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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 407 out of 8,010

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VAERS ID: 1653930 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

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

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Medium


VAERS ID: 1653989 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-20
Onset:2021-08-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Cardiac telemetry abnormal, Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram ST segment abnormal, Myocarditis, Palpitations, Troponin increased, Ventricular extrasystoles
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented with chest pain, palpitations and SOB 4 days after 2nd Pfizer COVID-19 vaccine. Found to have elevated troponin of 8.48 and diffuse non-specific ST changes on EKG. Diagnosed with myocarditis. Echo with no structural abnormalities. Troponin peaked at 9.273. Patient was kept on telemetry monitoring that showed multiple PVCs. Given Prednisone daily and observed for 4 days. CRP on day of admission was 9.8, day of discharge was 2.07. Discharged on 7 day course of Prednisone.


VAERS ID: 1653995 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No w
CDC Split Type:

Write-up: A two to three inch diameter circular red rash at the injection site for over a week post 3rd booster shot. Pt reported having similar side affects with the 3rd shot as the other two, but the severity of symptoms has been getting worse. Red rash is very warm to the touch


VAERS ID: 1654027 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Feeling abnormal, Hypoaesthesia, Paraesthesia, Tremor, Tunnel vision
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (narrow), Vestibular disorders (broad), Hypoglycaemia (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: Pepcid, protonix, low dose aspirin, metoprolol, provera, estrace
Current Illness:
Preexisting Conditions: A-fib
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left hospital after the 15 minute wait time. About 5 minutes later as I was driving talking with my husband by I give I began feeling strange. My head began to fell numb and tingle. I began to feel as if I was going to black out? tunnel vision, shaking, difficult breathing. I kept talking and pulled over. I never passed out. But felt the same sensation a few minutes later. Took about 20 minutes to feel like I could drive again.


VAERS ID: 1654100 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: venous doppler
CDC Split Type:

Write-up: bilateral dvt legs


VAERS ID: 1654151 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: The morning after my 2nd moderna covid shot. I heard deep whistling in my ears. Ever since I?ve had a buzzing in my ears that is the worst when I first wake up. It is tinnitus and I?ve had it for about a week. I?m going crazy and I would have not took the shot if I knew this was going to happen.


VAERS ID: 1654157 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None disclosed at time of event.
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Following administration of vaccine, patient was sat in a chair in pharmacy counsel room, and fainted. Vaccine was administered by a pharmacy intern, and stated that he was unconscious and convulsing and bumped his head on the wall that he was sat adjacent too. Pharmacy manager attended to patient, and he had already regained consciousness. No visible injury to head and blood pressure was monitored and was 115/73 with a pulse of 66. Patient was given water to drink and offered a gatorade, plus a snack, and monitored for another 15 minutes. Patient stated that he was feeling better and ha no other complaints or reported any injury nor pain to the head. Mother was present the whole time and did not have any additional concerns or requests for additional medical attention.


VAERS ID: 1654194 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Fatigue, Headache, Immediate post-injection reaction, Injected limb mobility decreased, Injection site pain, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Employee influenza vaccine, patient age 24, date 11/6/20. Swelling, redness and itchiness throughout 2 weeks after vaccination.
Other Medications: Cymbalta 90mg daily in the AM. Lactulose 15ml daily as needed.
Current Illness: IBS
Preexisting Conditions: IBS Constipation Generalized Anxiety Disorder Chronic Depression
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Immediate left arm and shoulder pain upon injection. Chills, nausea, fatigue, dizziness, headache, left arm/shoulder pain, weakness felt about 10-12 hours after vaccination. Severe left shoulder/arm pain, fatigue, overall weakness 8/25/21 and 8/26/21. Unable to lift left arm up fully.


VAERS ID: 1654327 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWU180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Muscle strain, Nausea, Pelvic pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/27/21- went to urgent care for pelvic and lower back pain. Was told it was a muscle strain and possibly an inflammatory response to the vaccine.
CDC Split Type:

Write-up: Severe low back pain, pelvic pain lasting 1 week so far. nausea and chills started 5 days after 2nd shot, still have on day 7.


VAERS ID: 1654983 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose, Blood pressure increased, Blood pressure measurement, Cough, Eating disorder, Headache, Illness, Pyrexia, Skin discolouration, Unevaluable event, Weight decreased
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Hypotonic-hyporesponsive episode (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: LANTUS; HUMALOG
Current Illness: Allergy to antibiotic; Diabetic; Kidney cancer
Preexisting Conditions: Medical History/Concurrent Conditions: Arterial thrombosis; Bronchitis; Chest injury; COVID-19; Disorder gastrointestinal; Sickness
Allergies:
Diagnostic Lab Data: Test Date: 20210824; Test Name: Blood pressure; Result Unstructured Data: 188; Test Date: 20210824; Test Name: Blood pressure; Result Unstructured Data: 186/79/83; Test Date: 20210824; Test Name: Blood pressure; Result Unstructured Data: 123/54; Test Date: 20210825; Test Name: Blood pressure; Result Unstructured Data: 186/79; Test Date: 20210825; Test Name: Blood glucose; Result Unstructured Data: 100; Test Name: Blood pressure; Result Unstructured Data: 190/120; Test Name: Blood pressure; Result Unstructured Data: 186
CDC Split Type: USJNJFOC20210851803

Write-up: COUGH; HEAD HURTS SO BAD; FEVER; BLOOD PRESSURE WENT UP; COULD NOT EAT; GOT A LOT OF THINGS WRONG; ARMS BLACK AND BLUE; LOST WEIGHT; GOT SICK; This spontaneous report received from a patient concerned an 8-decade old female, race and ethnicity unknown. The patient''s height, and weight were not reported. The patient''s past medical history included: covid-19, hole in chest, clotted artery in heart/ blood clot in artery, intestinal problem, sick, and possible bronchitis, and concurrent conditions included: diabetic, kidney cancer, and antibiotic allergy. The patient was previously treated with azithromycin, doxycycline; and experienced almost died when treated with influenza vaccine. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, frequency 1 total, administered on 24-AUG-2021 ,13:00 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included insulin glargine for diabetes, and insulin Lispro for diabetes. On an unspecified date last year, the patient stated her blood pressure was190/120 units unspecified. The patient stated that after vaccination she felt fine, could not pass out. On 24-Aug-2021, around 17:00 to 18:00 she stated that her head hurts bad, blood pressure went up and got sick. The patient experienced headache, fever and she could not eat. The patient stated that she got lots of thing wrong with her. The patient took Tylenol, and extra blood pressure medicine at night and was able to sleep. The Laboratory data included: Blood pressure (NR: not provided) 188, 186/79/83, 123/54, 186. The patient stated her arms are black and blue. On 25-AUG-2021, the patient experienced cough. Laboratory data included: Blood glucose (NR: not provided) 100, and Blood pressure (NR: not provided) 186/79. The action taken with covid-19 vaccine was not applicable. The patient was recovering from head hurts so bad, and the outcome of cough, blood pressure went up, arms black and blue, fever, lost weight, could not eat, got a lot of things wrong and got sick was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210851803-COVID-19 VACCINE AD26.COV2.S-blood pressure went up. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1655368 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fibromyalgia, Headache, Nausea, Paraesthesia, Peripheral coldness
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chills-Medium, Systemic: Headache-Mild, Systemic: Nausea-Mild, Systemic: Tingling (specify: facial area, extemities)-Medium, Additional Details: Tingling in hand and coldness in extremities. Patient has history of fibromyalgia and does not believe it to have contributed to latest onset of symptoms. Still currently having side effects as of 8/29/21, is contacting MD 8/30/21 for follow up.


