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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 39 out of 4,799

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VAERS ID: 1450273 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Remicade, Hydroxychloroquine, Restasis
Current Illness:
Preexisting Conditions: Chrohn''s Disease, Ulcerative Colitis, Remicade induced Lupus
Allergies: dicloxacillin
Diagnostic Lab Data: The emergency room was so full I was unable to be treated for any of my symptoms.
CDC Split Type:

Write-up: I received the vaccine in my left arm around 11:00 am on June 30, 2021. Tingling/Numbness started in my right arm at approximately 2:00 am July 1, 2021. The tingling/numbness remained in the right arm and traveled into my right leg at approximatey 3:00 pm. Around 12:00 am the tingling and numbness were still in my right arm and leg, and now traveling up my left leg. By 8:00 am the tingling and numbness had subsided.


VAERS ID: 1450283 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / N/A LA / IM

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

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

Write-up: Patient reported to PCP that she received Moderna Covid19 vaccine (lot 006C21A) at another facility on 5/20/21 and then received one dose of Pfizer vaccine as documented here on 7/1/21. Patient denied adverse reaction to either, simply concerned whether further doses would be required. No further doses administered of either product.


VAERS ID: 1450316 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A - / IM

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

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

Write-up: Individual presented for vaccination for Covid-19. Right after the vaccinator administered the Janssen vaccine without issue the data collector realized he had completed a series of vaccination with the Moderna product on 3/27/2021. He was observed for about 30 minutes post-vaccination without issue. He was informed that he had received a dose of Janssen but was already vaccinated with the Moderna series and should not seek further vaccination.


VAERS ID: 1450338 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-22
Onset:2021-07-01
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Erythema, Limb discomfort, Peripheral swelling, Rash erythematous, Rash pruritic, Rash pustular
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pussy sores and a rash on my arms and legs. Covid toes except it is my entire sole of my foot. My feet are red, swollen and feel tight and on fire. I felt better with massage and a hot shower but it is lingering. Half of my body is rash like and the other is sores that have a small amount of puss in the center. Very itchy and on fire. After benedryl lotion the rash is just red raised and present.


VAERS ID: 1450415 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-02
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA156051 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, ipratroprium, fluoxetine, losartan, budesonide suspension for inhalation
Current Illness: None
Preexisting Conditions: COPD, hypertension, obesity, anxiety, bipolar 2 disorder
Allergies: gatifloxacin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was 2 days out of date when administered. No adverse event seen


VAERS ID: 1450423 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-28
Onset:2021-07-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Moderna Dose 1, face rash
Other Medications: None
Current Illness: None
Preexisting Conditions: Seborrhic Dertmatitis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Face hives broke out on Thursday, June 24th Eyes swole up on Friday, June 25th


VAERS ID: 1450442 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown (pt does not fill rx''s at our pharmacy)
Current Illness: None
Preexisting Conditions: Has had prior adverse reactions to needle sticks (i.e. drawing blood, other vaccinations) - would get lightheaded/faint
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s hands felt tingly, was very lightheaded, broke out in cold sweat. After about an hour of lying down, patient felt fine and was able to walk on his own.


VAERS ID: 1450518 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-15
Onset:2021-07-01
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/2/2021- SARS Coronavirus-2, PCR detected
CDC Split Type:

Write-up: Developed s/s of COVID 7/1, tested positive for COVID 7/2


VAERS ID: 1450537 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anion gap decreased, Basophil percentage decreased, Blood creatinine increased, C-reactive protein increased, Chest pain, Chills, Condition aggravated, Cytomegalovirus test, Cytomegalovirus test negative, DNA antibody negative, Enterovirus test negative, Eosinophil percentage decreased, Epstein-Barr virus antibody negative, HIV antigen negative, Haematocrit increased, Human herpes virus 6 serology negative, Immature granulocyte count, Lymphocyte percentage decreased, Monocyte percentage increased, Myocarditis, Neutrophil count increased, Neutrophil percentage increased, Painful respiration, Parvovirus B19 test negative, Protein total increased, Pyrexia, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Serum ferritin increased, Streptococcus test, Troponin increased, Vomiting, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allergy serum 1 dose Q28 days
Current Illness:
Preexisting Conditions: Allergic rhinitis
Allergies: no known allergies
Diagnostic Lab Data: Chem profile 7/1/2021 07:57 Sodium Level: 138 Potassium Level: 4.4 Chloride: 104 Bicarbonate Level: 26 Anion Gap: 8 (L) BUN: 11 Creatinine: 0.95 (H) Modified Schwartz eGFR: $g=60 Glucose: 129 (H) Calcium: 9.4 Alkaline Phosphatase: 168 Albumin: 3.9 Protein, Total: 8.1 (H) AST: 20 ALT: 29 Bilirubin, Total: 1.0 7/2/2021 06:35 Sodium Level: 139 Potassium Level: 4.5 Chloride: 106 Bicarbonate Level: 24 Anion Gap: 9 BUN: 10 Creatinine: 0.68 Modified Schwartz eGFR: $g=60 Glucose: 106 (H) Calcium: 9.6 cardiac profile 7/3/2021 11:49 hsTnT: 1,367 (HP) hsTnT Interpretation: Critical (P) 7/3/2021 18:26 hsTnT: 1,474 (HP) hsTnT Interpretation: Critical (P) 7/4/2021 00:05 hsTnT: 1,457 (HP) hsTnT Interpretation: Critical (P) 7/4/2021 06:03 hsTnT: 1,070 (HP) hsTnT Interpretation: Critical (P) 7/5/2021 07:57 hsTnT: 206 (HP) hsTnT Interpretation: Critical (P) Hematology 7/1/2021 07:57 WBC: 14.13 (H) RBC: 5.29 Hemoglobin: 15.2 Hematocrit: 44.8 MCV: 84.7 MCH: 28.7 MCHC: 33.9 RDW: 13.6 Platelet: 217 MPV: 10.3 Neut Auto: 80.0 Immature Granulocyte Automated: 0.5 Lymph Auto: 9.1 (L) Monocytes Automated: 10.0 Eos Auto: 0.2 Basophil Auto: 0.2 NRBC Auto: 0.0 Neutrophil Absolute Count: 11.30 (H) Immature Granulocyte Absolute Count: 0.07 (H) Lymph Absolute: 1.28 Mono Absolute: 1.42 (H) Eos Absolute: 0.03 Baso Absolute: 0.03 NRBC Absolute: 0.00 Sed Rate: 9 anemia profile 7/1/2021 14:47 Ferritin: 202 (H) Infectious Disease 7/1/2021 07:42 COVID-19 PCR: Not Detected 7/1/2021 14:14 RESPIRATORY PATHOGENS BY FILM ARRAY: Rpt COVID-19 PCR: Not Detected 7/1/2021 14:47 Anti-DNase B Titer, S: 147 CMV IgG Ab: Negative CMV IgM Ab: Negative EBV VCA IgM: Negative EBV DNA QUANT: Rpt EBV VCA IgG: Negative EBV Nuclear Ab: Negative Parvo B19 IgG: Negative COVID-19 Anti-Spike Antibody: Positive (A) COVID-19 Anti-Nucleocapsid Antibody: Positive (A) COVID-19 Antibody Interpretation: See Comment Interpretation: SEE COMMENTS ADENOVIRUS PCR QUANTITATIVE: Rpt Adenovirus DNA Quant: 0 CMV DNA QUANT BY PCR: Rpt CMV DNA, Quant: 0 Enterovirus qRT-PCR (serum): Not Detected EBV DNA Quant: 0 Parvovirus B19 qPCR (serum): Not Detected HHV6 qPCR (Serum): Not Detected Parvovirus B19 IgM Ab: Negative HIV 1/2 Ab Ag Screen: Nonreactive
CDC Split Type:

Write-up: Pt mother called and stated that pt is vomiting and has a fever of 101.9 pt mother state that pt received the second dose of COVID vaccine on 6/29/21 and now he is having these symptoms. Pt mother state that pt had these symptoms before with the first dose however they resolved on there own. Pt is now complaining of chest pain is unable to take a deep breath because it causes him pain. Patient Has not attempted treatment at home. CHIEF COMPLAINT: VOMITING (one episode of vomiting this morning) and FEVER (fever started on Wednesday) Assessment/Plan DIAGNOSIS at time of disposition: 1. Acute myocarditis, unspecified myocarditis type 2. Acute chest pain 3. COVID-19 virus not detected Patient presents with chest pain 2 days after 2nd COVID-19 vaccine. Labs were obtained and his troponin is elevated to 122 and his CRP is also elevated. I discussed case with ID, recommended admitting to Cardiology for workup for myocarditis. 14 y/o previously healthy male who presented to hospital after onset of chest pain, fever, chills, and vomiting this morning. Found to have elevated troponin and mild ST changes on EKG. Patient recently received 2nd Pfizer-BioNTech COVID vaccine on 6/29. Admitted for close monitoring and further work up of suspected myopericarditis following COVID vaccination.


VAERS ID: 1450649 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

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

Write-up: Patient received the vaccine Wednesday June 30th, and woke up Thursday July 1st with a fever. He called to let us know about his fever on Monday July 5th and said it persisted through the weekend.


VAERS ID: 1450657 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-01
Onset:2021-07-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anosmia, COVID-19, Chest X-ray normal, Cough, Diarrhoea, Influenza virus test, Malaise, Pain, Pulmonary granuloma, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, HLD and PDA closure in childhood
Allergies: NKA
Diagnostic Lab Data: Diagnostic Results (07/01/2021 22:10 CDT XR Chest Portable) FINDINGS: Normal cardiomediastinal silhouette. No focal parenchymal process. Scattered pulmonary granulomata. No pleural effusions. No pneumothorax. No acute osseous abnormalities. IMPRESSION: No acute cardiopulmonary findings which can be seen in early COVID-19 pneumonia.
CDC Split Type:

Write-up: Patient also reporting cough, body aches, malaise, and diarrhea for ~4-5 days; unable to pin down date of onset. He reports loss of smell that he endorses as 2/2 congestion. Patient vaccinated for COVID with 2nd dose in March, but brother and father were not and are currently treated for it with his father still in the hospital. At OSH, COVID + flu PCR combination swab + for COVID. No oxygen requirement.


VAERS ID: 1450662 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-07-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ischaemic stroke
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow)

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

Write-up: Stroke (ischemic)


VAERS ID: 1450664 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Chest pain, Cytomegalovirus test, Electrocardiogram ST segment elevation, Enterovirus test, Epstein-Barr virus test, Human herpes virus 6 serology, Immunoglobulin therapy, Intensive care, Parvovirus B19 test, SARS-CoV-2 antibody test positive, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 7/4/21 COVID19 spike ab positive Pending blood/serum tests: Enterovirus PCR, parvovirus PCR, HHV6 PCR, COVID19 nucleocapsid Ab, EBV panel, Adenovirus PCR, CMV PCR, EBV PCR
CDC Split Type:

Write-up: Healthy 16yr old boy with no PMHx. Received dose #1 vaccine on 6/9/21 and dose #2 6/30/21. Developed chest pain on 7/1 relieved temporarily with Tylenol but returns when Tylenol wore off. Progressive worsening over next 2 days. Mom took pt to Urgent Care 7/3 who referred pt to ER. EKG with diffuse ST elevation, no fever, Troponin elevated at 11. Afebrile. He was transferred to our hospital and admitted to PICU 7/3. Chest pain initially improved with ibuprofen but worsened on hospital day #2 with higher troponin. Started on IVIG and solumedrol, ibuprofen changed to Toradol with good response. No pressors, otherwise hemodynamically stable.


VAERS ID: 1451963 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078CZIA / 1 - / SYR

Administered by: Work       Purchased by: ?
Symptoms: Ageusia, Anosmia, Axillary pain, Lymphadenopathy, Pain in extremity, Parosmia
SMQs:, Taste and smell disorders (narrow), Tendinopathies and ligament disorders (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? No
Previous Vaccinations:
Other Medications: ADHD meds
Current Illness: None
Preexisting Conditions: Adhd
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The day after my arm was sore and 2 days after. Swelled lymph nodes in arm and the lymph nodes in armpit. I have a lot of pain in armpit. Then like around the 3 rd Maybe 4 days after. I notice my smell is off and hardly can taste food. And as of today july/6 i still hardly can smell or taste anything. My armpit lymph nodes still swelled and still in pain. My hole arm is not sore no more. Just the armpit


VAERS ID: 1452195 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Injection site vesicles
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:

Write-up: Right arm blistered at the injection site and the spot is still there


VAERS ID: 1452601 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-07-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Decreased appetite, Diarrhoea, Dyspepsia, Emotional distress, Headache, Immobile, Irritability, Loss of personal independence in daily activities, Nausea, Pain, Pain in extremity, Pyrexia, Sneezing, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Adverse reaction after 1st vaccination (similar to COVID-19)
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None, recommended by physician by virtual/ZOOM appointment.
CDC Split Type:

Write-up: Headache, chills, fever, irritability, no appetite, cough, sneezing, body aches, immobilized, heartburn, sore arm, emotional, unable to care for my children, nausea, diarrhea, vomiting,


VAERS ID: 1453082 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-22
Onset:2021-07-01
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Heavy menstrual bleeding, Postmenopausal haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Seroquel, Furosemide, Rouvastatin, Zoloft, Ropinerole
Current Illness: None
Preexisting Conditions: Depression/anxiety, high cholesterol
Allergies: None
Diagnostic Lab Data: None at the moment but have a doctor?s appointment scheduled for July 15 @ 9am
CDC Split Type:

Write-up: After 9 months of being without a period due to menopause, had menstrual flooding out of no where that is heavy for a day or two, then goes away, then comes back. At the time of this notice, it is still ongoing and has not resolved. Heaviest period I have EVER had in my life with extreme abdominal pain/cramping that I have NEVER had before.


