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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 405 out of 8,010

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VAERS ID: 1632818 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-25
Onset:2021-08-24
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 LA / SYR

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

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

Write-up: Received Moderna vaccines on 12/29/20, 1/25/21 Tested positive for COVID by PCR on 8/24/21 From Group Home Admitted to Hospital on 8/24/21 to ICU


VAERS ID: 1632822 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Nightmare, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Nightmares, headache, fever 102.1 F, severe joint pain (7 / 10), shaking chills


VAERS ID: 1632826 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-20
Onset:2021-08-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardioversion, Catheterisation cardiac abnormal, Chest pain, Intensive care, Pericardial effusion
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Insulin Dependent Diabetic
Preexisting Conditions: History of cardiac stents, MI and internal cardiac defibrillator
Allergies: Erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 7:10 AM on 8/24/21 Patient reported that her ICD was firing and that she would be going to the ED for evaluation. After arriving at the ED Patient''s husband reported that the Patient would be having a cardiac catheterization completed due to chest pain . Around 11:10am on 08/24/21. Husband reported following the cardiac catheterization that there was no new blockage identified, with fluid build up surrounding heart, the treatment was to provide diuretics with plan for the patient to remain in the hospital for at least 24 hours. On 8/25/21 husband reported that the patient remained in the ICU for monitoring of output. Cardiac defibrillator did not deliver any further shock (defibrillation).


VAERS ID: 1632827 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

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

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

Write-up: Approximately 25-30 minutes after vaccination, patient complained of itchiness to arm only.


VAERS ID: 1632839 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-25
Onset:2021-08-24
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 UN / SYR

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

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

Write-up: Received Moderna vaccines on 2/25/21, 3/25/21; tested positive for COVID by PCR on 8/24/21 hospitalized for ileal perforation on 8/25/21; incidental finding of asymptomatic COVID infection.


VAERS ID: 1632844 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Other       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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Nkda
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was given Pfizer for her second dose. Her first dose was Moderna. When asked if she was receiving her second dose of Pfizer she answered yes. Not discovered until after it was given that her first dose was Moderna. No adverse effect noted 30 minutes after shot was given


VAERS ID: 1632848 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unkown
Preexisting Conditions: unknowm
Allergies: unknown
Diagnostic Lab Data: Advised patient to take Tylenol for pain and monitor the swollen Lymph node , if does not feel improvement in few days of feels getting worse, contact pharmacy and doctor
CDC Split Type: 2439285

Write-up: Patient came to pharmacy complaining he has swollen lymph node in left armpit started on 08/24/2021 evening, with minor pain


VAERS ID: 1632858 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-19
Onset:2021-08-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 252E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site erythema, Injection site rash, Injection site swelling, Rash, Rash maculo-papular
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza Vaccine , 1987
Other Medications: Actemra, Gabapentin, Budesonide, Eliquis, cardizem, zyrtec, Vitamin d, melatonin
Current Illness: Atrial fib
Preexisting Conditions: Rheumatoid Arthritis, cluster headaches, Allergies, collangeous colitis
Allergies: sulfa, tegretol, dilantin, gluten, celebrex,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 5 days After injection, Diffusely red and swollen rash developed on the upper left arm, followed by a maculopapular rash covering the whole body . Prior to this I experienced headaches for 4 days, no fever,


VAERS ID: 1632878 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0173 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Parosmia, Taste disorder
SMQs:, Taste and smell 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: hydrocodone
Current Illness: no
Preexisting Conditions: pain management, COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Everything smell and taste like ash mouth very dry


VAERS ID: 1632892 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-08-24
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, citracal, MVI, prednisone, risedronate, valacyclovir, vitamin C
Current Illness:
Preexisting Conditions: Arthritis Hypertension Osteoporosis RA Temporal arteritis
Allergies: Penicillins
Diagnostic Lab Data: COVID (+) 8/24/21
CDC Split Type:

Write-up: Admitted 8/24/21 with COVID PNA, remains hospitalized on 8/25/21. Currently receiving remdesivir, requiring 3L O2. Began having symptoms 8/19/21.


VAERS ID: 1632901 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature decreased, Chest discomfort, Dizziness, Hypoaesthesia oral, Impaired driving ability, Impaired work ability, Vision blurred
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Per patient allergic reaction to: Flu vaccine. TDAP vaccine, and TB test. Pt stated allergic reactions caused her to "fall down"
Other Medications: Nothing on file
Current Illness: unknown
Preexisting Conditions: PPD Positive
Allergies: Per patient: allergy to flu vaccine, TDAP vaccine, and TB Test.
Diagnostic Lab Data: Vital signs taken on 8-24-2020
CDC Split Type:

Write-up: 0859 Pt received the first dose of Pfizer Lot # ew0168 at approximate 0830. Pt states having "heavy feeling in chest, dizziness, and it''s hard to concentrate my vision on things", but denies throat swelling, tongue swelling, itching, and no hives noted. Per pt she has had an allergic reaction in the past to the flu vaccine, TDAP, and TB test. Vital Signs at 0859 BP: 138/91 (108) HR: 80 SPO2: 100% RA RR: 20 Pain:0/10 Temp: 96.3 F 0908 Pt states heaviness in chest lessened after drinking water and states it is no longer difficult to focus her vision. 0910 Spoke with Dr about patients symptoms and he recommended patient be given Cetrizine 10 mg and monitor patient until she returns to baseline. Dr also advised that pt see her PCP and discuss reaction to first dose so that it can be determined if she is safe to receive the second dose of pfizer. 0917 Pt states she no longer has chest heaviness and lip numbness is lessening. Vital Signs at 0925 BP: 120/67 HR: 77 SPO2: 99% RA Pain: 0/10 0929 Administered Cetrizine 10 mg. Advised patient not to drive or return to work after receiving medication. 0940 Pt states no chest pain or heaviness, no lip numbness. Pt stable and not in distress. Pt passed walking test. Reminded patient not to drive or return to work after receiving medication. Advised patient to see her PCP to determine if it is safe for her to receive the second dose of the Pfizer vaccine.


