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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 382 out of 8,010

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VAERS ID: 1677296 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-08-26
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Erythema, Flushing, Hypersensitivity, Insomnia, Off label use, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ROSUVASTATIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Hasn''t been able to sleep in the last two days; Severe allergic reaction; Body is flush; Burning sensation in her body; Body reddish; Eruption all over their body, and it moving to their groin area; Got itchiness on their body,all of their body got horrible; Doctor recommended to wait 3 month to take their second dose; This spontaneous case was reported by a consumer and describes the occurrence of HYPERSENSITIVITY (Severe allergic reaction), PRURITUS (Got itchiness on their body, all of their body got horrible), FLUSHING (Body is flush), INSOMNIA (Hasn''t been able to sleep in the last two days), BURNING SENSATION (Burning sensation in her body), ERYTHEMA (Body reddish) and RASH (Eruption all over their body, and it moving to their groin area) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 052E21A and 018B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included ROSUVASTATIN for an unknown indication. On 08-Apr-2021 at 11:00 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 25-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 26-Aug-2021, the patient experienced PRURITUS (Got itchiness on their body,all of their body got horrible) (seriousness criterion hospitalization) and OFF LABEL USE (Doctor recommended to wait 3 month to take their second dose). On 29-Aug-2021, the patient experienced FLUSHING (Body is flush) (seriousness criterion hospitalization), BURNING SENSATION (Burning sensation in her body) (seriousness criterion hospitalization), ERYTHEMA (Body reddish) (seriousness criterion hospitalization) and RASH (Eruption all over their body, and it moving to their groin area) (seriousness criterion hospitalization). On an unknown date, the patient experienced HYPERSENSITIVITY (Severe allergic reaction) (seriousness criterion hospitalization) and INSOMNIA (Hasn''t been able to sleep in the last two days) (seriousness criterion hospitalization). The patient was treated with METHYLPREDNISOLONE SODIUM SUCCINATE (METHYLPRED) on 27-Aug-2021 for Adverse event, at an unspecified dose and frequency. At the time of the report, HYPERSENSITIVITY (Severe allergic reaction), PRURITUS (Got itchiness on their body,all of their body got horrible), FLUSHING (Body is flush), INSOMNIA (Hasn''t been able to sleep in the last two days), BURNING SENSATION (Burning sensation in her body), ERYTHEMA (Body reddish), RASH (Eruption all over their body, and it moving to their groin area) and OFF LABEL USE (Doctor recommended to wait 3 month to take their second dose) outcome was unknown. Additional treatment medication included was Allergy relief medication. On 27 Aug 2021, all of their body got horrible, and patient went to the hospital. Patient never had an allergic reaction in their entire life. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. This is a case of Off label dosing frequency. Further information will be requested to clarify if patient was hospitalized due to the events associated with second dose administered. This case was linked to MOD-2021-300936 (Patient Link).; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. This is a case of Off label dosing frequency. Further information will be requested to clarify if patient was hospitalized due to the events associated with second dose administered.


VAERS ID: 1677535 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Louisiana  
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 FD8448 / 3 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose, Blood glucose increased, Extra dose administered, Off label use
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), 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: Blood pressure (diagnosed a good while ago, she doesn''t remember when); Diabetes (diagnosed a good while ago, she doesn''t remember when)
Preexisting Conditions: Medical History/Concurrent Conditions: Breast cancer (States she is cancer free now.); Surgery (she doesn''t have a breast on the right.)
Allergies:
Diagnostic Lab Data: Test Name: Blood sugar; Test Result: 400 mg/dl; Comments: 400- high; Test Date: 20210827; Test Name: Blood sugar; Test Result: 367 mg/dl; Comments: 367-high
CDC Split Type: USPFIZER INC202101117084

Write-up: blood sugar still high at 367; third dose was yesterday 26Aug; third dose was yesterday 26Aug; This is a spontaneous report from a contactable consumer (patient). A 64-year-old female patient received BNT162B2 (COMIRNATY, Batch/Lot Number: FD8448), via an unspecified route of administration, administered in left arm on 26Aug2021 (at the age of 64-year old) as dose 3, single for COVID-19 immunization. Medical history included breast cancer from 2000, she did not have a breast on the right, and was cancer free now; and ongoing blood pressure and diabetes diagnosed on an unspecified date. There were no concomitant medications. Historical vaccine included BNT162B2 (COMIRNATY), first dose on 27Jan2021 (lot number EFA765) and reported that the first time she took she could feel her head getting woozy and blood sugar was 400; then second dose on 23Feb2021 (lot number EN6200), both via an unspecified route of administration in left arm (at the age of 64-years-old) for COVID-19 immunization. The patient wanted to know if the COVID vaccine could elevate the blood glucose level because she had a history of diabetes and had been forgetting to take her medicine, but the first time she took it her blood sugar it was at 400 mg/dl. It dropped a bit low now on 27Aug2021, but it was still high at 367 mg/dl. She was going to check it again soon. She confirmed that it began at the time of report, ongoing and improving a little bit. The outcome of the event was recovering.


VAERS ID: 1677579 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: South Carolina  
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 - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (if_covid_prior_vaccination: Yes); Drug allergy (known allergies: sulfur)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101134026

Write-up: Dizzy; Nauseous; Headache; Tired; This is a spontaneous report from a contactable consumer, the patient. A 65-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 26Aug2021 at 11:00 (at the age of 65-year-old) as a single dose for COVID-19 immunisation. The patient medical history included COVID-19 respiratory infection from unknown date and allergy to sulfur drug. Prior to the vaccination, the patient was diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The Concomitant medication included lisinopril (MANUFACTURER UNKNOWN) for an unknown indication on an unknown date and unknown if ongoing. The patient previously received pethidine hydrochloride (DEMEROL) and experienced drug allergy. On 26Aug2021 at 11:00, the patient felt dizzy right after the vaccination and 6 days later still the patient felt nauseous, tired and experienced headache. The events did not result in doctor or other healthcare professional office/clinic visit/ emergency visit. Therapeutic measures were not taken as a result of adverse events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events dizzy, nauseous, tired and headache was not recovered at the time of this report. The batch/lot numbers for, BNT162b2, were not provided and will be requested during follow up.


VAERS ID: 1677585 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-08-26
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 - / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: None
Allergies:
Diagnostic Lab Data: Test Date: 20210830; Test Name: Abbott; Result Unstructured Data: Test Result: Positive; Comments: Nasal Swab.
CDC Split Type: USPFIZER INC202101134959

Write-up: Tested positive with Covid 19 30Aug2021; Tested positive with Covid 19 30Aug2021; This is a spontaneous report from a contactable consumer or other non hcp. A 60-years-old non-pregnant female patient received bnt162b2 (BNT162B2, Formulation Solution for injection, Lot number: EP7533 Expiry date: Unknown, Age at vaccination: 60 Years) via intramuscularly on 31Mar2021 as dose 2, single for COVID-19 immunisation. The patient previously took bnt162b2 (BNT162B2, Lot number: EN6202, Expiry date: Unknown) via an unspecified route of administration on 10Mar2021 as dose 1 single, for COVID-19 immunisation. The patient medical history was none and concomitant medications were not reported. The patient had no known allergies. The patient was not positive for COVID-19 prior to vaccination and had been tested post vaccination. Patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 26Aug2021, the patient tested positive with covid 19. The patient underwent lab tests and procedures which included sars-cov-2 test, positive on 30Aug2021, Nasal Swab. The adverse events resulted in Emergency room/department or urgent care. It was unknown if patient received treatment for the events. The outcome of the events was recovering. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1678164 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Kentucky  
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 040C21A / 2 - / OT

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

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

Write-up: Vaccinated with the expired vaccine for their 2nd doses; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Vaccinated with the expired vaccine for their 2nd doses) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 040C21A) for COVID-19 vaccination. No Medical History information was reported. On 26-Aug-2021 at 10:16 AM, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Vaccinated with the expired vaccine for their 2nd doses). On 26-Aug-2021, EXPIRED PRODUCT ADMINISTERED (Vaccinated with the expired vaccine for their 2nd doses) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medications were provided. No treatment medications were provided.


VAERS ID: 1678281 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-06
Onset:2021-08-26
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 LA / OT

Administered by: Unknown       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: FOSAMAX; IMITREX [SUMATRIPTAN]
Current Illness: Bone disorder (NOS); Migraine
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Accidentally received 3rd dose; This spontaneous case was reported by a consumer and describes the occurrence of EXTRA DOSE ADMINISTERED (Accidentally received 3rd dose) in a 76-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002A21A and 013M20A) for COVID-19 vaccination. Concurrent medical conditions included Bone disorder (NOS) and Migraine. Concomitant products included ALENDRONATE SODIUM (FOSAMAX) for Bone disorder (NOS), SUMATRIPTAN (IMITREX [SUMATRIPTAN]) for Migraine. On 06-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 26-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 26-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXTRA DOSE ADMINISTERED (Accidentally received 3rd dose). On 26-Aug-2021, EXTRA DOSE ADMINISTERED (Accidentally received 3rd dose) had resolved. Patient received 3rd dose of Moderna vaccine accidentally instead of receiving shingles vaccine.


VAERS ID: 1678287 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E214 / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dizziness, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOSARTAN; ASPIRIN [ACETYLSALICYLIC ACID]; MULTIVITAMINS [VITAMINS NOS]
Current Illness: Lung cancer stage III
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: I have been so dizzy; Also have diarrhea; Arms are a little sore; Chills; Nauseous; This spontaneous case was reported by a consumer and describes the occurrence of DIZZINESS (I have been so dizzy), DIARRHOEA (Also have diarrhea), PAIN IN EXTREMITY (Arms are a little sore), CHILLS (Chills) and NAUSEA (Nauseous) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 059E214) for COVID-19 vaccination. Concurrent medical conditions included Lung cancer stage III. Concomitant products included LOSARTAN, ASPIRIN [ACETYLSALICYLIC ACID] and MULTIVITAMINS [VITAMINS NOS] for an unknown indication. On 25-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Aug-2021, the patient experienced DIZZINESS (I have been so dizzy), DIARRHOEA (Also have diarrhea), PAIN IN EXTREMITY (Arms are a little sore), CHILLS (Chills) and NAUSEA (Nauseous). At the time of the report, DIZZINESS (I have been so dizzy), DIARRHOEA (Also have diarrhea), PAIN IN EXTREMITY (Arms are a little sore), CHILLS (Chills) and NAUSEA (Nauseous) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment information was not reported by reporter. Most recent FOLLOW-UP information incorporated above includes: On 02-Sep-2021: Follow up contain no new information


