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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 381 out of 8,010

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VAERS ID: 1659143 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-04
Onset:2021-08-26
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 2 - / IM

Administered by: School       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Dyspnoea, Nasal congestion, Pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Afib, HTN, BPH
Allergies: NKA
Diagnostic Lab Data: (coutpatient walk in SARS CoV AG postiive on 8/16/21)
CDC Split Type:

Write-up: He completed Covid Pfizer vaccines on 2/4/21. He noted cough, body aches, and nasal congestion, and he was tested covid antigen-positive at walkin clinic on 8/16/21. Despite receiving monoclonal antibody as an outpatient on 8/20/21, his symptoms of SOB and weakness were worse, so he came to Hospital on 8/26/21 and was admitted. He is now requiring 6L of oxygen and is currently on the 6th day of hospitalization.


VAERS ID: 1659144 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Michigan  
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 (JANSSEN)) / JANSSEN 204A21A / N/A RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: doxycycline 100mg BID Buspar 10mg BID Zyprexa 10mg q day
Current Illness: psych
Preexisting Conditions: psych
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt requested a Covid vaccination. After receiving the vaccine and as I was putting the vaccine into system, it was discovered that the pt was not truthful with the nurse and had received the same vaccine 06/16/2021. Notified of same when discovered. Pt has had no ill effects as of this report.


VAERS ID: 1659167 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Utah  
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 EW0168 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Myalgia, Pyrexia, Rhinorrhoea, Skin exfoliation, Throat irritation
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On 8/24/2021 my daughter- Lili, received her first dose of Pfizer vaccine (EW0168) at the Hospital (Pediatrics). Two days later (8/26), she started experiencing runny nose, scratchy throat, headache, muscle pain and fever (39.0?C). It lasted until Sunday (8/29). On Sunday we?ve discovered that her skin on hand palms is peeling off. (small patches) As of today, most of her symptoms are gone, with the exception of runny nose. My biggest concern is peeled skin - is that normal?


VAERS ID: 1659196 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
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 EW0167 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 25 mg, daily multi-vitamin, daily probiotic.
Current Illness: None
Preexisting Conditions: Chronic bladder infections as a smaller child. No infection in the last few years. Not a current issue.
Allergies: None
Diagnostic Lab Data: Visual observation and guidance from pediatrician.
CDC Split Type:

Write-up: Swollen lympnode in right armpit, accompanied by moderate pain.


VAERS ID: 1659208 (history)  
Form: Version 2.0  
Age: 64.0  
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 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Disturbance in attention, Headache, Injection site pain, Injection site swelling, Malaise, Pain, Tinnitus
SMQs:, Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, multivitamin, ASA 81 mg.
Current Illness: None
Preexisting Conditions: Lower back pain.
Allergies: Vancomycin, Phenergan, Versed.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain and swelling at injection site even after 5 days. Headaches, body aches, tinnitus, general malaise, difficult concentration for 5 days


VAERS ID: 1659262 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-07
Onset:2021-08-26
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Headache, Myalgia, Nasal congestion, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid 8/27/2021
CDC Split Type:

Write-up: Client received Pfizer vaccines on March 7 and April 7, 2021. He developed Covid symptoms (fever x 2 days, myalgia, headache, nasal congestion) on 8/26. Tested positive for Covid on 8/27 PCR. Reported as a breakthrough Covid case in fully vaccinated person.


VAERS ID: 1659277 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
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 005C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Hypoaesthesia, Paraesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: redness, swelling in arm that extends the entire arm with associated numbness/tingling of hand and fingers


VAERS ID: 1659281 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Georgia  
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 - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Blood calcium normal, Blood creatinine normal, Blood potassium normal, Blood sodium normal, Blood urea normal, Chest X-ray normal, Glomerular filtration rate decreased, Haemoglobin normal, Pain, Pain in extremity, SARS-CoV-2 test negative, Urine analysis normal, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Retroperitoneal fibrosis (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg once daily, Divalproex 500 mg 2 tablets once a day, Ezetimibe 10 mg once daily, Fluoxetine 20 mg once daily, Hydroxyzine Pamoate 25 mg every 8 hours, Perphenazine 4 mg once daily.
Current Illness: COVID-19 (positive on 07/28/21)
Preexisting Conditions: Hypercholesterolemia, Schizoaffective disorder (stable), Hepatic steatosis (asymptomatic), Alcohol abuse (in remission since 2019).
Allergies: Simvastatin.
Diagnostic Lab Data: Negative urinalysis, WBC 5.8, hemoglobin 14.2, sodium 140, potassium 4.1, BUN 12, serum creatinine 1.0, serum calcium 9.8, GFR 79, SARS-CoV2 rapid test negative Benign chest x-ray. All tests done on August 28, 2021
CDC Split Type:

Write-up: Severe lower back pain radiating to lower extremities, weakness of lower extremities. Symptoms gradually progressing since the day after receiving the above vaccination.


VAERS ID: 1659311 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-20
Onset:2021-08-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Colitis, Diarrhoea haemorrhagic
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient started experiencing abdominal pain and bloody diarrhea 6 days post vaccination. She went to emergency room and was diagnosed with colitis and doctor said it is likely unrelated to the vaccine but patient believes it was caused by the vaccine given the time frame.


VAERS ID: 1659456 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-14
Onset:2021-08-26
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, Influenza like illness, SARS-CoV-2 test negative, 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: Depakote; Seroquel; Zoloft; Prednisone
Current Illness: None
Preexisting Conditions: Asthma; Migraines; Type 1.5 Diabetes; Non-Epileptic Seizures; Depression; Anxiety; Bipolar disorder
Allergies: Aspirin; Statins; Imitrex; Pollen
Diagnostic Lab Data: rapid Covid test- negative PCR Covid test- positive
CDC Split Type: vsafe

Write-up: Right after the shot I had flu like symptoms. I came in contact with someone who tested positive for COVID on 08/25/2021. I was put in quarantine and I felt like I was having pneumonia. I went to the doctor, and they tested me for COVID. The rapid test came back negative but the PCR came back positive.


VAERS ID: 1659709 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Arkansas  
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 - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Contusion, Cytomegalovirus test, Full blood count, Pain in extremity, Paraesthesia, Thyroxine, Ultrasound Doppler, Vitamin D
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), 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: influenza vaccine in 2020, but brand uknown.
Other Medications: Current Outpatient Medications: ? liothyronine (CYTOMEL) 25 mcg Tablet, 1/2 tablet (12.5mcg) Monday, Wed., Friday, and Full tablet (25mcg) Sunday, Tuesday, Thursday, Saturday., Disp: 90 Tablet, Rfl: 1 ? celecoxib (CeleBREX) 200 mg capsu
Current Illness: None.
Preexisting Conditions: Patient Active Problem List ? Age related osteoporosis ? Gastroesophageal reflux disease without esophagitis ? Hormone replacement therapy (HRT) ? Mild episode of recurrent major depressive disorder ? Generalized osteoarthrosis, involving multiple sites
Allergies: Sulfa, PCN, Tylenol, Ceftin, Oxycodone.
Diagnostic Lab Data: CBC, CMP, TSH, T4, Vit D and venous doppler left upper extremity.
CDC Split Type:

Write-up: Left arm pain with paresthesias Bruising starting 24 hours later on inner biceps area.


VAERS ID: 1659721 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
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 (MODERNA)) / MODERNA 001B21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diplopia, Dizziness, Electrocardiogram, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Ocular motility disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Januvia, glypizide, hydrochorothiazide, atorvastatin, .percocet, albuterol, gabapentin, calcium, benazepril
Current Illness: None
Preexisting Conditions: diabetes, htn
Allergies: Morphine
Diagnostic Lab Data: EKG, further testing to be order by Dr
CDC Split Type:

Write-up: Pt presents to Emergency seeking care for vaccine side effects. Pt recently received Moderna injection #1 from Pharmacy on 8.26/21 and presents with dizziness, double vision and multiple falls since her vaccination. Pt states adverse effects are getting worse and needs medical attention


VAERS ID: 1659739 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chest pain, Fall, Mobility decreased, Myalgia, Pain, Pulmonary pain
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Extreme back/muscle pain, unable to move due to the extreme pain. Pain in left mid/upper back radiating to left chest/lungs. Pain caused me to fall to floor and I was unable to move from the floor fro multiple hours.