VAERS ID: 1632903 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-22
Onset:2021-08-24
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood lactic acid decreased, C-reactive protein increased, COVID-19, Dyspnoea, Endotracheal intubation, Fall, Fibrin D dimer, Intensive care, Mechanical ventilation, Procalcitonin increased, Respiratory disorder, SARS-CoV-2 test positive, Serum ferritin normal
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, gout, hyperlipidemia, osteoarthritis, T2DM, obesity, OSA, HTN
Allergies: no known allergies
Diagnostic Lab Data: 8/24/21 1438: COVID + 8/24 labs: CRP 18.61, Lactate 1.7, Procalcitonin 1.45, d-dimer 1.31, ferritin 284
CDC Split Type:

Write-up: Pt presented to ED on 8/24/21 with complaints of shortness of breath and falls. Tested positive for COVID-19 on 8/24/21. Progressive respiratory decline in ED requiring intubation . Currently in ICU on mechanical ventilator and receiving remdesivir and dexamethasone


VAERS ID: 1632911 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Hyperventilation, Mydriasis, Seizure, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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: Atarax
Current Illness:
Preexisting Conditions: Anxiety
Allergies: Penicillin, Ativan
Diagnostic Lab Data:
CDC Split Type:

Write-up: During the COVID clinic on 8/24 an employee received the Pfizer Vaccination. Approx. 15min post vaccination the employee''s began to exhibit shortness of breath and took her prescribed anti-anxiety medication orally. Within two minutes her pupils dilated and she became verbally unresponsive to my questions. She had a pulse and was breathing, however she began to hyperventilate. She began to convulse so the vaccination team laid her down on the ground from her chair. A rapid response was called overhead and the RR team responded immediately. She was presumed to have a panic attack precipitated by the vaccine administration. She was provided a respirator by RT to support her oxygenation. We obtained IV access as per MD but we did not give any medications due to known allergies to recommended treatments. MD was present. We called 911. She was lifted from the floor to the gurney. EMS arrived quickly (within 10min) and we transferred care to EMS who then transported her to medical facility. She recovered and returned to work the following day.


VAERS ID: 1632914 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-15
Onset:2021-08-24
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Limb discomfort, Peripheral swelling, Skin warm
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose of moderna vaccine on 8/15/21 in her left arm. She came in on 8/24/21 in the evening stating that her arm had no redness or swelling, but then as of yesterday was red, swollen and felt warm to touch. I recommended otc options to help her with the discomfort. But I told her if it continues, gets worse or shows signs of infection she should visit her doctor. She was satisfied with this response


VAERS ID: 1632919 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-19
Onset:2021-08-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Dysarthria, Hemiparesis, Ischaemic stroke, Magnetic resonance imaging head abnormal, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Brain MRI/MRA (8/24) confirming acute/sub-acute infarct
CDC Split Type:

Write-up: Pt developed acute ischemic stroke in L parietal region on 8/24/21. Was in gym class when developed slurred speech, acute-onset weakness in R arm, and b/l legs. Continues to have residual tingling of R hand, otherwise all other symptoms have resolved without intervention.


VAERS ID: 1632934 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paxil 10 mg daily
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tenderness in arm with redness immediately around the site. Not unbearable.


VAERS ID: 1632939 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-17
Onset:2021-08-24
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Oxygen saturation decreased
SMQs:, Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: APAP, ASA, atorvastati, colestipol, Ampyra, furosemide, glucosamine-chondroitin, modafinil, potassium chloride, omeprazole
Current Illness:
Preexisting Conditions: MS, CAD, OSA, T2DM
Allergies: Amantadine, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid-19 infection; SOA, weakness. O2 stats dropped below 90% currently requiring 2 L O2


VAERS ID: 1632949 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

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

Write-up: Vaccine 2nd dose was administered by vaccinator 14 days apart


VAERS ID: 1632960 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Rash, Swollen tongue, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: symbicort inhaler, albuterol inhaler, zyrtec 10 mg, prednisone 10 mg, accolate 20mg
Current Illness: None
Preexisting Conditions: None
Allergies: montelukast sodium= Headache Moderna covid 19 vaccine= Itching
Diagnostic Lab Data: No tests done
CDC Split Type:

Write-up: Employee reported Itchy throat, Tongue felt swollen, Rash on Bil arms a few hours after receiving vaccine


VAERS ID: 1632966 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / SYR

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

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

Write-up: After about 24 hours after recieving the second shot, I noticed a rash forming on my arm. It?s now been 48 hours after the shot and the rash is growing larger. It itches and burns slightly, but not to the point where it is unbearable.


VAERS ID: 1632968 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Cognitive disorder, Dyskinesia, Feeding disorder, Speech disorder, Wheelchair user
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Dyskinesia (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: Coumadin Lisinopril Metoprolol
Current Illness: Dementia Neuropathy Controlled Hypertension Hyperlipidemia
Preexisting Conditions: Neuropathy HTN Hyperlipidemia
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was fine in the morning her cognition was as normal was oriented to time place not date. 4 hours after Moderna booster was called by father in law. She could not feed herself nor open her mouth. This writer assessed her skin color normal BP Pulse rate and Respiratory rate all within normal limits. O2Sat was at 98% she was afebrile and did have output. Her eyes were glossy she had no memory of myself her son or her husband. She would answer a question with maybe 2-3 words which had nothing to do with question followed by word confabulation. such as "Did you IIIIZZZZTTTZZZ" always letters and no full sentances that made sense. this went on till 3 am. They were going to take her to her Physician today. (08/25/2021) Caregiver got her up at 10 am. dressed her put her in the wheelchair( she is non-ambulatory). She is normal. No odd speech.She can answer questions and is fully aware of her surroundings. It is amazing her come back! Please look into this. Thank You


VAERS ID: 1632973 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse event but vaccine was found to be expired. Vial removed from freezer on 7.20.2021 and expired on 8.20.2021. Dose given on 8.24.2021.


VAERS ID: 1632985 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse event, but vaccine was found to be expired. Removed from freezer on 7.20.2021 expired on 8.20.2021 and given on 8.24.2021.