VAERS ID: 1655378 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Back pain, Fatigue, Flushing, Headache, Hyperhidrosis, Lethargy, Myalgia, Pain, Photophobia, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Systemic: Body Aches Generalized-Severe, Systemic: Exhaustion / Lethargy-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Severe, Systemic: Tinnitus-Medium, Additional Details: extreme light sensitivity, muscle soreness, "bones ache", loss of taste and smell, back pain


VAERS ID: 1655567 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blister, Pruritus
SMQs:, Severe cutaneous adverse reactions (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Proventil inhaler, Hydrochlorothiazide, Multi vitamins, betamethasone dipropionate for Eczema, Anoro Ellipta, busPIRone.
Current Illness: NA
Preexisting Conditions: Asthma
Allergies: Codeine
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Itchy blister patches on right arm and not at injection site


VAERS ID: 1655573 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Significant left side pain and weakness in lower left extremity


VAERS ID: 1655597 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-05
Onset:2021-08-24
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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: Janssen on 5/5. Positive on 8/26 ADMITTED 8/24 TO CURRENT


VAERS ID: 1655675 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Menstrual disorder, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: MORPHINE, MACROBID
Diagnostic Lab Data:
CDC Split Type:

Write-up: SWELLING AND BURNING OF ALL MEMBRANES ON MY BODY. VACCINE ALSO STARTED MENSTRAUTION AFTER NOT MENSTRUATING FOR 27 MONTHS.


VAERS ID: 1655743 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-18
Onset:2021-08-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait inability, Groin pain, Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (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: One a Day Vitamin Super Greens Grapeseed Oil Famotadine
Current Illness: None
Preexisting Conditions: Allergies
Allergies: Sulfur Bacitracin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Initial reaction was pain, redness and swelling at the injection site which lasted 10 days. Several days later, after the injection, I woke up and had the most severe pain in my groin on the left side. For two days I could not walk. I tried ice, muscle cream and Advil, but the pain would not go away. On the third day I felt better and by the fourth day, I had no pain in the groin.


VAERS ID: 1655751 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Musculoskeletal stiffness, Pallor
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)

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

Write-up: After 5 minutes of getting the Moderna shot , the patients body got stiff and he fell of the chair he was sitting . The patient got up 1 minute after all this happened stating that he was feeling fine although he looked pale on his face. Called 911 right away and an ambulance took the patient for more evaluation 10 minutes after .


VAERS ID: 1655778 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-24
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Lymph node palpable, Menstruation delayed, Neck pain
SMQs:, Fertility disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Have a palpable left neck lymph node noticed 2 weeks after 1st dose. Node is still palpable not painful but neck is swore off left side. My period is late. I am consistently regular and have been since I was a teenager.


VAERS ID: 1655792 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / UNK - / IM

Administered by: Military       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: trazadone 100mg, fluoxetine 40mg, ziprasidone 20mg, olanzapine 10mg
Current Illness:
Preexisting Conditions: adjustment disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient endorsed nausea, vomiting, loss of taste/smell, and cough 7 hours after vaccination.


VAERS ID: 1655827 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-10
Onset:2021-08-24
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 - / -

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

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

Write-up: Covid 19 positive 08/25/21 with 08/24/21 onset


VAERS ID: 1655881 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-30
Onset:2021-08-24
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: COPD exacerbation
Preexisting Conditions: COPD, DM, Afib,HTN, Hypothyroidism
Allergies: NKA
Diagnostic Lab Data: SARS CoV PCR COVID 19 negative on 7/31/21, Positive on 8/24/21 and 8/25/21.
CDC Split Type:

Write-up: He had Pfizer vaccines on 1/9/21 and 1/30/21. He was origianally admitted for SOB at hospital on 7/31/21. His COVID test was negative on 7/31/21. He transitioned to the Inpatient Rehab Unit in the same hospital on 8/6/21. He complained nausea and had episode of vomiting on 8/24/21, and he was tested for COVID, which resulted in positive. He was discharged home after he completed rehabilitation on 8/26/21. (Hospital Total length of stay is 26 days. 3 days after positive COVID)


VAERS ID: 1655898 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-02-04
Onset:2021-08-24
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DICLOFENAC GEL, RIFAXIMIN, GABAPENTIN
Current Illness: NONE
Preexisting Conditions: HTN, MIGRAINE, CERVICAL RADICULITIS, HYPERLIPIDEMIA, SPASTIC DYSPHONIA, RETROCRURAL MASS, CHRONIC DIARRHEA, NASH, IBS, DEPRESSION, SHOULDER PAIN, DYSPNEA, OSTEOPENIA, ANXIETY, CERVICAL SPONDYLOSIS
Allergies: ASPIRIN, BACTRIM, CODEINE, LOMOTIL
Diagnostic Lab Data: 08/24/21: SARS-COV-2 RNA - POSITIVE
CDC Split Type:

Write-up: SORE THROAT


VAERS ID: 1655904 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-30
Onset:2021-08-24
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: vit D deficiency, vit b12 deficiency,
Preexisting Conditions: hyperlipidemia, hx of thyroid antibody positive.
Allergies: NKDA
Diagnostic Lab Data: exam done 8/26
CDC Split Type:

Write-up: Bells Palsy, sx started 8/24.


VAERS ID: 1655936 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-25
Onset:2021-08-24
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 02M20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 AR / IM

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

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

Write-up: POSITIVE COVID


VAERS ID: 1655937 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-18
Onset:2021-08-24
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 1. Albuterol 90 mcg 2 puffs inhaled q.2 hour p.r.n. wheezing. 2. Symbicort 160/4.5 mcg 2 puffs inhaled b.i.d. 3. Furosemide 20 mg p.o. daily. 4. Spiriva 18 mcg inhaled daily.
Current Illness: 1. COPD with chronic hypoxic respiratory failure requiring 2-3 liters of oxygen at baseline. 2. Former smoker. 3. Hard of hearing. 4. Prostate cancer, in remission.
Preexisting Conditions: See section 11
Allergies: No known drug allergies
Diagnostic Lab Data: Ordered Test: SARS-CoV-2 (COVID-19) RNA [Presence] in Respiratory specimen by NAA with probe detection Ordered Test Codes: 94500-6 (LN LOINC)/ Status: Final Accession Number: F2021-015551 Specimen Source: Anterior Nasal (AN) Swab Specimen Site: Specimen Collection Date/Time: 2021-08-20 12:00:00.0
CDC Split Type: 950122

Write-up: Case completed 2 dose Pfizer vaccine series on 2/18/21, and was admitted to hospital on 8/24/21 for Respiratory failure related to Covid diagnosis.


