care. Referred to ophthalmology . Diagnosis of episcleritis. Started on steroid eye drops.


VAERS ID: 1657245 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Disorientation, Electrocardiogram normal, Fall, Hyperhidrosis, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: came with her father for the Pfizer vaccine around 8pm Thursday evening. After the vaccine she stood up and walked to a different chair while I was giving her father his vaccine. While giving his vaccine the divider between the chairs was knocked over and when we looked over noticed that was on the floor. She sat up slowly, stated that her vision was blurry and felt disoriented. I helped her sit in the chair and checked her blood pressure which was 60/43 and PR 66. Her father stated that she has SVT and takes atenolol to help control it. I called EMT. Pt was alert, answered questions, felt clammy and sweaty and vision was improving. EMT arrived @ 8:20pm and BP was 121/78. They hooked her up to EKG in the ambulance and looked good. Dad later came to tell me that she was brought home and they would check with cardiologist on Friday.


VAERS ID: 1657427 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / SYR

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

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

Write-up: Hives over legs, arms and neck.


VAERS ID: 1657429 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Feeling cold, Flushing, Pharyngeal swelling, Swollen tongue, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Facial flushing, facial redness, chills, hives, feeling of throat swelling and tongue swelling - all progressively getting worse. Post vaccination treated with IM injection of Solu-Medrol, Pepcid (pill), Zyrtec (pill).


VAERS ID: 1657558 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-28
Onset:2021-08-26
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Headache, Pain, Respiratory tract congestion, Rhinorrhoea, 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: symptoms started 8/26/21 with congestion, runny nose, body aches and headache. Covid positive 8/30/21 Symptoms improving 8/30/21


VAERS ID: 1657743 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-26
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Malaise, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), 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: MRNA 1273
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210858504

Write-up: MINOR SORE ARM; INAPPROPRIATE SCHEDULE OF VACCINE ADMINISTERED; DONT FEEL GOOD FOR 24 HOURS; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on MAR-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. Concomitant medications included mrna 1273 for prophylactic vaccination. On 26-AUG-2021, the patient experienced dont feel good for 24 hours. On 27-AUG-2021, the patient experienced inappropriate schedule of vaccine administered. On an unspecified date, the patient experienced minor sore arm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from dont feel good for 24 hours, and the outcome of minor sore arm and inappropriate schedule of vaccine administered was not reported. This report was non-serious.


VAERS ID: 1657746 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-08-26
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram, Diarrhoea, Fatigue, Feeling abnormal, Haematochezia, Headache, Injection site reaction, Limb discomfort, Neck pain, SARS-CoV-2 antibody test, Tremor, Urinary tract infection
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210701; Test Name: COVID-19 antibody test; Result Unstructured Data: Positive 86.9; Test Date: 202108; Test Name: CAT scan; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210858571

Write-up: BLOOD IN STOOL; SHAKINESS; URINARY TRACT INFECTION (UTI) SYMPTOMS SUCH AS SEDIMENT IN URINE; BRAIN FOG; NECK PAIN; INJECTION SITE REACTION; DIARRHEA; ARMS FEEL HEAVY; HEADACHE; FATIGUED; This spontaneous report received from a patient concerned an adult female of unknown race and ethnicity. The patient''s height, and weight were not reported. The patient''s past medical history included: covid in JAN-2021. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, 1 total, administered on 26-AUG-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On unspecified date in 01-JUL-2021, patient had COVID-19 antibody test, and it was positive 86.9 and patient was wondered why she was being mandated to get the vaccine. On 26-AUG-2021, the patient experienced blood in stool, urinary tract infection (UTI) symptoms such as sediment in urine (kidney pain, back pain, fever), shakiness, brain fog, neck pain, injection site reaction, diarrhea, arms feel heavy, headache, and fatigued. On an unspecified date in AUG-2021, The patient went to the hospital for evaluation due to the bloody stool and kidney pain, and had computerised tomogram (CAT) scan done. The patient reported that as per health care provider (HCP), the CAT scan was clear and it was from the shot. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from shakiness, blood in stool, diarrhea, urinary tract infection (UTI) symptoms such as sediment in urine (kidney pain, back pain, fever), neck pain, headache, brain fog, injection site reaction, fatigued, and arms feel heavy. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0-20210858571-Covid-19 vaccine ad26.cov2.s-Blood in stool. This event(s) is considered unassessable. The event(s) has an compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1658130 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053CZ1N / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Back pain, Chills, Cough, Dizziness, Feeling hot, Headache, Injection site bruising, Migraine, Musculoskeletal stiffness, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (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: Nope
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: No
CDC Split Type:

Write-up: First day a little dizzy but I was fine went to work came home arm was sore but not bad at all . Fell asleep had chills bad got hot felt like a fever but didn?t have one and had a migraine from hell and sick to my stomach my lower back and hip hurt a little then my resting heart rate started going from 124-134 resting not moving at all I laid back down woke up with a stiff neck the headache the necked day wasn?t bad but still hurt and that?s when my husband seen I had a huge bruise where I got my shot I have a dry cough but not bad at all but the bruise is very dark and purple


VAERS ID: 1658142 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), Medication errors (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: Error: Wrong Route (SC, IM, etc.)-


VAERS ID: 1658420 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-19
Onset:2021-08-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Discomfort, Dizziness, Electrocardiogram, Extra dose administered, Heart rate increased, Peritonitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Medication errors (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: About five days later began having chest pain, dizziness , high pulse rate and general discomfort. Went to urgent care, own internist, then hospitalized over night on August 28-29. Working dx is Peritonitis. Saw cardiologist on 8/31. He redid EKG... much improved since discharge. Believes it is Peritonitis, possibly due to 3rsd series Moderna vaccine. BP, dizziness, pain and heart rate are now normal. Medications are high does ibuprofen and colchocaazine


VAERS ID: 1658426 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-05
Onset:2021-08-26
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Condition aggravated, Lung infiltration, Mental status changes, Pneumonia, SARS-CoV-2 antibody test, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Urinary tract infection, White blood cell count increased
SMQs:, Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acidophilus-pectin, citrus (Acidophilus Probiotic) 100 million cell-10 mg Capsule Directions: 1 capsule oral daily (Active) aspirin 81 mg tablet,chewable Directions: 1 tablet oral daily (Active) atorvastatin 80 mg Tablet Directions: 1
Current Illness:
Preexisting Conditions: Chronic UTIs, CHF with HFpEF, MI, endarterectomy, and AAA repair; Peripheral Arterial Disease
Allergies: Biaxin; codeine; penicillin
Diagnostic Lab Data: Timeline 1.) SARS-CoV-2 PCR (-) on 8/5/21 2.) SARS-CoV-2 Antigen (-) on 8/24/21 3.) SARS-CoV-2 PCR (+) on 8/30/21 4.) SARS-CoV-2 IgG 2.05; IgM 6.25 on 8/30/21
CDC Split Type:

Write-up: Admitted to hospital with Altered Mental Status Pneumonia vs UTI - CXR Showed new/increasing infiltrates in the Right Upper and Mid Lung that are consistent with pneumonia - WBC count of 12.4


VAERS ID: 1658477 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-25
Onset:2021-08-26
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 UN / 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT WAS FULLY VACCINATED FOR COVID19. DOSE 1 - 2/24/21 (LOT 013M20A); DOSE 2 - 3/25/21 (LOT 003A21A). TESTED + 8/28/2021 - S/O 8/26/2021


VAERS ID: 1658480 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Migraine, Nervousness, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: Buproprion/Wellbutrin
Current Illness: None
Preexisting Conditions: I have had instances of high blood pressure, but nothing serious.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The morning after my vaccination, I woke up with a migraine and I started noticing my heart beating out of my chest randomly. This went on throughout the first day. It made me nervous, but I dealt with it. I felt better the second day following the vaccination and the symptoms subsided.


VAERS ID: 1658490 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-18
Onset:2021-08-26
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM

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

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

Write-up: Second dose given 2/25/21. covid +/admitted to hospital/ on oxygen + dexamethasone + remdesivir


VAERS ID: 1658497 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-08-26
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, 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: PCR test @ pharmacy on 8/26/2021
CDC Split Type:

Write-up: Patient became ill and tested PCR positive for Covid $g 14 days after the completion of vaccine series


VAERS ID: 1658498 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-23
Onset:2021-08-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Pt stated that several days after her injection redness appeared in the area of the injection and spread toward elbow. Pt states that redness is about the same when reported to pharmacy on 8/30/21. Pt also reports soreness of arm of about 1-2 on pain scale of 1-10 with 10 being intolerable pain.