VAERS ID: 1632991 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7494 / 1 LA / 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? 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: No adverse event, but vaccine was found to be expired. Removed from freezer on 7.20.2021 expired on 8.20.2021 and given on 8.24.2021.


VAERS ID: 1632999 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient reported numbness and tingling to the corner of the left side of his mouth approximately 45 minutes after vaccination given.


VAERS ID: 1633008 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / SYR

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

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

Write-up: Patient stated that she has hives on her arm. Patient stated that she is allergic to latex and they put a band aid on her arm and the provider stated that the band aid was latex free. The hives are very itchy and red.


VAERS ID: 1633018 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling cold, Headache, Pain, 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: Ibuprofen
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Chills, Body Aches, Headache. Took 1000mg Acetaminophen which helped reduce symptoms for about 5-6 hours. Started around 8 PM and is still continuing (through 2:30 pm 8/25/2021). it was the worst around 2am 8/25/2021 when I woke up from sleeping.


VAERS ID: 1633025 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Injection site pain, Wrong product administered
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxybutinin ER 5mg
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: None as of yet
CDC Split Type:

Write-up: Patient received Pfizer vaccine instead of Zostivax. Has already received Janssen vaccine. Sore at injection site.


VAERS ID: 1633066 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Immediate post-injection reaction, Injection site erythema, Injection site rash, Injection site vesicles, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Patient experienced red, bumpy, hot, blistered skin where the shot/bandage was the day after. Right after the vaccination, patient experienced pressure from left collar bone to right collar bone instantly.


VAERS ID: 1633077 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-22
Onset:2021-08-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UAG12525 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Hyperaesthesia, Muscle twitching, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Constant twitching in the left side of my face for the last two days. I also have blurred vision and my eyes hurt and feel sensitive to the touch.


VAERS ID: 1633094 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-21
Onset:2021-08-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Myocarditis, Pain, Respiratory symptom, SARS-CoV-2 test negative, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D, Fish oil
Current Illness: None prior; URI symptoms/achiness after 2nd dose
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: troponin elevation
CDC Split Type:

Write-up: Patient developed acute chest pain consistent with myopericarditis requiring hospitalization 72 hours post 2nd dose of Moderna vaccination. COVID testing negative.


VAERS ID: 1633108 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: Patient was given undiluted Pfizer Covid 19 vaccine


VAERS ID: 1633121 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: Patient states he has had a similar reaction to influenza vaccine before
Other Medications: Albuterol Sulfate 8.5gm Proair HFA
Current Illness: ETOH
Preexisting Conditions:
Allergies: azithromycin (Verified Allergy, Mild, rash, 8/24/21) cefixime (Verified Allergy, Mild, rash, 8/24/21) Amoxicillin (Verified Allergy, Unknown, UNK, 8/24/21) PCN (penicillin) (Verified Allergy, Unknown, UNK, 8/24/21) Promethazine (Verified Allergy, Unknown, UNK, 8/24/21) erythromycin base (Verified Allergy, Unknown, Unknown, 8/24/21) mold (Verified Allergy, Unknown, Unknown, 8/24/21) prochlorperazine (Verified Allergy, Unknown, Unknown, 8/24/21) ragweed pollen (Verified Allergy, Unknown, Unknown, 8/24/21) C-CHLOR (Allergy, Mild, rash, 4/30/15) fluroquinolones (Allergy, Unknown, Unknown, 1/26/18)
Diagnostic Lab Data:
CDC Split Type:

Write-up: lightheadedness and dizziness, hypotensive at BP 80/63, diaphoretic


VAERS ID: 1633132 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site warmth, Pain, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Injection site is hot, arm is very very swollen all the way down to the elbow. Severe fatigue, chills, and body aches. Fever lasting about a day


VAERS ID: 1633141 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / IM

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

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

Write-up: Pt states he has developed a red, itchy rash on parts of his back, mostly on the left side. Rash appeared 8/24/21; 1 day after receiving his 3rd dose of Modern COVID-19 vaccine.


VAERS ID: 1633344 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Arthritis, Decreased appetite, Fatigue, Somnolence
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (narrow), Hypoglycaemia (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: None
Current Illness: Shogren?s, arthritis
Preexisting Conditions: After the vaccine, I experienced extreme fatigue, sleepiness, joint pain, arthritis flare-up that started two days after the first dose and got worse after the second shot.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arthritis flare up after the first dose. Extreme fatigue, sleepiness, lack of appetite, extreme joint pain after the second dose.


VAERS ID: 1633346 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Discomfort, Dizziness, Feeling cold, Hypoaesthesia, Injection site hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

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

Write-up: Client complained of numbness and tingling in Right arm 15 minutes following vaccine administration. Denied any other symptoms such as SOB, HA, CP or numbness and tingling of mouth, face or lips. Client denied any pertinent medical history, medication use, or allergies to any medications/foods/environment. At 1138 a first set of vitals taken: BP 150/98, HR: 64, RR: 16, A&Ox4, bilateral grip was equal and strong and bilateral capillary refill was $g2 seconds. Client stated the numbness was rated an 8/10 in discomfort. Skins were warm, dry and normal for ethnicity. Client stated she had a history of high blood pressures that were untreated. Bilateral hands were cool to touch and client complained of feeling cold. Client stated last oral intake was at dinner the evening before. Client ambulated to zero gravity chair without incidence and was given a foil blanket, juice and granola bar. At 1147 a second set of vitals taken: BP 132/92, RR: 16, HR: 80, A&Ox4. Client stated the numbness and tingling had migrated to left arm as well as right arm, and stated, "it feels like when your arm falls asleep", continued to deny SOB, CP, HA, and tingling of mouth and face. At 1205 a third set of vitals taken: BP 142/84, RR 16, HR: 64. Client continued complaint of numbness and tingling of bilateral hands and arms. Denied SOB, HA, CP or any other symptoms. At 1210 vitals taken BP 138/90, HR 70, RR 14. Client stated otherwise feels fine, but continued complaint of light headed, feeling cold and numbness and tingling in bilateral arms and hands. Client''s skin was warm, dry and normal color for ethnicity. At 1215 vitals taken: BP 136/86, RR 16, HR 72, A&Ox4, bilateral grip: equal and strong, bilateral capillary refill $g2 seconds. Client continued to complain of feeling numbness in arms and hands. At 1220 client asked to use the restroom, stated she was feeling "woozy" upon sitting up from zero gravity reclined position. Client stated she would like to be assessed by EMS as she was not improving. At 1225 EMS called at client''s request. At 1232 client care transferred to EMS. Client continued to have stable vital signs and no other distress or symptoms. Client signed AMA from EMS care at 1237. At 1240 client educated on ER precautions and advised to follow up with PCP if numbness and tingling persist or worsened. Client verbalized understanding and left the observation site on her own accord with a steady gait.