VAERS ID: 1678503 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dizziness, Exposure during pregnancy, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Prenatal vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 1st trimester estimated due date May 10, 2022. 2nd pregnancy 6:00 pm day 1 of second dose had a fever of 102 till the following afternoon on the second day around noon while taking Tylenol as well as nausea and lightheadedness during that same time. By 6:00 pm the following day no longer had a fever but was experienced chest pains almost called emergency services but did not feel it was life threatening at that time. Ended up falling asleep and woke up on day 3 feeling much better


VAERS ID: 1678546 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Injected limb mobility decreased, Injection site pain, Magnetic resonance imaging, X-ray
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: anastrozole (ARIMIDEX) 1 mg tablet Take 1 mg by mouth daily. Saccharomyces boulardii (FLORASTOR) 250 mg Capsule Take by mouth. pyridoxine (VITAMIN B6) 100 mg Tablet Take 1 Tablet (100 mg) by mouth daily. nystatin-triamcinolone (MYCOLOG) 100
Current Illness: Chronic renal insufficiency, stage 3 (moderate) Essential hypertension Infiltrating ductal carcinoma of breast Postoperative hypothyroidism Rheumatoid arthritis involving multiple sites with positive rheumatoid factor
Preexisting Conditions: Chronic renal insufficiency, stage 3 (moderate) Essential hypertension Infiltrating ductal carcinoma of breast Postoperative hypothyroidism Rheumatoid arthritis involving multiple sites with positive rheumatoid factor Osteoarthritis
Allergies: NKDA
Diagnostic Lab Data: Xray shoulder MRI shoulder
CDC Split Type:

Write-up: COVID booster injection in left arm. Patient experienced onset of pain and limitation of range of motion. Pain has improved but continues to have limitation of range of motion. There is concern for shoulder injury after vaccine administration


VAERS ID: 1678603 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
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 017E21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Dyspnoea, Feeling abnormal, Headache, Pain in extremity, Pulmonary congestion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1. Aspirin 81mg 2. Amlodipine Besylate 5mg 3. Alfuzosin HCL 10 mg 4. Carvedilol 6.5 mg (2x) 5. Ranexa/Ranolazine 1000mg (x2) 6. Finasteride 5mg 7. Nitrostat/Nitroglycerin 50mcg (as needed) 8. Pantoprazole 40 mg 9. Atorvastatin 20 mg. 10.
Current Illness: None
Preexisting Conditions: Heart Attack, Coronary Artery Disease, Cervical surgery (June 2021); Back surgery/fusion (February, 2021); High Blood Pressure; Cholesterol
Allergies: Seasonal
Diagnostic Lab Data: Covid 19 Test - Negative X-rays - Pulmonary infiltrate in left lung on CXR
CDC Split Type:

Write-up: Difficulty breathing, pain/heaviness/congestion in chest, chills, headache, severe headache, feeling miserable, right arm pain.


VAERS ID: 1678697 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-15
Onset:2021-08-26
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Dyspnoea, Hypoxia, Muscular weakness, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Very pleasant 43-year-old female who is status post renal transplant presenting the emergency department for evaluation. The patient notes leg weakness, nausea, vomiting, diarrhea, shortness of breath. These min going on 3-4 days. The patient was diagnosed as COVID 19 positive on 08/15/2021. These have been worsening since that time. Here in the emergency department the patient''s vital signs were stable. Renal function at baseline. However, she had significant exertional hypoxemia. She is admitted for further management.


VAERS ID: 1678769 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-16
Onset:2021-08-26
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Fatigue, Nausea, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Transplant Renal (HCC) Apnea Sleep Obstructive Obesity Body Mass Index 30-39.9 Adult Gout Chronic Kidney Dise
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: CHIEF COMPLAINT Fatigue and nausea HISTORY OF PRESENT ILLNESS Patient is a 72 y.o. female with a past medical history significant for metastatic Meckel cell carcinoma on pembrolizumab, CKD stage 4 status post renal transplant x2, immunosuppressed state secondary to prednisone and sirolimus, hyperparathyroidism secondary to renal disease, diabetes mellitus type 2, coronary artery disease, hypertension, and obstructive sleep apnea who presented to ED on 08/26/2021 after experiencing fatigue and nausea of 1 week duration.


VAERS ID: 1678853 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Dysgeusia, Fatigue, Headache, Joint noise, Joint stiffness, Mobility decreased, Muscle tightness, Vertigo
SMQs:, Taste and smell disorders (narrow), Dystonia (broad), Parkinson-like events (broad), Vestibular disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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: Symbicort Wellburtin
Current Illness: None
Preexisting Conditions: Mild Asthma
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 2 first day: Metal taste in mouth, headache, tired Day 2: Widespread Moderate/Severe joint pain, mild headache, fatigue Day 3: Moderate joint pain, intermittent vertigo, stiff joints especially hands/wrist with numb pinching feel, fatigue Day 4: Mild achy joints, prickles in hands and feet. Stiff joints especially hands, painful to grasp objects, numb feeling is wrists popping joints, fatigue Day 5 : aches are better, mostly knees, elbows, shoulders, hands and wrists. Wrists are still pinching, gnawing ache, fatigue Day 6-12 : Mild Burning, throbbing, gnawing, aching joint pain, Muscle tightness, fatigue


VAERS ID: 1679120 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-09
Onset:2021-08-26
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: apixaban, ASA, canagliflozin/metformin, fenofibric acid, fexofenadine, finasteride, glipizide, insulin, metoprolol, omeprazole, quinapril, ranitidine, simvastatin, tamsulosin
Current Illness:
Preexisting Conditions: BPH, CAD, DM type 2, hyperlipidemia, HTN, IHD, pacemaker, OSA
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/26/21: pt presents to ED with weakness for 7 days and tests COVID pos 8/28/2021: discharged on zinc mild case


VAERS ID: 1679129 (history)  
Form: Version 2.0  
Age: 49.0  
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 - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Diabetes 2, High BP
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Subacromial-subdeltoid bursitis. My shoulder joint has been hurting ever since I took the shot.


VAERS ID: 1679139 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-03-04
Onset:2021-08-26
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Fatigue, Feeling abnormal, Headache, Malaise, Nasopharyngitis, Pain, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None - diabetic so I was on Insulin
Current Illness: Allergies; Diabetic
Preexisting Conditions: Diabetic
Allergies: PCN - Penicillin; Tetracycline; Milk; Seasonal allergies
Diagnostic Lab Data: COVID tests 2 positive each time (one 10 days later) at Urgent Care
CDC Split Type: vsafe

Write-up: Follow up report: Thursday night I was feeling sick, and I never felt sick. I went on Friday morning to get a COVID test - they did an immediate one - both came back positive for COVID - I had had shortness of breath and even my eyelashes hurt when I blinked. I had a fever the first day I went in - but it was only 99. I had a hot car so it might have been that. I didn''t have a fever after that. I wasn''t nauseated. I was very tired, coughing and headache that has not gone away. The brain fog was bad - that went on for about three days. I thought I was losing my mind. Diagnosed - Dr.''s set me up for antibody infusion. I had that done a week ago Monday morning (30th). That helped the brain fog lift, and I was feeling a bit better. I now have a cold, and I am so tired. Now I have a little bit of the congestion (didn''t have that at first). I don''t ache anymore or shortness of breath. I got COVID tested again on Sunday at Urgent Care - it came back this morning as positive.


VAERS ID: 1679150 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-06
Onset:2021-08-26
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pain, Eyelid function disorder, Facial pain, Facial paralysis, Hypoaesthesia, Neck pain, Pain in jaw
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Glaucoma (broad), Hearing impairment (broad), Periorbital and eyelid disorders (narrow), Osteonecrosis (broad), Ocular motility disorders (narrow), Arthritis (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None. Perhaps a dental abscess.
Preexisting Conditions: Burning on top of hand.
Allergies: None
Diagnostic Lab Data: Have not been treated.
CDC Split Type:

Write-up: Paralysis of right side of face. Unable to lift right brow. Unable to close forcefully right eyelid. Unable to lift right lip. Numbness of right cheek. Throbbing pain in back of ear, behind right neck close to skull, pain below right jaw, right cheekbone. Has not been treated. Pain has tamed down.


VAERS ID: 1679151 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-06
Onset:2021-08-26
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chills, Fatigue, SARS-CoV-2 test negative, Urine analysis
SMQs:, 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: Bethanechol; Flomax; lisinopril; fluticasone; Metamucil
Current Illness: N/A
Preexisting Conditions: Type 2 Diabetes
Allergies: N/A
Diagnostic Lab Data: Urine test, blood work, Covid-19 test, negative.
CDC Split Type: vsafe

Write-up: Chills, fatigue. I took Advil.


VAERS ID: 1679205 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Mexico  
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 (JANSSEN)) / JANSSEN 043AZ1A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Electrocardiogram, Headache, Hypoaesthesia, Hypoaesthesia oral, Immediate post-injection reaction, Injection site pain, Laboratory test, Muscle spasms, Nausea, Pain, Pain in extremity, Paraesthesia, Paraesthesia oral, SARS-CoV-2 test negative, X-ray
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), COVID-19 (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sulfasalizine, Pepcid, baby aspirin and imitrex.
Current Illness: None
Preexisting Conditions: Rheumatoid arthritis, PCOS, and GERD
Allergies: None known
Diagnostic Lab Data: Xrays Labs EKG
CDC Split Type:

Write-up: After injection, I had immediate lip and mouth tingling and numbness, as well as in my right arm. After the vaccine a few hours later, I started having headaches, body aches, nausea, chills and right arm pain at injection site. I went to bed and woke up with the same symptoms, but increased body aches, left leg pain. A day later I started having chest pain and continued left leg calf/ thigh cramping and pain. I got Covid tested and was negative. I ended up going to the ER for the chest pain and left leg pain. ER doc said it was continued reactions to the vaccine. I went to the ER again and had a chest X-ray and vein scan. D-dimer was elevated.


VAERS ID: 1679384 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: reports having soreness in arm after 1st covid vaccination
Other Medications: amtriptyline, sumatriptan, vitamin D, topamax, ibuprofen, vitamin D, meclizine
Current Illness: history of prior covid vaccination 8/4/2021.
Preexisting Conditions: fatty liver, cervical radiculopathy, migraines
Allergies: sertraline
Diagnostic Lab Data: labs ordered
CDC Split Type:

Write-up: patient reports having bodyaches affecting both legs and arms. symptoms still persistent approximately 1 week after vaccination


VAERS ID: 1681646 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-15
Onset:2021-08-26
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Myalgia, Vaccination site erythema, Vaccination site nodule, Vaccination site swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Fatigue; Sore arm; knot at the injection site.; red knot at the injection site.; swollen at the injection site.; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE NODULE (knot at the injection site.), VACCINATION SITE ERYTHEMA (red knot at the injection site.), VACCINATION SITE SWELLING (swollen at the injection site.), FATIGUE (Fatigue) and MYALGIA (Sore arm) in a 33-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939902) for COVID-19 vaccination. No Medical History was provided. Concomitant products included ETONOGESTREL (NEXPLANON) for an unknown indication. On 15-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Aug-2021, the patient experienced VACCINATION SITE NODULE (knot at the injection site.), VACCINATION SITE ERYTHEMA (red knot at the injection site.) and VACCINATION SITE SWELLING (swollen at the injection site.). On an unknown date, the patient experienced FATIGUE (Fatigue) and MYALGIA (Sore arm). At the time of the report, VACCINATION SITE NODULE (knot at the injection site.), VACCINATION SITE ERYTHEMA (red knot at the injection site.), VACCINATION SITE SWELLING (swollen at the injection site.), FATIGUE (Fatigue) and MYALGIA (Sore arm) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Birth control orally and now injectable (Nexplanon) No Treatment Medications were provided.