VAERS ID: 1658631 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3180 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Muscle spasms, Paraesthesia, Spinal X-ray, Spinal pain
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Leg swelling from Pertussis within DTP, 5 months old, 2/11/1988, unknown type and brand name
Other Medications: Omeprazole, Women''s Multi-Vitamin, Low Dose Aspirin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Amoxcillin, Penicillin, Pertussis, seasonal allergies
Diagnostic Lab Data: Test: XR Spine Lumbar 2-3 views for Dorsalgia - Results: No acute fracture or malalighment. No soft tissue abnormality. No paravertebral soft issue abnormality. - Date: 8/26/21
CDC Split Type:

Write-up: 2 days after the 1st COVID-19 dose my right foot and leg started to tingle and feel slightly numb in the early afternoon. About 10 minutes later I had a intense stabbing pain in the lower spine with uncontrollable spasms. It felt as though needles were being injected into my spine repeatedly causing intense spasms. I went to Urgent Care that evening due to it not getting any better. An x-ray was done of my lower spine and it did not show any issues. The doctor advised me to take a muscle relaxer and Ibuprofen. As of today I still have some spasms and spinal pain. It is not as intense, but it''s still very much there.


VAERS ID: 1658656 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-19
Onset:2021-08-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Discomfort, Dizziness, Electrocardiogram, Heart rate increased, Pericarditis
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: About five days later began having chest pain, dizziness , high pulse rate and general discomfort. Went to urgent care, own internist, then hospitalized over night on August 28-29. Working dx is Pericarditis Saw cardiologist on 8/31. He redid EKG... much improved since discharge. Believes it is Pericarditis possibly due to 3rsd series Moderna vaccine. BP, dizziness, pain and heart rate are now normal. Medications are high does ibuprofen and colchocaazine


VAERS ID: 1658698 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-08-26
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Confusional state, Cough, Respiratory tract congestion, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), 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 came in with a history of mild dementia, confusion, temp 103.3, cough and congestion no vomiting or gi symptoms. Diagnoses: Acute Covid and UTI.


VAERS ID: 1658708 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-15
Onset:2021-08-26
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin, Vistaril
Current Illness:
Preexisting Conditions:
Allergies: Ibuprofen
Diagnostic Lab Data: Covid-19 08/26/2021
CDC Split Type:

Write-up: Patient received 2nd Moderna vaccine on 03/15/2021. Tested positive for Covid-19 on 08/26/2021.


VAERS ID: 1658715 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Neck pain, Pain in extremity
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Chest pain occurred the next day and lingered for 3 days. Pain throughout upper shoulders, neck and arms began on the third day and is still present and getting worse.


VAERS ID: 1658727 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Feeling abnormal, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: The left side of my face feels numb and I have brain fog. I am currently being tested and seen by a medical provider to determine treatment.


VAERS ID: 1658730 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-12
Onset:2021-08-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (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: prilosec
Current Illness: one week prior: negative covid test, symptoms equal to sinus infection
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: pressure in chest, discomfort - effects felt in 90 degree and above temperature, strenuous physical labor; rest, stay out of heat;


VAERS ID: 1658769 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

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

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

Write-up: Pt complained of full body itching . Denied difficulty breathing or any other complaints. She agreed to Benadryl 25 mg IM to resolve symptoms. Itching began to resolve immediately. 30 minutes later itching was almost fully resolved and pt had no other signs/ symptoms. She left ambulatory planning to go directly home.


VAERS ID: 1658819 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor,Plavix,lasix, levothyroxine, lisinopril, lopressor, Omeprazole
Current Illness: None
Preexisting Conditions: HTN, Hypothyroid, A-Fib, CAD, Hyperlipidemia
Allergies: Egg, Sulfa, Miconazole, Bacitracin, Neomycin, Polymyxin B
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cellulitis of left upper extremity (Primary) Comments: #2 Covid last week. Worsening left deltoid tenderness/redness/itching since. No fever. No SOB. Keflex now. Cool compress. Oral Zyrtec for itch. ROV 10 days Orders: - cephalexin (KEFLEX) 500 mg capsule; Take 1 capsule (500 mg total) by mouth 2 (two) times a day for 10 days. Dispense: 20 each; Refill: 0