VAERS ID: 1659930 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-31
Onset:2021-08-26
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Ageusia, Anosmia, Asthenia, COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Condition aggravated, Dyspnoea, Fatigue, Hypoxia, Pain, Pulmonary embolism, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol inh, aspirin EC, Symbicort inh, vitamin D, MVI, simvastatin
Current Illness:
Preexisting Conditions: History of breast cancer (ER positive HER-2 negative) completed 7 years of treatment, COPD emphysema, HLD, and tobacco use disorder
Allergies: NKDA
Diagnostic Lab Data: COVID status positive on 8/26/21.
CDC Split Type:

Write-up: Patient received Moderna COVID vaccine on 3/3/21 and 3/31/21. On 8/20/21, she started having weakness, fatigue, body aches as well as shortness of breath with hypoxia, fever, and some loss of smell/taste. Patient presented to our Medical Center and was admitted on 8/26/21 for acute hypoxic respiratory failure due to COVID-19 pneumonia as well as AE of COPD exacerbation and small right-sided pulmonary embolism (likely secondary to COVID-19). As of today (8/31/21), patient is still admitted in the inpatient med/surg setting.


VAERS ID: 1659946 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
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 / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac flutter, Chest discomfort, Fall, Fear, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Tachyarrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: The evening after my shot I had a deep flutter of the heart while lying down to go to sleep. It was a scary feeling so I took notice of any other abnormalities but nothing else occurred that night. The next morning as I was preparing to get up I felt like I almost fell over to my left side and it felt like I lost conscience very briefly because I started falling over (to the left). I paused to focus and proceeded slowly getting up. Nothing else happened that day. It?s A few days later and I notice some chest heaviness. I keep taking deep breaths and and drinking water.


VAERS ID: 1660122 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
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 020F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oral herpes
SMQs:, Oropharyngeal infections (narrow), 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: UNKNOWN
Current Illness: NON
Preexisting Conditions:
Allergies: UNKNOWN
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient said she developed cold sores within hours of vaccination


VAERS ID: 1660322 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-20
Onset:2021-08-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Axillary pain, Fatigue, Flank pain, Injection site reaction, Musculoskeletal pain, Pain in extremity, Rash erythematous, Rash pruritic, Skin indentation, Skin swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On the 20th in the evening it had gradiated to extreme fatigue. The 26th I got pain in my right armpit. Over a few days, 3 or 4, it seemed to travel up my under arm. Then 8 days in, the 27th, I got an oval red itchy rash at injection site for about 3 days, then on the 29th and 30th, my bottom and the sides and small amount down the back of legs started hurting really bad. Felt like bruises sometimes and sometimes like hurting skin from flu, the skin seemed a bit swollen and made indentations easy from normal sleep patterns in blankets. Not sure what else might come next....


VAERS ID: 1661007 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-08-26
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1085029 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (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: BNT 162
Current Illness: Cancer
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210826; Test Name: Antibody test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210860500

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned a 63 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: cancer. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1085029 expiry: UNKNOWN) dose was not reported, 1 total administered to left arm on 14-MAR-2021 for prophylactic vaccination. Concomitant medications included bnt 162 for prophylactic vaccination. On 26-AUG-2021, he did an antibody test and it was negative test (confirmed immunological vaccine failure). After received the vaccine he had no side effects at all. The patient''s arm was not even hurting from the injection. He could not even tell which arm he got the vaccine. He drove for a couple of hours to get the vaccine and on his way back he drank a couple of bottles of electrolytes as he was advised that this will help after getting the vaccine. The patient''s doctor suggested to get another shot of Pfizer Covid-19 vaccine which he received on August 26th, 2021. The patient was not on any other medications other than OTC pain killers and vitamins. Laboratory data included: Antibody test (NR: not provided) Negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with a product quality complaint: 90000191530. This case, from the same reporter is linked to 20210860607 and 20210860781.; Sender''s Comments: V0; 20210860500-COVID-19 VACCINE AD26.COV2.S-Confirmed Immunological Vaccination Failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1662041 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthma, Chest discomfort, Chest pain
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: flared up of asthma-Medium, Additional Details: Resulted in visit to MD for albuterol inhaler due to more flare ups of asthma symptoms. Also experiencing chest tightness and has received orders for labs for troponin levels to rule out possible myocarditis.


VAERS ID: 1662056 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 RA / IM

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

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

Write-up: PATIENT UNDER 18 RECEIVED MODERNA, WHICH IS ONLY INDICATED FOR 18 AND OLDER. PATIENT DID NOT HAVE ANY ADVERSE REACTION.


VAERS ID: 1662276 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Balance disorder, Chest X-ray, Computerised tomogram head, Dizziness, Headache, Laboratory test, Nodule, Pruritus, Skin burning sensation, Syncope, Tinnitus, Urticaria
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol HCTZ Losartan Sertraline Diclofenac Glucosamine chondroitin Benadryl prn Melatonin prn Tylenol prn
Current Illness: Left hip injury from fall April 17
Preexisting Conditions: Chronic HTN managed well with medication
Allergies: No known allergies
Diagnostic Lab Data: Labs drawn in ER on 8/28 CT scan of head, CXR
CDC Split Type:

Write-up: 8/26, Generalized itching, hives, knots in face and neck, skin burning 8/27 Continued itching, headache, tinnitus 8/28 Syncope, weakness, headache, dizziness, loss of balance, tinnitus, joint pain As of today''s date 9/1, continued tinnitus, joint pain, weakness, headache


VAERS ID: 1662316 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Life Threatening? Yes
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal vitamins, Vitamin D and Levothyroxine
Current Illness: NO
Preexisting Conditions: no
Allergies: NO
Diagnostic Lab Data: NO
CDC Split Type:

Write-up: Only able to get pregnant through IVF/FET. I received the vaccine at 11 weeks pregnant. And the next day I was bleeding and miscarried.


VAERS ID: 1662423 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Headache, Hypoaesthesia, Multiple sclerosis, Muscular weakness, Nausea, New daily persistent headache, Pain, Pain in extremity, Pyrexia, Swelling, Vision blurred, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (broad), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow), 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: covid 19 moderna Feb 2021.
Other Medications: vitamin D3, ferrous sulfate, depo-provera, Baclofen, Relpax prn, selenium, Tumeric
Current Illness: Multiple Sclerosis, Migraine
Preexisting Conditions: Multiple Sclerosis, Migraine
Allergies: Tecfidera
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Onset of nausea, vomiting, headache 15 min after the shot. Then approximately 4 to 6 hours after shot had right leg weakness, pain and shooting pain numbness. She had fever of 101 day 2. Through Day 5 continued with nausea and headache but vomiting subsided. The pain, numbness has improved also after 2 to 3 days of medrol dose pack of steroids through neurology. Swelling under arm to axilla per patient by day 2 was baseball size and now decreased to < golf ball size. Patient contacted neurology after shot and she was treated for MS flare. She also reports now in retrospect after Dose #1 of covid 19 vaccine had headache, nausea, fever for several days after shot and then on Day #14 had eye blurriness she treated with medrol dose pack and sxs subsided. But she reports ongoing daily headache since her intial covid 19 vaccine. She has been followed by her neurologist for above.


VAERS ID: 1662443 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / SYR

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

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

Write-up: 34wk 4d pregnant at time of shot. Experienced mild fatigue and malaise day after shot. Three days after shot developed sciatica on right side. Likely pregnancy induced. Not yet resolved.


VAERS ID: 1662491 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Yellow skin
SMQs:, Cholestasis and jaundice of hepatic origin (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Red eyes, swollen lips within 24hr safter dose, 45yrs old , done 2013, unknown brand
Other Medications: None
Current Illness: Thrombocytopenia
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None at this time 9/1/2021
CDC Split Type:

Write-up: Right and left palms of hand yellow under the skin. Right and left top of hand yellow under skin. Underside of Right and left wrist yellow under skin. As of 9/1/2021 symptoms seem to be subsiding but not completely. No treatment as of yet.


VAERS ID: 1662512 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-20
Onset:2021-08-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash
SMQs:, 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: A 46 year old female patient received the first COVID-19 vaccine on August 20,2021. On August 26, 2021, itchiness developed at the injection site. The next day, on August 27, 2021, a rash developed. The rash was approximately 5 inches long and 3-4 inches wide. The patient used topical Benadryl to treat the itching. The patient did not notify a primary care provider. The pharmacist recommended oral antihistamines and to continue to monitor symptoms and notify primary care physician at patient''s discretion.


VAERS ID: 1662668 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-14
Onset:2021-08-26
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Dyspnoea, Headache, Infusion, SARS-CoV-2 test positive, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro, Coreg, Carafate, Prevacid, ASA, Vit B-12, Docusate,
Current Illness: Depression, acid reflux noted at PCP visit 1/11/21
Preexisting Conditions:
Allergies: Latex, adhesive tape
Diagnostic Lab Data: Positive COVID-19 PCR on 8/30/21
CDC Split Type:

Write-up: Patient vaccinated in Feb/Mar and in August 2021, developed suspected upper respiratory tract infection around 8/26/21 manifesting as headache initially progressing to cough and shortness of breath with no fever. On 8/29/21, patient noted loss of taste/smell and reached out to PCP for COVID screening. Positive PCR result from test 8/30/21 and patient reported worsening shortness of breath and cough with no fever, leading to infusion on 9/1/21 of REGEN-COV. This is reported on 9/1/21 and no future information is known at this time.