VAERS ID: 1681666 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-01-12
Onset:2021-08-26
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Extra dose administered; given an expired dose; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (given an expired dose) and EXTRA DOSE ADMINISTERED (Extra dose administered) in a 77-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 041B21A, 010M20A and 041L20A) for COVID-19 vaccination. No Medical History information was reported. On 12-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 26-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 26-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (given an expired dose). On an unknown date, the patient experienced EXTRA DOSE ADMINISTERED (Extra dose administered). On 26-Aug-2021, EXPIRED PRODUCT ADMINISTERED (given an expired dose) had resolved. At the time of the report, EXTRA DOSE ADMINISTERED (Extra dose administered) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Relevant concomitant medications were not reported by reporter Treatment information was not provided by reporter


VAERS ID: 1681682 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-11
Onset:2021-08-26
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acute leukaemia, Blood test, Dizziness, Fatigue, Gait disturbance, Haemoglobin, White blood cell count
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ATENOLOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high (High blood pressure)
Allergies:
Diagnostic Lab Data: Test Date: 202102; Test Name: Blood work; Result Unstructured Data: normal; Test Date: 20210826; Test Name: Hemoglobin; Result Unstructured Data: Decreased; Test Date: 20210826; Test Name: White blood count; Result Unstructured Data: Decreased
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Acute leukemia; Light headedness; Too week to walk; Fatigue; This spontaneous case was reported by a consumer and describes the occurrence of ACUTE LEUKAEMIA (Acute leukemia) in an 85-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Blood pressure high (High blood pressure). Concomitant products included ATENOLOL for Blood pressure high. On 11-May-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In 2021, the patient experienced DIZZINESS (Light headedness), GAIT DISTURBANCE (Too week to walk) and FATIGUE (Fatigue). On 26-Aug-2021, the patient experienced ACUTE LEUKAEMIA (Acute leukemia) (seriousness criteria hospitalization and medically significant). The patient was hospitalized on 26-Aug-2021 due to ACUTE LEUKAEMIA. At the time of the report, ACUTE LEUKAEMIA (Acute leukemia), DIZZINESS (Light headedness), GAIT DISTURBANCE (Too week to walk) and FATIGUE (Fatigue) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In February 2021, Blood test: normal (normal) normal. On 26-Aug-2021, Haemoglobin: 5.5 (Low) Decreased. On 26-Aug-2021, White blood cell count: 0.2 (Low) Decreased. No treatment medications were reported. Patient was hospitalized with acute leukemia with 5.5 hemoglobin and 0.2 white blood count and was complaining of fatigue and light headedness for the last month. For past two weeks he has been too week to walk. Patient''s last bloodwork up in February 2021 was normal. Patient does have high blood pressure and takes Atenolol. Patient was not sure the vaccine was related and did not know exact date of first dose and did not have lot numbers. Company Comment: Very limited information regarding this events has been provided at this time. However, based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information has been requested.; Sender''s Comments: Very limited information regarding this events has been provided at this time. However, based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information has been requested.


VAERS ID: 1681685 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Burning sensation, Chest discomfort, Chest pain, Dyspnoea, Feeling abnormal, Feeling hot, Headache, Hypersensitivity, Nausea, Palpitations, Pruritus, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: GABAPENTIN; MORPHINE
Current Illness: Neurofibromatosis, type 1 (von Recklinghausen''s disease) (since 4 years old)
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (5 or 6 days, treatment received: They gave me pain medicine and Benadryl. 11th 12 or 13th of July 2020 (testing done in hospital))
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: blood work; Result Unstructured Data: normal
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: itchy/an itching all over on the inside; burning an itching all over on the inside; throw-up; feeling really weird/ horrible/ Miserable; Feeling hot; headache; stomach hurting; chest bothering/uncomfortable feeling in chest; Feeling like I could not breath; nauseous; Chest starting hurting; heart started racing; just said allergic reaction; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (itchy/an itching all over on the inside), BURNING SENSATION (burning an itching all over on the inside), VOMITING (throw-up), FEELING ABNORMAL (feeling really weird/ horrible/ Miserable), FEELING HOT (Feeling hot), HEADACHE (headache), ABDOMINAL PAIN UPPER (stomach hurting), CHEST DISCOMFORT (chest bothering/uncomfortable feeling in chest), DYSPNOEA (Feeling like I could not breath), NAUSEA (nauseous), CHEST PAIN (Chest starting hurting), PALPITATIONS (heart started racing) and HYPERSENSITIVITY (just said allergic reaction) in a 29-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included COVID-19 (5 or 6 days, treatment received: They gave me pain medicine and Benadryl. 11th 12 or 13th of July 2020 (testing done in hospital)) in July 2020. Concurrent medical conditions included Neurofibromatosis, type 1 (von Recklinghausen''s disease) (since 4 years old). Concomitant products included GABAPENTIN and MORPHINE for an unknown indication. On 26-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Aug-2021, the patient experienced PRURITUS (itchy/an itching all over on the inside) (seriousness criterion medically significant), BURNING SENSATION (burning an itching all over on the inside) (seriousness criterion medically significant), VOMITING (throw-up) (seriousness criterion medically significant), FEELING ABNORMAL (feeling really weird/ horrible/ Miserable) (seriousness criterion medically significant), FEELING HOT (Feeling hot) (seriousness criterion medically significant), HEADACHE (headache) (seriousness criterion medically significant), ABDOMINAL PAIN UPPER (stomach hurting) (seriousness criterion medically significant), CHEST DISCOMFORT (chest bothering/uncomfortable feeling in chest) (seriousness criterion medically significant), DYSPNOEA (Feeling like I could not breath) (seriousness criterion medically significant), NAUSEA (nauseous) (seriousness criterion medically significant), CHEST PAIN (Chest starting hurting) (seriousness criterion medically significant), PALPITATIONS (heart started racing) (seriousness criterion medically significant) and HYPERSENSITIVITY (just said allergic reaction) (seriousness criterion medically significant). The patient was treated with EPINEPHRINE (EPIPEN) for Adverse event, at an unspecified dose and frequency; DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) (intravenous) for Adverse event, at a dose of 25 milligram; CALCIUM for Adverse event, at an unspecified dose and frequency; ONDANSETRON HYDROCHLORIDE DIHYDRATE (ZOFRAN [ONDANSETRON HYDROCHLORIDE DIHYDRATE]) for Adverse event, at an unspecified dose and frequency; KETOROLAC TROMETHAMINE (TORADOL) for Adverse event, at an unspecified dose and frequency and PREDNISONE for Adverse event, at an unspecified dose and frequency. At the time of the report, PRURITUS (itchy/an itching all over on the inside), BURNING SENSATION (burning an itching all over on the inside), FEELING HOT (Feeling hot), CHEST DISCOMFORT (chest bothering/uncomfortable feeling in chest) and HYPERSENSITIVITY (just said allergic reaction) had not resolved and VOMITING (throw-up), FEELING ABNORMAL (feeling really weird/ horrible/ Miserable), HEADACHE (headache), ABDOMINAL PAIN UPPER (stomach hurting), DYSPNOEA (Feeling like I could not breath), NAUSEA (nauseous), CHEST PAIN (Chest starting hurting) and PALPITATIONS (heart started racing) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Blood test: normal (normal) normal. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. other treatment medications included oxygen therapy, steroidal medications. patient reported, treating with Benadryl 25 mg did not stopped her itching. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, more information is required for further assessment.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, more information is required for further assessment.


VAERS ID: 1682067 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Dyspnoea exertional, Influenza like illness, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: topical HRT, tramadol, lexapro, PPI
Current Illness:
Preexisting Conditions: PVC, MVP, cervical dystonia, cavernous malformation
Allergies: MRI dye, latex, doxy, levaquin, PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: at night after vaccination, had chest tightness, tachycardia 140 with sob and oxygen 91% on pulse ox (with fever and flu like sx). still feels winded with exertion 9/7/21


VAERS ID: 1682427 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-08
Onset:2021-08-26
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Aortic arteriosclerosis, Asthenia, Bordetella test negative, COVID-19, Chest X-ray, Chlamydia test negative, Condition aggravated, Decreased appetite, Diarrhoea, Dizziness, Early satiety, Enterovirus test negative, Essential hypertension, Human metapneumovirus test, Human rhinovirus test, Hyponatraemia, Hypophagia, Hypothyroidism, Influenza A virus test negative, Influenza B virus test, Lethargy, Malaise, Mycoplasma test negative, Nausea, Respiratory syncytial virus test negative, Respirovirus test, SARS-CoV-2 test positive, Scoliosis
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Hypertension (narrow), Hypothyroidism (narrow), Vestibular disorders (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 mg tablet cholecalciferol, vitamin D3, 25 mcg (1,000 unit) tablet levothyroxine (SYNTHROID) 100 mcg tablet metoprolol tartrate (LOPRESSOR) 25 mg tablet
Current Illness:
Preexisting Conditions: Non-Hospital Atrophic vaginitis Postmenopausal atrophic vaginitis Sebaceous cyst Vaginal dysplasia Pelvic pain Thyroid disorder Onychomycosis
Allergies: NKA
Diagnostic Lab Data: 09/02/21 1659 Respiratory virus detection panel Collected: 09/02/21 1549 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected X-ray chest 2 views [3300995824] Resulted: 09/02/21 1524 Order Status: Completed Updated: 09/02/21 1525 Narrative: XR CHEST 2 VW IMPRESSION: Stable chest with no acute cardiopulmonary process. END OF IMPRESSION: INDICATION: weakness Weakness. TECHNIQUE: PA and lateral projections of the chest are acquired. COMPARISON: 10/7/2019 FINDINGS: No focal consolidation or pulmonary edema. There is mild scoliosis of the thoracic spine unchanged from prior study. No pneumothorax or pleural effusion. Normal cardiomediastinal silhouette. Atherosclerosis of the aortic arch. Surgical clips are noted of the lower chest.
CDC Split Type:

Write-up: ED to Hosp-Admission Current 9/2/2021 - present (6 days) Essential hypertension, Hypothyroid, Hyponatremia, COVID-19, Diarrhea Chief Complaint Patient presents with ? Weakness - Generalized History of Present Illness Patient is a remarkable 86-year-old female in excellent health, past medical history significant for hypothyroidism and hypertension, active and independent in activities of daily living, works and engages in social activities. Patient has been generally unwell for 1 week''s time. Her closest dance partner had upper respiratory symptoms 1 week ago. She is fully vaccinated against COVID-19. She does not routinely mask in public or in dance halls. She has had 1 week of lethargy, malaise, nausea, poor appetite, poor p.o. intake, early satiety, and diffuse watery diarrhea. She has had no upper respiratory symptoms, has not been short of breath or coughing, no fevers. She is generally weak and lightheaded. She saw her primary care physician on 830, had a rapid Covid test in the office which was negative, and in her vaccination status this was thought to be accurate. Repeat Covid is positive today.