VAERS ID: 1633567 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-18
Onset:2021-08-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Loss of consciousness, Myalgia, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Pt states that she woke up at 10pm shaking uncontrollably, patient lost consciousness and woke up with sore muscles.


VAERS ID: 1633569 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Fall, Fear of injection, Head injury, Headache, Nausea, Panic reaction
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Pt came for covid vaccine. He started panicking once he saw the syringe. I tried as much as I can to calm him down before administering the vaccine. after the injection, he complained of feeling nauseous and he needed drinking water. I stepped out to get the water, coming back and saw him on the floor. He seemed disoriented at first, he started answering my questions coherently. I helped him to a sitting position and activated cold white because he was complaining of head hurt because he hit the head on the floor when he fell. Ambulance was called and he was checked out and released.


VAERS ID: 1633576 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Body temperature increased, Cough, Feeling of body temperature change, Injection site erythema, Injection site pruritus, Injection site swelling, Lethargy, Malaise, Mobility decreased, Musculoskeletal stiffness, Oropharyngeal pain, Pain, Pain in extremity, Pyrexia, Rhinorrhoea, SARS-CoV-2 test negative, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: Very sick following 1st dose of Moderna covid shot, tested negative for covid
Preexisting Conditions: Partial temporaral lobe epilepsy
Allergies: Allergic to sulfa antibiotics Allergic to mango and ginger (food allergy)
Diagnostic Lab Data: Negative covid test 1 week following first shot.
CDC Split Type:

Write-up: Following the first shot I was very sick (fever, cough, runny nose, sore throat, lethargic, coughing) took a covid test and tested negative. After the second shot, developed itching at the shot site within 2 hours. Woke up the next morning sore and with a runny nose. 20 hours after receiving the shot I have a stiff neck, all over body aches, redness and swelling 3? in diameter at the injection site that did not improve with heat or ice, temperature of 101 degrees that did not improve with tylenol. Shaking, cold and hot flashes, pain in arm and armpit, unable to lift arm well.


VAERS ID: 1633588 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-22
Onset:2021-08-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chest discomfort, Chest pain, Headache, Muscle spasms, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: muscle cramping and pain in legs and arms (legs first), chest tightness and pain, temperature of 101.8F, headaches


VAERS ID: 1633602 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: I was on my 5th day of my menstrual cycle, which is nearly the end of my cycle, but the next day (day 6 of my menstrual cycle) I have severe menstrual cramps and fresh and heavy bleeding, as if it was day 1 of my menstrual cycle. I have had off and on severe bleeding and menstrual cramps since that day.


VAERS ID: 1633612 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Pain in extremity, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient experienced sore arm at first, but around 10 pm the next day the skin on her underarm and chest began to get hot and swell. I advised her to take ibuprofen and diphenhydramine. She mentioned she was going to urgent care because her throat was sore (not related to shot).


VAERS ID: 1633614 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-20
Onset:2021-08-24
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / IM

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

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

Write-up: Fully vaccinated and tested positive for Covid-19


VAERS ID: 1633626 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Blood test abnormal, Chest discomfort, Electrocardiogram abnormal, Hypertension, Hypoaesthesia oral, Nausea, Palpitations, Paraesthesia oral, Pharyngeal hypoaesthesia, Pharyngeal paraesthesia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Busperone Lexapro
Current Illness: Kidney Stones on right side
Preexisting Conditions: Chronic neck issues Depression Anxiety
Allergies: Kiwi Pineapple Flomax Gabapentin
Diagnostic Lab Data: 08/24/2021 EKG found heart tachycardia Blood tests levels low in many areas
CDC Split Type:

Write-up: Tongue & throat tingling & numbness. Took 2 Benadryl that helped. Heart racing & blood pressure got high. Chest tightness. Feeling nauseous off & on. Went to ER they completed EKG & several blood tests. Gave Ativan to settle heart racing down & a short term blood pressure pill for high blood pressure.


VAERS ID: 1633786 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: States has felt faint after previous vaccines
Other Medications: none
Current Illness: none
Preexisting Conditions: History of low blood pressure, reported needle phobia, hand tremors, and syncope after vaccines
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client complained of feeling lightheaded and dizzy while sitting in the observation unit. RN moved client to lay down on a cot. Client stated had not eaten since noon. Client''s skin pale and moist, vitals taken: at 1913: BP 103/70, HR 93 bpm, SpO2 97% RR: 20. Client stated dizziness gone while lying down, denies itchiness or SOB. At 1917 RN sat client up and he was able to eat food and drink water. Vitals taken: 912/50, HR 111 bpm, SpO2 99%, RR 19. At 1920 client c/o dizziness returned while sitting, still pale and skin moist, PHN instructed client to lie back down. Denied nausea. Client AxO x4. At 1923 client stated dizziness is gone. Vitals taken" BP 98/57, HR 93 bpm, SpO2 100%, RR 21. At 1935 client was sat up, vitals taken: BP 106/72, HR 111, RR 18. Skin dry and appropriate color for Ethnicity. Client stated symptoms resolved, stated "feeling better." RN educated client to f/u with PMD. Client stood up at 1943 and walked off with a steady gait unassisted.