VAERS ID: 1662778 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-31
Onset:2021-08-26
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Anaemia, Anaemia of chronic disease, Anxiety, Asymptomatic COVID-19, End stage renal disease, Haemoglobin decreased, Renal impairment, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Retroperitoneal fibrosis (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Contains critical data CORONAVIRUS (COVID 19) PCR - Asymptomatic, No Close Contact Exposure, or Screening Only Status: Final result Specimen Information: NASOPHARYNGEAL SWAB 0 Result Notes Ref Range & Units 8/26/21 2104 CORONAVIRUS SARS COV 2 PCR (RESP) POSITIVE Panic
CDC Split Type:

Write-up: Admission Date: 8/26/2021 Pending issues/labs/tests: CBC, BMP and INR in 2 days. Admission Diagnoses: Anemia [D64.9] Anemia of chronic disease [D63.8] Renal dysfunction [N28.9] Discharge Diagnoses/Hospital course: Patient is a 72-year-old male who was hospitalized for anemia the anemia is progressive decline I will continue to follo On 8/26/2021 4:53 PM. The patient hemoglobin did trend down on 2 days prior to discharge however the patient''s hemoglobin has remained stable on the day of discharge compared to yesterday. The patient is very anxious to be discharged home. Patient will have to quarantine 11 days from 8/26- (September 7 is the day that quarantine ends.) ASSESSMENT/PLAN: Acute issues: Acute on chronic anemia most likely anemia of chronic disease/end-stage renal disease POA -status post 1 packed red blood cell unit. Hemoglobin is trending down today did discuss possibility of being discharged tomorrow. Chronic kidney disease stage V POA -nephrology consulted I do not see any urgent need for dialysis at this time but appreciate assistance. Asymptomatic Covid positive -patient is not on oxygen he was satting 100% on 2 L and was subsequently weaned off. DVT prophylaxis - none Other medical issues: Chronic systolic heart failure, permanent atrial fibrillation, hypertension, COPD, hyperlipidemia and protein calorie malnutrition


VAERS ID: 1662845 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none reported
Current Illness: no illnesses prior to vaccination
Preexisting Conditions: none reported
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB, chest pain, chest tightness


VAERS ID: 1662973 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Throat irritation, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: oxaliplatin infusion 8/26 1200-1400 5-Hydroxytryptophan (5-HTP OR) acetaminophen 500 MG tablet albuterol HFA (Ventolin HFA) 108 (90 Base) MCG/ACT inhaler ALBUTEROL IN Boswellia-Glucosamine-Vit D (OSTEO BI-FLEX ONE PER DAY OR) capecitabine
Current Illness: Stage III Colon Cancer
Preexisting Conditions: GERD Arthritis Asthma IBS Hypertension
Allergies: Wheat Bran Codeine Azithromycin Milk Protein Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt was given her 3rd dose of the pfizer vaccine early in her treatment day, before infusion began. Completed full infusion (2hrs) w/o incident. After infusion completed, PICC line dressing was changed and pt went to the restroom. Upon returning to the room (approx 30 min after completion of infusion), pt c/o SOB, scratchy throat and RN could hear audible wheezing. HR 79, BP 153/113 O2 in low 90s. O2 2L applied. Given 25mg diphenhydramine, 4mg dexamthosone, and an albuterol nebulizer treatment per covering provider orders. VS returned to baseline within 30 min, O2 weaned off. pt monitored in clinic for 1hr, discharged home in the company of friend/family member. Nurse coordinator checked in with patient the next morning, no further trouble breathing overnight. Covering provider felt symptoms were most consistent with reaction to oxaliplatin infusion, but reported to VAERS per clinic protocol.


VAERS ID: 1663152 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Product preparation error, Product preparation issue, Skin irritation
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium 500 Mg, Vitamin D-3 1000 Unit, Tamoxifen Citrate 20 Mg, Atorvastatin Calcium 20 Mg, Lisinopril 20 Mg, Metformin HCl ER 750 Mg
Current Illness: N/A
Preexisting Conditions: Diabetes
Allergies: N.K.D.A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Medical Assistant administered an un-reconstituted dose of vaccine to patient. Provider and patient were made aware of the situation. Patient was called on 8/27/2021, patient stated she is feeling fine and denies fevers, dizziness, SOB, N/V, chest pain, or any other complications. Patient only stated she had a sore arm. Patient was called again on 08/30/2021, patient stated she is feeling good with no issues. Her arm was no longer hurting or irritated.


VAERS ID: 1663221 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Blood test, Chest X-ray, Dry mouth, Dyspnoea, Electrocardiogram, Heart rate increased, Hyperhidrosis, Rash macular, Tremor
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline; Doxycycline; Singulair; Allegra
Current Illness:
Preexisting Conditions:
Allergies: Allergy Shot Anaphylaxis; Penicillin; Stone fruit; Seasonal Allergies
Diagnostic Lab Data: Chest X-Ray Blood Work EKG
CDC Split Type: vsafe

Write-up: I started to have a dry mouth and high heart rate within a few minutes of the vaccine. I then started to sweat and shake profusely, and I had splotchy skin on my arms and legs. I was given Epinephrine and I went to the Hospital by ambulance. I was treated and released that day. The next evening I was having difficulty breathing and I used my inhaler and it cleared it up. The following day I had difficulty breathing again but my inhaler did not work. I went to the Emergency Room. I was treated with IV Steroids, and I am taking a prescription for Prednisone. It has been four days since my Asthma attack and I feel better but I am still shaky.


VAERS ID: 1663226 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F108448 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Cough, Immediate post-injection reaction, Injection site erythema, Injection site mass, Injection site pain, Injection site reaction, Injection site swelling, Rash
SMQs:, Anaphylactic reaction (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness:
Preexisting Conditions: Asthma, Hypothyroidism
Allergies: Peanuts, Walnuts, Almonds and almond oil, Cashews, Pistachios, Navy beans, Sesame seeds, Scallops, Pecans, Grass, Dogs, Mold
Diagnostic Lab Data: None yet. Made an appointment with Cardiologist for September 15, 2021.
CDC Split Type:

Write-up: Reaction at injection site characterized by formation of a hard lump, redness, swelling and pain at injection site immediately after vaccine administration. Later developed a rash, cough and chest tightness. Now am experiencing intermittent chest pain.


VAERS ID: 1663389 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Loss of personal independence in daily activities, Malaise, Mobility decreased, Walking aid user
SMQs:, Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (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: 2019
Other Medications: dofetilide warfarin tamsulosin simvistatin levothroxine mirtazipine magnesim calcium B12 D3
Current Illness: Had dental procedure done on 08/25 2021 two extractions
Preexisting Conditions: none
Allergies: NONE
Diagnostic Lab Data: none the next day I was very tired, couldn''t do anything until Mon am felt like a little walk. Tues. felt better, Wed back to normal self. I thought, on the nite of the 25/26 that I was dying, I feel lucky to be alive. I might report that in 2019 I took the larger flu shot and had a very similar experience plus regurgitating everything that i had inmy stomach
CDC Split Type:

Write-up: by 3pm was in bed feeling weak and tired. Tried to get out of bed @ 5pm and could not. Called my wife and she was able to get me up. Returned to bed with aid of walker and was there for nest 12 houre This was the 3rd or booster shot as my immune system is weak and I was a prime patient for the booster


VAERS ID: 1663404 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aggression, Anxiety, Fatigue, Feeling abnormal, Injection site pain, Mood altered, Stress, Thinking abnormal
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu shot 2010
Other Medications: no
Current Illness: no
Preexisting Conditions: Raynauds
Allergies: no
Diagnostic Lab Data: haven''t been yet. hoping it will all subside.
CDC Split Type:

Write-up: Soreness in place of shot. Headaches. Unable to think clearly...ie fuzzy headed. I am at one week tomarrow and feel as though I''m going thru menapause all over again. I''m moody, mean, argumentive, can''t think clearly, tired, stress(anxiety)...foggy doing and saying things that are not normal.