VAERS ID: 1682630 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939893 / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Inflammation, Joint stiffness, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid symptoms: fever, aches, fatigue. Age 71. 2nd Moderna Covid 19 dose on Mar 3, 2021
Other Medications: levothyroxine. Turmeric, vitamin D, zinc, aspirin
Current Illness: none
Preexisting Conditions: hypothyroidism
Allergies: none
Diagnostic Lab Data: Inflammation elevated. Rheumatoid arthritis and PMR ruled out as diagnoses. No other apparent cause.
CDC Split Type:

Write-up: Sever pain and stiffness in shoulders and hips every morning. Eases during the day with medication and movement.


VAERS ID: 1682657 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest pain, Costochondritis, Cough, Electrocardiogram, Fatigue, Migraine, Urine analysis
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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: The took all my vital signs and then they did the EKG, urine, blood work panel. EKG showed that my heart was jumping.
CDC Split Type: vsafe

Write-up: It started the next day I woke up with a Margarine around 5am and then about 2pm I started getting tired and then 6pm is when the chest pain started. The 8/27/2021 I still was having all the same symptoms and then at 6pm I went to the ER. They hook me up to fluids with anti inflammatory. The doctor stated it was a reaction to the vaccine. He also stated to go home and take Ibuprofen 600 mg every 6 hours. So I did that and the pain didn''t go away. A week later I went to see my Doctor. He really do anything but chest vital and between my breast and stated that I had Costochondritis. he stay it was information of the rib cage and he prescribe Naproxen 500 mg twice a day for a month. I started the meds and the pain started to subside 9/6/2021. Every once in a while I will have a dry cough and it will hurt but not as bad.


VAERS ID: 1682670 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-18
Onset:2021-08-26
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Mellitus. Hypertension/High Blood Pressure, ESRD, A-fib
Allergies:
Diagnostic Lab Data: 08/26/2021 PCR+ COVID-19 test at Synergy Laboratories
CDC Split Type:

Write-up: Runny nose/Congestion, Cough (new onset or worsening of chronic cough), Fatigue or tiredness, hospitalized


VAERS ID: 1682725 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Dizziness and when went to emergency they said I was experiencing Vertigo


VAERS ID: 1682744 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-21
Onset:2021-08-26
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Heart rate irregular, Injection site pruritus, Insomnia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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: Tylenol; Levothyroxine 50mg (once daily)
Current Illness: Stress
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Heavy breathing, thighs, legs and face was shaky on left side of body. Irregular heartbeat for a little while, unable to sleep, itching arm at injection sight.


VAERS ID: 1682784 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eyelid disorder, Eyelid pain, Headache
SMQs:, Periorbital and eyelid disorders (narrow)

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

Write-up: Left eyelid is heavy and aches, massive headache on left side


VAERS ID: 1683037 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-20
Onset:2021-08-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood test, Computerised tomogram, Head discomfort, Headache, Hyperacusis, Metamorphopsia, Migraine, Musculoskeletal discomfort, Nausea, Photophobia, Swelling, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (narrow), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: At the emergency room on the first day of event I was given an IV of saline, they took blood for analysis and a CT scan.
CDC Split Type:

Write-up: Headache developed followed by fainting spell, narrowed vision, head and neck pressure, kaleidoscope eye and later progressed into migraine like symptoms. Debilitating head pain, sensitivity to light and sound and slight nausea. this persisted for four days before slowly fading in intensity. Slight headache and occasional swelling of head and neck pressure persist to this day.


VAERS ID: 1683052 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 LA / 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: n/a
Preexisting Conditions: epilepsy
Allergies: Soy, rosemary
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient was given vaccine underthe age recommended by the manufacturer.


VAERS ID: 1683274 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-22
Onset:2021-08-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Vertigo
SMQs:, Vestibular disorders (narrow)

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

Write-up: headache and vertigo


VAERS ID: 1683291 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Chest pain, Depersonalisation/derealisation disorder, Dizziness, Dyspnoea, Fatigue, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: KNDA
Diagnostic Lab Data: Patient called back today 09/08/2021 and stated she was feeling better but was not herself completely after the shot. Feeling of fatigue is what she stated. We told her to follow up with her Primary Care Physician. She stated she would.
CDC Split Type:

Write-up: Patient stated that she started to have chest pain and feeling of dizziness shortly after the shot. She soon said her throat was closing and could not talk or breathe. She came toward the pharmacy from the waiting room to alert the staff but could not talk. The pharmacist said to call 911, sat the patient down and administered an EpiPen. After the EpiPen she said she could breath better, shortly after that the paramedics came to take her to the Hospital. She was observed for 2 hours then released with steroidal medication.


VAERS ID: 1683295 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-21
Onset:2021-08-26
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Tested PCR positive @ pharmacy/store on 8/29/2021
CDC Split Type:

Write-up: Patient tested positive for COVID after completing the Pfizer vaccine series $g 14 days prior to illness


VAERS ID: 1683333 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: cefadrixal/duricef Sometimes when i eat garlic meat or onions ill break out in hives from waist down until it gets processed in my system.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The first one i was itchy that night that was it. The second one three days later getting these little twinges of chest pain every now and then. They seem to be fading away now, but still once in awhile. Never sought treatment


VAERS ID: 1683618 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Muscle discomfort, Nausea, Neck pain, Pain in jaw
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (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: Cancer; Diabetes
Preexisting Conditions: Medical History/Concurrent Conditions: Open heart surgery (a couple of heart procedures last year.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: There is something or pain in the left neck area.; Pain went up to her jaw and to her left temple; She felt like she had to throw up, and she still feels that way.; Massive headache; Something in the muscle between arm and neck; This spontaneous case was reported by a consumer and describes the occurrence of NECK PAIN (There is something or pain in the left neck area.), PAIN IN JAW (Pain went up to her jaw and to her left temple), NAUSEA (She felt like she had to throw up, and she still feels that way.), HEADACHE (Massive headache) and MUSCLE DISCOMFORT (Something in the muscle between arm and neck) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036B21A) for COVID-19 vaccination. The patient''s past medical history included Open heart surgery (a couple of heart procedures last year.). Concurrent medical conditions included Diabetes and Cancer. On 26-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Aug-2021, the patient experienced NECK PAIN (There is something or pain in the left neck area.), PAIN IN JAW (Pain went up to her jaw and to her left temple), NAUSEA (She felt like she had to throw up, and she still feels that way.), HEADACHE (Massive headache) and MUSCLE DISCOMFORT (Something in the muscle between arm and neck). At the time of the report, NECK PAIN (There is something or pain in the left neck area.), PAIN IN JAW (Pain went up to her jaw and to her left temple), NAUSEA (She felt like she had to throw up, and she still feels that way.), HEADACHE (Massive headache) and MUSCLE DISCOMFORT (Something in the muscle between arm and neck) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. The concomitant medications were not reported. The treatment information was not provided. Patient consented to safety follow up through her phone or email. She consented to safety follow up to her doctor.


VAERS ID: 1683622 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Unknown  
Location: Arkansas  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental underdose
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: Comments: Medical history was not provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Didn''t turned all the way in into the patient/not all the vaccine was actually injected into the patient; This spontaneous case was reported by a nurse and describes the occurrence of ACCIDENTAL UNDERDOSE (Didn''t turned all the way in into the patient/not all the vaccine was actually injected into the patient) in a 48-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) 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) (Intramuscular) 1 dosage form. On 26-Aug-2021, the patient experienced ACCIDENTAL UNDERDOSE (Didn''t turned all the way in into the patient/not all the vaccine was actually injected into the patient). On 26-Aug-2021, ACCIDENTAL UNDERDOSE (Didn''t turned all the way in into the patient/not all the vaccine was actually injected into the patient) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The reported wanted to know if should re administer. No concomitant medications provided. No treatment medications provided.


VAERS ID: 1683627 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-25
Onset:2021-08-26
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023D21A / 1 - / OT

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

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

Write-up: administered expired dose at 17 hours and 35 minutes; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered expired dose at 17 hours and 35 minutes) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 0939901 and 023D21A) for COVID-19 vaccination. No Medical History information was reported. On 25-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 26-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (administered expired dose at 17 hours and 35 minutes). On 26-Aug-2021, EXPIRED PRODUCT ADMINISTERED (administered expired dose at 17 hours and 35 minutes) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant product information was provided. Treatment information was not provided.


VAERS ID: 1683637 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 - / OT

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

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

Write-up: administered this expired vaccine vial to one patient; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered this expired vaccine vial to one patient) in a 41-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 040A21A) for COVID-19 vaccination. No Medical History information was reported. On 26-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered this expired vaccine vial to one patient). On 26-Aug-2021, EXPIRED PRODUCT ADMINISTERED (administered this expired vaccine vial to one patient) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. This vaccine vial was moved from the freezer to a refrigerator on 31Jul2021 and had been stored in the refrigerator since. No Concomitant medications was provided. No Treatment medication was provided. Most recent FOLLOW-UP information incorporated above includes: On 27-Aug-2021: Patients initial was updated. Product dose information was added.