VAERS ID: 1453597 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Headache, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXCEDRIN EXTRA STRENGTH
Current Illness: Asthma; Gastrointestinal disorder; Pain; Spinal stenosis; Uterine cancer
Preexisting Conditions: Medical History/Concurrent Conditions: Back surgery (She had a back surgery in the past due to severe neck and back issues and uses a walker.); Hysterectomy; Comments: The patient was not pregnant at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210703446

Write-up: PAIN EVERYWHERE; SHORTNESS OF BREATH; HEADACHE; MUSCLE ACHES ALL OVER BODY; This spontaneous report received from a patient concerned a 56 year old female. The patient''s weight was 120 pounds, and height was 64 inches. The patient''s past medical history included back surgery, and hysterectomy, and concurrent conditions included spinal stenosis, asthma, pain, gastrointestinal disorders, and uterine cancer, and other pre-existing medical conditions included the patient was not pregnant at the time of vaccination.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, and expiry: UNKNOWN) dose was not reported, administered on 01-JUL-2021 for prophylactic vaccination. Concomitant medications included acetylsalicylic acid/caffeine/paracetamol for pain everywhere, shortness of breath, headache, and muscle aches all over body. On 01-JUL-2021, the subject experienced pain everywhere. On 01-JUL-2021, the subject experienced shortness of breath. On 01-JUL-2021, the subject experienced headache. On 01-JUL-2021, the subject experienced muscle aches all over body. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, muscle aches all over body, shortness of breath, and pain everywhere. This report was non-serious.


VAERS ID: 1453611 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210708852

Write-up: HEADACHE; This spontaneous report received from a consumer concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 03-JUL-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On JUL-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of headache was not reported. This report was non-serious.


VAERS ID: 1454062 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01788121 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram head, Laboratory test
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 7/1/2021 ER visit with lab work and CT head.
CDC Split Type:

Write-up: Bells Palsy


VAERS ID: 1454183 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: SOB, dizziness, and chest tightness at 1920, NP wanted PT put on bed with legs elevated and to monitor BP. BP did not improve after 15 minutes and another NP notified and assessed PT. New orders for IV placement, give 1000 mL NS via IV, and send to ER for evaluation. IV was placed at 0950 in R AC and 911 Notified. EMS 2 attendants placed PT on stretcher and transported PT to local Medical Center at 1020.


VAERS ID: 1454211 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Ringing in ears constant !


VAERS ID: 1454222 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Heart rate increased, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: Made visit to Urgent Care Center. EKG was found to be normal, no other action taken. Subject was advised to visit ER for cardiac related symptoms. Call was made to PCP office and were advised to visit ER for cardiac related symptoms,
CDC Split Type:

Write-up: Subject passed-out for about 20 seconds, 5 minuets after injection. Approx. 24 to 36 hours later began experiencing intermittent chest pains and rapid heart beats. This has continued for the last 8 days.


VAERS ID: 1454244 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, SARS-CoV-2 antibody 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: Methotrexate, leucovorin, Plavix
Current Illness:
Preexisting Conditions: RA (PMR)
Allergies:
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Same as I had when I had Covid-19 seven months previously: extreme fatigue and total loss of appetite, but this time it lasted only 13 hours instead of 10 days or more. I tested positive for Covid-19 antibodies 2 weeks prior to the shot.


VAERS ID: 1454340 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-07-01
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Breast mass, Chills, Erythema, Fatigue, Lymphadenopathy, Pain in extremity, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pepcid, Primatene tablets, Afrin Nasal Spray, Tylenol
Current Illness: None
Preexisting Conditions: Allergies, Rhinitis, GERD
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Swelling, erythema and pain right upper extremity associated with fever, chills, weakness and fatigue. Swelling extends from shoulder to mid humerus and extend from the axilla down to the level of the breast. Large palpable mass adjacent to right breast. Seen in PCP''s office on 6/29/21. Started on Bactrim without responce. Currently on Clindamycin


VAERS ID: 1454411 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C27A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose, Blood pressure increased, Hyperhidrosis, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Baclofen; berberine
Current Illness:
Preexisting Conditions: Diabetes
Allergies: Augmentin; Vicodin
Diagnostic Lab Data: Covid test. EKG. Checked my diabetes.
CDC Split Type: vsafe

Write-up: I felt okay, until that night when I was trying to sleep I was sweating so bad I took BP it was 198/100 and the next morning it was same, I called advice nurse she said to go to ER if it goes over 105 when I checked it again it was 107 so I went to the ER.


VAERS ID: 1454473 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-19
Onset:2021-07-01
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiovascular evaluation, Chest X-ray normal, Chest pain, Fibrin D dimer normal
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Paxil 20 mg tablet daily
Current Illness: No
Preexisting Conditions: Obstructive sleep apnea, mild asthma
Allergies: Cats
Diagnostic Lab Data:
CDC Split Type:

Write-up: She presents emergency department with chest pain that started 24 hours ago. She states that when she woke up yesterday she was experiencing central chest pain, no radiation. She states that if she applies pressure to her right anterior intercostal muscles with her hand, the pain is alleviated. The pain is worsened if the patient leans forward, alleviated by leaning back. Pericarditis Diagnosis management comments: Chest pain, story is concerning for pericarditis. Cardiac workup is negative and given it has been 24 hours since onset of chest pain, a single cardiac workup is sufficient rule out cardiac disease. D-dimer is negative. Chest x-ray, no acute cardiopulmonary abnormalities. Patient feels significantly improved after Toradol. Story remains consistent pericarditis, patient is given outpatient NSAIDs, I advised follow-up with primary care provider within the next week as may need further testing. Advised good return precautions in case of worsening chest pain, difficulty breathing, any worsening condition. Patient discharged in stable condition.


VAERS ID: 1454540 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-11
Onset:2021-07-01
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: COVID-19 PCR -positive. Individual tested positive for COVID-19 after vaccination.
CDC Split Type:

Write-up: Vaccine Breakthrough


VAERS ID: 1454584 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 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: Albuterol, doxycycline, tretinoin
Current Illness:
Preexisting Conditions: asperger syndrome
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error: 1st dose Moderna vaccine given to a 17 year old during annual wellness exam in clinic (not yet approved for use under 18 years). No adverse effects noted and per CDC guidance, will proceed with Moderna for dose #2.


VAERS ID: 1454617 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Diarrhoea, Dizziness, Headache, Lethargy, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu Vaccine 2009, hives, wheezing, tachycardia
Other Medications: Nexium, Magnesium, Zinc, Vitamin C, Vitamin E, Multi Vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: Latex, kiwi, avocado, banana, water chestnuts, dust mite.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Temperature of 101.7 initially, tremors, headache, nausea, dizziness, diarrhea, extreme lethargy. Lasting for 48 hours.


VAERS ID: 1454855 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dyspepsia, Heart rate irregular
SMQs:, Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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: Aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Continuous chest and heart pain. Irregular heartbeat (only a few times) and heart burn (only once).