VAERS ID: 1663416 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-15
Onset:2021-08-26
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Fatigue, Pain, Respiratory tract congestion
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: moderate symptoms experienced- body aches, fatigue, cough, congestion starting 8/26/21. Has not seeked medical care. Still with symptoms 9/1/21


VAERS ID: 1663792 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-15
Onset:2021-08-26
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Hypotension, Knee arthroplasty, Lethargy, Osteoarthritis, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (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? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 MG tablet aripiprazole (ABILIFY) 30 MG tablet aspirin EC 81 MG enteric coated tablet atenolol (TENORMIN) 50 MG tablet atorvastatin (LIPITOR) 40 MG tablet Blood Pressure Monitoring (BLOOD PRESSURE CUFF) MISC diazePAM (
Current Illness: 08/23/2021 she underwent a right total knee arthroplasty.
Preexisting Conditions: Hypercholesteremia Dissection, vertebral artery (HCC) Suicidal behavior Severe major depression, single episode (HCC) Chronic migraine without aura, with intractable migraine, so stated, with status migrainosus Possible Nummular headache Osteoarthritis of left knee Essential hypertension, benign Chronic schizophrenic (HCC) GERD (gastroesophageal reflux disease) Renal insufficiency Anxiety Osteoarthritis of right knee CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Obesity Tachycardia Primary osteoarthritis of right knee
Allergies: Oxycodone - hallucinations Amoxicillin - other
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found to be COVID-19 positive during hospital admission (patient fully vaccinated) Admission Date: 8/23/2021 Discharge Date: 08/27/2021 Hospitalization - 8.23.21 - Active Hospital Problems Diagnosis Date Noted POA ? Primary osteoarthritis of right knee 08/23/2021 No DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Primary osteoarthritis of right knee [M17.11] HOSPITAL COURSE: Was admitted to the Hospital 08/23/2021. She underwent a right total knee arthroplasty. After short stay in PACU and she was transferred to the floor. She is placed on appropriate antibiotics was DVT prophylaxis. PT and OT rest evaluate see patient postop day 1. To begin weight-bearing as tolerated. Patient postoperatively was very lethargic and had low blood pressure possibly secondary to her psychotropic drugs. She did continue to improve and was finally discharged home on 08/27/2021. She will continue weight-bearing as tolerated lower extremity. She will follow up in the office in 2 weeks for re-x-ray and re-evaluation lower extremity. She was called in or prescription for pain medication. She will change her aspirin to 2 times a day of an 81 mg. She will re-initiate her home medication as prior to surgery. Visiting therapy and nurse have been set up to follow up outpatient. It is of note that patient did have a positive COVID test with a subsequent negative follow-up test performed. Prognosis for patient is guarded.


VAERS ID: 1665400 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-26
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Feeling abnormal, Influenza like illness, Insomnia, Nausea, Respiratory rate, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient had no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210827; Test Name: Body temperature; Result Unstructured Data: 101 F; Test Date: 20210827; Test Name: Respiratory rate; Result Unstructured Data: between 14-18; Test Date: 20210827; Test Name: Body temperature; Result Unstructured Data: up to 102 F
CDC Split Type: USJNJFOC20210856157

Write-up: EXTREME FLU LIKE SYMPTOMS (FEVER); SHAKINESS; NAUSEA; INSOMNIA; FEELING BAD; This spontaneous report received from a patient concerned a 25 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: Patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, expiry: UNKNOWN) dose was not reported, administered on 26-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On AUG-2021, treatment medications included: paracetamol. On 26-AUG-2021, the patient experienced insomnia. On 26-AUG-2021, the patient experienced feeling bad. On 27-AUG-2021, the patient experienced extreme flu like symptoms (fever). On 27-AUG-2021, the patient experienced shakiness. On 27-AUG-2021, the patient experienced nausea. Laboratory data included: Body temperature (NR: not provided) 101 F, up to 102 F, and Respiratory rate (NR: not provided) between 14-18. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from extreme flu like symptoms (fever), and shakiness, and the outcome of nausea, insomnia and feeling bad was not reported. This report was non-serious.


VAERS ID: 1665418 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-26
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling cold, Headache, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210857345

Write-up: BODY PAINING/BODY ACHE; FEELING VERY COLD; HEADACHE; This spontaneous report received from a consumer via a company representative concerned a 23 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 26-AUG-2021 11:00 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 26-AUG-2021, the patient experienced feeling very cold. On 26-AUG-2021, the patient experienced body paining/body ache. On 26-AUG-2021, the patient experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, feeling very cold, and body paining/body ache. This report was non-serious.


VAERS ID: 1665452 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-08-26
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ENALAPRIL; HCTZ; LEVOTHYROXINE; ALLOPURINOL
Current Illness: Abstains from alcohol; Blood pressure; Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210826; Test Name: SARS-CoV-2 IgG antibody test; Result Unstructured Data: negative; Comments: does not give numerical results.
CDC Split Type: USJNJFOC20210900292

Write-up: This spontaneous report received from a health care professional (Nurse) concerned a 59 year old white and unknown ethnicity of male. The patient''s weight was 290 pounds, and height was 75 inches. The patient''s concurrent conditions included: non alcohol user, non smoker, and blood pressure, and other pre-existing medical conditions included: The patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: 1805025, expiry: UNKNOWN) dose was not reported, 1 total administered on 17-MAR-2021 for prophylactic vaccination. Concomitant medications included allopurinol 300 mg, enalapril 20mg, hydrochlorothiazide 25mg, and levothyroxine100mcg once a day. On 26-AUG-2021, the patient''s blood sample was collected. 30-AUG-2021, the laboratory test results received for SARS-CoV-2 IgG antibody test (SARs Covid - IgG spike test (does not give numerical results) -semi QN test) was found to be negative (units unspecified) which was concluded as confirmed immunological vaccine failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with a product quality complaint: 90000191666.; Sender''s Comments: V0:20210900292-COVID-19 VACCINE AD26.COV2.S- Confirmed immunological vaccine failure- This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.


VAERS ID: 1665721 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Hearing impairment (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish Oil, Aloe Vera gel pills, Probiotic pill
Current Illness: None known
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: Within a few minutes after the shot I experienced lightheadedness/dizziness & an overall weird feeling in my whole body. By mid afternoon I was certain that I had ringing in both ears. To date I continue to have constant ringing in both of my ears. I did not have this before the vaccine.


VAERS ID: 1666066 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-17
Onset:2021-08-26
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Blood fibrinogen normal, COVID-19, Fibrin D dimer increased, Immune thrombocytopenia, Platelet count decreased, SARS-CoV-2 test positive
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), 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: COVID-19 confirmed via PCR in Iran on approximately 7/12/21, negative result (unknown test, unknown date) since that time, but again positive via PCR on 8/26/21
Preexisting Conditions: T2DM, HTN
Allergies:
Diagnostic Lab Data: Platelet counts: 8/26 - 3 8/27 - 1 8/28 - 5 8/29 - 44 8/26 Ddimer - 1220 Fibrinogen - 261 aPTT - 25.1 (usual range 21-31)
CDC Split Type:

Write-up: ITP per heme/onc provider. Received dexamethasone 40 mg po daily x4 doses from 8/26 to 8/29


VAERS ID: 1666119 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1) Lumigan Opth Soln 7.5ml0.01% - One drop each eye once a day 2) Losartan Tabs 25mg ? Once a day 3) Hydrochlorothiazide Tabs 12.5mg ? Once a day 4) Omeprazole Dr Caps 40mg ? Once a day 5) Atorvastatin Tabs10mg ? Once a day
Current Illness: None
Preexisting Conditions: HBP, gastro-reflux
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/26/21: At 23 hours, general tiredness; fever of 101.3; fever dissipated in 8 hours 8/28/21: At 60 hours; severe night sweats


VAERS ID: 1666274 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

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

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

Write-up: Client received #1 Pfizer on 8-26-21 at clinic. He stated and completed form stating that he had not received any other Covid vaccine. Upon entering in at a later time it was discovered he had received the Janssen vaccine prior on 5-18-21.