VAERS ID: 1683672 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-28
Onset:2021-08-26
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Cardiac flutter
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Tachyarrhythmia terms, nonspecific (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: CRYSELLE; METFORMIN; KLONOPIN; TRINTELLIX
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (If covid prior vaccination: Yes); Polycystic ovary
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101116509

Write-up: Heart flutters all day on 26Aug. Happened every couple of seconds, nothing in my routine changed.; This is a spontaneous report from a contactable consumer or other non hcp (patient). A 25-year-old (non-pregnant) female patient received second bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; solution for injection, Batch/Lot Number: EL9262) via an unspecified route of administration, administered in arm left on 28Jan2021 at 11:00 (at the age of 25-year-old) as Dose 2, single for COVID-19 immunization. Medical history included PCOS, covid-19 (If covid prior vaccination: Yes). Known allergies: Bactrim, Pyridium. Concomitant medications included ethinylestradiol, norgestrel (CRYSELLE); metformin (METFORMIN); clonazepam (KLONOPIN); vortioxetine hydrobromide (TRINTELLIX) all taken for an unspecified indication, start and stop date were not reported (Other medications in two weeks). Patient did not have other vaccine in four weeks. Patient has not tested for covid post vaccination. The patient previously took first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; solution for injection, Batch/Lot Number: EK9231) via an unspecified route of administration, administered in arm left on 07Jan2021 11:00 (at the age of 24-year-old) at dose 1, single for COVID-19 immunization. On 26Aug2021 at 08:00 the patient experienced heart flutters all day. Happened every couple of seconds, nothing in my routine changed. Patient did not receive treatment for the adverse events. Outcome of the event was resolved on an unspecified date in 2021. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1683673 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-08-26
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, 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: Pulmonary embolism (prior PE due to a surgery in 2019)
Allergies:
Diagnostic Lab Data: Test Date: 20210826; Test Name: PCR Test; Test Result: Positive ; Comments: positive test confirmed by PCR
CDC Split Type: USPFIZER INC202101117363

Write-up: positive test confirmed by PCR; positive test confirmed by PCR/a fever for about 3 days, severe headache, ear pain and lethargy; This is a spontaneous report from a contactable consumer (wife of patient). This consumer reported for 47-year-old male patient (husband). A 47-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Solution for injection; Lot number: UNKNOWN), via an unspecified route of administration as dose 2, single on 13Apr2021 and dose 1 via an unspecified route of administration as dose 1, single on 23Mar2021 both for covid-19 immunisation. The patient medical history included prior pulmonary embolism (PE) due to a surgery in 2019. The patient''s concomitant medications were not reported. As per reporter, patient received his first vaccine dose on 23Mar2021 and his second on 13Apr2021. Patient had a positive test confirmed by PCR (medically significant) on 26Aug2021. Patient had a telemed appointment with his doctor today and patient''s partner was surprised by his symptoms despite being fully vaccinated.The patient had a fever for about 3 days, severe headache, ear pain and lethargy. Reporter thought he might have the delta variant and she was wondering if he would be able to get tested to see if has it. Lab tests and procedures which included SARS-COV-2 test: positive on 26Aug2021 positive test confirmed by PCR. At the time of this report, outcome of event was unknown. The lot number for the vaccine [BNT162B2], was not provided and will be requested during follow-up.


VAERS ID: 1683898 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 AR / IM

Administered by: Military       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Blood gases normal, Coagulation test normal, Computerised tomogram head normal, Dizziness, Epistaxis, Full blood count normal, Headache, Metabolic function test, Myalgia, Nausea, SARS-CoV-2 test negative, Urine analysis normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: Recalls adverse reaction to varicella vaccine. Recalls that she developed varicella like symptoms afterwards.
Other Medications: Yaz birth control, Flonase, Prilosec
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: Seafood, Shellfish, Milk, and Bees
Diagnostic Lab Data: 1 Sep 2021: normal CBC, CMP, UA, ABG and coag studies; normal head CT; negative COVID swab,
CDC Split Type:

Write-up: Headaches, dizziness, myalgias, arthralgias, nose bleeds, nausea, GI distress. After approx one week of symptoms she was seen in the ED for evaluation. Normal workup. Managed symptomatically. By 2 weeks her symptoms were gradually resolving and nose bleeds had stopped.


VAERS ID: 1684484 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Medium


VAERS ID: 1684496 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-04
Onset:2021-08-26
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed COVID-19 requiring hospitalization post-vaccination.


VAERS ID: 1684508 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Electrocardiogram normal, Gastrooesophageal reflux disease, Injection site pain, Lymphadenopathy, Menstruation irregular, Panic attack, Syncope, Vertigo
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow), Fertility disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Genvoya, Topamax, Women''s vitamins
Current Illness: None
Preexisting Conditions: Human immunodeficiency virus
Allergies: none
Diagnostic Lab Data: 8/26- EKG was normal and was diagnosed with a panic attack, which have never happened before
CDC Split Type:

Write-up: Injection site pain, swollen lymph nodes under the left armpit, fainting, panic attack and anxiety, menstrual changes, acid reflux, vertigo


VAERS ID: 1684701 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS YR532 / 2 RA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. TO39467 / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH CN1583 / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U7117BA / 5 LA / IM

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

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

Write-up: Meningococcal B was given instead of Menactra


VAERS ID: 1684957 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-29
Onset:2021-08-26
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chills, Cough, Headache, Myalgia, Rales, SARS-CoV-2 test negative, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril - 12.5 milligrams, estradiol - 0.25 milligrams, vit D3 - 400 IUs, Sunergetic Advance I-gummies
Current Illness: no
Preexisting Conditions: obesity, high blood pressure,
Allergies: contrast dye, Sulphur drugs
Diagnostic Lab Data: chest x ray - dense atherosclerotic calcification of the aortic arch and bloodwork- all came back normal except respiratory - positive for cough; muscles - positive for myalgias; headaches - positive; pulmonary - moist rales and wheezing , right lower chest; positive for chills
CDC Split Type: vsafe

Write-up: 27 Aug2021- My allergies kicked in like I normally get . Next day it got worse, a terrible headache and cough. I was isolated because of Covid. I sent on the trip and in a hotel on Sat am to urgent care for covid testing and was negative and doctor was concerned about my wheezing . When test results came back - he said positive for chills.


VAERS ID: 1685042 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-05
Onset:2021-08-26
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / UNK LA / -

Administered by: Pharmacy       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blood pressure pills
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data: Positive covid test
CDC Split Type:

Write-up: Contracted COVID 5 1/2 months after vaccine


VAERS ID: 1685313 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-08-26
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: renal insufficiency CKD status post nonfunctioning kidney on left, hypertension, obstructive sleep apnea, gout
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1685334 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-04-01
Onset:2021-08-26
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Bradycardia, COVID-19, Cardiac failure, Chronic kidney disease, Chronic obstructive pulmonary disease, Cor pulmonale, Encephalopathy, Endotracheal intubation, Extubation, Hypervolaemia, Metabolic acidosis, Polyuria, Pulmonary oedema, Respiratory disorder, Right ventricular failure, SARS-CoV-2 test positive, Shock, Transaminases increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coreg, spironolactone, xanax
Current Illness:
Preexisting Conditions: AFib, HF, remote MI w/ stents, CAD, HTN, HLD, GERD, COPD, prostate CA
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient had COVID-19 positive test 8/23/21, acute respiratory failure with hypoxia, COVID 19 infection, encephalopathy, bradycardia, shock. anion gap metabolic acidosis with poor respiratory compensation, COPD, AKI on probable CKD, transaminitis, and decompensated right heart failure with cor pulmonale and volume overload. Pt intubated on arrival for marked worsening of his encephalopathy. Likely etiology d/f decompensated right heart failure with pulmonary edema and possible Covid pneumonitis. Shock now resolved. Respiratory status and AKI now improved with diuresis, and extubated 9/7.


VAERS ID: 1685363 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-02
Onset:2021-08-26
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Received COVID vaccines on 4/2/21 and 4/23/21 and was admitted to the hospital on 8/26/21 for COVID-19.


VAERS ID: 1685436 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO186 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Chills, Dizziness, Headache, Heart rate increased, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (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? 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: 1st shot on 8/5/2021, immediate elevated heart rate lasted 8 hours. Also,. 2 hours later rash on chest. 2nd shot on 8/26/2021, Immediate elevated heart rate, anxiety. These episodes have continued to last, which today is 9/9/2021. Few days after 2nd shot, chills, headache, with increased anxiety and episodes of normal heart rate of 70 and will immediately jump to 130, light headedness. This has happened since the 2nd injection of the heart rate increase 16 times. The anxiety has not let up. Went to physician on 9/7/2021 and he had no answers and told me that he has never heard of issues.


VAERS ID: 1685754 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-12
Onset:2021-08-26
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anosmia, COVID-19, Cough, Diarrhoea, Dyspnoea, Headache, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), 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 dose12/23/21 2nd dose01/12/21 Diagnosed covid positive:08/3021 Symptom onset:08/26/21 Exposure: Symptoms:cough, SOB,loss of smell,sore throat,diarrhea,headache,nasal congestion


VAERS ID: 1685757 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-07
Onset:2021-08-26
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Exposure to SARS-CoV-2, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 dose12/16/2021 2nd dose01/07/2021 Diagnosed covid positive:08/30/21 Symptom onset:08/26/21 Exposure:Travel Symptoms:fever, cough, headache


VAERS ID: 1685759 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-02
Onset:2021-08-26
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Fatigue, Myalgia, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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 dose01/12/21 2nd dose02/02/21 Diagnosed covid positive:08/29/21 Symptom onset:08/26/21 Exposure: Symptoms:cough, fatigue, muscle aches,loss of smell/taste,sore throat,runny nose.


VAERS ID: 1685761 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 RA / IM

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

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

Write-up: A red rash with small little bumps all around the stomach and back area.


VAERS ID: 1685765 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Arthralgia, Asthenia, Back pain, Condition aggravated, Fatigue, Musculoskeletal stiffness, Neck pain, Spinal pain
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil 2
Current Illness: No
Preexisting Conditions: Migraines Depression Anxiety PTSD Dissociative disorder
Allergies: Seafood
Diagnostic Lab Data:
CDC Split Type:

Write-up: Anxiety 185 heart rate Affected mood and emotions Migraines Neck Back Shoulders Spine Extreme pain Fatigue Stiffness Weak


VAERS ID: 1685777 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Migraine, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Body aches, migraine, break out over entire body. dizzy and extreme exhaustion for 6 days


VAERS ID: 1685803 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Blood test normal, Discomfort, Dyspnoea, Electrocardiogram normal, Head discomfort, Limb discomfort, Magnetic resonance imaging normal, Muscle contracture, Nausea, Tinnitus, Tremor, Vertigo, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Nodules on Thyroid
Allergies: None
Diagnostic Lab Data: Hospital visit on Friday august 27th I received an EKG and bloodwork and was given anti anxiety medication. All tests came back negative. I went back to hospital Sunday august 29th and received the same tests. All again negative. On Monday august 30 I contacted primary care dr and was given script for anti anxiety. When I took the medicine I was very energetic and bouncing on the sofa. I stopped taking it because coming down off worsened the anxiety attacks greatly. Later that week I was given a script for Zoloft but also couldn?t take it because it made my anxiety worse. On Sunday sept 5 I went back to the Er for vertigo, numbness in my left arm, blurred vision, head pressure, and ringing in my ears. I had more tests done and all came back negative. Later that night I went back in because the vertigo, blurred vision, and head pressure was too much. I was kept for observations and given an MRI to rule out any other possible causes. All came back fine. The anxiety attacks are beginning to dissipate all together but I am still experiencing vertigo.
CDC Split Type:

Write-up: Debilitating anxiety attacks. No prior history of anxiety attacks. The first week after the shot the anxiety attacks lasted 3 hours and happened at least 3 times a day. During those attacks I could not breath and every muscle contracted. I believed I was having a heart attack. After the first week the anxiety attacks went down to about one a day and lasted about an hour or two. For a full two weeks I had debilitating vertigo, nausea, ringing in my ears, heaviness in my left arm and left jaw, and spells of uncontrollable shaking.