VAERS ID: 1633791 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-21
Onset:2021-08-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

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

Write-up: Herpes zoster on top of nose


VAERS ID: 1633795 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (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: protonix
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKDA
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt presented 08/25/2021 to the pharmacy complaining of feeling as if something was stuck in his throat. He was referred to see a physician. Pt returned about 2 hours later with his hand turning a bluish color. Advised pt go to the ER to be examined. No further follow up available at this time.


VAERS ID: 1633988 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Severe diarherra starting 18 hours post 3rd vaccine dose


VAERS ID: 1634184 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased, Body temperature increased, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plaquenil, folic acid, bupropion, methotrexate, humira, lantus, novolog, atorvastatin, duloxetine, gabapentin
Current Illness:
Preexisting Conditions: SLE, RA, Type 1 Diabetes, Fibromyalgia, hyperlipidemia, major depressive disorder, anxiety
Allergies: Allergic to Latex, Aspirin, Morphine Delayed hypersensitivity reaction to many antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 24 hours, temp rose to 102.3, extreme musculoskeletal pain, elevated blood glucose levels (350+) with correction doses of novolog not really helping


VAERS ID: 1634194 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-21
Onset:2021-08-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Novolog Insulin; Rosuvastatin
Current Illness:
Preexisting Conditions: Type 1 Diabetes
Allergies: Aspirin; Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left Arm Numbness, Tingling, and Weakness from shoulder to 5th digit of hand. Onset approximately 72 hours post vaccination. Ibuprofen and cold compress only partially relieves symptoms.


VAERS ID: 1634541 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 06AEA1A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Skin warm, Tenderness
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: 1st covid vaccine moderna had rash develop 7 days after injection
Other Medications: Metformin, lantus, victoza, invokanna
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm swelling spread down past my elbow to my forearm. Very hot and tender, dark red nearly bruised looking


VAERS ID: 1634882 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Muscle spasms, Pain in extremity
SMQs:, Dystonia (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: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: Patient had no any seasonal allergies, medications and previous medical history, no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210848975

Write-up: CRAMPS IN BOTH LEGS FROM KNEE TO ANKLE; SEVERE ARM PAIN THAT RADIATES FROM SHOULDER TO ELBOW LIKE HAD SURGERY ON IT; This spontaneous report received from a patient concerned a 37 year old female. The patient''s weight was not reported and height was 61 inches. The patient''s concurrent conditions included: non smoker, and non alcohol user, and other pre-existing medical conditions included: Patient had no any seasonal allergies, medications and previous medical history, no drug abuse or illicit drug usage. 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 23-AUG-2021 11:30 for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow up to request batch/lot number. No concomitant medications were reported. On 24-AUG-2021, the patient experienced cramps in both legs from knee to ankle. On 24-AUG-2021, the patient experienced severe arm pain that radiates from shoulder to elbow like had surgery on it. Treatment medications included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from severe arm pain that radiates from shoulder to elbow like had surgery on it, and cramps in both legs from knee to ankle. This report was non-serious.


VAERS ID: 1634885 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210824; Test Name: Body temperature; Result Unstructured Data: 101.1 F
CDC Split Type: USJNJFOC20210849009

Write-up: BODY ACHES; SORE ARM; HEADACHES; FEVER OF 101.1F; This spontaneous report received from a patient concerned a 58 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A expiry: UNKNOWN) dose was not reported, administered on 23-AUG-2021 15:30 for prophylactic vaccination. No concomitant medications were reported. On 24-AUG-2021, the patient experienced body aches. On 24-AUG-2021, the patient experienced sore arm. On 24-AUG-2021, the patient experienced headaches. On 24-AUG-2021, the patient experienced fever of 101.1f. Laboratory data included: Body temperature (NR: not provided) 101.1 F. Treatment medications included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from body aches on 24-AUG-2021, and was recovering from headaches, sore arm, and fever of 101.1f. This report was non-serious.


VAERS ID: 1634895 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18200096 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling hot, Injection site pain, 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:
Current Illness: Allergy to animal dander; Allergy to molds; Environmental allergy; Ragweed allergy; Sulfonamide allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210849236

Write-up: SWELLING IN RIGHT HAND/SWELLING IN THE PALM AND BACK OF RIGHT HAND; ITCHING IN RIGHT HAND/ ITCHINESS IN THE PALM AND BACK OF RIGHT HAND; HAVING A LITTLE HEAT TO IT AS WELL; MILD INJECTION SITE PAIN; This spontaneous report received from a patient concerned a 38 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: sulfa allergy, ragweed allergy, pet dander allergy, molds allergy, and environmental allergy. The patient experienced drug allergy when treated with cefalexin, and cefixime. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 18200096,and expiry: UNKNOWN) dose was not reported, administered on 24-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 24-AUG-2021, the patient experienced swelling in right hand/swelling in the palm and back of right hand. On 24-AUG-2021, the patient experienced itching in right hand/ itchiness in the palm and back of right hand. On 24-AUG-2021, the patient experienced having a little heat to it as well. On 24-AUG-2021, the patient experienced mild injection site pain. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from swelling in right hand/swelling in the palm and back of right hand, mild injection site pain, itching in right hand/ itchiness in the palm and back of right hand, and having a little heat to it as well. This report was non-serious.


VAERS ID: 1634902 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no significant medical history
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210849602

Write-up: DRY HEAVING; VOMITING; This spontaneous report received from a consumer concerned a 52 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient had no significant medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: 21-SEP-2021) dose was not reported, administered on 20-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 24-AUG-2021, the patient experienced dry heaving. On 24-AUG-2021, the patient experienced vomiting. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from vomiting, and dry heaving. This report was non-serious.


VAERS ID: 1636177 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu
Other Medications: Lexapro Womens multivitamin Vitamin D Vitamin C Zinc, calcium, magnesium
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, vomiting, fever, fatigue


VAERS ID: 1636188 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Heart rate irregular, Hypoaesthesia, Pain, Palpitations
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Sexual dysfunction (broad)

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

Write-up: Patient experienced heart palpitations and irregular heartbeat while resting in chair watching TV. Patient has no previous history of heart issues. Patient regularly tracks his heartbeat, typical at-rest heartbeat is approx 89 bpm. During event, at-rest heartbeat peaked to 120 bpm. Event lasted approximately 4 hours. Patient took several Tylenol which did help to calm down his heart. Additional side-effects noticed during this time included pain over his entire body, as well as a numbness in his fingers. Patient still experiencing mild pain across his entire body as of 8:00 AM on 8/26/2021.