VAERS ID: 1655998 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pruritus, Lethargy, Lip pruritus, Pruritus, Rash, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topiramate 100ng daily. WAS NOT TAKEN ON DAY OF VACCINE. VIT C 500mg taken twice weekly-not taken on day of vaccine
Current Illness: None
Preexisting Conditions: Asthma, cluster headaches, abnormal heart beats(Aflutters), venous Insufficiency,
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 5 mins after receiving the vaccine, my right arm started itching at the injection site. The itching then spread all the way down my arm to even my fingertips. There were also small bumps on my arm. The tip of my tongue had also started itching. After 15 mins I reported this and the NURSE PRACTIONER on site gave me 25mg of BENADRYL. I continued to itch. I left the site ABOUT 30mins later. Later that evening about 745pm when I Was home my arm started itching again and bumps started appearing. The tip of my tongue and my lips also started itching. I took another dose of benadryl at home. The itching subsided about half hr to 45 mins later. I then fell asleep. I woke up at bout 2am. The next day I had no itching but I had a headache and felt lethargic(malaise). I saw my primary care on 8/26/21. On that day I still had a slight headache and still felt generally really tired(lethargic).


VAERS ID: 1656022 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haematuria
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Tubulointerstitial diseases (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: None
Current Illness: Bladder polyps
Preexisting Conditions: Occasional bladder infection
Allergies: Penicillin, food additives
Diagnostic Lab Data: Infection
CDC Split Type:

Write-up: Gross Hematuria


VAERS ID: 1656117 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Patient female 58 years old is in the observation are and reports to the EMT of feeling dizzy. Approximately 30 min after the administration of the vaccine. Vitals signs are taken BP 120/70, pulse 60min, Sp0 99%, glucose 101. Consultation with Doctor R. is make, and she indicates to keep patient under observation for 15 more mins. Patient''s condition is reassessed, vitals are taken 15 minutes later BP 120/70, pulse 60, Sp02 99%, dextrose 105. Patient reports not feeling dizzy. She proceeds to leave the vaccination center accompanied by her husband.


VAERS ID: 1656135 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-10
Onset:2021-08-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, Chest X-ray, Electrocardiogram, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALLPURINOL, ASPIRIN, ATORVASTATIN, COREG CR, LASIX, LOSARTIN, NITROGLYCERIN PRN, OMEGA 3S, KCL10MeQ, TRILIPIX, B12, VIT D
Current Illness: HYPERTENSION, HYPERLIPIDEMA, PERIPHERAL NEUROPATHY,
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: HOSPITAL ADMISSION WITH EKG, CTA, XR CHEST AND ICR VASUCLAR TRANSCATHER INFUSION 8/29/21 CURRENTLY INHOUSE AND UNDER TREATMENT
CDC Split Type:

Write-up: PT ADMITTED TO MEDICAL CENTER FOR PE


VAERS ID: 1656136 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: 31 year old walking patient stands in observation area. Reports to the paramedic of feeling nauseous after the vaccine administration. We proceed on taking her vital signs BP 130/80, pulse 76min, Spo2 99%, glucose 71mg/dl. Patient reports not having eaten anything all day. 4oz of juice is given to her. Vitals are re-evaluated BP 130/80, pulse 87, Spo2 99%, DEXTROSE 113. Patient reports not having any nausea and feeling good and proceeds to leave the vaccination center.


VAERS ID: 1656137 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: doxepin, ibuprofen, vitamin d3, levothyroxine, trazadone, sertraline,
Current Illness: na
Preexisting Conditions: hyperlipidemia, hypothyroidism, HTN, smoker,
Allergies: morphine, codeine, seroquel, penicillin
Diagnostic Lab Data: na
CDC Split Type:

Write-up: patient vaccinated with Moderna that expired on 8/11/2021. Moderna vials were moved from Freezer to fridge on 7/12/2021


VAERS ID: 1656150 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Diarrhoea, Discomfort, Fatigue, Headache, Hot flush, Malaise, Myalgia, Nausea, Pain, Pallor, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone, Zoloft, topiramate ER, Claritin, Colestid
Current Illness: None
Preexisting Conditions: Intracranial hypertension AKA pseudotumor cerebri + bilateral transverse sinus stenosis: dx''d 2016 Polymyalgia rheumatica caused by a virus last summer that was not covid. Been on prednisone daily since last August 2020.
Allergies: Penicillin, sulfa based rx, imitrex
Diagnostic Lab Data: None yet. Going to urgent care today.
CDC Split Type:

Write-up: Fatigue, malaise, body aches, muscle aches, joint pain, nausea, diarrhea for first two days, decreased appetite, headaches, inability to sleep for more than an hour due to being so uncomfortable, occasional chills/hot flashes but no fever, told that I look very pale compared to my normal paleness. It has been 6 days since I got my second covid shot.


VAERS ID: 1656234 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-20
Onset:2021-08-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blister, Erythema, Facial pain, Headache, Herpes zoster
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Glaucoma (broad), Hypersensitivity (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none known
Preexisting Conditions: none known
Allergies: codeine makes me itch
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4 days after 2nd shot the top of my head hurt as if I had bumped it hard. Day 5 it felt like I had been hit by a hammer on my head. A quarter size spot was starting to get red. Day 6 red bumps appeared and pain radiated on my entire head and most of my face. By evening the bumps were blisters. Same up to day 10; the blisters are larger and sorer, pain is more intense. I took 500mg Valacyclovir on day 7, 8, and 10. SHINGLES


VAERS ID: 1656272 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-08-24
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: positive covid test with symptoms


VAERS ID: 1656289 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-08-24
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / 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: Covid-19 test
CDC Split Type:

Write-up: Employee tested positive for Covid-19 after completing vaccination series


VAERS ID: 1656331 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Pain, Pain in extremity
SMQs:, 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: Oxycodone, Belbucca, Lyrica, One a Day Vitamin, Vitamin D, Iron, Melatonin, Benadryl
Current Illness: None
Preexisting Conditions: Herniated discs, Maralgia Parenthica
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: General achy and headache for first 24 hours - Tylenol Sharp pulsing pain in upper right thigh for the first 24 hours - ice pack On day 5 a sharp constant pain in left back hip joint area that is occurring as I write this - ice packs are all that seems to help


VAERS ID: 1656408 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-03-25
Onset:2021-08-24
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 mg tablet Take 1 tablet by mouth Daily. 7/14/21 Ascorbic Acid (VITAMIN C) 100 MG tablet Take 100 mg by mouth Daily. aspirin 81 mg chewable tablet Take 81 mg by mouth Daily. atorvaSTATin (LIPITOR) 40
Current Illness: ? Ascending aortic aneurysm (HCC) Last CT 3/2016: Aortic root 4.3 cm, ascending aorta 4.7 cm; CTA Chest 1/2018 maximum 4.9 cm (TRILEAFLET aortic valve) ? GERD (gastroesophageal reflux disease) 4/1/2016 ? HTN (hypertension) Diagnosed ~2000 ? Hypertriglyceridemia 4/1/2016 ? Insomnia 4/1/2016 ? Mediastinal lymphadenopathy Due to sarcoidosis ? Pre-diabetes 4/1/2016 ? Sarcoidosis
Preexisting Conditions: see section 11
Allergies: ? Cephalexin Keflex ? Penicillins
Diagnostic Lab Data: SARS-CoV-2 RNA Resp Ql NAA+probe DETECTED Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Ordered Test Codes: 94500-6 (LN LOINC)/ Status: Final Accession Number: 212360121LP-198922 Specimen Source: SOFT TISSUE SAMPLE Specimen Site: ENTIRE NASOPHARYNX(181200003) Specimen Collection Date/Time: 2021-08-24 18:46:00.0
CDC Split Type: 1080469

Write-up: Case completed 2 dose Covid vaccine series on 3/25/21, and ws then hospitalized for Covid on 8/24/21.