VAERS ID: 1686754 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-15
Onset:2021-08-26
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alopecia, Dry eye, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Corneal disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Hypersensitivity (narrow), 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: Vitamin c, glucosamine chondroitin, zinc
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy skin, rash on face, back of neck, torso, hair loss, dry eyes


VAERS ID: 1686760 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram normal, Ejection fraction normal, Electrocardiogram normal, Myocarditis, Pericarditis, Troponin increased
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol as needed
Current Illness: Nopne
Preexisting Conditions: None
Allergies: Amoxicillin, Clindamycin, Penicillin
Diagnostic Lab Data: EKG - Normal Echo - Normal Troponin - Peak 0.3 ng/mL
CDC Split Type:

Write-up: Chest pain and Troponin elevation starting 3 days after 2nd dose of COVID vaccine. Suspected mild myocarditis. Normal ejection fraction. Discharged with Ibuprofen for chest pain for suspected pericardial inflammation.


VAERS ID: 1688517 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052EZIA / UNK LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: chest itches; Rash; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (chest itches) and RASH (Rash) in a 25-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 052ezia) for COVID-19 vaccination. No Medical History information was reported. On 26-Aug-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Aug-2021, the patient experienced RASH (Rash). On an unknown date, the patient experienced PRURITUS (chest itches). At the time of the report, PRURITUS (chest itches) outcome was unknown and RASH (Rash) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No Concomitant medications were provided. No Treatment medications were provided. Most recent FOLLOW-UP information incorporated above includes: On 29-Aug-2021: Follow up received and contains: event - chest itches added


VAERS ID: 1689278 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-22
Onset:2021-08-26
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness unilateral, Eye haemorrhage, Eye operation
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: blood vessel burst in back of eye and an ophthamologist did surgery to stop the hemorrhaging. Still recovering. Some sight has returned to the eye.


VAERS ID: 1689344 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Breast pain, Breast swelling, Fatigue, Headache, Pain, Pain in extremity
SMQs:, Angioedema (broad), Lipodystrophy (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: typical side effects post COVID vaccine
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: nickel
Diagnostic Lab Data: None Had I not been a physician myself, I would have sought medical care
CDC Split Type:

Write-up: Pain, inflammation and swelling of L breast consistent with mastitis. Also had significant L arm pain, body aches, headaches and fatigue, no fever or adenopathy, specifically no axillary adenopathy. Naproxen taken daily beginning 8/27 and for 3 days. No antibiotics. Symptoms began improving 8/29, resolved by 8/31


VAERS ID: 1689348 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Herpes zoster oticus, Nausea, Photophobia
SMQs:, Acute pancreatitis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), 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: Patient has stated that she has had adverse reactions to vaccines in the past. Reporter is not knowledgeable of which vaccines
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 2nd vaccine on 8/25/21. She started having moderate headaches, right eye pain with hypersensitivity to light, and nausea. She called her physician on 8/27/21 to inform him of what was going on. He ordered pain medications. Patient''s pain became more intense and she went in to the see her physician on 8/31/21. She was diagnosed with Ramsey Hunter Syndrome and was referred to an optometrist. She was seen per the optometrist on 8/31/21 and he confirmed the diagnoses of Ramsey Hunter Syndrome. She was placed on Zovirax, anti-inflammatory, and pain medications. She had follow up with the optometrist on 9/10/21 and was diagnosed with Huntchinson''s Sign . She will off work for entire month of September.


VAERS ID: 1689959 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-23
Onset:2021-08-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E218 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Antibody test, Arthralgia, Asthenia, Biopsy skin, Blood test, Condition aggravated, Feeling cold, Hypoaesthesia, Magnetic resonance imaging, Nerve conduction studies, Paraesthesia, Rheumatoid arthritis
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (narrow), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: N/A
Preexisting Conditions: Rheumatoid Arthritis (recent diagnosis in June 2021); Thyroid cancer (a year ago)
Allergies: Macrobid; Wheat; Latex; Certain fruits & vegetables
Diagnostic Lab Data: MRI; Nerve conduction study; Blood test; EMG; Skin biopsy; Lumbar test; Antibody test.
CDC Split Type: vsafe

Write-up: Tingling & numbness of my legs and arms; Joint pain; Weakness from my calf, feet, wrists, and to my hands came back & it has continued to progress up to my thighs; Cold sensation; Rheumatoid Arthritis (recently diagnosed in June 2021) flared up; My symptoms have worsened after taking each dose.


VAERS ID: 1690320 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-13
Onset:2021-08-26
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Head discomfort, Headache, Impaired work ability, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: Fluoxetine- 80 MG daily Valacyclovir- 500mg daily
Current Illness:
Preexisting Conditions:
Allergies: Lactose intolerance
Diagnostic Lab Data:
CDC Split Type:

Write-up: My symptoms started out mild with a light headache and fatigue. I figured it was just lingering side effects from the vaccine. Each day I felt no progress. Fever and chills eventually started as well as nausea and dizziness. I have a pressure in my head as well. For the past week now I''ve been dealing with the dizziness and nausea everyday. I''ve had to miss several days of work because of it. I have tried allergy medications to relieve any pressure in my head and thinking maybe it will help with any congestion that could be leading to dizziness. I have made no progress.


VAERS ID: 1690536 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Palpitations, Vision blurred
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (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: Red 40
Diagnostic Lab Data:
CDC Split Type:

Write-up: Two days after receiving vaccine, chest tightness, pain, shortness of breath, heart palpitations, dizziness, blurred vision lasting 5 days.


VAERS ID: 1691574 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Coagulation time shortened
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: USMODERNATX, INC.MOD20212

Write-up: This spontaneous case reported by a consumer, describes the occurrence of shortened coagulation time (blood hasn''t clotted this quickly before) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 vaccine, batch# 053E21A) for COVID-19 immunization. No medical history reported. On Aug 26, 2021 at 10:25 am, patient received the first dose of mRNA-1273 (Moderna COVID-19 vaccine), intramuscular; 1 dosage form. On Aug 26, 2021, patient experienced shortened coagulation time (blood hasn''t clotted this quickly before). At the time of the report, shortened coagulation time (blood hasn''t clotted this quickly before) outcome: unknown/not provided. The action taken with mRNA-1273 (Moderna COVID-19 vaccine), intramuscular: unknown. Concomitant medications and treatment information not reported. Patient reported she never experienced a blood clot so quickly before.


VAERS ID: 1691576 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-02-01
Onset:2021-08-26
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pt received Pfizer as booster dose instead of Moderna; This spontaneous case was reported by a pharmacist and describes the occurrence of INTERCHANGE OF VACCINE PRODUCTS (Pt received Pfizer as booster dose instead of Moderna) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Co-suspect product included non-company product TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) for COVID-19 vaccination. No Medical History information was reported. In February 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 26-Aug-2021, the patient received third dose of TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Aug-2021, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (Pt received Pfizer as booster dose instead of Moderna). On 26-Aug-2021, INTERCHANGE OF VACCINE PRODUCTS (Pt received Pfizer as booster dose instead of Moderna) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment information was provided.


VAERS ID: 1691610 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Dose administered greater than 12 hours after initial vial puncture; Vial was not stored in refrigerator and administered to patient; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose administered greater than 12 hours after initial vial puncture) and PRODUCT STORAGE ERROR (Vial was not stored in refrigerator and administered to patient) in a 38-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036B21A) for COVID-19 vaccination. No Medical History information was reported. On 26-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose administered greater than 12 hours after initial vial puncture) and PRODUCT STORAGE ERROR (Vial was not stored in refrigerator and administered to patient). On 26-Aug-2021, EXPIRED PRODUCT ADMINISTERED (Dose administered greater than 12 hours after initial vial puncture) and PRODUCT STORAGE ERROR (Vial was not stored in refrigerator and administered to patient) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication information was provided No treatment medication information was provided


VAERS ID: 1691640 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VENLAFAXINE; ZYPREXA
Current Illness: Post-traumatic stress disorder; Thyroid disorder NOS
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Dose administered to patient after improper storage and handling; Vaccine thawed then freezed then thawed then gven to the patient; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) and EXPIRED PRODUCT ADMINISTERED (Vaccine thawed then freezed then thawed then gven to the patient) in a 43-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002C21A) for COVID-19 vaccination. Concurrent medical conditions included Thyroid disorder NOS since 02-Aug-2021 and Post-traumatic stress disorder since 21-Jul-2021. Concomitant products included VENLAFAXINE from 14-Jul-2021 to an unknown date and OLANZAPINE (ZYPREXA) from 21-Jul-2021 to an unknown date for Mental disorder. On 26-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Aug-2021, the patient experienced PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) and EXPIRED PRODUCT ADMINISTERED (Vaccine thawed then freezed then thawed then gven to the patient). On 26-Aug-2021, PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) and EXPIRED PRODUCT ADMINISTERED (Vaccine thawed then freezed then thawed then gven to the patient) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Treatment information was not provided. This case was linked to MOD21-136361 (E2B Linked Report). This case was linked to MOD-2021-299985 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 01-Sep-2021: Patient details updated. Patient''s relevant history updated. Vaccine information and vaccination facility information included. Concomitant medications included. New event- Expired vaccine used added.; Sender''s Comments: MOD21-136361:


VAERS ID: 1691656 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ATORVASTATIN; MIRTAZAPINE; AMLOPINE; PANTOPRAZOLE
Current Illness: Drug allergy (Cough syrup); Hepatitis C (Hep c); Hypertension (HTN); Penicillin allergy (PCN)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Dose administered to patient after improper storage and handling; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) in a 57-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002C21A) for COVID-19 vaccination. Concurrent medical conditions included Drug allergy (Cough syrup), Penicillin allergy (PCN), Hypertension (HTN) since 27-Feb-2020 and Hepatitis C (Hep c) since 27-Feb-2020. Concomitant products included AMLODIPINE BESILATE (AMLOPINE) from 05-Aug-2021 to an unknown date for Blood pressure high, ATORVASTATIN from 28-Jul-2021 to an unknown date, MIRTAZAPINE from 05-Aug-2021 to an unknown date and PANTOPRAZOLE from 05-Aug-2021 to an unknown date for an unknown indication. On 26-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Aug-2021, the patient experienced PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling). On 26-Aug-2021, PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Treatment information was not provided. Reporter states that they received 100 vials out of this one of the vials was taken out of the freezer on 26 Aug 2021 and thawed. Seven vaccination shots were given to patients on 26 Aug 2021. Some patients were given their first shots and some were given their 2nd shot and the remaining 90 vials were disposed on 27 Aug 2021 along with the one used vial. Most recent FOLLOW-UP information incorporated above includes: On 01-Sep-2021: Follow up received on 01-Sep-2021 contains significant information includes Reporter''s address, Patient demographics (Height, Weight, Race and age at vaccination), Medical history, Suspect product anatomical location, Concomitant products(Strength, route, start date and indication) and event outcome.