VAERS ID: 1636192 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-08-24
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

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

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1636360 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: bREO eLIPTA; DIVALPROEX 125; MIRTAZEPINE 15; BUMETAMIDE 1MG; RIVASTIGMINE 3MG; SIMVASTATIN 40MG; POTASSIUM ER 20MG; LISINOPRIL 2.5; PEPTO-BISMOL; ALBUTEROL
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NKA
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: FIRST DOSE OF MODERNA WAS DELIVERED AND INJECTION GIVEN 7/27/2021. ONLY 2 DOSES WERE USED AND THE REMAINDER WAS TO BE WASTED. THE FIRST VIAL WAS NOT DISPOSED OF AND WAS ACTUALLY USED FOR THE 2ND DOSE


VAERS ID: 1636375 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / IM

Administered by: Public       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AR2159

Write-up: Pfizer BioNTech COVID 19 vaccine EUA- vial of pfizer was mixed at 0955, set at room temperature 72 degrees F, was to waste at 1555, dose was administered at 1642. No adverse reaction noted, patient denies any symptoms. Pt waited 15 minutes after injection and still denied any problems


VAERS ID: 1636383 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Hyperhidrosis
SMQs:, Neuroleptic malignant 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: no
Preexisting Conditions: no
Allergies: penicillin, fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache & sweating began Tuesday after vaccine, by Wednesday the headache was bad, in bed for 24hours, took motrin 800mg x2, did not help


VAERS ID: 1636385 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Dizziness, Fatigue, Headache, Insomnia, Nausea, Pyrexia, Restlessness
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fever, nausea, light headed, fatigue, back pain, restlessness, difficulty sleeping


VAERS ID: 1636390 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AR2160

Write-up: Pt in clinic to get paper work to come back at 1730 to get second covid shot, I was leaving for lunch told her I would give it to her then, since there was no moderna in the clinic we had discussed how many pfizer shots we had left to give and she had been told to come I assumed it was Pfizer. Pt did not have her card at that time but went to get it out of car after giving the vaccine, she gave me her card to put info on I noticed she had been give moderna the first shot assured pt it was icy but I would call and let her know. She was not upset notified supervisor and database.


VAERS ID: 1636405 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-08-24
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer on 3/19 and 4/18. Positive on 8/24 admitted on 8/24 to current


VAERS ID: 1636411 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A12A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Gait inability, Headache, Hypoaesthesia, Motor dysfunction, Muscle contractions involuntary, Nausea, Neck pain, Pain in extremity, Palpitations, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: First it came on as just tiredness, then it moved in to complete body numbness, sorta like when you lay on your arm and it goes tingly, however when numb I couldn''t support my body weight to walk, or even move, this started around 2000. Around 2300 it moved in to sharp pains in my legs, arms, neck, back of head, lump showed up on my neck near my arty. Then it all went away with in seconds, I was fine for a couple hours and got some sleep and around 0300 complete body numbness, trembles, muscle contractions, pelvic area contractions. Through all of this my heart has been racing, at rest heart beat between 100-130... before vacation my resting heart beat was less than 70 typically. Around 0600 when my girlfriend got up to head to work I showed her the area of the lump, and she "worked me up" and looked for any other bumps over my body, and this alone was the worst pain I''ve ever experienced, and I''ve been burnt, broken bones, etc. I waited until around 0900 and talked with a nurse friend and she advised me to go to the ER, which I didn''t do as everything started to subside, so more or less felt like I''ve over came whatever the problem was so I opted not to take up a bed in the ER if the issue was over. Throughout the rest of the day I had multiple spells of numbness and loss of control of motor skills, then as soon as I lost them, they''d come back and no issues. 08/25 evening around 2200 stomach ache and some nausea hit, and mostly went away around 0130 08/26. As far as the time of me writing this no other reactions, and or issues today


VAERS ID: 1636440 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Injection site pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: I had covid on august 3rd but had very mild symptoms. Just a runny nose and fatigue.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initially I only had pain at the injection sit but then the next evening my left arm starting hurting and it was a shooting pain down to my hand. This has continued for two days. On Wednesday I began having chest pains on the left side that intensify when I lean forward.


VAERS ID: 1636443 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Injection site erythema, Injection site swelling, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: nausea, diarrhea, generalized achiness, redness, pain and swelling at injections site all began 8/24/21.


VAERS ID: 1636446 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-16
Onset:2021-08-24
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Swelling sore red with heat at injection site.


VAERS ID: 1636455 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-08-24
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: He presented to the ED on 8/24/2021 for fever, nausea, diarrhea and weakness for the two to three days prior to admission. He lives alone at home and was unable to take care of himself, so was admitted to hospital on 8/24 for weakness. Fully vaccinated for COVID-19, no prior infections.


VAERS ID: 1636466 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-13
Onset:2021-08-24
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Pain in extremity, Polymerase chain reaction positive
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? 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: PCR test came back positive on 8/24/21.
CDC Split Type:

Write-up: Patient presented to facility with chest pain radiating to left arm. Patient ruled out non-infectious.


VAERS ID: 1636478 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Headache
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: Eczema GERD (gastroesophageal reflux disease) Anxiety disorder, unspecified
Allergies: no known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccination administered and patient was observed after 15 minutes for reaction. After 6 minutes patient complained of headache and "feeling a little weird" to clinical support staff. He was observed for the 15 minutes and still reported feeling weird. He was observed for an additional 5 minutes and was asked again by clinical support staff how he was feeling and he reported he was the same. Patient was asked by clinical support staff if he wanted to stay a little longer for observation and he stated he was ok to go. He was instructed by clinical support staff to contact the office with any other complications.