VAERS ID: 1656428 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia
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? 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: About 15 minutes after my vaccine I felt my left side of the face go numb. It fells like after having dental work and your mouth face is numb. It is still felling the same since the time of the vaccine.


VAERS ID: 1656517 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-09
Onset:2021-08-24
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood urine, Flank pain, Kidney infection, Muscle spasms, Urine analysis abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Retroperitoneal fibrosis (broad), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin Lexapro Ambien Xanax Losartan potassium
Current Illness: None
Preexisting Conditions: Depression
Allergies: None
Diagnostic Lab Data: Checked urine for blood 8/25 stated treatment with cipro 8/25. Pain got worse 8/29 went for a 2nd urine check, still blood in urine starting treatment Sulfamethoxazole-TMP DS
CDC Split Type:

Write-up: 8/25 flank pain and cramps, went to Dr, blood in urine, diagnosed with kidney infection


VAERS ID: 1657549 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Hypoaesthesia, Muscular weakness, Myalgia, Pain in extremity, Paraesthesia, Pyrexia, Sensory loss, Sleep disorder, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 20mg Buproprion SR 150mg daily
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx. one minute after the injection, my entire right arm felt numb and tingled. I felt pain in my right forearm muscle. At approx. 1330 on my drive home I had right facial numbness with decreased sensation (which is still present to this day: August 30th) At 1400 I developed a fever of 99.6 and had pain in my right calf and my right calf muscle felt weak. At 1414 I had further decreased sensation in the right side of my face spreading to my eyebrow. Approx. 12-14 hours after the injection I woke up in the middle of the night with a fever of 100.8, muscle aches, chills and I threw up. I felt bad for approx. the next 24 hours. I have recovered from all of the above symptoms with the exception of the right facial numbness/decreased sensation- I have never had a problem like this before, and am concerned that the second shot will cause total paralysis.


VAERS ID: 1657569 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-09
Onset:2021-08-24
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain lower, Anxiety, Back pain, Balance disorder, Bladder pain, Constipation, Diplopia, Fatigue, Feeling hot, Headache, Heart rate increased, Hyperacusis, Hypoaesthesia, Pain, Pain in extremity, Paraesthesia, Photophobia, Pollakiuria, Urinary retention
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Ocular motility disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (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: Women?s multi vitamin, emergen-C , D3, Wellbutrin,Klonpin
Current Illness:
Preexisting Conditions: Cancer
Allergies: None
Diagnostic Lab Data: No tests as of yet but I do have an appointment with my PCP tomorrow in which I will tell her all of these symptoms .
CDC Split Type:

Write-up: First was excruciating back pain along with light and sound sensitivity the first week and has persisted along with rapid heart beat and anxiety, next in the 3rd week Numbness and tingling in both feet , the past 2 days I?ve developed unbearable pain in my thighs. Also headaches that come and go , today I?ve noticed some double vision and loss of balance and very tired the past 4 days for no reason. Also from the very beginning of the vaccine I?ve been constipated. Another thing I?ve noticed today is the inability to urinate completely? I feel like I need to go more frequently but have trouble pushing it out . In the past couple of hours I?ve noticed pain in my lower abdomen in the bladder area(stabbing/throbbing pain) today my body has felt hot, so much so that I kept checking my temperature but it was always normal 98.2 being the highest. Nothing further at this time.


VAERS ID: 1658125 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8447 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

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

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


VAERS ID: 1658489 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-06
Onset:2021-08-24
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 UN / IM

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

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

Write-up: PT WAS FULLY VACCINATED WITH PFIZER - DOSE 1 :3/6/21 (EL3302); DOSE 2 : 4/06/21 (ER8730). S/O 8/24/21; TESTED + 8/27/21


VAERS ID: 1658527 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-04
Onset:2021-08-24
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Atypical pneumonia, Blood creatinine increased, Blood gases abnormal, Blood pH decreased, Blood potassium increased, Body temperature increased, COVID-19, Chest X-ray abnormal, Continuous positive airway pressure, Dyspnoea, Exposure to SARS-CoV-2, Fall, Fatigue, Glomerular filtration rate decreased, Hypoxia, Leukocytosis, Metabolic acidosis, Productive cough, SARS-CoV-2 test positive, Sputum discoloured
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Home Medications Reviewed by RN on 08/24/21 at 0947 Med Sig Last Dose Dt/Time albuterol (PROVENTIL, VENTOLIN, PROAIR) HFA 108 (90 Base) MCG/ACT INHAL Aero Soln inhale 2 Puffs into the lungs every 6 hours as needed for FOR SHORTNES
Current Illness: Past Medical History: Diagnosis Date ? (HFpEF) heart failure with preserved ejection fraction ? A-fib ? Adrenal insufficiency Questionable AI due to low cortisol and repeated hypoglycemic episodes in 1/2020. No cosyntropin test on file ? Anemia ? Arthritis ? BPH (benign prostatic hyperplasia) ? Carotid stenosis- R ICA 30-49%, L ICA <30% 5/4/2021 ? Chronic low back pain ? Chronic pain ? CVA (cerebral vascular accident) 10/24/2020 ? Dyslipidemia ? ESRD (end stage renal disease) on dialysis Monday, Wednesday and Friday''s. ? GERD (gastroesophageal reflux disease) ? Gout ? Hypercholesterolemia ? Hyperparathyroidism ? Hypertension ? Mild intermittent asthma 5/4/2021 ? MR (mitral regurgitation) mild to moderate ? NSTEMI (non-ST elevated myocardial infarction) 04/06/2021 ? Obesity ? Oliguria and anuria ? OSA on CPAP 5/4/2021 Uses a c-pap ? Pneumonia due to infectious organism 1/8/2020 ? Prediabetes ? Syncope Near syncope with atrial fibrillation ? Transient cerebral ischemia 11/2020
Preexisting Conditions: Past Medical History: Diagnosis Date ? (HFpEF) heart failure with preserved ejection fraction ? A-fib ? Adrenal insufficiency Questionable AI due to low cortisol and repeated hypoglycemic episodes in 1/2020. No cosyntropin test on file ? Anemia ? Arthritis ? BPH (benign prostatic hyperplasia) ? Carotid stenosis- R ICA 30-49%, L ICA <30% 5/4/2021 ? Chronic low back pain ? Chronic pain ? CVA (cerebral vascular accident) 10/24/2020 ? Dyslipidemia ? ESRD (end stage renal disease) on dialysis Monday, Wednesday and Friday''s. ? GERD (gastroesophageal reflux disease) ? Gout ? Hypercholesterolemia ? Hyperparathyroidism ? Hypertension ? Mild intermittent asthma 5/4/2021 ? MR (mitral regurgitation) mild to moderate ? NSTEMI (non-ST elevated myocardial infarction) 04/06/2021 ? Obesity ? Oliguria and anuria ? OSA on CPAP 5/4/2021 Uses a c-pap ? Pneumonia due to infectious organism 1/8/2020 ? Prediabetes ? Syncope Near syncope with atrial fibrillation ? Transient cerebral ischemia 11/2020
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is a 67y.o. male with a past medical history of ESRD on hemodialysis, afib, asthma, and adrenal insufficiency who presents with shortness of breath and a fall. He reports that he fell last night and was on the ground all night, and because of the fall he is now having shortness of breath. He was diagnosed with covid 7 days ago, and he is vaccinated fully with Pfizer since March. He has a minor cough that is productive of brown sputum. His SOB is worsened by exertion and was helped by breo and albuterol. He reports that he didn''t hit his head and nothing hurts. He does reports he has fatigue and weakness which is abnormal for him. He denies use of alcohol, tobacco, or other drugs. In the ED his potassium was 7.2 and had a creatinine of 17.7. His GFR is 3, and an ABG showed metabolic acidosis with a pH of 7.27. To treat his high potassium the ED gave him sodium bicarb, calcium gluconate, and albuterol to bridge him until he could receive hemodialysis. According to EMS he was satting in the 70s so they gave him duonebs and started him on CPAP, which brought him into the 90s. He also had a temperature of 101.4, and was given a dose of tylenol which brought it down to 100.3. 67y.o. year old male who presents to Hospital due to increasing SOB/hypoxia. Patient reports his wife was having symptoms of possible Covid last week and went to be tested for covid and was found to be positive. He therefore went to be tested and also was positive about 8/20/21. He has become progressively more short of breath and subsequently came to ER where he was found to be acutely hypoxic and is requiring High flow O2 40% BIPAP. CXR 8/24: Patchy bilateral airspace disease suggestive of atypical pneumonia Procalcitonin not reliable in dialysis patient. Leukocytosis noted. Patient is fully vaccinated for COVID, Pfizer 2/11-3/4/ 2021 I do not have confirmation of COVID testing.