VAERS ID: 1455092 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-10
Onset:2021-07-01
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Psoriasis on elbows
Preexisting Conditions: Asthma
Allergies: Latex
Diagnostic Lab Data: Have not been to drs. yet because the outbreaks stopped. If they don''t clear up in a weeks, I will go . They are starting to fade a little and have not spread.
CDC Split Type:

Write-up: Woke up to rash & outbreak spots on both arms & both legs (have photos). About 4 more came out during the day. No more outvreak after that


VAERS ID: 1455102 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Back pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Other ischaemic heart disease (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: Plaquenil 200mg Alpha lipoic acid Coq10 Fish oil Vit d
Current Illness: Sjogrens Endometriosis
Preexisting Conditions: Sjogrens Endometriosis
Allergies: Bella donna Pineapple Pinenuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart pain, needles in Heart type of pain. Pain in back. Went to er


VAERS ID: 1456711 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-03
Onset:2021-07-01
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6204 / 2 - / OT

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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Date: 20210701; Test Name: rapid pcr; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC2021820843

Write-up: He then developed Covid and tested on 01Jul2021; He then developed Covid and tested on 01Jul2021; This is a spontaneous report from a contactable other health care professional. A 58-year-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot Number: EN 6204) via intramuscular route on 03Mar2021 (at the age of 57-years-old) as dose 2, single and first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot Number: EL 9267) via intramuscular route on 12Feb2021 (at the age of 57-years-old) 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 were not reported. Prior to vaccination patient was not diagnosed with COVID-19. Since the vaccination the patient had been tested for COVID-19. The patient received any vaccines within four weeks prior to the vaccination was unknown and no other medications in two weeks. On 01Jul2021, Nasal Swab (rapid PCR) test was positive. The patient received 2 doses of Pfizer vaccine, he then developed covid. Adverse events resulted in doctor or other healthcare professional office/clinic visit. The patient did not receive any treatment for the event. The patient underwent lab tests and procedures which included positive rapid PCR, nasal swab on 01Jul2021. The events were reported as non-serious. The outcome of the events were unknown.; Sender''s Comments: Based on the current available information and the consistency with the known safety profile of the suspect product BNT162B2, there is a reasonable possibility that events vaccination failure and covid-19 were related to suspect drug based on the temporal relation between the vaccination and onset of events. 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: 1457092 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1067 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Peripheral swelling, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Pt called our office 7/8/21 stating she had an adverse reaction to the Pfizer vaccine (second dose) administered on 6/29/21. Pt states she went to urgent care on 7/3/21 due to hives on body and ended up going to ER on 7/4/21 for hives and swollen feet. Tried to submit adverse reaction online herself, was not able to. Called the office 7/8/21 at 10:50am for help with submitted the reaction. Pt states that she is feeling better.


VAERS ID: 1457104 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-07-01
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebellar stroke
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I63.9 - Occipital infarction (CMS/HCC)


VAERS ID: 1457109 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-07-01
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -

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

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

Write-up: G51.0 - Bell palsy


VAERS ID: 1457110 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-07-01
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

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

Write-up: I61.9 - Hemorrhagic stroke (CMS/HCC)


VAERS ID: 1457122 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Private       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies: PENCILLIN AND SULFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: RASH ON BILATERAL LEGS, FEET, ARMS, AND HANDS. ITCHING SYSTEMATICALLY. THE RASH SHOWED UP THE NEXT MORNING. WOKE UP WITH THE RASH. I HAVE USED HYDROCORTISONE CREAM AND TAKING ANTIHISTAMIES


VAERS ID: 1457135 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-07-01
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, Computerised tomogram abnormal, Hypoxia, Lung opacity, Respiratory failure, Respiratory viral panel, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: QVAR,Bumex, Plavix, Wellbutrin, Mycelex, Toprol XL, Farxiga, Aldactone, Klor-Con, Cozaar, Zaroxolyn, Bentyl, Asa 81mg, Nitrostat, Colcrys, Norco, Duoneb, Ventolin, Colace, Prvacid, Synthroid, Flomax,Zofran, Zyloprim, Sinus Rinse, Corlanor
Current Illness: unknown
Preexisting Conditions: Asthma COPD Acid Reflux, CAD CA, CHF, Hodgekin Lymphoma at age 22, HTN, Hyperlipidemia, IgG4 deficiency, Left Ventricular, systolic dysfunction, Type 2 DM, testicular CA, Thyroid CA, sleep apnea, nutcracker esophagus
Allergies: Avelox, Imdur, Entresto, moxifloxacin
Diagnostic Lab Data: CTA of chest bilateral opacities noted in lobes, 2 positive PCR tests for covid, negative remainder of respiratory panel
CDC Split Type:

Write-up: Respiratory Failure related to positive covid test. PCR positive on 07/01/2021 and PCR positive 07/07/2021. Patient placed on BIPAP due to hypoxia in ER and admitted. Remdesivir and decadron administed as inpatient. unknown exposure date admitted 07/07/2021


VAERS ID: 1457154 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Seizure like phenomena, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: The 15 year old female complained of being anxious. She was shaking almost like she was having a seizure for about 2 minutes. She felt better and went home with her dad.


VAERS ID: 1457173 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Dizziness, Dyspnoea, Fatigue, Headache, Mobility decreased, Pain in extremity, Palpitations, Pyrexia, Tinnitus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CONCOR; hydroxyzine -HCl - (did not take it 3days before and 3 days after)
Current Illness: Fever, Throat pain, sinus infection
Preexisting Conditions: Sjogren''s Syndrome and joint inflammation
Allergies: Severe Urticaria. NSAIDS. Sulfa, Latex, Penicillin
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: The first day: I had symptoms of fatigue, mild headache, dizziness and buzzing in my ears, could not get out of bed, in the afternoon I had fever (99F), my arm was burning and it hurt. I called the Dr. and she told me the symptoms the vaccine causes (headache, burning). She told me to wait a week and if it continued to go see a doctor. I took anti-allergy medicine and it helped me. I am taking azelastine (nasal allergy) and it has helped me. 2nd day: Rapid heart palpitations (heart pounding). 3rd day: Palpitations and shortness of breath when changing positions. I also have a pain above my hip on the right side.


VAERS ID: 1457177 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-12
Onset:2021-07-01
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Pyrexia
SMQs:, 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 dose 03/22/2021 pfizer,Lot# ER8727 2nd dose: 04/12/2021 Pfizer,Lot# EW0150 Diagnosed covid positive: 07/02/2021 Exposure: Symptoms:Fever, fatigue, headache.