VAERS ID: 1636509 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 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: 2 pills of Famotidine -took last evening and one the day before (8/24) Cetirizine took 2 weeks ago for bee sting--took again last evening (8/25)
Current Illness: GI issues, diarrhea about a month ago, over the weekend of 8/6/2021, Subsided spontaneously.
Preexisting Conditions: None
Allergies: Insect stings nickel sensitivity
Diagnostic Lab Data: No treatment at this time. Advised to call HCP for more direction.
CDC Split Type:

Write-up: Noticed a rash on her arm beginning Tuesday, 8/24 at injection site. Rash began to spread to elbow and thighs by Wednesday. Thursday am, rash on other elbow and face (7:30AM). Denies any swelling of the mouth or tongue, no difficulty breathing.


VAERS ID: 1636514 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-03
Onset:2021-08-24
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Body temperature increased, Chills, Headache, Migraine
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine Besylate 5mg , Ubrelvy 50mg
Current Illness:
Preexisting Conditions:
Allergies: Peanuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: A headache about 3 hours after receiving the shot which by the next day became a full migraine, chills and a temperature of 100.2.


VAERS ID: 1636524 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-02-12
Onset:2021-08-24
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 LA / IM

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

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

Write-up: Covid infection despite covid vaccination


VAERS ID: 1636543 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 UN / IM

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

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

Write-up: MODERNA VACCINE THAT WAS OPENED ON 7/27/21 AND NOT DISCARDED WAS USED FOR THE FIRST VACCINATION IN ERROR. UNKNOWN IF ANY ADVERSE EFFECTS


VAERS ID: 1636552 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LL / IM

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

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

Write-up: EXPIRED MODERNA VACCINE WAS USED FOR SHOT 2 IN ERROR


VAERS ID: 1636575 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-19
Onset:2021-08-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Herpes zoster, Injection site discolouration, Injection site pain, Malaise, Myalgia, Pyrexia, Tongue eruption
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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: Pfizer, 2nd dose 04/2021 - headache, fatigue, malaise, low grade fever, mild muscle soreness
Other Medications: Montelukast 10 mg; Norvasc 2.5; Prednisone 6mg; Levoxyl 100 mcg; Adderall 10mg; Supplements: Fish Oil; Probiotics; Vit D; Calcium+Magnesium ; Citicoline; Vit B Complex; Vit E, methyl S-P
Current Illness: No Acute illness at time of vaccination. Chronic health conditions being treated at time of vaccination include: Hypothyroidsm; Undifferentiated connective tissue disorder; RA; Asthma
Preexisting Conditions: Chronic health conditions being treated at time of vaccination include: Hypothyroidsm; Undifferentiated connective tissue disorder; RA; Asthma
Allergies: Hypersensitive to epinephrine
Diagnostic Lab Data: Physical exam by PCP
CDC Split Type:

Write-up: Vax date 08/19/2021 On 8/25/2021, Pt. reported rash on trunk, predominately located around front and right side around rib cage, with general malaise and mild headache. Medical exam same day determined rash and sx to be consistent with shingles / herpes zoster. From date of vaccine on 8/19/2021 to 8/25/2021, participant had ongoing mild tenderness around injection site, with slight discoloration.


VAERS ID: 1636576 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-20
Onset:2021-08-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 059E21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash erythematous, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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: Bupropion Pravastatin Buspripone
Current Illness: Sinus infection two weeks prior
Preexisting Conditions:
Allergies: Tramadol Hydroxzine
Diagnostic Lab Data: N/a for item 19 Item 20 - as of todays date swelling has went down and no new areas
CDC Split Type:

Write-up: Hives - red flat swollen patches from left arm above elbow , shoulder, back of neck, mid back, right shoulder, above elbow, front collar bone. Two spots on left hand and one spot on right hand


VAERS ID: 1636592 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Myalgia, Pain, Skin sensitisation, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: fatigue, body aches, drowsiness, skin/muscle sensitivity, 3 days


VAERS ID: 1636598 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-31
Onset:2021-08-24
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Only one recorded dose of vaccine administered, second dose was not registered, but partially immunized patient cotracted covid infection


VAERS ID: 1636603 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Herpes zoster, Impaired work ability, Inappropriate schedule of product administration, Neck mass, Nodule, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid 19 Moderna
Other Medications: Advare, escatalopram, imipramine, Ventolin FHA, omeprezole.
Current Illness: Rash, from first covid shot, on 4/14/2021 about the time I get it healed up it flares again. DIAGNOSED as Herpes Zoster rash.. on my hands and groin.. very painful itchy and my doctor prescribed viral medicine, helps with itch and pain.. Valtrex 2x daily on 4/24/2021
Preexisting Conditions: Asthma, obesity, chronic headaches
Allergies: Sulpha, wheat sensativity
Diagnostic Lab Data: Only 2 days in today in 26th of August.. I took 4 hours away from my job yesterday.. due to sever pain and itchy of rash.
CDC Split Type:

Write-up: Pain in joints, fever, terrible Herpes Zoster rash on hands and groin. Thus rash feels like it''s attacking my scalp hands and groin. Also breakout on my left buttock, back very itchy.. my arms are also very itchy. I AM TAKING BENEDRYL round the clock to keep from itchy ..painful lump located on my throat near thyroid gland.


VAERS ID: 1636656 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-07
Onset:2021-08-24
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Fatigue, Peripheral swelling, Ultrasound Doppler normal
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: tired, arm swollen,


VAERS ID: 1636678 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Headache, Hyperhidrosis, Nausea, Oropharyngeal pain, Pain, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: claritin, omeprazole, vitamin C, multi-vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Lightheadedness, shakiness, sweating upon onset of symptoms; elevated BP; nausea, headache, body aches throughout the day, low grade temperature in evening; onset of sore throat in pm & next am with worsening headache & continued body aches throughout the next day.