VAERS ID: 1658591 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-08-24
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Asthenia, Blood creatinine increased, Blood gases normal, Blood lactate dehydrogenase increased, Blood lactic acid, Blood potassium normal, Blood sodium normal, Blood urea increased, Body temperature increased, Brain natriuretic peptide increased, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Diarrhoea, Dyspnoea, Fibrin D dimer, Glomerular filtration rate decreased, Hypotension, Liver function test normal, Nausea, Neutrophil count decreased, Oxygen saturation decreased, Pneumonia, Procalcitonin, SARS-CoV-2 test positive, Troponin increased, Vomiting, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Home Medications Reviewed by (Nurse Practitioner) on 08/27/21 at 1429 Med Sig Last Dose Dt/Time azithromycin (ZITHROMAX) 250 MG PO Tab take 250 mg by mouth once daily. FOR 6 DAYS ++ STILL AT PHARMACY ++ NOT STARTED YET Med Not
Current Illness: DM (diabetes mellitus) ? High cholesterol ? HTN (hypertension) ? Neuropathy
Preexisting Conditions: DM (diabetes mellitus) ? High cholesterol ? HTN (hypertension) ? Neuropathy
Allergies: Sulfa Antibiotics Unable to specify Unknown as per son
Diagnostic Lab Data: This is a 83y.o. female with medical history of HTN and DM II with insulin, lives at home. She presents in ED for shortness of breath and generalized weakness for 3 days. Very poor historian. Her SaO2 dropped to 82% at home in room air , increased to 90% with Non rebreathe mask when EMS came. She also reports slight nauseas, vomiting and diarrhea, no bloody emesis. She denies chest pain , LOC or recent fall. No home oxygen. She received 2 dose of COVID vaccine . ED course: arrive ED with Non Rebreather and SaO2 90%. Temp 103F, HR 104, hypotensive, BNP 166, covid detected, procal 1.56, CRP 48.8, LDH 353, lactic 3.1, D dimer $g 10000, Troponin 0.15----0.27, sodium 140, K 3.7, BUN 25, Cr. 1.18, GFR 43, liver function panel WNL, VBG no acute concerns, WBC 14.2, Neutrophils 11.7, CXR consistent with pneumonia. CTA chest no PE. Decadron inj 6mg, admit in patient for further evaluation and management, ID consult
CDC Split Type:

Write-up: This is a 83y.o. female with medical history of HTN and DM II with insulin, lives at home. She presents in ED for shortness of breath and generalized weakness for 3 days. Very poor historian. Her SaO2 dropped to 82% at home in room air , increased to 90% with Non rebreathe mask when EMS came. She also reports slight nauseas, vomiting and diarrhea, no bloody emesis. She denies chest pain , LOC or recent fall. No home oxygen. She received 2 dose of COVID vaccine . ED course: arrive ED with Non Rebreather and SaO2 90%. Temp 103F, HR 104, hypotensive, BNP 166, covid detected, procal 1.56, CRP 48.8, LDH 353, lactic 3.1, D dimer $g 10000, Troponin 0.15----0.27, sodium 140, K 3.7, BUN 25, Cr. 1.18, GFR 43, liver function panel WNL, VBG no acute concerns, WBC 14.2, Neutrophils 11.7, CXR consistent with pneumonia. CTA chest no PE. Decadron inj 6mg, admit in patient for further evaluation and management, ID consult


VAERS ID: 1658600 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Immediate post-injection reaction, Injection site erythema, Injection site pruritus, Lymphadenopathy, Pain, Vaccination site pain, Vaccination site swelling, Vaccination site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: after the vaccine a bruise appeared almost immediately. One week after vaccine the site is swollen, hot, red, sore to the touch, and itchy. Lymph nodes under arms and in neck are swollen. Body is sore and achy.


VAERS ID: 1658612 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Dermatitis allergic, Erythema, Peripheral swelling, Pruritus, Rash, Rash vesicular, Scab, Skin discolouration, Skin warm, Skin weeping
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe allergic skin reaction on both arms starting within a couple of hours after being vaccinated on 8/24/2021. Reaction included swelling, hot to the touch, red/purple discoloring, blistery bumps and some weeping and intense itching and burning. I met with a dermatologist (MD) and was prescribed the steroid Prednisone (10 day course) on 8/25/2021. I was hopeful my body would recover and begin to self-control the skin reaction, without needing the steroids. I would have preferred not to have to take them. However, over the next three days, 8/25/2021 - 8/27/2021 the allergic reaction only intensified with all symptoms getting worse each day. I started the steroids on 8/28/21 and the skin reaction is improving


VAERS ID: 1658623 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arrhythmia, Dyspnoea, Electrocardiogram abnormal, Extrasystoles, Fatigue, Lethargy, Migraine, Palpitations, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tachyarrhythmia terms, nonspecific (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Heart palpitations Tachycardia Shortness of breath Migraine Fatigue Lethargy


VAERS ID: 1658680 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-11
Onset:2021-08-24
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test negative
SMQs:, COVID-19 (broad)

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

Write-up: blood showed no antibodies


VAERS ID: 1658711 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-26
Onset:2021-08-24
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Full blood count, Haemoglobin decreased, Heavy menstrual bleeding, Immune thrombocytopenia, Iron deficiency anaemia, Laboratory test, Platelet count decreased, White blood cell count normal
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: eczema
Allergies: Fish containing products, tree nuts
Diagnostic Lab Data: CBC, iron studies on 8/23/2021: hgb 8.7 with platelets 64k and normal WBC and indices CBC, iron studies on 8/31/2021: hgb 9.3, platelets 28k with immature platelet fraction 11.7%. No signs of hemolysis on labs or peripheral smear.
CDC Split Type:

Write-up: 4 weeks after her second shot in the COVID-19 series, the patient developed asymptomatic thrombocytopenia to 64k found during the workup for iron deficiency anemia related to heavy menses. The following week, her platelets were down to 28k with an elevated immature platelet fraction consistent with idiopathic thrombocytopenia purpura. At this visit, her anemia was improving with iron supplementation.