VAERS ID: 1457178 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia oral
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: Patient complained of dizziness and numbness of her upper lip after the first dose of Pfizer. Patient verbalized she felt better after the intervention and she went home. BP 162/80; HR 80


VAERS ID: 1457183 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-07-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FW0181 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: gavapin, inhaler, nabulizer, iron and birth control
Current Illness: none
Preexisting Conditions: asthma, fibromyalgia
Allergies: asprin, toderal, citnal,
Diagnostic Lab Data: none
CDC Split Type: vsafe

Write-up: chest pains, fatigue, toes hurting, my nose was stopped and body aches


VAERS ID: 1457187 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-24
Onset:2021-07-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009O21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Breo Spiriva baclofen gabapentin singulair Zoloft tizanidine
Current Illness:
Preexisting Conditions: COPD Multiple Sclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large red rash @ injection site swelling ,feverish to touch,pain & itching


VAERS ID: 1457189 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hyperhidrosis, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient complained of facial numbness and tingling, sweating but no SOB. BP 130/72; O2 Sat 98%; HR 112. She got J&J vaccine. The ambulance was called and they came. Care was transferred to the paramedic but the patient refused to go to the ER.


VAERS ID: 1457197 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Seizure like phenomena, Syncope, Unresponsive to stimuli, Vaccine positive rechallenge
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was experiencing symptoms after 10 minutes of receiving J&J vaccine. He passed out for 5 minutes without any verbal response; with signs of seizure. He has a history of the same reaction with another vaccine. He got epinephrine 0.3mg IM Lot OFM625 Exp. Nov. 22. The ambulance was called and the patient''s care was transferred to the paramedic. The patient was transferred to the ER.


VAERS ID: 1457202 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Confusional state
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Patient called to report "bouts of confusion" starting ~24 hrs post vaccination. Patient reported already improving at time of call.


VAERS ID: 1457247 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-15
Onset:2021-07-01
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR 7/5/2021 positive for Covid
CDC Split Type:

Write-up: Also received COVID19 Pfizer vaccine #2 on April 5 at same location. On July 1, client had nasal congestion and loss of taste and smell. Tested positive PCR on 7/5 for Covid. VAERS report submitted because client is fully vaccinated and tested positive with symptoms for Covid.


VAERS ID: 1457265 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-08
Onset:2021-07-01
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: XARELTO STARTER PACK 15 & 20 MG TBPK nystatin (NYSTOP) 100000 UNIT/GM POWD powder APPLY TOPICALLY TO THE AFFECTED AREA(S) TWO TIMES A DAY insulin detemir (INSULIN DETEMIR) 100 units/mL pen Inject 15 Units into the skin daily. glipIZIDE (GL
Current Illness:
Preexisting Conditions: Cardiac Essential hypertension First degree AV block Hyperlipidemia Pulmonary embolism Nephrology Overactive bladder Neurologic Type 2 diabetes mellitus with polyneuropathy Fibromyalgia Charcot foot due to diabetes mellitus Orthopedic Lymphedema of leg Endocrine Dyslipidemia Hypothyroidism ENT Benign paroxysmal positional vertigo Digestive Irritable bowel syndrome Vitamin D deficiency Musculoskeletal Glaucoma Other Generalized weakness Morbid obesity History of bowel resection for diverticulitis Diverticulitis
Allergies: Amoxicillin Clavulanic Acid Erythromycin Erythropoietin Beta [Epoetin Beta] Latex LisinoprilCough Sitagliptin Sulfa Antibiotics Tannic Acid Tetracycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB AND DVT RESULTING IN HOSPITALIZATION ON 07/01/21


VAERS ID: 1457282 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast feeding, Breast induration, Breast pain, Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Lipodystrophy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyradin-S (levothyroxine sodium hydrate) 75mcg
Current Illness: None
Preexisting Conditions: Hashimoto''s Disease
Allergies: possibly sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: I''m currently breastfeeding a 14 month old. I think my right breast had a little hard spot the morning before I got the vaccine, but in the past when it happened I just breastfed and massaged the spot and nothing would come of it. The day we got vaccinated I don''t recall noticing any symptoms when breastfeeding. But, the morning after the vaccine, my right breast had a red patch and a little hard patch and let down was painful. I went to the doctor that afternoon and was diagnosed with mastisis. I haven''t had it before, that I am aware of. The doctor prescribed me 10 days worth of antibiotics. My symptoms subsided in a few days. Now it''s been a week and I feel fine. I am still taking the antibiotics as reccommended. The doctor thought it was most likely not related to the vaccine. I am reporting it since the CDC called me since I was signed up for VSafe.


VAERS ID: 1457402 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 LA / IM

Administered by: Senior Living       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP, Aspirin, Atorvastatin, Baclofen, Bisacodyl, Docusate, Glycolax, Levetiracetam, lexapro, lisinopril, lovenox, melatonin, multivitamin, norvasc, plavix, zyprexa
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Reesident received 3rd dose of Pfizer covid vaccine series on the same day, a few hours after the 2nd dose was given.


VAERS ID: 1457468 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-08
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: none - was given at age 16


VAERS ID: 1457470 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-04
Onset:2021-07-01
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Menstrual disorder
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: Amitriptyline 25MG Rizatriptan 10MG
Current Illness: Migraines
Preexisting Conditions: Migraines
Allergies: Dramamine Ambien
Diagnostic Lab Data:
CDC Split Type:

Write-up: My first period since the vaccine was very weird. It stopped and started three times and it was very light. This is very unusual for my menstruation.


VAERS ID: 1457486 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-15
Onset:2021-07-01
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2, Nucleic acid test, Respiratory symptom, SARS-CoV-2 test positive, Sick relative
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: na
Current Illness: none
Preexisting Conditions: DM htn hyperlipidemia
Allergies: asa pcn
Diagnostic Lab Data: 7/2/21 sars-cof 2 qualititaeive NAA detected.
CDC Split Type:

Write-up: pt tolerated vaccine well. 7/1 pt had uri symtoms after exposure to family member with + covid.


VAERS ID: 1457498 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dry throat, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer Vaccine
Other Medications: Benadryl Solumedrol
Current Illness:
Preexisting Conditions:
Allergies: Ferrous Sulfate Hydrocodne- acetaminophen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Staff notified RN that Pt was in the triage room and she needed help. Patient ID x 2, on assessment, Pt stated her throat feels dried up and she cannot breath appropriately. V/S was done and Pt''s BP was 116/69, Pulse 81, R 22, Oxygen saturation 100%. Pt stated she had just recently gotten her second shot of the COVID-19 vaccine, Pfizer. She stated she had a rxn to the first dose. Pt was placed on 2liters of oxygen and Provider was informed. Provider, NP ordered Solumedrol and benadryl. Medications were given at 0835am IM. Pt was continued to be monitored. BP at 0840 was 113/58, oxygen 100%, pulse 79, R 20. Pt was informed she is having a rxn to the vaccine and would be monitored before she could go home. After 0910, Pt''s BP was taken manually and BP was 110/72, Pulse 78, R 18, and Oxygen saturation 100%. Pt was observed for about an hour before been discharged. Provider asked RN to schedule Pt for a telehealth appointment for tomorrow. Pt was scheduled for the appointment. Pt stated she feels much more better and alright and she can breath well. Pt''s husband at bedside. Patient aware and verbalized understanding of all instructions and patient to return PRN to the clinic. BSN, RN/PHN