VAERS ID: 1666296 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

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

Write-up: Rash


VAERS ID: 1666321 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-08-26
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, SARS-CoV-2 test positive
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet Ascorbic Acid (VITAMIN C PO) aspirin 81 MG chewable tablet atorvastatin (LIPITOR) 40 MG tablet azaTHIOprine (IMURAN) 50 MG tablet carvedilol (COREG) 6.25 MG tablet cholecalciferol (VITAMIN D3) 50 MCG (2
Current Illness: Found to be COVID-19 positive on 8.25.21 (fully vaccinated) - him and wife positive Sinusitis
Preexisting Conditions: AVR 23 Stentless Freestyle Aortic stenosis CAD (coronary artery disease) S/P 5 v CABG 1998 Kidney Transplant Hypertension Dyslipidemia Balance problem Acute on chronic diastolic congestive heart failure (HCC) Hypothyroidism Anxiety Incarcerated incisional hernia Atrial flutter (HCC) NSVT (nonsustained ventricular tachycardia) (HCC) Hypertensive urgency Acute on chronic anemia GI bleed Anemia in CKD (chronic kidney disease) Cardiac failure (HCC) Chronic gout without tophus Acute on chronic diastolic heart failure due to valvular disease (HCC) ESRD needing dialysis (HCC)
Allergies: Propoxyphene N-apap Hives Amlodipine Besy-benazepril Hcl Other Avapro [Irbesartan] Rash Darvocet [Acetaminophen] Doxycycline Diarrhea Hydrocodone-acetaminophen GI Upset Lisinopril Norvasc [Amlodipine] Fatigue Phenyleph-chlorphen-hydrocod Agitation Procardia [Nifedipine] Other, Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (after being fully vaccinated - him and wife) Admission Date: 8/27/2021 Admitting Diagnoses: Principal Problem: ESRD needing dialysis (HCC) COVID-19 infection Active Problems: Aortic stenosis CAD (coronary artery disease) S/P 5 v CABG 1998 Kidney Transplant Hypertension Dyslipidemia Hypothyroidism Chronic gout without tophus Details of Hospital Stay PRESENTING PROBLEM: ESRD needing dialysis (HCC) HOSPITAL COURSE: 8-year-old male with end-stage renal disease on hemodialysis, renal transplant. Patient tested positive for COVID on 08/26 and was unable to dialyze on that day because his schedule had to be switch from T THS to MWF because of his COVID. The next day, he also missed his dialysis because of diarrhea from COVID. He therefore presented to the emergency department to have dialysis done. He did not have any hypoxia on admission. He underwent dialysis today and was uneventful. Patient was discharged home. Patient was advised that he is on day 8 of his COVID illness and is therefore still at risk of developing COVID pneumonia and hypoxia. Patient is the primary caretaker of his wife who has dementia and also has COVID. Patient was advised to make arrangements to care for his wife in case he needs to be admitted for COVID pneumonia. He was advised to watch out for shortness of breath. Dialysis nurse will checked his oxygen saturation on Monday, 8/30, during his dialysis session.


VAERS ID: 1666354 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-06
Onset:2021-08-26
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, 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: Covid positive due to house member testing positive


VAERS ID: 1666355 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-08-26
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Decreased appetite, Dyspnoea, Fibrin D dimer increased, Haemodialysis, Lung infiltration, Platelet count decreased, Productive cough, Pyrexia, SARS-CoV-2 test positive, Thrombocytopenia
SMQs:, Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), 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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet aspirin EC 81 MG enteric coated tablet atorvastatin (LIPITOR) 40 MG tablet benzonatate (TESSALON) 100 MG capsule carvedilol (COREG) 25 MG tablet dexamethasone (DECADRON) 6 MG tablet diphenhydrAMINE-Zinc
Current Illness: Cough -- $g found to be COVID-19 positive 8.26.21 Multiple hospital admissions: ESRD; dialysis; hyperkalemia; SOB; leg / facial swelling; uremia
Preexisting Conditions: Anemia of chronic disease ESRD needing dialysis (HCC) Hypertension Hyperlipidemia Monoclonal gammopathy of unknown significance Non-proliferative diabetic retinopathy, severe, both eyes (HCC) Stage 5 chronic kidney disease on chronic dialysis (HCC) Daytime sleepiness Subepithelial esophageal mass Cardiac pacemaker in situ Dependence on renal dialysis (HCC) Right kidney mass End stage renal failure on dialysis (HCC) ESRD (end stage renal disease) on dialysis (HCC) ESRD on hemodialysis (HCC) Peripheral neuropathy Renal mass Chronic heart failure with preserved ejection fraction (HCC) Coronary artery disease Diabetes mellitus type 2, insulin dependent (HCC) Acute respiratory failure (HCC) ESRD needing dialysis (HCC) Counseling regarding advance care planning and goals of care Clear cell carcinoma of right kidney (HCC) Appendicitis ESRD needing dialysis (HCC) Debility Other constipation Goals of care, counseling/discussion ESRD needing dialysis (HCC) Pneumonia due to COVID-19 virus
Allergies: Captopril Swelling, Angioedema, Throat swelling Penicillins Hives Adhesive Tape Rash Norco [Hydrocodone]
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (8.26.21) - after being fully vaccinated Admission Date: 8/26/2021 Discharge Date: 8/30/2021 Active Hospital Problems Diagnosis Date Noted POA ? Pneumonia due to COVID-19 virus 08/26/2021 Yes ? ESRD (end stage renal disease) on dialysis (HCC) 07/31/2019 Yes HOSPITAL COURSE: 68 year old man with hx of CAD, pacemaker in place, NIDDM2, HTN, ESRD on HD on compassionate dialysis program. He was dialyzed on 8/23/21 and felt well. Developed cough, sputum, shortness of breath over the past 3 days. He developed a fever. Denied any weight gain or pedal edema or chest pain. His appetite has been down. He presented to the ER on 8/26/21. In the ER, he had a fever 38, 76 bpm, 95% on RA, CXR showed bilateral infiltrates, COVID PCR was positive. He will be admitted for further treatment of COVID pneumonia. CRP 64.6. D-dimer 1130. He is previously vaccinated, Pfizer COVID-19 vaccine: 3/18/2021, 2/23/2021. He was started on Decadron 6 mg po daily and received 5 doses, he needs 5 more days. Should stay in isolation until he finish Decadron 6 mg daily. He was evaluated by the dr. and was found to needs 2 l/m at all times. Airway Oxygen will deliver portable tank to room for DC home. ESRD on hemodialysis, he had 2 hemodialysis while in hospital. Should continue compassionate hemodialysis as before. He had mild thrombocytopenia with Plt. Count of 110 at discharge. PCP to follow.


VAERS ID: 1666396 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2020-12-30
Onset:2021-08-26
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia
SMQs:, Infective pneumonia (narrow), 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptomatic COVID infection, COVID pneumonia, hospitalized for IV antibiotics and breathing treatments.


VAERS ID: 1666420 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / UNK LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Nurse at facility gave dose to this staff member from a vial that had never been used and only contained 4 doses.


VAERS ID: 1666441 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / UNK RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Staff member received one of 4 doses that came out of a 10 dose vial.


VAERS ID: 1666462 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Resident received one dose of four doses that were given out of a 10 dose vial. Vial was short 6 doses. Vial was dispensed from pharmacy with vial top securely in place.


VAERS ID: 1666466 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-26
Onset:2021-08-26
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

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

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

Write-up: positive covid-19 test on 8/26/2021


VAERS ID: 1666475 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / UNK RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Resident received one of 4 doses that came out of a 10 dose vial. Reported to VAERS via phone and the representative asked that I report through this reporting tool.


VAERS ID: 1666523 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Flushing, Interchange of vaccine products, Palpitations, Pharyngeal swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations: Moderna - similar reaction
Other Medications: Took pepcid and zyrtec night before.. Took benadryl 15 minutes before.
Current Illness: none
Preexisting Conditions: asthma, allergies
Allergies: Moderna and J&J vaccine
Diagnostic Lab Data: No tests. Seen in urgent care the following Monday.
CDC Split Type:

Write-up: Six minutes in I felt flushing and heart pounding and some swelling in my throat. I had pre-medicated with benadryl so I took another one. The heart pounding eased in just a minute or two and also the flushing. I had had an allergic reaction to Moderna January 7th , so thought I was ok to just go home and take the same meds the ER had given me in January. I called my doctor''s office the next day to get more prednisone.


VAERS ID: 1666695 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-21
Onset:2021-08-26
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 - / -

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

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

Write-up: Itchy rash on chest and stomach, spreads to arms turning a purplish color.


VAERS ID: 1666703 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute cardiac event, Acute myocardial infarction, Bundle branch block right, Dyspnoea, Electrocardiogram ST segment abnormal, Implantable defibrillator insertion, Intensive care, Mechanical ventilation, Resuscitation, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Conduction defects (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Respiratory failure (broad)

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

Write-up: Patient received vaccination on 08/25. on 08/26 patient developed SOB with witnessed cardiac event. CPR start immediately, found to be in v fib. single shock administered and 1 round of epi. ROSC. ekg showed St changes with RBBB. NSTEMI, pt transferred to ICU and placed on vent. Ultimately patient transferred to outside hospital for placement of AICD.


VAERS ID: 1666724 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-07
Onset:2021-08-26
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anosmia, COVID-19, Chills, Exposure to SARS-CoV-2, Fatigue, Headache, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/10/21 2nd dose02/07/21 Diagnosed covid positive:08/26/21 Symptom onset:08/26/21 Exposure:Travel Symptoms:Fever, fatigue, loss of smell, chills, runny nose,headache, congestion.