VAERS ID: 1658753 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-08-24
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Pyrexia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tamsulosin, Digoxin, Cartia XT, Finastride, Lisinopril, Metformin, Insulin
Current Illness: HTN, DM, Hyperlipidemia, CHF A-fib, Hearing loss
Preexisting Conditions: HTN, DM, Hyperlipidemia, CHF A-fib, Hearing loss
Allergies: NKA
Diagnostic Lab Data: rapid test for COVID 19
CDC Split Type:

Write-up: Fever, shortness of breath, cough


VAERS ID: 1658847 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: none
Preexisting Conditions: none
Allergies: No known allergies
Diagnostic Lab Data: Patient plans to see her adult provider for recommendation.
CDC Split Type:

Write-up: Patient states she has an itchy rash on both her lower legs since the day after receiving the Pfizer vaccine. It was advised she take Benadryl and to see her adult provider to assess if this could be related to the vaccine and/or if she needs any further treatment for the rash.


VAERS ID: 1658850 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blister, Erythema, Induration, Musculoskeletal pain, Peripheral swelling, Rash, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metoprolol, hydralazine, Symbicort, calcitriol, probiotic product, calcium citrate-vitamin D, amiloride, omeprazole, magnesium, albuterol
Current Illness:
Preexisting Conditions: hypertension, hyperlipidemia, asthma, morbid obesity, CKD
Allergies: clindamycin, adhesive tape, amoxicillin, azithromycin, Biaxin, pantoprazole, penicillins, vancomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to hospital from her PCP office for worsening bilateral buttock pain with noted erythema and tenderness with some blistering with the left buttock area more tender and indurated than the right side. Patient noted that no trauma was involved to the areas. She noted tat she had the initial tenderness to both buttocks since the previous day but since that time they have progressively gotten worse and she feels as though the left buttock has been developing a blistering appearance to the rash. She denied any other recent symptoms of fever, chills, dizziness, syncope, blood in urine/stool/sputum, dysuria, abdominal pain/nausea/vomiting/diarrhea. She also noted that she had been having increasing amounts of leg swelling but is uncertain as to how long it had been worsening.


VAERS ID: 1658853 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (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: Vitamin C, multivitamin, vitamin D, Zinc, Melatonin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Facial twitching to left side of face


VAERS ID: 1658917 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Yellow Fever vaccine
Other Medications: Levothyroine, IH (intracranial hypertension), Sjogren?s Syndrome, Obesity, Chornic headaches due to IH.
Current Illness: See item #9
Preexisting Conditions: See item #9
Allergies: IVP dye, shellfish, morphine, zithromax (IV medication cause hives), chicken, eggs, bell peppers, garlic, oregano, and Milk
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Daily very severe headache since receiving 2nd dose of the Moderna vaccine.


VAERS ID: 1658923 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-02
Onset:2021-08-24
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Bronchitis chronic, COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Condition aggravated, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization albuterol sulfate 108 (90 Base) MCG/ACT cholecalciferol (VITAMIN D3) 50 MCG (2000 UT) capsule dexamethasone (DECADRON) 6 MG tablet diltiazem (CARDIZEM ER) 120 MG 12 hr capsule escitalop
Current Illness: NA
Preexisting Conditions: Follicular lymphoma grade I Arrhythmia COPD (chronic obstructive pulmonary disease) with chronic bronchitis Preauricular mass Acute exacerbation of chronic obstructive pulmonary disease (COPD) Pneumonia of right lower lobe due to infectious organism Acute hypoxemic respiratory failure Secondary malignancy of parotid lymph nodes Neoplasm of parotid gland Chronic midline low back pain without sciatica Intracranial mass Meningioma Clinical dx based on MRI of 11/23/20 Ureteral stone with hydronephrosis and gross hematuria 6/6/21 Pneumonia due to COVID-19 virus COVID-19
Allergies: Advair - SOB Azithromycin - SOB
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient Hospitalized; COVID-19 positive 8.24.21. Admitted for COVID pneumonia. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Respiratory insufficiency COVID-19 Pneumonia due to COVID-19 virus HOSPITAL COURSE: Patient is a 81 y.o. female who presented with COVID pneumonia. Doing much better at this time. Continued remdesivir and Decadron. Continued supplemental oxygen. Patient finished 3 days total of remdesivir and 3 days of IV Decadron. She has weaned down to 2 L and states she is feeling much better. States her breathing is ?normal for her? at this time. Discharge home on her normal 2 L of oxygen. Will finish an additional 7 days of orally Decadron as an outpatient. Advised her to follow-up in 1-2 weeks with her primary care physician. Active Issues Requiring Follow-up Acute hypoxemic respiratory failure Assessment & Plan Continue on 5 L of oxygen at this time. August 25th: Much improved at this time. On 3 liters oxygen COPD (chronic obstructive pulmonary disease) with chronic bronchitis Assessment & Plan Continue on room meter dose inhaler for chronic obstructive pulmonary disease. August 20th: Patient on 3 liters today. Continue pulmonary regimen. * Pneumonia due to COVID-19 virus Assessment & Plan Patient placed on COVID protocol at this time. Started on remdesivir at this time. Started on IV Decadron at this time. Continue oxygen. She normally is on 2 L of oxygen. Currently on 5 L at this time. Continue to watch closely. August 25th: Continue remdesivir and IV Decadron at this time. August 26th: Finish 3 days of remdesivir and 3 days of IV Decadron. Patient is on her baseline 2 L of oxygen at this time. Placed on orally Decadron 6 mg orally q.day for an additional 7 days. Discharge home at this time.


VAERS ID: 1658972 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of personal independence in daily activities, Mobility decreased, Musculoskeletal disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 112 daily Vitamin D 50,000 iu once a week
Current Illness: None
Preexisting Conditions: Multiple Sclerosis
Allergies: None
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: I took a 3 hour nap earlier in the day the day I received the booster. At approximately 8pm that same evening, my legs stopped working. My husband had to physically lift me and put me in the rollator that converts into a wheelchair. He had to sit me on the toilet, and put depends on me in case I needed to use the bathroom overnight since I was not capable of getting in or out of the bed on my own. I attempted to call my neurologist, but it was after hours and there was no doctor on call. My husband put me in the bed and rolled me over. I laid there, unable to move until the next day around noon. I have recovered as far I know but will never take this drug again.