VAERS ID: 1457502 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Pallor, Paraesthesia, Posture abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: At 1845 EMT noticed client leaning to the side of her chair and family member alerted staff she needed help. EMT and RN responded at 1845. Site Manager informed lead PHN . PHN arrived at 1849. Upon arrival client sitting on chair, pale, awake and questioning why so many people were surrounding her. First vitals at 1849 by EMT Anthony: blood pressure 120/70, pulse 61, oxygen sat 99%. Client reported "I felt dizzy and tingling of my legs" and "then I remember being surrounded by staff". Family member reported he "saw her faint for a few seconds". Client alert and oriented x4. Reports history of syncope with blood draws, no other medical history, no medications and no known allergies. Client able to transfer to anti-gravity chair without assistance. Vitals at 1855: blood pressure 110/70, pulse 65, oxygen sat 98%. Client denied headache, blurred vision, nausea, chest pain, or shortness of breath. Client also reports tingling sensation below knees in addition to dizziness. RN assessed legs and client with full sensory and motor intact. Vitals at 1902: blood pressure 120/68, pulse 72, oxygen sat 95%. Per client tingling sensation and dizziness improving. Vitals at 1913: blood pressure 108/68, pulse 76, oxygen sat 99%. Per client dizziness and leg tingling resolved. Client sat in upright position in anti-gravity chair for remainder of observation time. Client stated family would drive her home. PHN advised client to follow up with provider and gave ER precautions. RN had client stand at 1918 from chair to assess for dizziness. Client stated feeling fine. Client left facility with steady gait at 1920.


VAERS ID: 1457528 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dry throat, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: notified RN that Pt was in the triage room and she needed help. Patient ID x 2, on assessment, Pt stated her throat feels dried up and she cannot breath appropriately. V/S was done and Pt''s BP was 116/69, Pulse 81, R 22, Oxygen saturation 100%. Pt stated she had just recently gotten her second shot of the COVID-19 vaccine, Pfizer. She stated she had a rxn to the first dose. Pt was placed on 2liters of oxygen and Provider was informed. Provider ordered Solumedrol and benadryl. Medications were given at 0835am IM. Pt was continued to be monitored. BP at 0840 was 113/58, oxygen 100%, pulse 79, R 20. Pt was informed she is having a rxn to the vaccine and would be monitored before she could go home. After 0910, Pt''s BP was taken manually and BP was 110/72, Pulse 78, R 18, and Oxygen saturation 100%. Pt was observed for about an hour before been discharged. Provider asked RN to schedule Pt for a telehealth appointment for tomorrow. Pt was scheduled for the appointment. Pt stated she feels much more better and alright and she can breath well. Pt''s husband at bedside. Patient aware and verbalized understanding of all instructions and patient to return PRN to the clinic.


VAERS ID: 1457542 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-09
Onset:2021-07-01
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / PUBLI / UNK LA / IM

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

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

Write-up: Patient became COVID-19 positive after being fully vaccinated. Patient is also not asymptomatic.


VAERS ID: 1457566 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-14
Onset:2021-07-01
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

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

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

Write-up: pt experienced delayed body rash on back/arms/legs- beginning 7/5/21- advised pt to try Benadryl and consult with physician regarding 2nd dose of Moderna


VAERS ID: 1457582 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-02
Onset:2021-07-01
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Macular degeneration
SMQs:, Retinal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I was taking thyroid medication and Wellbutrin.
Current Illness: None
Preexisting Conditions: I have high blood pressure.
Allergies: I''m allergic to Codeine.
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I went to the eye doctor on 07/01/2021 and was diagnosed with macular denegeneration.


VAERS ID: 1457584 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-05
Onset:2021-07-01
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Electrocardiogram, Full blood count, Hypertension, Thrombosis
SMQs:, Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Hypertension (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: Metformin
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: No
Diagnostic Lab Data: EKG, CBC
CDC Split Type: vsafe

Write-up: Blood clots, high blood pressure


VAERS ID: 1457866 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood thyroid stimulating hormone, Bronchitis, Chest X-ray, Chest discomfort, Cough, Diarrhoea, Discomfort, Dysphonia, Fatigue, Full blood count, Heavy menstrual bleeding, Hypertension, Immature granulocyte count increased, Laryngitis, Metabolic function test, Myalgia, Nausea, Ocular hyperaemia, Pain, Paraesthesia, Pregnancy test negative, Respiratory tract congestion, SARS-CoV-2 test negative, Tinnitus, Urine analysis normal, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Graves Disease
Allergies: Allergic to penicillin
Diagnostic Lab Data: lab tests completed in ER: CBC with diff (WBC elevated to 11.3, immature granulocytes elevated), CMP (all WNL), pregnancy test urine (negative) , urinalysis (no abnormalities), chest x-ray (no abnormalities), TSH lab (WNL), COVID test (negative)
CDC Split Type:

Write-up: 6/29/21: 2nd COVID19 (Moderna) vaccine on 6/30/21: fatigue, muscle aches, cough, congestion, heavy menstrual cycle began, diarrhea 7/1/21: unproductive/dry cough, voice became hoarse, congestion, diarrhea, extreme fatigue and body aches in PM 7/2/21: laryngitis/voice completely gone, continued unproductive cough, congestion, diarrhea 7/3/21: continued unproductive cough, chest tightness, diarrhea, went to urgent care and was diagnosed with bronchitis and prescribed prednisone 7/4/21: continued all symptoms as noted above 7/5/21: continued symptoms as noted above + nausea 7/6/21: continued symptoms as noted above, continued nausea, progressively worsening cough 7/7/21: continued all symptoms as noted above 7/8/21: woke up feeling extremely fatigued, eyes red, global feeling of weakness, new onset of tingling and pressure sensation left side of face, neck, and left upper arm, new onset tinnitus, high BP prompted ER visit and diagnosis of adverse effects of vaccine


VAERS ID: 1457886 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Computerised tomogram abdomen, Lymphadenitis
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: as above. 7/1/2021
CDC Split Type:

Write-up: Moderate to severe Abdominal Pain. CT Abdomen completed with + mesenteric adenitis


VAERS ID: 1457891 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Fatigue, Injection site erythema, Injection site pain, Injection site reaction, Injection site swelling, Injection site warmth, Insomnia, Limb discomfort, Rash macular, Rheumatoid arthritis
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune 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: Embrel Injection but I have not taken it for one week before Lisinopril 20mg, Hydrochlorothiazide 50mg Levothyroxine 100mcg, Pravastatin 20mg Vitamin D
Current Illness:
Preexisting Conditions: Rheumatoid Arthritis Hypothyroidism Hypertension Kidney Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I got my first dose of the vaccine on the advice of my Rheumatologist. I have not been able to see him yet. Two days after the first dose my left arm was really bothering me. My arm was red below the injection site and it was hot, raised up and painful. I couldn?t sleep on that side. I was very tired that week. I used antibiotic ointment and alcohol pads with a cold washcloth. I went back to the pharmacy. It looks better now after eight days. It is a little splotchy now, but the pain has gone down. I have also had more joint pain since I got the vaccine but that may be because I have not had any Embrel for two weeks. It feels like my Rheumatoid Arthritis is flared up.