VAERS ID: 1666726 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-12
Onset:2021-08-26
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, Headache, 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose12/23/21 2nd dose01/12/21 Diagnosed covid positive:08/26/21 Symptom onset:08/26/21 Exposure:community Symptoms:Headache.


VAERS ID: 1666897 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Paraesthesia, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetirizine 10mg Lisinopril 5mg Omeprazole 20mg Womens one a day multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Iodine Ciprofloxacin Levaquin Naproxen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Feeling faint (5 minutes) Tingling of left arm and face (60 minutes) Slight swelling in throat but not severe. (10 minutes)


VAERS ID: 1667116 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-13
Onset:2021-08-26
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB, Blood creatine phosphokinase increased, Cardiac dysfunction, Conduction disorder, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram abnormal, Headache, Immunoglobulin therapy, Inflammatory marker increased, Myocarditis, N-terminal prohormone brain natriuretic peptide increased, Pain, Troponin I increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: unknown
Preexisting Conditions: history of Kikuchi Disease. Obesity
Allergies: none
Diagnostic Lab Data: EKG significant for ST elevations, mild interventricular conduction delay, and PR depressions. Maximum lab values as follows: Troponin I 20/98, CK 1,258, CK-MB, 79.5, pro-BNP 655. Echo demonstrating reduced function with EF of 38%.
CDC Split Type:

Write-up: Patient was admitted for myocarditis on 8/29/21 with diffuse ST changes on EKG and elevated inflammatory markers. It is unclear if this event was related to vaccination as it was several months removed from the second shot it the series. there was significant heart dysfunction on echo with EF of 38%. Heart function quickly recovered to normal EF of 63% 3 days later after having support with milrinone and enalapril. Patient also received IVIG. the quick improvement of function fits more with vaccine related myocarditis as opposed to viral myocarditis. Infectious workup negative to date. Possible viral trigger with symptoms of headache and body aches for 3 days before presentation. Unclear at this time whether vaccine related or from an unknown viral etiology.


VAERS ID: 1667129 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Swollen tongue, Tongue pruritus
SMQs:, Anaphylactic reaction (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: 15 minutes after getting vaccinated patient stated that her tongue felt itchy. I ask if she felt anything else , she said it''s itchy and she may felt a little swollen tongue. I ask patient to wait another 15 minutes and let me know if she needed emergency service. In about ten minutes she told one of our tech she would like emergency service. I call 911 and was referred to paramedic line. They told me to watch patient and have Epipen ready. When ems arrive she said her daughter also felt itchy tongue. I let EMS take care of patient. After close at 7 pm. I made a call to follow up and patient said she was ok


VAERS ID: 1667142 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia oral, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received 2nd dose of Pfizer Covid-19 Vaccine; Pt was advised to stay for 15 after dose due to not having any previous hx of anaphylaxis. about 10 min after vaccine administration pt c/o itchiness in throat and tingling sensation on lips. Rapid Response was called. VSS BP: 127/68 HR 96 SPO2 98%. Rn administered Benadryl per Dr order. Pt was given precautions per RN and left clinic with steady gait, a&o and with no other s/s.


VAERS ID: 1667369 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tongue pruritus
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: 15 minutes after getting vaccinated patient stated that her tongue felt itchy . I ask if she felt anything else she said it felt itchy and maybe swollen. I ask if she can breathe. She said she can. I told her to wait 15 more minutes and let me know if I should call EMS. In about 10 minutes, she told the front counter technician that she needed EMS. I call 911 and was routed to paramedic. They told me to watch patient with an Epipen ready. While sitting in chair, she said she felt bump on her legs and was trying feel it and showed me . I couldn''t see anything. When EMS arrive , she said that her daughter also felt itchy tongue. After closing at 7 pm , I call patient to follow up. She said she is ok.


VAERS ID: 1667407 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Heart palpitations at random times.


VAERS ID: 1668480 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Ataxia, Balance disorder, Chills, Dizziness, Gait disturbance, Magnetic resonance imaging normal, Myalgia, Nausea, Neurological examination
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: sulfasalazine & methotrexate since May 2020 by rheumatologist
Current Illness: autoimmune inflammatory arthritis
Preexisting Conditions: h/o progressively worsening asymmetrical oligoarthritis, inflammatory back pain, found with highly elevated CRP, ESR
Allergies: NKA
Diagnostic Lab Data: in the ER, patient symptoms improved with IV hydration, Zofran and meclizine. The patient was stable for discharge to home with meclizine and zofran ODT
CDC Split Type:

Write-up: Patient completed two doses of Pfizer vaccines on 01/07/21. (first dose 12/18/20). Patient presented to community vaccine clinic on 08/26/21 around 10am. Patient stated that he is immunocompromised and met criteria for the 3rd dose. Patient received 3rd dose of Pfizer COVID-19 vaccine on 08/26/21. patient presented to emergency department on 8/28/21 with C/O dizziness, ataxia, VSS. He noted an onset of some mild muscle aches and pain, around 7 PM on 08/26/21. he felt nauseated and chill, as if his gait was off. The next day, he almost fell and felt as if his gait was substantially off. Had no recent travel or sick contact. Neurology was consulted. MRI no significant findings.


VAERS ID: 1669561 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-08-26
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Asthenia
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210857611

Write-up: FEELING WEAK; This spontaneous report received from a consumer concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 26-AUG-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 26-AUG-2021, the patient experienced feeling weak. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of feeling weak was not reported. This report was non-serious.


VAERS ID: 1670076 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-20
Onset:2021-08-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 RA / IM

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

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

Write-up: I just wanted to inform you that I have had a reaction to the Moderna vaccine, first injection, which I received on Friday, August 20, 2021. In researching, I believe my reaction is considered COVID arm as reported by other vaccine recipients as well. At 6 days post-vaccination, my right deltoid area (site of injection) became much more red than it had after initial vaccination. Additionally, the area became hot to the touch, very pruritic, along with having areas of induration under the skin. A day later, a progressive symptom is that my right shoulder joint is painful. My concern here is that the discomfort feels like it is actually within the joint capsule, not in the muscle or surrounding subcutaneous areas. I am not sure if this could be attributed to influx of immune cells, but certainly the joint feels full and painful. The research I have done indicates that symptomatic treatment of COVID arm includes Cetirizine or Benadryl, along w/ anti itch creams.


VAERS ID: 1670310 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-19
Onset:2021-08-26
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Atelectasis, COVID-19, Chest X-ray abnormal, Fatigue, General physical health deterioration, Lung opacity, Pulmonary fibrosis, Pyrexia, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Bacitracin-Polymyxin B ointment, Aricept, Vitamin D2, Pepcid, Advair Diskus, Magnesium oxide, melatonin 3mg, Fiber-Lax, Flomax, Lamisil, Detrol
Current Illness: COPD, Dementia
Preexisting Conditions: History of BPH, COPD, and Dementia. Chronic lower extremity edema, macrocytosis, chronic back pain, basal and squamous cell skin carcinomas, neuropathy.
Allergies: Adhesive Tape, Fentanyl
Diagnostic Lab Data: COVID PCR NP swab 8/26/21- Positive Chest Xray 8/26/21-Low lung volumes and elevated right and left hemidiaphragms, with linear opacities lung bases likely reflecting atelectasis or scarring. Slight progression of the right lung base when compared to previous exams
CDC Split Type:

Write-up: Patient completed COVID-19 Moderna vaccine series on 2/19/21. Lot number is not available to writer. Patient was admitted to the reporting hospital on 8/27/21 with an admitting diagnosis of Fever. Patient was reported in ER to have fatigue, fever and general recent decline. Patient comes from an assisted living facility with his wife. Admission test for COVID was positive on PCR NP Swab 8/26/21. Pt was discharged 8/27/21.


VAERS ID: 1670335 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-02
Onset:2021-08-26
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, COVID-19, COVID-19 pneumonia, Fatigue, Malaise, Productive cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pulmonary hypertension (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Azithromycin 250mg, Plavix 75mg, Norco, Magnesium, melatonin, Analgesic balm, Toprol, UriVArx, Selenex, Zocor 40mg, Vitamin D, Flonase, nitroglycerin tablets
Current Illness: Iron deficiency anemia, hip fracture
Preexisting Conditions: Coronary artery disease w/ PCI with DES to OM1, 3rd degree heart block s/p pacer aortic stenosis s/p TAVR October 2020, prostate cancer s/p radiation therapy, recent colonoscopy with post polypectomy bleeding required 4 units pRBCs
Allergies: None
Diagnostic Lab Data: COVID-19 PCR NP swab 8/26/21 Positive CT Angiography Chest 8/27/21 1. No acute or chronic pulmonary embolism. 2. Right lower lobe pneumonia
CDC Split Type:

Write-up: Patient completed Pfizer COVID-19 vaccination on 2/2/21. Lot number and site not specified in medical record. Patient was admitted to the reporting hospital on 8/26/21 with an admitting diagnosis of COVID-19 pneumonia. Patient was reported in the ER to have a productive cough, malaise, fatigue and fever. No known COVID exposure, but did come from congregate living settings. Admission test for COVID was positive per PCR NP swab on 8/26/21.