VAERS ID: 1658975 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 0001573925 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Injection site pain, Lymphadenopathy, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: September 2020, influenza, unknown name
Other Medications: Advair 250/50, Montelucast Sodium, Vit. E 400IU
Current Illness: none
Preexisting Conditions: moderate/severe persistent asthma, pelvic/spinal injury
Allergies: Hydrocodone, Erythromycin, Asmanex HFA, Doxycycline, Tramadol, Sudafed, Triamcinolone
Diagnostic Lab Data: none
CDC Split Type:

Write-up: injection site pain, headache, muscle pain, joint pain, fever, feeling unwell, swollen lymph nodes


VAERS ID: 1659005 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Formication, Hypoaesthesia, Injection site discomfort, Injection site pain, Limb discomfort, Musculoskeletal discomfort, Paraesthesia, Pruritus, Rash, Rhinorrhoea, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: armour thyroid, calcium plus magnesium and D
Current Illness: none
Preexisting Conditions: autoimmune thyroiditis, thyroid disorder, asthma-stable and not needing treatment, just avoid triggers
Allergies: multiplechemicalsensitivity, PCN, Benadryl, Thimerisol, preser
Diagnostic Lab Data:
CDC Split Type:

Write-up: burning and discomfort at injection site, then discomfort under arm, down arm,forearm, up neck, and behind shoulder area; same day toe joint pain; numbness and prickly sensation starting on top of feet then into lower shins/legs, then hands; runny nose, fatigue; next day day added itching and rash at upper thighs; crawling sensations or sensation of bugs landing on skin; joint pain, left hand tremor; continue with prickly/needles sensations, crawly sensation, joint pain, toe pain, itching, fatigue. Also had face rash briefly today. Wondering if I might be allergic to some of the secondary ingredients


VAERS ID: 1659035 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-24
Onset:2021-08-24
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Pyrexia, SARS-CoV-2 test, Sinus congestion
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: PMC- molecular rapid COVID -19 test 8-26-2021
CDC Split Type:

Write-up: sinus congestion, fever


VAERS ID: 1659079 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: No adverse event reported - patient was only 11 years old at time of vaccination. Family was anxious to get child vaccinated, supplied incorrect date of birth on forms provided.


VAERS ID: 1659091 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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:
Other Medications: Metoprolol Baby Aspirin
Current Illness: None
Preexisting Conditions: None.
Allergies: None
Diagnostic Lab Data: Diagnosed Shingles 8/30/21
CDC Split Type:

Write-up: Developed Shingles - first symptom 8/21 (pain - right side of body), rash appeared (lower right side of back) 8/28, diagnosed 8/30, medication started 8/30


VAERS ID: 1659157 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: At a work place COVID vaccine clinic the patient requested a Janssen vaccine. It was confirmed that he had not had a COVID vaccine from completed patient form and verbally. Upon adding his information into the state immunization data base it was found that the patient had received a Moderna vaccine from another establishment in June. When identified, patient was asked about this and he stated he though it was a flu shot. An interpretor was brought in and the patient confirmed this again in his native language. Location where the Moderna vaccine was given was called and this vaccination was confirmed. Patient was held for a longer observation after vaccination and nursing on site at work location was notified. No adverse signs/symptoms seen or noted. State immunization board labeled Moderna shot as invalid.


VAERS ID: 1659223 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-22
Onset:2021-08-24
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 Sofia antigen test with a positive result.
CDC Split Type:

Write-up: Patient received the Moderna COVID-19 vaccine on 3/25/21 and 4/22/21, so was fully vaccinated when they tested positive for COVID-19 on 8/24/21.


VAERS ID: 1659224 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Influenza like illness, Migraine, Nausea, Pain, Pyrexia
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: I felt strong flu symptoms as I was told I could (fever of 101, shivers, nausea, migraine, soreness) My breastfed baby (6 months old) puked all of her food the day of my second shot.


VAERS ID: 1659315 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site discomfort, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pramipexole, metformin, fluoxetine, lisinpril, rosuvastatin, fish oil B Complex, adrenalin, aspirin.
Current Illness: None
Preexisting Conditions: Diabetes, coronary artery disease
Allergies: Penicillin, tetracycline
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme pressure during injection. Two hours later, I was in such extreme pain I could not use my arm. It was very difficult to raise it at all. This lasted 5 days. As of today, I am able to use my arm but there is still some pain.


VAERS ID: 1659471 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, 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: None
Current Illness: None
Preexisting Conditions: None.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting with a headache the next morning at 0700, by 0900 I had a 102? fever. I maintained the fever, chills, and body aches through the next 18 hours. Everyday since over the last 8 days i have had a headache that will not go away.


VAERS ID: 1659494 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN ??????? / 1 OT / ID
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Immediate post-injection reaction, Incorrect route of product administration, Injection site pain, Injection site reaction, Product administered at inappropriate site, Wrong product administered
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: COVID-19 (via natural transmission)
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None as this date/time
CDC Split Type:

Write-up: Patient (my son) office visit was to receive: 1. PDD Test (TB-Bubble) 2. Influenza Seasonal QIV only. While administering the PDD Test (TB-Bubble) on his left-lower forearm (Intradermal) the NP inadvertently administered a Johnson & Johnson COVID-19 Vaccine - in the wrong location - not Intramuscular - and without request or awareness of the patient, who had already had Covid-19 (07/02/2021 - 07/09/2021). Once injected there was immediate reaction with a large rise/bubble at the injection site and high level of pain described by the patient. The NP immediate realized the deviation and informed the patient of what had occurred. The NP then proceeded to the 1. PDD Test (TB-Bubble) in the right lower forearm 2. Influenza Seasonal QIV, despite the known deviation. The NP did not provide the: Manufacture, Lot, or NDC related to the COVID-19 Vaccine for this visit (this information was excluded from his"IMMUNISATIONS Administered in the Summary of Care) The NP also refused to provide a Vaccine Card or any documentation of the event. It was until a follow-up visit to get the PPD test read that he was informed that the Manufacture of the COVID-19 Vaccine was Johnson & Johnson (but still was never provided: Lot, NDC or Vaccine Card or any documentation of the related to the COVID-19 Vaccine event). On 08/24/2021 I reported to this to pharmacy and they opened CASE. Note: They have not made contact with me and I have not been successfully in making contact with them. On 08/31/2021 I reported to this to "Johnson & Johnson" and they opened REQUEST (and J&J documented a report).


VAERS ID: 1660129 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-08-18
Onset:2021-08-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Appendicitis, Blood test, Ultrasound scan abnormal
SMQs:, Acute pancreatitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allegra
Current Illness: N/A
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: Ultrasound and bloodwork
CDC Split Type:

Write-up: One week after second dose of the Pfizer Covid vaccine, my son had terrible stomach pain which ended up being an inflamed appendix/appendicitis which resulted in an appendectomy.


VAERS ID: 1660131 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Lymph gland infection, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Muscle ache; headache; fatigue; infected lymph node.


VAERS ID: 1660289 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Lymphadenopathy, Musculoskeletal stiffness, Paraesthesia, Paraesthesia oral, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: 6 hours after vaccine my Tongue and gums became tingly (pins and needles) numbness, neck stiffness, swollen left underarm with hard painful bulge, over all joint pain, left arm numbness and swelling, fever . 1 week after vaccine still continue with the painful hard bulge from left underarm arm and Neck numbness and stiffness.