VAERS ID: 1457906 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Fatigue, Neck pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: SULFA ANTIBIOTICS
Diagnostic Lab Data: Was treated at Medical Center on 7/3. Tests and treatment are unknown to pharmacy at this time.
CDC Split Type:

Write-up: Patient called on 7/7 and let us know that she had been treated in the ER for HR $g100, on and off fever, dizziness, shortness of breath when lying down, fatigue, and neck pain since receiving her second dose of the vaccine. She is following up with a cardiologist and will let us know of the outcome of this appointment.


VAERS ID: 1458142 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Mobility decreased, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro Volnea
Current Illness: N/a
Preexisting Conditions: Endometriosis
Allergies: Erythromycin
Diagnostic Lab Data: N/a only COVID vaccine
CDC Split Type:

Write-up: Shoulder and muscle pain has not dissipated. Challenging to raise left arm.


VAERS ID: 1458361 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-06-24
Onset:2021-07-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris, Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (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: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heartache started about a week after getting 2nd shot of Pfizer. Never had heart issues before in my life. I''ve noticed sharp, pulsing pain in the left side of my chest while in store. There pain pulses lasted for about a minute, then subsided. Since it subsided, I though it might have been muscle pain. However, I had the same pain happening 2 days later. Now it has been 2 weeks since my 2nd shot of Pfizer and I continue to get pulsing pain in heart area almost daily. It usually last anywhere from 1-3 minutes and then subsides. The pain is sharp, but tolerable, hence I did not go to a doctor with this issue yet. Again, I have never ever had this kind of pain in my life ago, nor I ever had any heart-related medical condition. I really hope it is temporary and will pass. For now I will continue to monitor and observe the symptoms.


VAERS ID: 1458362 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Headache, Pain
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Chills Body aches Headache Dizziness Exhaustion


VAERS ID: 1458368 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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

Write-up: Rash all over my legs


VAERS ID: 1458374 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Kurvelo birth control
Current Illness: Sinus infection
Preexisting Conditions: Celiac disease
Allergies: Gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itching, lump in arm


VAERS ID: 1458479 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Gastrointestinal disorder, Headache, Injection site pain, Menstruation delayed, Musculoskeletal stiffness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Fertility disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Symptoms after my second dose of Pfizer is a missed period, armpit pain (like a popping sensation), neck stiffness, muscle aches, headache, vaccination site soreness, and gastrointestinal changes. 2nd shot took place on July 5, 2021 at 3-3:15pm.


VAERS ID: 1458768 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210704358

Write-up: VIAL INITIALLY PUNCTURED AND HAD BEEN MAINTAINED IN THE REFRIGERATOR FROM THE TIME OF INITIAL PUNCTURE; This spontaneous report received from a pharmacist concerned a 41 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1816022, expiry: 15-AUG-2021) dose was not reported, administered on 01-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUL-2021, the subject experienced vial initially punctured and had been maintained in the refrigerator from the time of initial puncture. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vial initially punctured and had been maintained in the refrigerator from the time of initial puncture was not reported. This report was non-serious. This case, from the same reporter is linked to 20210703146.


VAERS ID: 1459699 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

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

Write-up: An incorrect DOB was provided for the individual receiving the vaccine in the presence of an adult who claimed to be the legal guardian.


VAERS ID: 1459709 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tumeric, kealnor birth control pills.
Current Illness: hemochromatosis and solar dermatitis
Preexisting Conditions: hemochromatosis and solar dermatitis
Allergies: myroxylon pereirae resin, nickel, bacitracin, disperse orange 3, methyldibromo glutaronitrile, propolis, benzophenone-3, goldsodiumthiosulfate, cobalt ii chloride hexahydrate, 2-n-octyl-4-isothiazolin-3-one
Diagnostic Lab Data:
CDC Split Type:

Write-up: just sore left arm i was numb head to toe only on my right side. it''s been 9 days i am not bck to 1005, my right side of my face doesn''t feel rigth and still has numbness feeling.


VAERS ID: 1459727 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 RA / IM

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

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

Write-up: Administered 1st dose of Moderna vaccine to 13 year old


VAERS ID: 1459732 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 13 year old received one dose of Moderna vaccine


VAERS ID: 1459734 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: diffuse itching, rash near site of injection


VAERS ID: 1459771 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-06
Onset:2021-07-01
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram, Blood test, Computerised tomogram, Echocardiogram, Magnetic resonance imaging, Optic ischaemic neuropathy, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (narrow), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: MRI, CAT scan, Echo, MRA, Bloodwork - admitted to hospital on July 6, released July 8, 2021.
CDC Split Type:

Write-up: Had sudden ?eye? stroke. Neurologist at hospital could not rule out this being an adverse affect from vaccine since there were no underlying health issues or past history of any health issues. Lost 25% vision in right eye due to sudden stroke.


VAERS ID: 1459797 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-06
Onset:2021-07-01
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011120A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dizziness postural, Dyspnoea, Fatigue, Flushing, Palpitations
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Childhood vaccine; this vaccine caused me to feel nauseous and experience flu-like symptoms.
Other Medications:
Current Illness:
Preexisting Conditions: Lung damage from radiation treatment for breast cancer, pre-existing non calcified lung nodules and mucus plugs.
Allergies:
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I have been experiencing this month more fatigue than usual. My face also feels flushed occasionally which I did not have before and I get very dizzy. When getting up from a bed I get extremely dizzy and I have to sit down. I continue with SOB that comes and goes and my heart palpitations are still present but not as frequent as before.


VAERS ID: 1459799 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash pruritic, Rash vesicular
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: Vyvanse, Lexapro, Montelukast, Breo Ellipta, Pepcid A/C
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On the back and side of my left leg and knee, a strong itchy rash developed which has left small little blisters for over a week now.


VAERS ID: 1459805 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-20
Onset:2021-07-01
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, Bilevel positive airway pressure, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Dyspnoea, Hypercapnia, Hyperkalaemia, Hyponatraemia, Intensive care, Lung infiltration, SARS-CoV-2 test positive, Sepsis, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown.
Current Illness: unknown
Preexisting Conditions: emphysema, BPH, and recurrent UTI, hypertension
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: received Moderna COVID-19 vaccine on 2/21/21 and 3/20/2021 7/4/21: 75 y/o male with PMHx of emphysema, BPH, and recurrent UTI who presented to the emergency department via EMS due to concerns from family that patient appeared to have worsening dyspnea over the past 3 days. Workup in ED revealed positive COVID-19 status, WBC 12.9, BNP 4900, and CXR with infiltrates consistent with possible pneumonia. continued as inpatient: azithromycin and ceftriaxone prescriptions that were started on 7/3. Has COVID-19 viral pneumonia, acute respiratory failure with hypoxia, hypercarbia, hyponatremia, hyperkalemia, acute kidney injury, and sever sepsis. 7/5: patient admitted to the ICU. on BiPAP support. started remdesivir.