VAERS ID: 1658861 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-01
Onset:2021-08-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Headache, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: This events started right away the same day I was administered the vaccine. I experienced all as follows: Nausea, Vomiting, Headache, Severe body ache, Fatigue and No appetite


VAERS ID: 1658909 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-06
Onset:2021-08-26
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthenia, COVID-19, Computerised tomogram thorax abnormal, Confusional state, Cough, Dyspnoea, Hypoxia, Pulmonary embolism, Respiratory failure, Respiratory symptom, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient started experiencing upper respiratory symptoms (cough, shortness of breath) and weakness on ~ 8/22/21. His son brought him to the ER on 8/26/21 since patient started to wheeze and his symptoms were not improving with OTC medications. He was noted to be confused in the ER as well as hypoxic, and heated high flow oxygen was started due to respiratory failure. Pt was admitted to the hospital and was started on COVID treatment with remdesivir and dexamethasone since he tested positive for COVID in the ER on 8/26. He is also receiving Eliquis 5 mg BID for suspected PE on CT (patient was on Eliquis 2.5 mg BID prior to admission for Afib). Pt is currently on day 5 of hospitalization (on 8/31) and is now on room air with good O2 saturation. Hospital discharge is anticipated to be soon.


VAERS ID: 1658920 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-21
Onset:2021-08-26
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Called doctor''s office on Monday, 8/30/21 AM to report symptoms. Dr. recommended same treatment with the Benedryl and Zyrtec. Dr. advised against getting a Booster vaccine. (nurse) stated they DO NOT report these symptoms to VAERS.
CDC Split Type:

Write-up: Sat, 8/21/21 PM - body aches Sun, 8/22/21 AM - body aches, chills, low grade fever, fatigue Sun, 8/22/21 PM - body aches, chills, low grade fever, fatigue Mon, 8/23/21 AM - body aches, chills, fatigue Mon, 8/23/21 PM - body aches, chills fatigue Tue, 8/24/21 AM - fatigue Tue, 8/24/21 PM - fatigue Wed, 8/25/21 AM - fatigue Wed, 8/25/21 PM - fatigue Thu, 8/26/21 AM - fatigue Thu, 8/26/21 PM - hives on arms and legs Fri, 8/27/21 AM - hives on arms, legs, chest and back Fri, 8/27/21 PM - hives on arms, legs, chest and back Sat, 8/28/21 AM - severe hives on arms, legs, hands, feet, back, chest, scalp (symptoms subsided after Diphenhydramine HCI 25mg) Sat, 8/28/21 PM - no symptoms Sun, 8/29/21 AM - severe hives on arms, legs, hands, feet, back, chest, scalp (symptoms subsided after Diphenhydramine HCI 25mg) Sun, 8/29/21 PM - hives lessened to feet only and subsided on own (no medication taken) Mon, 8/30/21 AM - no symptoms Mon, 8/30/21 PM - no symptoms


VAERS ID: 1658959 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-08-26
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Alanine aminotransferase increased, Aspartate aminotransferase increased, COVID-19, Condition aggravated, Cough, Diarrhoea, Dyspnoea, Fibrin D dimer, Nausea, Pain, SARS-CoV-2 test positive, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 8/26: Pulse ox reportedly 86%. Required 2L oxygen. D-Dimer: 0.35 mg/L. 8/27: AST = 78; ALT = 116
CDC Split Type:

Write-up: Patient admitted to hospital on 8/26/21 for shortness of breath, mild cough, body aches, nausea, vomiting, and diarrhea. Also with left sided abdominal pain. Tested positive for COVID-19 on 8/26/21. Patient is fully vaccinated with Pfizer. Dose #1 4/13/21; Dose #2 5/4/21 (lot numbers unknown). Also reports that he was previously infected with COVID in 2020. Started dexamethasone 6 mg daily x 10 days. COVID did not progress to lower respiratory tract infection. Patient discharged 8/27/2021.