VAERS ID: 1670349 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-01
Onset:2021-08-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dysphonia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Parkinson-like events (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asthma inhaler PRN
Current Illness: none
Preexisting Conditions: asthma
Allergies: Iodine
Diagnostic Lab Data: no lab work done
CDC Split Type:

Write-up: Developed wheezing and hoarse voice after vaccine. Sent to Hospital ED for treatment. VS 36.7 90, 132/72 sat 100% room air. Received diphenhydramine, famotidine, dexamethasone and multiple (5) med nebs with ipratropium/albuterol, Discharged to home.


VAERS ID: 1670458 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

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

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

Write-up: None


VAERS ID: 1670489 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Menstrual disorder, Menstruation delayed
SMQs:, Fertility 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: Magnesium, ortho tri cyclen low
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Did not start period on expected start date. 3 days late and my cycle is very predictable. When I did start it was not my normal period. I bled very heavy on day one and then on day two almost none. This is not normal for me.


VAERS ID: 1670507 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Nausea, Swelling face, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: facial swelling, nausia, vomiting and hives. treated with steroids and zofran


VAERS ID: 1670675 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-14
Onset:2021-08-26
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       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: Positive results


VAERS ID: 1670722 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

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

Write-up: Tachycardia, 130s, X 9 days started the day after the second vaccine, non-specific EKG changes


VAERS ID: 1670737 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Large red welt on arm shot was administered to. Swollen, itchy, hard. Side effect is ongoing has not gotten better.


VAERS ID: 1670876 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site discharge, Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin XL, Azelastine, Celebrex, Voltaren topical 1% Gel, Estrodiol, Flonase, Levothyroxine, Medroxyprogesterone, Omeprazole, Rifaximin, Tramadol
Current Illness: none known
Preexisting Conditions: Hypothyroid, History Malignant Melanoma, Obesity, GERD, Gastritis,
Allergies: no know allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient states she received vaccine on 8/26/21. Later that day injection site started swelling and had a 2 inch circle around that was red, swollen and hard. Also caused pain from shoulder to elbow and arm was painful when lying on her left side. 2 days later she noted arm was still sore and itching and also noted clear liquid coming from injection site. Patient took Benadryl which helped with itching. Pt was seen in clinic today. faint bruising noted around injection site approximately 2 inches around. no tenderness to touch.


VAERS ID: 1670900 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eructation, Headache, Heart rate increased, Injection site pain, Injection site reaction, Injection site swelling, Muscle tightness, Neck pain, Night sweats, Paraesthesia, Rash, Rash erythematous, Rash pruritic, Sensory disturbance
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (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: None.
Current Illness:
Preexisting Conditions:
Allergies: I have allergies to some nuts, and fruits.
Diagnostic Lab Data: I visited the Pharmacist that gave me the injection (Thursday, Sept 2nd) and she said I could put ice on it. She speculates it was a topical reaction, and should the symptoms persist past Monday (Sept. 06) that I should go to my Dr. My Dr. recommended I go to urgent care today (Sept. 03rd), and the urgent care Dr. Prescribed Prednisone.
CDC Split Type:

Write-up: I developed a large sore rash at injection site the following day(August 25th) . It burned, itched, and was swollen. I experienced headaches, tightness I my jaw, and excessive burping. I''d go to sleep with headaches, aches in my neck, and accelerated pulse. I sweat the bed that Friday night. On that Saturday(August 28th), symptoms seemed to be going away. Around Tuesday(August 31st), the rash became bright red again, the itching and burning returned, and the site is not a raised hard knot. Last night (Friday Sept. 3rd) I felt as though I had a cut on my left hand thumb, but no cut. It now feels like a needle pricking my thumb. This sensation comes and goes.


VAERS ID: 1673424 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-24
Onset:2021-08-26
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / -

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: Test Date: 20210826; Test Name: Covid test Nasal Swab; Test Result: Positive
CDC Split Type: USPFIZER INC202101115492

Write-up: Vaccination Failure; Nasal Swab: Positive; This is a spontaneous report received from a contactable consumer(patient). A 35-year-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Left on 03Mar2021 (Lot Number: EL3247) at age of 34-year-old, dose 2 via an unspecified route of administration, administered in Arm Left on 24Mar2021 (Lot Number: EP6955) at age of 34-year-old, both as single dose for covid-19 immunisation. Medical history included Penicillin hypersensitivity. No covid prior vaccination. The patient''s concomitant medications were not reported. No other vaccine in four weeks. The patient experienced vaccination failure on 26Aug2021. No treatment received. The patient underwent lab tests and procedures which included sars-cov-2 test (Nasal Swab): positive on 26Aug2021. The outcome of events was not recovered. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1673439 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ELIQUIS; METOPROLOL
Current Illness: Anticoagulant therapy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101119226

Write-up: This is a spontaneous report from a contactable consumer (patient). A female patient of an unspecified age received first dose of bnt162b2 (BNT162B2, solution for injection), via an unspecified route of administration on 26Aug2021 (Batch/Lot number was not reported) as SINGLE for covid-19 immunization. Medical history included ongoing anticoagulant therapy from an unknown date. Concomitant medication included ongoing apixaban (ELIQUIS) and Metoprolol; both taken for blood thinner start and stop date was not provided. On 26Aug2021 after receiving the first dose of Pfizer Covid 19 Vaccine, the patient had chills, felt tired and had a little arm pain. On 26Aug2021, the patient took Ibuprofen, as a treatment. Patient scheduled for the second dose of Pfizer Covid 19 Vaccine on 16Sep2021 but was unable to make it since she was scheduled for a surgery on that day. The outcome of events was unknown. Information on the lot/batch number has been requested.


VAERS ID: 1674462 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Sinus headache
SMQs:

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

Write-up: Each evening I have a severe headache. Ibuprofen helps a little but not much. It feels like a sinus headache and hurts in the front and top of my head. I have an appointment with my PCP this Wednesday and plan to discuss with her.


VAERS ID: 1674513 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OOUFZIA / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Colitis, Computerised tomogram abdomen, Diarrhoea, Full blood count
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Dexilant, Viibryd, B12,B6,nexletol, zetia, cardizem,lasix, potassium, asa,Gabapentin, seroquel, iron, phenergan
Current Illness: None
Preexisting Conditions: HTN, CAD,elevated cholesterol, asthma,gerd,depression,hx of stroke,
Allergies: Allergies Pcn Sulfa rash Codeine Tetracycline Emycin Percocet Clindamycin Statins pain Macrobid Cefuroxime Thimerosal Cephalexin Nuts pistachio caused wheezing Not supposed to take NSAIDS d/t kidney disease
Diagnostic Lab Data: Ct scan and and pelvis and CBC and chemistries 08/31/2021
CDC Split Type:

Write-up: Severe diarrhea and admitted to hospital with colitis


VAERS ID: 1674745 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-13
Onset:2021-08-26
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Heavy menstrual bleeding, Mood swings
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen 1-2/week
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Nons
CDC Split Type:

Write-up: My monthly periods have always been 28 days apart, lasting for 4 days. Consistent like this for years, except when pregnant. After my second covid vaccine, my period lasting for twice as long, and with twice the blood loss. I had worse fatigue, mood swings, and ?brain fog? during this time as well. All very atypical for me.


VAERS ID: 1674776 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500 mg
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced tinnitus after getting the first dose of Pfizer Biontech Covid-19 vaccine


VAERS ID: 1675112 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Brain natriuretic peptide normal, Chest pain, Dyspnoea, Electrocardiogram normal, Troponin normal
SMQs:, Anaphylactic reaction (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Normal troponin, BNP and EKG. Normal physical exam.
CDC Split Type:

Write-up: chest pain, shortness of breath. normal EKG and cardiac enzymes. Started 12 hours post vaccination, lasted one week.