VAERS ID: 1459956 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS 393C7 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Nausea, Renal disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The patient presented to the ER the day following the vaccines. She reported to her primary provider that she was experiencing fatigue, nausea, and vomiting since she received the vaccine. She received IV fluids and ondansetron. When contacted by the pharmacy the patient stated she had kidney damage as well. As of 7/9 /21, she is still experiencing side effects.


VAERS ID: 1460041 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Client received Pfizer 05/2021 is overdue for second vaccine and currently is unable to seek second dose and is requesting a second vaccine


VAERS ID: 1460055 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Severe, Additional Details: left arm is hurting 9 days after injection patient said doctor has but her on gabapentin with diagnoses of hitting nerve with injection


VAERS ID: 1460123 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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: Pantoprazole 40mg daily Lisinopril 10mg daily Multi Vitamin
Current Illness: Barretts Esophagus Lymphodema on left side of body
Preexisting Conditions: Barretts Esophagus Lymphodema on left side of body
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Aching in left leg, pricking needles feeling through out body


VAERS ID: 1460139 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-04
Onset:2021-07-01
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphonia, Head discomfort, Oropharyngeal pain, Sinusitis, Upper-airway cough syndrome
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Last week, I woke up on Thursday morning, with a sore throat and head pressure. Also my voice was gone. I went to Urgent Care and had a visual exam. I was diagnosed with a sinus infection - they saw the post nasal drip. They prescribed me amoxicillin and Prednisone that I took for five days and I''m still on amoxicillin (had a 10 day course of that).


VAERS ID: 1460145 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Cough, Depression, Fatigue, Headache, Inflammation, Vaccination site rash
SMQs:, Anaphylactic reaction (broad), Depression (excl suicide and self injury) (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Medications: Ascorbic Acid 500mg PO daily Ca-Vit D3 500mg-200Unit PO BID Duloxetine 60mg PO QAM and 30mg PO QPM APAP, Ibuprofen PRN Pain Miconazole 2% cream. Apply to affected areas BID. Zolpidem CR 12.5mg PO PRN QHS for Sleep
Current Illness:
Preexisting Conditions: PMH: ? Anxiety disorder ? Bipolar 1 disorder ? Cancer 2016 Skin CA under eyes ? Depression ? Depressive disorder ? Fractures ? Hypertension ? Manic depression
Allergies: Pt w/ allergies to Poison Oak (anaphylaxis), Poison Ivy (anaphylaxis), Lidocaine topical (rash), Blackberries (hives/rash), Shellfish (hives/rash), lactose (intolerance)
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt w/ allergies to Poison Oak (anaphylaxis), Poison Ivy (anaphylaxis), Lidocaine topical (rash), Blackberries (hives/rash), Shellfish (hives/rash), lactose (intolerance) Reports receiving Moderna vaccine on 7/1/21 @ pharmacy and developed a rash within 10 min to R arm where the vaccine was administered. Pt took own supply of benadryl but otherwise no medical care rendered. Denies s/s of anaphylaxis. Pt developed cough, fatigue, HA the next day. On 7/8 pt reported an increase in depression symptoms and increase of ongoing pain 2/2 inflammation from vaccine. PMH: ? Anxiety disorder ? Bipolar 1 disorder ? Cancer 2016 Skin CA under eyes ? Depression ? Depressive disorder ? Fractures ? Hypertension ? Manic depression Current Medications: Ascorbic Acid 500mg PO daily Ca-Vit D3 500mg-200Unit PO BID Duloxetine 60mg PO QAM and 30mg PO QPM APAP, Ibuprofen PRN Pain Miconazole 2% cream. Apply to affected areas BID. Zolpidem CR 12.5mg PO PRN QHS for Sleep


VAERS ID: 1460152 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / UNK UN / IM

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

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

Write-up: Palpitations


VAERS ID: 1460209 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

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

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

Write-up: Moderna COVID 19 vaccine administered to patient under 18 years of age. No adverse reaction reported.


VAERS ID: 1460230 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Seizure, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amitritylaine, quetiapine, diazepam, lamotrigine, montelukast, hydrocortisone, ritalin, tizanidine, trintellix
Current Illness: n/a
Preexisting Conditions: Ehlders Danlos syndrome, Mast cell activation syndrome, currently being worked up for MS due to neurologic symptoms
Allergies: liquid benadryl (only liquid form), hydrocodone, cipro
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Within a few minutes of receiving the vaccine the patient started convulsing and her tongue began to protrude from her mouth and was visibly swollen and she was struggling to breathe. Administered epinephrine and benadryl per standard anaphylaxis protocol and symptoms started to resolve but then resumed, repeated dose approx 5 minutes later and EMS system activated. Pt transported to the hospital and was monitored for approx 2 hours and given lorazepam and discharged home.


VAERS ID: 1460258 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-28
Onset:2021-07-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Hypoaesthesia, Pain, Paraesthesia, Vascular injury
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (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: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Burst blood vessel in left palm. Pinky and ring finger bruising and numbness, and sudden strong pain similar to a Charlie horse felt throughout said areas. Dull tingling in fingers.


VAERS ID: 1460318 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 3 LA / IM

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

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

Write-up: Invalid 3rd dose administered. Patient is under nursing supervision in a skilled facility. Per nurses at the facility, patient has exhibited no adverse reactions to this dose.


VAERS ID: 1461687 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-06-07
Onset:2021-07-01
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram, Condition aggravated, Electrocardiogram normal, Seizure, Urine analysis normal
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: epilepsy- stable/ seizure-free for past 4 years before having the seizure, off medication (lamictal) for past 6 months
Allergies:
Diagnostic Lab Data: cat scan -clean urine sample -clean blood work- clean ekg -normal
CDC Split Type:

Write-up: a tonic clonic seizure, 2 min 30 second long


VAERS ID: 1461778 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Medium, Additional Details: Patient''s blood pressure was 114/80 pulse 68. Symptoms resolved after 15 minutes.


VAERS ID: 1461992 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Sore Arm for a couple days then the pain went away then after a couple days the pain came back so bad she couldn''t move her arm. Patient is going to speak with md as well.


VAERS ID: 1462009 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-10
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Immunisation, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Vial of vaccine improperly reconstituted. Patient''s mother notified. Patient re-vaccinated with proper dosing of 0.3ml on 7/10/2021 at 1310. RN observed for 20 minutes post vaccination. No problems.


VAERS ID: 1462052 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-10
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Vaccine improperly reconstituted and administered on 7/8/2021. Patient made aware on 7/9/2021. Patient was re-vaccinated with appropriate 0.3 ml dose on 7/10/2021. Patient was observed for 20 minutes and no adverse reaction noted.


VAERS ID: 1462063 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-10
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Vial of vaccine reconstituted improperly and administered on 07/08/2021. Patient''s mother notified on 07/09/2021 and home visit was conducted on 07/10/2021 to re-vaccinate with appropriate dose of 0.3ml.


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