VAERS ID: 1658966 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash erythematous
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: Citalopram, Montelukast, Solifenacin, Nasacort nasal spray, Multi and B vitamins
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Sulfa, iodine and lobster
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red rash for one week post injection


VAERS ID: 1658971 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312832 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site erythema, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: PT REPORTS PAIN, SWELLING AND REDNESS OF INJECTION SITE(LEFT ARM). SSX STARTED RIGHT AFTER AND STILL ONGOING.


VAERS ID: 1658994 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swelling in R axilla which spread to R flank


VAERS ID: 1658995 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Chest pain, Dyspnoea, Respiratory rate increased
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Mother reports that patient felt like his heart was going to explode, dyspnea, rapid breathing, chest pain, doom sensation about 5 minutes after receiving the Covid 19 vaccination. Pharmacy witnessed the event and watched pt for 15 minutes. Mom states they did not advise him to go to the hospital after the reaction. Has been taking Benadryl at home x 4 days.


VAERS ID: 1659021 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Haemoglobin decreased, Reticulocyte count increased, Sickle cell anaemia with crisis
SMQs:, Haemolytic disorders (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hydroxyurea, folic acid, acetaminophen, meloxicam, oxycodone
Current Illness: Sickle cell pain crisis on 8/13/21
Preexisting Conditions: Sickle cell disease Normocytic anemia
Allergies: None known
Diagnostic Lab Data: 8/26/21 hemoglobin 8.5, reticulocytes 1.9.
CDC Split Type:

Write-up: Sickle cell pain crises, started hours after vaccination, required hospitalization starting 8/27/21 and continues until present (8/31/21), and an ER visit on 8/26/21. She is likely to stay for 7 days (currently on day 5 of hospitalization) and is recovering.


VAERS ID: 1659046 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-08-26
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Public       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 RECEIVED COVID-19 VACCINE PFIZER Dose 1 date: 01/28/2021 AND Dose 2 date: 02/18/2021. PATIENT TESTED POSITIVE TO COVID ON 8/26/21.


VAERS ID: 1659056 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Eye movement disorder, Malaise, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: per patient, history of passing out from needles. This instance seemed different and much worse than how pt described previous
Other Medications: not known
Current Illness: not known
Preexisting Conditions: not known
Allergies: none
Diagnostic Lab Data: none known
CDC Split Type:

Write-up: FRM VAERS "PATIENT REPORTED A HISTORY OF PASSING OUT FROM NEEDLES. IMMEDIATELY AFTER GIVING THE VACCINE PATIENT REPORTED FEELING FINE. A FEW MINUTES AFTER IMMUNIZATION DELIVERY, THE PATIENT REPORTED FEELING ILL, THEN PATIENT BEGAN TO SHAKE FOR A FEW SECONDS (LIKE THE BEGINNING OF A SEIZURE). PHARMACY INTERN LATER REPORTED SHE SAW PATIENTS "EYES ROLL BACK", WHEN PATIENT STOPPED SHAKING SHE COMPLAINED OF CHEST PAIN. WE CALLED 911. PATIENT REPORTED SHE WAS NOT HAVING ANY DIFFICULTY BREATHING OR SCRATCHY/SWOLLEN THROAT. PATIENT''S ARM AT INJECTION SITE LOOKED NORMAL, NO RASH OR SWELLING. I HELPED PATIENT TO LAY DOWN, ELEVATED FEET, AND GAVE PATIENT ICE PACK FOR NECK WHILE WAITING ON PARAMEDICS. PARAMEDICS REPORTED PATIENT''S VITALS WERE STABLE AND SHE WAS CLEAR FROM THEIR PERSPECTIVE. PATIENT CONTINUED TO RECOVER IN PHARMACY FOR ~1-1.5 HR UNTIL SHE LEFT.


VAERS ID: 1659065 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071E21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Paraesthesia, Vitreous floaters
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Retinal disorders (narrow)

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

Write-up: I personally experienced a sudden onset of paresthesia from my right fingertips up to my elbow on my right arm. It was associated with a severe headache and floaters in my vision. The paresthesia persisted for 15 minutes. The floaters lasted for approximately 30 minutes. And the headache lasted for three days. There were no relieving factors.


VAERS ID: 1659068 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-19
Onset:2021-08-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

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

Write-up: patient called and reported new itchy, rash at injection site one week after immunization delivery. per patient, she did not experience any injection site reaction immediately following immunization. Patient was advised to follow up with MD/PCP.


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