VAERS ID: 1675119 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest discomfort, Chest pain, Chills, Electrocardiogram normal, Fatigue, Pain, X-ray normal
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-Vitamin, Vitamin D3, Elderberry (chewable).
Current Illness: none
Preexisting Conditions: none
Allergies: Shellfish, mushrooms, mesquite, pigweed, cats
Diagnostic Lab Data: August 30, 2021 - EKG (results good), Blood Draw (results pending) August 31, 2021 - EKG (results good), Blood Draw (results good), and X-Ray (results good)
CDC Split Type:

Write-up: Fatigue, body aches, chills, chest pain, chest tightness, and chest pressure. I went to my primary care doctor for treatment on Monday, August 30, 2021 and was instructed that if the pain got worse to go to the emergency room. While at my Primary Care doctor they conducted an EKG (good) and drew my blood, results will be given on Tuesday, September 7th. On Tuesday, August 31, 2021 I went to Hospital Emergency Room because the pain became too much to take. They did an X-ray, drew blood, and did an EKG all of which came back good. They recommended me to a Cardiologist of which I will see Tuesday, September 7th as well.


VAERS ID: 1675138 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

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

Write-up: RASH ON BOTH LEGS THE DAY AFTER THE INEJCTION. WENT TO SEE MD AND PRESCRIBED FOR HYDROXYZINE AND TRIAMCINOLONE CREAM


VAERS ID: 1675164 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2020-12-29
Onset:2021-08-26
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / 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: Metformin, Lisinopril and Celexa
Current Illness: none
Preexisting Conditions: DM Hx of Breast Ca Anemia
Allergies: latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID infection, hospitalization after 8 months


VAERS ID: 1675227 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Pain, Pyrexia, Rash macular
SMQs:, 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? 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: AMOXICILLIN
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: had extreme general body aches/pain, headache, blotchy skin, chills, fever


VAERS ID: 1675286 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-23
Onset:2021-08-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling cold, Influenza like illness, Influenza virus test, Pain, Pyrexia, SARS-CoV-2 test negative, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3 (Rx) 100,000 IU daily, Ferrous Sulfate (Rx) 325 mg daily, Levothyroxin 100 mcg daily, Methotrexate 10mg 1 x per week, hydroxychloroquine 400 mg daily, Folic Acid (Rx) 10 mg daily, Align Probiotic 1 daily, Florastor Probiotic 500
Current Illness: Rheumatoid arthritis
Preexisting Conditions: Intestinal adhesions subsequent to Rouen Y Gastric Bypass 1996, 4 abdominal surgeries afterwards repairing adhesions or incisional hernias with last being 12/18/2017. Attendant problems associated with malabsorption of nutrients and bowel surgeries.
Allergies: None
Diagnostic Lab Data: 2 Covid-19 rapid tests, 1 Binax self administered and one administered at the medical clinic brand unknown. Both negative. One flu swab at clinic brand and results unknown.
CDC Split Type:

Write-up: Third day out from vaccination I awakened extremely cold and shaking. I had body aches and was running a low grade fever 100.2 I believe. I was shaking so badly I could not even make my coffee. It was almost like what I would imagine rigors to be like. I administered a Binax Rapid Covid-19 test that was negative. I had a wellness appointment scheduled for that morning at 9:30. I kept the appointment and converted into a regular office visit. I was running the same low grade temperature there as well. I was administered another rapid Covid-19 test which was negative. I was administered a flu swab but have never heard back as to whether it was positive or negative. I was told I would be treated like I had the flu. I was given a five day regimen of azythromycin or Z pack. I continued to suffer flu like symptoms but never as severe until that Saturday when I began to noticeably improve. I was able to return to work that following Monday.


VAERS ID: 1675350 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain, Lymph node pain, Lymphadenopathy, Myalgia, Nausea, Neck pain, Pain, Peripheral swelling, Pyrexia, Rash erythematous
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Patient experienced irregular menstrual bleeding following the first dose of the Covid vaccine on 07/28/2021. (Moderna IM)
Other Medications: Prenatal vitamin Progesterone only birth control
Current Illness: None
Preexisting Conditions: None
Allergies: Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine was administered on 8/25/21. I woke up on 8/26/21 with severe muscle aches and left arm injection site pain. The pain around the site of injection extended up into the neck on the left side and down to the elbow. The muscle pain was significant and progressed throughout the day. By the afternoon, I had a severe headache, nausea, exhaustion, and was running a fever. Temperature was 101.4 at 3:00 pm. I took ibuprofen 400 mg for the fever and pain at that time. On 8/27/21, the fever had resolved, but my left arm was significantly swollen from the shoulder to the elbow. A flat, red rash had appeared that covered approximately 75% of the skin on the upper arm. The muscle aches were improved, but still present. Lymph nodes in bilateral axilla were extremely swollen. They made it painful to sit with arms resting at my side. On 8/28/21, the rash and armswelling was slightly improved. The rash covered approximately 50% of the skin on the upper arm. Lymph node swelling had improved, but was still present on the left side. The nodes were still painful to any movement or touch. On 8/30/21, the lymph node swelling resolved. The rash fully resolved on 9/1/21.


VAERS ID: 1675374 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Insomnia, Palpitations, Thyroid hormones increased
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (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: thyroid medication SPM active herbal supplements
Current Illness:
Preexisting Conditions: hypothyroidism
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: The next day after the vaccination, I have been feeling heart palpitation, shortness of breath, difficulty falling asleep. This is still ongoing and has been close to 2 weeks now. In about a week, I suspected it has to do with my thyroid becoming overactive, so I decreased the dose of my thyroid medication, which has greatly alleviated the symptoms. I have yet to be able to see a doctor for the side effect. I hope it is not Myocarditis.


VAERS ID: 1675760 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Rheumatoid arthritis
SMQs:, Arthritis (narrow), Immune-mediated/autoimmune 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: 2nd Moderna shot 3-11-2021: chills, headache, fatigue. lasted 1 day.
Other Medications: Xeljanz 5mg for Rheumatoid Arthritis Xeralto 20 mg blood thinner for a-fib Lipitor 10 mg for Cholesterol Spirive inhaler 2x in am
Current Illness: none
Preexisting Conditions: Rheumatoid Arthritis, Atrital Fibrillation
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I have RA and take medication to suppress my immune system. The booster shot, boosted up my immune system and so I had a flare-up of my joints, feet,knees,hands and shoulders. I stopped my Xeralto and instead t have been taken 3 Aspirens every morning to control the inflammation of my RA. It is now for the first time today, that I woke up with out pain. so I am ok again, but did want you to know of my reaction to the booster shot.


VAERS ID: 1675768 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-08-26
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cardioversion, Fatigue, Heart rate increased, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Weakness and fatigue, heart rate over 200, cardioversion needed twice, test positve for covid on 8/26/21 after covid vaccines were given on 2/26/21 and 3/26/21


VAERS ID: 1676057 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: For approximately 24 hours I had a severe head ache and very tired. Left arm was very sore for several days.


VAERS ID: 1676479 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Persistent nose bleeds for over a week that are difficult to stop. Sometimes several in a day.


VAERS ID: 1676804 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Bacterial vaginosis, Herpes ophthalmic, Oedema peripheral, Oral herpes
SMQs:, Cardiac failure (broad), Angioedema (broad), Oropharyngeal infections (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Ocular infections (narrow), Opportunistic infections (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: sertraline, atorvastatin
Current Illness: none
Preexisting Conditions: none
Allergies: Sulfa
Diagnostic Lab Data: ER MD prescribed valtrex, ofloxin, erythromycin, flagyl
CDC Split Type:

Write-up: edematous arm from elbow to to shoulder, viral outbreak in mouth and eyes, BV


VAERS ID: 1677105 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-08-26
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210826; Test Name: COVID-19 virus test; Result Unstructured Data: Positive.
CDC Split Type: USJNJFOC20210908708

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient concerned a 54 year old white and non Hispanic or Latino female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808978, and expiry: 11-SEP-2021) dose was not reported, 1 total, administered on left arm on 31-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On 26-AUG-2021, the patient tested positive for Covid-19 (suspected covid-19 infection and suspected clinical vaccination failure) and was quarantined. Patient lost taste and was fatigued. On 05-SEP-2021, at about midnight and at 15:00, patient went to the bathroom. The patient reported no muscle pain and no bunion pain. The patient had lost taste and smell again. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected clinical vaccination failure and suspected covid-19 infection was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0:20210908708-COVID-19 VACCINE AD26.COV2.S-Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1677283 (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: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental overdose
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: Administered 1 ml instead of 0.5 ml; This spontaneous case was reported by an other health care professional and describes the occurrence of ACCIDENTAL OVERDOSE (Administered 1 ml instead of 0.5 ml) in a 55-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 26-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 ml. On 26-Aug-2021, the patient experienced ACCIDENTAL OVERDOSE (Administered 1 ml instead of 0.5 ml). On 26-Aug-2021, ACCIDENTAL OVERDOSE (Administered 1 ml instead of 0.5 ml) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant drug was not reported. Treatment medication was not reported.


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