VAERS ID: 1636704 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Discomfort, Feeling hot, Hyperhidrosis, Somnolence
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Poly-cystic Ovary Syndrome (PCOS)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within about 5 minutes of receiving the first dose of Pfizer vaccine, after I was sitting in the waiting area, I suddenly started sweating, had to gasp for air (was wearing a mask and had to lift it briefly for a breath of air), and felt an intense drowsiness and like I was about to faint. My eyes were closing, my body felt heavy, there was a warm feeling going up my neck and into my head. I was about to call out to the nurse but then it was gone. Just like that. And didn?t happen again. I even stayed longer than the 15 minute requirement to be safe, and I sat in my car in the parking lot for another 30 minutes, and I did not have any other side effects. I felt really embarrassed to say anything because when I got checked in, no one told me, ?If you start to feel funny, let us know.? They just acted like no one has any affects ever. I didn?t even know who I would ask for help if I was going to faint. I guess they would have noticed me on the floor and would have come over! Anyway? It was a small side effect, very sudden, very early after receiving the vaccine, and nothing since then, but I wanted to report it. Thank you.


VAERS ID: 1636730 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Fatigue, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Suboxone Lexapro B12 Vyvanse Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Server pain in right arm, chest pain on right side, extreme fatigue


VAERS ID: 1636804 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

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

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

Write-up: PATIENT DID NOT INDICATE THAT SHE HAD A PREVIOUS COVID VACCINE MAKING OURS A MIXED VACCINE. PATIENT REC''D A PFIZER VACCINE 3/12/2021 AT ANOTHER FACILITY.


VAERS ID: 1636845 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, Lisinopril, Prilosec
Current Illness: N/A.
Preexisting Conditions: ADHD, HTN, Prediabetes, GERD, Chronic Low back Pain
Allergies: N/A.
Diagnostic Lab Data: N/A. Pt did not receive medical care.
CDC Split Type:

Write-up: Pt noted to have dizziness, heart racing, and possible hyperventilating with in the 1st hour, resolved after 1.5 hours.


VAERS ID: 1636863 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-08-24
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise, Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine Breakthrough. Admitted inpatient med surge for COVID symptoms


VAERS ID: 1636884 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Laboratory test, Palpitations, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Difficulty breathing, heart racing, legs and hands were shaking, and he felt chills.


VAERS ID: 1636890 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-21
Onset:2021-08-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oral herpes
SMQs:, Oropharyngeal infections (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin Immune support vitamin C, D and Zinc Allegra Flonase
Current Illness: Sinuses Plantar fasciitis
Preexisting Conditions:
Allergies: Zyrtec
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever blisters


VAERS ID: 1636894 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Migraine, Nausea, Neck pain, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
CDC Split Type:

Write-up: I had pain in neck almost after the shot, and pain in my arm where it hurt to move it. The next day I was nauseous on and off, had a extremely bad migraine.


VAERS ID: 1636902 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-29
Onset:2021-08-24
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: PATIENT TESTED POSITIVE TO COVID-19 ON 8/24/21. PATIENT HAD RECEIVED PFIZER COVID-19 VACCINE AS FOLLOWS, Dose 1 date: 12/29/20 and Dose 2 date: 1/19/21.


VAERS ID: 1636917 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 AR / IM

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

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

Write-up: Swollen Lymph Node under arm


VAERS ID: 1636942 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Arthralgia, Cardiac flutter, Chills, Dizziness, Hyperhidrosis, Injection site pain, Pyrexia, Sleep disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Triamcinolone .1% topical cream for poison ivy rash, multivitamin, 81 mg aspirin, 5,000 iu vitamin d, Flonase, 10 mg zyrtec, 40 mg adderall, calamine lotion was taken in the morning prior to vaccine
Current Illness: Poison ivy rash on arms.
Preexisting Conditions: Blood clotting disorders: factor 2 deficiencies, lupus anticoagulant, ADHD
Allergies: Lamictal
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 10 hours after receiving the covid 19 injection, my arm started to hurt at the injection site, I got a 101.4 degree fever. 14 hours after receiving it my heart began to flutter and I immediately vomited and started sweating perfusely but also got cold chills at the same time. I felt like death was upon me. I could not even hold water down in my stomach. I couldn''t sleep that night either. The whole next day I had fever and chills and all my joints ached and were painful. I felt dizzy every time I stood up. 2 days after the injection, I have a very swollen lymph node under my right arm pit and my fingers hurt in my right hand really bad. I have messaged my physician regarding these symptoms and they said those are common. I just wanted you guys to have my information so that you can add it to your studies.


VAERS ID: 1636950 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-08-24
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Differential white blood cell count, Full blood count, Lethargy, Metabolic function test, SARS-CoV-2 test
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Melatonin, busPIRone, Atrovastatin, Cholecalciferol, Asorbic Acid, amLODIPine Besylate, Cardura tablet, Multivitamin, Atenolol, Acetaminophen, Cymbalta, Isosorbide Dinitrate, Trazodone, HumaLOG
Current Illness: UTI
Preexisting Conditions: Kidney disease/ failure, Frontotemporal dementia, major depressive disorder, UTI, Hypothyroidism, Enterococcus as cause elsewhere, restlessness, angina pectoris, localized edema, chronic venous hypertension, dermatitis, weakness, delusional, obesity, muscle weakness, dysphagia, cognitive communication deficit,
Allergies: Bees
Diagnostic Lab Data: Rapid COVID antigen, CBC W Diff, BMP,
CDC Split Type:

Write-up: lethargic, change in baseline


VAERS ID: 1636972 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 OT / IM

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

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

Write-up: It is not an adverse reaction. patient wrote on the consent form that he had moderna as the first dose. he did not bring his cdc card. when we tried to bill the second shot , it turned out that he actually got Pfizer as his first shot.


VAERS ID: 1636988 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1076 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Pain in extremity, Product preparation issue
SMQs:, Tendinopathies and ligament disorders (broad), 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: Client could not remember the names of his medication
Current Illness: None
Preexisting Conditions: HTN, Diabetes
Allergies: blood pressure medication but could not remember name
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pfizer vaccine was diluted incorrectly. Client states his arm is sore but other than that he feels fine.


VAERS ID: 1636990 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Fatigue, Nausea, Neck pain
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Fatigue, shoulder and neck pain worsening over last 4 days, diarrhea, nausea


VAERS ID: 1636994 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Patient reported excessive vomiting for 13 hours after the vaccine , body chills and aches, headache, and diarrhea. Patient continues to have these symptoms.


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