VAERS ID: 1691662 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FERROUS SULPHATE [FERROUS SULFATE]
Current Illness: Anaemia; Penicillin allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to antibiotic (Amoxicillin)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dose administered to patient after improper storage and handling; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) in a 42-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002C21A) for COVID-19 vaccination. Concurrent medical conditions included Anaemia, Penicillin allergy and Allergy to antibiotic (Amoxicillin). Concomitant products included FERROUS SULPHATE [FERROUS SULFATE] from 18-Aug-2021 to an unknown date for Anaemia. On 26-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Aug-2021, the patient experienced PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling). On 26-Aug-2021, PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Treatment information was not provided. It was reported that patient was given vaccine that was thawed, frozen and thawed. Most recent FOLLOW-UP information incorporated above includes: On 01-Sep-2021: Additional information included patient details, medical history, concomitant and event.


VAERS ID: 1691663 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPAKOTE; ZYPREXA; ZOLOFT; MIRTAZAPINE
Current Illness: Epilepsy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dose administered to patient after improper storage and handling; Expired vaccine used; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) and EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) in a 37-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002C21A) for COVID-19 vaccination. Concurrent medical conditions included Epilepsy since 11-Apr-2019. Concomitant products included VALPROATE SEMISODIUM (DEPAKOTE) from 28-May-2021 to an unknown date for Epilepsy, OLANZAPINE (ZYPREXA) from 09-Aug-2021 to an unknown date, SERTRALINE HYDROCHLORIDE (ZOLOFT) from 10-Aug-2021 to an unknown date and MIRTAZAPINE from 23-Aug-2021 to an unknown date for Mental state abnormal. On 26-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Aug-2021, the patient experienced PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) and EXPIRED PRODUCT ADMINISTERED (Expired vaccine used). On 26-Aug-2021, PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) and EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Treatment information was not provided. Patient race information was given as black It was reported that patient was given vaccine that was thawed, frozen and thawed. Most recent FOLLOW-UP information incorporated above includes: On 01-Sep-2021: Additional information received and contains new information. Reporter details, Patient details , vaccine details, Concomitant medications were updated.


VAERS ID: 1691665 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: Pain
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dose administered to patient after improper storage and handling/Patient was given vaccine that had been thawed, re-frozen and thawed again; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling/Patient was given vaccine that had been thawed, re-frozen and thawed again) in a 36-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002C21A) for COVID-19 vaccination. Concurrent medical conditions included Pain. Concomitant products included PARACETAMOL (TYLENOL) from 15-Aug-2021 to an unknown date for Pain. On 26-Aug-2021 at 10:00 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Aug-2021, the patient experienced PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling/Patient was given vaccine that had been thawed, re-frozen and thawed again). On 26-Aug-2021, PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling/Patient was given vaccine that had been thawed, re-frozen and thawed again) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No treatment medication was provided. It was reported that no adverse event occurred. The patient race was Black. Most recent FOLLOW-UP information incorporated above includes: On 01-Sep-2021: Follow up received: patient details, concomitant medication, time and route of administration for first dose of vaccine was updated.


VAERS ID: 1691691 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: This spontaneous case reported by a pharmacist, describes the occurrence of administered expired product (received expired vaccine beyond 12 hour expiration limit of the punctured vial/the vial first punctured on Aug 19, 2021) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 vaccine, batch# 026C21A) for COVID-19 immunization. No medical history reported. On Aug 26, 2021, patient received the 2nd dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On Aug 26, 2021, patient experienced administered expired product (received expired vaccine beyond 12 hour expiration limit of the punctured vial/the vial first punctured on Aug 19, 2021). At the time of the report, administered expired product (received expired vaccine beyond 12 hour expiration limit of the punctured vial/the vial first punctured on Aug 19, 2021) outcome: unknown. Lot number: "026C21A" Number of doses/vials: "1 dose /1 vial." Date the vial was initially stored in the refrigerator: "Unknown." Date of administration of vaccine: "Aug 26, 2021." Did the vial undergo any previous temperature excursions? "No." Total amount of time the vial was exposed to room temperature range (8? to 25?C= 46? to 77? F): "Unknown." The action taken with mRNA-1273 (Moderna COVID-19 vaccine): unknown. The reporter did not provide any causality assessment, concomitant medication or treatment information.


VAERS ID: 1691696 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dose administered to patient after improper storage and handling; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) in a 20-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002C21A) for COVID-19 vaccination. No Medical History information was reported. On 26-Aug-2021 at 9:30 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling). On 26-Aug-2021, PRODUCT STORAGE ERROR (Dose administered to patient after improper storage and handling) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Relevant concomitant medications were not reported. The treatment information was not provided. It was reported that patient was given vaccine that was thawed, frozen and thawed. Most recent FOLLOW-UP information incorporated above includes: On 01-Sep-2021: Additional information received and added patient details (race information, height/ weight), suspect product details and additional information in I - narrative.


VAERS ID: 1691705 (history)  
Form: Version 2.0  
Age: 101.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-01
Onset:2021-08-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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.MOD20213

Write-up: Patient received Moderna vaccine (1st shot) and Pfizer vaccine (2nd shot); This spontaneous case was reported by a pharmacist and describes the occurrence of INTERCHANGE OF VACCINE PRODUCTS (Patient received Moderna vaccine (1st shot) and Pfizer vaccine (2nd shot)) in a 101-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Co-suspect product included non-company product TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) for COVID-19 vaccination. No Medical History information was reported. In August 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Aug-2021, the patient received second dose of TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) 1 dosage form. On 26-Aug-2021, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (Patient received Moderna vaccine (1st shot) and Pfizer vaccine (2nd shot)). At the time of the report, INTERCHANGE OF VACCINE PRODUCTS (Patient received Moderna vaccine (1st shot) and Pfizer vaccine (2nd shot)) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported No treatment information was provided


VAERS ID: 1691877 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient received expired Moderna Covid-19 vaccine; Patient received expired Moderna Covid-19 vaccine; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient received expired Moderna Covid-19 vaccine) and PRODUCT STORAGE ERROR (Patient received expired Moderna Covid-19 vaccine) in a 58-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007C21A) for COVID-19 vaccination. No Medical History information was reported. On 26-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient received expired Moderna Covid-19 vaccine). On an unknown date, the patient experienced PRODUCT STORAGE ERROR (Patient received expired Moderna Covid-19 vaccine). On 26-Aug-2021, EXPIRED PRODUCT ADMINISTERED (Patient received expired Moderna Covid-19 vaccine) had resolved. At the time of the report, PRODUCT STORAGE ERROR (Patient received expired Moderna Covid-19 vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Treatment medication was not reported. Relevant concomitant medications were not provided by the reporter. One dose was given 24AUG2021, second expired dose given 26AUG2021, and the last 3 doses were given on 27AUG2021.


VAERS ID: 1692122 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101110385

Write-up: The day after the shot I went to a cardio exercise class and fainted after 1/2 hr.; This is a spontaneous report from a contactable consumer or other non hcp (patient). A 73-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration, administered in Arm Left on 25Aug2021 (at the age of 73-year-old) (Batch/Lot number was not reported) as dose 2, single for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient had no known allergies. The patient did not take other vaccine in four weeks and did not took other medications in two weeks. The patient not had covid prior vaccination and not tested for covid post vaccination. The patient previously received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Left on an unknown date (at the age of 73-year-old) (Batch/Lot number was not reported) as dose 1, single for covid-19 immunization. On 26Aug2021 10:00AM, the day after the shot the patient went to a cardio exercise class and fainted after 1/2 hr. The patient not received any treatment for the event. The clinical outcome of the event was recovered on 26Aug2021. No follow-up attempts are possible; information about lot/batch numbe cannot be obtained.


VAERS ID: 1692143 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anorexia (other medical history : Anorexia)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101115627

Write-up: High fever; chest pain; back pain; This is a spontaneous report from a contactable consumer. A 35-year-old non-pregnant female patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Solution for injection, Lot number: FC3182 and expiration date was not reported), dose 2 via intramuscular route of administration in left arm on 25Aug2021 at 15:00 (age at vaccination 35-years-old) as single dose for COVID-19 immunization. The patient medical history included Anorexia. The patient''s concomitant medications were not reported. The historical vaccine included first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Solution for injection, Lot number: FA7484 and expiration dates were not reported), dose 1 via an intramuscular route of administration in left arm on 04Aug2021 at 15:00 pm as single dose for COVID-19 immunization. No other vaccine in four weeks and no other medications in two weeks. On 26Aug2021 at 02:30 PM the patient experienced high fever, chest pain and back pain. The Adverse event resulted in Emergency room/department or urgent care. The patient treated with the Tylenol for the adverse event. Prior to vaccination, the patient was not diagnosed with COVID-19 and since the vaccination, the patient was not been tested for COVID-19. Facility where the most recent COVID-19 vaccine was administered was reported as withheld. The outcome of the events was recovering. Follow-Up (07Sep2021): Follow-up attempts are completed. No further information is expected.


VAERS ID: 1692152 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-08-26
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / -

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:
Allergies:
Diagnostic Lab Data: Test Date: 20210826; Test Name: COVID-19; Test Result: Positive
CDC Split Type: USPFIZER INC202101116619

Write-up: Patient tested positive for COVID-19 after completing full vaccination series.; Patient tested positive for COVID-19 after completing full vaccination series.; This is a spontaneous report from a non-contactable other hcp. A 53-year-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, formulation: Solution for injection, Batch/lot number: EN5318) via an unspecified route of administration on 29Jan2021 (age at vaccination 53-years-old) as single dose, and second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/lot number: EN5318) via an unspecified route of administration on 19Feb2021 (age at vaccination 53years old) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has been tested for COVID-19. On 26Aug2021, the patient experienced patient tested positive for covid-19 after completing full vaccination series. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 26Aug2021. The patient did not receive any treatment for the adverse events. The clinical outcome of the event was unknown. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Based on information in the case, a possible causal association between the event Covid 19 and the suspect drug BNT162B2 cannot be excluded.


VAERS ID: 1692185 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-20
Onset:2021-08-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Blood test
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high
Allergies:
Diagnostic Lab Data: Test Date: 20210826; Test Name: blood work; Result Unstructured Data: Test Result:Unknown
CDC Split Type: USPFIZER INC202101119810

Write-up: Bell''s palsy; This is a spontaneous report from a contactable consumer (wife) reporting for patient (Reporters Husband). A 49-year-old male patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection), via an unspecified route of administration, administered in Left arm, upper arm on 20Aug2021 (Batch/Lot Number: FC3181, at the age of 49-year-old) as single dose for COVID-19 immunisation. The patient''s relevant medical history and concurrent conditions included high blood pressure from an unknown date. Concomitant medication included lisinopril taken for blood pressure high, start and stop date were not reported. There was investigation assessment, prior vaccinations were none. Reporter stated that they received their vaccine on Friday, last Friday and her husband. Well, they took him to the doctor the previous day, on 26Aug2021, he got Bell''s palsy, so she had called the pharmacy, they told her to report it to Pfizer too. Treatment for AE included reporter stated that they put him on steroid pack Prednisone. The patient underwent lab tests and procedures which included blood work (blood test): result unknown on Thursday, 26Aug2021 at the doctor''s office. The Reporter asked, how did they know if he was supposed to get the second shot and asked whether she supposed to wait for the side effect to clear up. Reporter also asked what she do there. Reporter seriousness for Bell''s palsy was unspecified. The outcome of event was unknown. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1692192 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-05
Onset:2021-08-26
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: USPFIZER INC202101120189

Write-up: Inflammation around the heart .; This is a spontaneous report from Non-contactable consumer female (patient). A 17-year-old female patient (not pregnant at the time of vacciantion) received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Batch/Lot number: Unknown), via an unspecified route of administration in left arm on 05Aug2021 (at the age of 17 years old) as single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient hasn''t been tested for COVID-19. On 26Aug2021 patient experienced inflammation around the heart. Therapeutic measures were taken as a result of inflammation around the heart with Computed tomography (ct), x-ray, electrocardiogram (ecg). The reported event led to patient''s prolonged hospitalization on an unspecified date. The reporter considered events as serious. The outcome of event was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1692205 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Deafness unilateral
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: LAXATIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Autoimmune disorder (Verbatim: Auto Immune disease); Cancer (Verbatim: Cancer I am a caner survivor, twice); Chemotherapy NOS (13 years ago); Degenerative bone disease (Verbatim: Degenerative bone disease); Hypertension (Verbatim: Hypertension); Progression of rheumatoid arthritis (Verbatim: Progression of rheumatoid arthritis); Radiation therapy (13 years ago)
Allergies:
Diagnostic Lab Data: Test Date: 202107; Test Name: Blood work; Result Unstructured Data: Test Result:Unknown
CDC Split Type: USPFIZER INC202101122883

Write-up: I can not hear out of my right ear; This is a spontaneous report from a contactable other healthcare professional (patient reported for herself). A 71-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot Number: FC3183), via an unspecified route of administration, administered in right arm on 25Aug2021 (at the age of 71-year-old) as dose number unknown, single for COVID-19 immunisation. Medical history included hypertension from an unknown date and unknown if ongoing Verbatim: Hypertension, autoimmune disorder from an unknown date and unknown if ongoing Verbatim: Auto Immune disease, rheumatoid arthritis from an unknown date and unknown if ongoing Verbatim: Progression of rheumatoid arthritis, degenerative bone disease from an unknown date and unknown if ongoing Verbatim: Degenerative bone disease, neoplasm malignant from an unknown date and unknown if ongoing Verbatim: Cancer I am a cancer survivor, twice, chemotherapy from an unknown date and unknown if ongoing 13 years ago, radiotherapy from an unknown date and unknown if ongoing 13 years ago. Retired nurse stated, "I am a cancer survivor, twice and I went through the whole thing, I went to the chemo, I went to the Radiation and that was 13 years ago. So, it''s a long time ago." No relevant family history was reported. Concomitant medications included bisacodyl (LAXATIN) taken for an unspecified indication, start and stop date were not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 26Aug2021, the patient experienced I cannot hear out of my right ear. RN confirmed the name of the product as Pfizer Covid-19 Vaccine. RN stated, "I used to be a nurse, but I am retired now." (Hence, captured as Retired Nurse). RN stated," It might have started yesterday but she really was not aware, but it was this morning when she was taking and noticed change in the ear and could not hear." "Yes, this morning I started taking new medication which was Morphine 15mg of this." RN stated," Morphine that is the new one. Okay you want to know rest of my Medication. First one was the Morphine, I take Laxatin which is Prozac and I take 20mg once a day." Therapeutic measures were taken as a result of I cannot hear out of my right ear (deafness). Retired nurse (RN) stated, "I had the Pfizer injection yesterday afternoon and now, Wednesday I had the vaccination, and I cannot hear out of my right ear, I don''t know it''s formed the (Incomplete sentence), I don''t know." The patient underwent lab tests and procedures which included blood test: unknown on an unspecified date in Jul2021. The outcome of the event was reported not resolved.; Sender''s Comments: Based on the temporal relation, the association between the event of deafness unilateral and the suspect product of BNT162B2 cannot be completely ruled out. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1692310 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry throat, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Autoimmune gastritis (Autoimmune atrophic gastritis); Fruit allergy (Known allergies: Pineapple); Rheumatoid arthritis.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101162188

Write-up: Mild/uncomfortable sore/dry throat; Mild/uncomfortable sore/dry throat; This is a spontaneous report from a contactable consumer, the patient. A 22-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FD8448) via an unspecified route of administration in the left arm on 24Aug2021 at 15:00 (at the age of 22-years-old) as a single dose for COVID-19 immunisation. Medical history included autoimmune atrophic gastritis and rheumatoid arthritis. The patient had known allergy to pineapple. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications included SKIN BRIGHT, two gummies daily, from an unknown date for an unknown indication and unknown if ongoing. On 26Aug2021 at 08:00, the patient experienced mild/uncomfortable sore and dry throat. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the events. The clinical outcome of the events mild/uncomfortable sore and dry throat were resolving at the time of this report.


VAERS ID: 1692960 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Breast swelling, Fatigue, Immunodeficiency, Influenza like illness, Lymphadenopathy, Nasal congestion, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor Quinipril Calcium supp Vitamin D supp
Current Illness:
Preexisting Conditions: Breast cancer, completed treatment on April 30. Htn, This was my 3rd Pfizer vaccine, 1st shot was 12/30/2020, 2nd shot 1/22/2021
Allergies: Chlorahexadine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Its been more than 2 weeks since my vaccine and I still feel extremely fatigued, flu like, stuffy nose in the mornings. Left breast and underarm still feels a little larger than my right side. Still have itching and 1-2 hives around my abdomen and now 1 on my right wrist.


VAERS ID: 1693039 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Hypoaesthesia, Insomnia
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: (OTC): multi-vitamin, D3, zinc
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/26 within an hour: numbness covering left arm and hand. By 5PM, mild numbness left side of neck and left jaw. Night of 8/26 into 8/27 morning, insomnia and brain fog. 8/27 through 9/4; arm and hand numbness persist, but not severe enough to hamper motor skills. Facial numbness (all left side only) in jaw, left ear, back of tongue, and eyelid. Numbness felt like novocain injection at dentist office that had nearly worn off. 9/5 through 9/11: most numbness gone, only a little in left hand and left jaw


VAERS ID: 1693243 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast, Multi-vitamin, vitimin d, vitamin c, magnesium, Glucosamine, zyrtec,
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Slight blurry vision in left eye. Vaccination received in left arm. Intermittent slight blurry vision in left eye for following weeks.


VAERS ID: 1693347 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Vaginal haemorrhage
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: fibroids
Allergies: allergy to cotton candy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: vaginal bleeding


VAERS ID: 1693419 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 UN / IM

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

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

Write-up: Employee requested Janssen and received Moderna Covid-19 vaccine


VAERS ID: 1693485 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Ventricular extrasystoles
SMQs:, Ventricular tachyarrhythmias (narrow), Hypokalaemia (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: Diltiazem, aproprizole, celebrex. 325 mg aspirin, simvastatin; hydroclorothiazide, clonazepam, vit, E, elderberry/sambuca, fish oil
Current Illness:
Preexisting Conditions: Heart PVCs HBP Osteoporosis Depression
Allergies: reglan Gabapentin Amnitriptilyne
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: Heart PVCs have increased exponentially.


VAERS ID: 1693757 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3187 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Breast pain, Headache, Limb discomfort, Menstruation irregular, Mood swings, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Depression (excl suicide and self injury) (broad), Other ischaemic heart disease (narrow), Lipodystrophy (broad), Fertility disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin d3
Current Illness: None
Preexisting Conditions:
Allergies: Fluoroquinolone antibiotics caused a achilles tendon issue
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within 20 min to half hour after this first vaccine dose I experienced sharp one second pains in what felt like uterus. Happened intermittently several times through day and faded away after 1st day. Also within half hour of vaccine both arms felt asleep or as if they had been in same position for a long time even though they were not. This continued first day or longer off and on. Within first half hour after vaccine experienced a brief one second strong headache in small section at back of head. On drive home after vax and first days my heart hurt. Brain for for first week. Worst affect was in days 6 and seven post first vaccine experienced moderate to severe continual headache. Lasted 2 to 3 days. I never get headaches like this. I did also experience sore breasts and mood swing as if my period was coming but it was not due to come for another 9 days. This is unusual for me as it usually only happens briefly the day before it starts now. My period did start on time on schedule 17 days after the vaccine. Also I had a weird thing happen on one day in which my earlobe itched and felt infected as they did many decades ago when I was allergic to metal from earring posts in my pierced ears.


VAERS ID: 1693847 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Intermenstrual bleeding
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Abnormal menstrual spotting and heavy bleeding


VAERS ID: 1694048 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-14
Onset:2021-08-26
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Myalgia, Oropharyngeal pain, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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:
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 dose12/24/21 2nd dose01/14/21 Diagnosed covid positive:09/04/21 Symptom onset:08/26/21 Exposure:home Symptoms:cough, fatigue,muscle aches,sore throat,runny nose.


VAERS ID: 1694127 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-26
Onset:2021-08-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site oedema, X-ray
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: X-ray to left arm remarkable, no fracture present.
CDC Split Type:

Write-up: Localized edema on left arm with blood pooling NOT at the site of injection, but in lower arm towards elbow.


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