VAERS ID: 1660976 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Computerised tomogram, Lumbar puncture, Magnetic resonance imaging
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Blind; Blood pressure high; Diabetic; Hyperlipidemia
Preexisting Conditions: Medical History/Concurrent Conditions: Gallbladder removal ((June 2021) due to upper GI issues)
Allergies:
Diagnostic Lab Data: Test Date: 20210824; Test Name: Spinal tap; Result Unstructured Data: HIGH PROTEIN; Test Date: 20210824; Test Name: MRI; Result Unstructured Data: Not reported; Test Date: 20210824; Test Name: CT scan; Result Unstructured Data: Not reported
CDC Split Type: USJNJFOC20210858451

Write-up: STROKE; This spontaneous report received from a consumer concerned a 56 year old male with unknown race and ethnicity. The patient''s height, and weight were not reported. The patient''s past medical history included: gall bladder removed recently (June 2021) due to upper Gastrointestinal (GI) issues, and concurrent conditions included: diabetic, blind, hyperlipidemia, and high blood pressure. The patient experienced drug intolerance and makes sick when treated with hydrocodone. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, and batch number: 202A21A expiry: unknown) dose was not reported, 1 total, administered on 16-AUG-2021 to left arm for prophylactic vaccination. No concomitant medications were reported. On 20-AUG-2021 Friday, the patient was fine after receiving the vaccine, he even mowed the yard. On 21-AUG-2021 Saturday, at the morning patient woke up and could barely get out of bed and could not walk due to his feet being numb, then reported his hands were numb. On 23-AUG-2021 Monday, patient went to the hospital and received fluids and other care, and was discharged. On 24-AUG-2021, patient went to his health care provider (HCP), who sent him to the hospital via ambulance to be admitted through the emergency room (ER) for possible stroke, although reporter stated they doubted that diagnosis due to both sides of the body being affected. On 24-AUG-2021, the patient was admitted to the hospital and has had a spinal tap, Computer tomography (CT) scans, Magnetic resonance imaging (MRI), and other tests. As per the reporter patient were treated it as Guillain Barre Syndrome(GBS). The reporter was upset the vaccine facility gave the sheets with possible side effects to them after having received the vaccine. On 29-AUG-2021, reporter reported that patient was still in the hospital and that the physicians state they was treating it as Guillain Barre Syndrome and/or a stroke. The reporter stated that, patient was treated with shots in the stomach as well as intravenous (IV) medications possibly Immunoglobulins but reporter does not exactly know the names as currently the hospital was not allowing any visitors and so only form of communication with patient through phone. The reporter called back to update the diagnosis, which she stated hospital found high protein in the spinal fluid which could be markers for stroke. As per the reporter physician called it an unusual stroke being that it was close to the brain stem. The reporter repeated that she did not like the fact that the vaccine administrators provided the information about the vaccine after the shot was given and that not that it would have changed our minds at that moment but still maybe something that they could do to improve the vaccination process. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from stroke. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210858451-COVID-19 VACCINE AD26.COV2.S-Stroke. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.


VAERS ID: 1661249 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-02
Onset:2021-08-24
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210823; Test Name: COVID test: Nasal Swab; Test Result: Positive; Comments: Post vaccination.
CDC Split Type: USPFIZER INC202101102146

Write-up: This is a spontaneous report received from a contactable other health care professional (HCP). A 42-year-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection) first dose via intramuscular administered at right arm on 22Jan2021 13:30 (lot number: EL3248) (at the age of 42-year-old) and second dose via intramuscular administered at left arm on 02Feb2021 13:30 (at the age of 42-year-old) (Lot Number: EL3248) as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient known allergies was unknown. Patient was not pregnant at the time of vaccination. It was unknown, if the patient receives any other vaccines within 4 weeks prior to the COVID vaccine and list of any other medications the patient received within 2 weeks of vaccination. Patient was not diagnosed with COVID-19 prior to vaccination and patient has been tested for COVID-19 since the vaccination. The patient had symptoms of cough and nasal congestion since 22Aug2021. The patient was diagnosed with being positive with COVID on 24Aug2021. The patient underwent lab tests and procedures which included sars-cov-2 test positive on 23Aug2021 Post vaccination. Outcome of events was not recovered. Based on temporal association and known safety profile of the product, a contribution from the suspect drug bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) to the events covid19 and drug ineffective cannot be completely excluded.


VAERS ID: 1661261 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, Nasal congestion, Oropharyngeal pain, Pain, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210824; Test Name: Rapid Test; Test Result: Positive
CDC Split Type: USPFIZER INC202101108291

Write-up: Had stuffy nose,; sore throat minor aches.; sore throat minor aches; Rapid Test 24Aug21 positive.; Rapid Test 24Aug21 positive.; This is a spontaneous report from a contactable consumer or other non hcp. A 27-year-old patient of an unspecified gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: solution for injection; Batch/Lot Number: Unknown, Expiration date: Unknown) dose 2 via an unspecified route of administration on an unspecified date as single dose and first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: solution for injection; Batch/Lot Number: Unknown, Expiration date: Unknown) dose 1 via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. On 24Aug2021 the patient did rapid test 24Aug21 result was positive and on an unspecified date the patient had stuffy nose, sore throat and minor aches. It was reported that event took place after use of products. The patient underwent lab tests and procedures which included SARS-CoV-2 test: positive on 24Aug2021. The clinical outcome of the events was unknown. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.


VAERS ID: 1661980 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-22
Onset:2021-08-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 063E21A / 1 LA / IM

Administered by: Pharmacy       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? No
Previous Vaccinations:
Other Medications: Vitamin b12 Vitamin d Melatonin Buspar Gabapentin
Current Illness: None
Preexisting Conditions: Lupus Rheumatoid arthritis
Allergies: Sulfa Rocephin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA


VAERS ID: 1662126 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Product administered at inappropriate site
SMQs:, Drug abuse and dependence (broad), Hypersensitivity (narrow), Medication errors (narrow)

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

Write-up: Patient states vaccine placement was incorrect. She said it was given too low and medial. Due to the vaccine, she has a rash around the injection site. She states her physician does not know if it is due to the vaccine, incorrect placement, or cellulitis.


VAERS ID: 1662174 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram, Electrocardiogram ambulatory, Full blood count, Hypoaesthesia, Palpitations, Paraesthesia, Product administered at inappropriate site, Troponin
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Medication errors (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, Vitamin D, Flonase
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Phenegren (promethazine)
Diagnostic Lab Data: EKG, at-home holter monitor, CBC, troponin levels
CDC Split Type:

Write-up: Significant heart palpitaions in otherwise healthy individual. (11 months postpartum). Symptoms persisted 5 days after vaccination. Administration of the shot occurred in incorrect position, posterior area of arm muscle, leading to tigling and numbness in fingers and hand.


VAERS ID: 1662223 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-21
Onset:2021-08-24
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Asthenia, Bordetella test negative, COVID-19, COVID-19 pneumonia, Chest X-ray normal, Chlamydia test negative, Convalescent plasma transfusion, Coronavirus test negative, Cough, Dyspnoea, Enterovirus test negative, Fatigue, Headache, Human metapneumovirus test, Human rhinovirus test, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Mycoplasma test negative, Nasal congestion, Oropharyngeal pain, Pyrexia, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Suspected COVID-19
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet allopurinol (ZYLOPRIM) 300 mg tablet azithromycin (ZITHROMAX) 250 mg tablet cholecalciferol (VITAMIN D3) 1,250 mcg (50,000 unit) capsule divalproex (DEPAKOTE) 125 mg EC tablet finasteride (PROSCAR)
Current Illness:
Preexisting Conditions: Non-Hospital Hypercholesterolemia Lumbar canal stenosis Back pain Chest pain Arthritis Benign essential hypertension C1-C2 instability Carpal tunnel syndrome Cervical facet syndrome Cervical radiculopathy Cervical spondylosis without myelopathy Cervicalgia Chronic obstructive pulmonary disease (CMS/HCC) Disc degeneration, lumbar Disorder of intervertebral disc of cervical spine Dry eyes Dyslipidemia Dyspnea Enlarged prostate Exertional shortness of breath Gout Headache Hoarseness Lumbar radiculopathy Myalgia and myositis Obstructive lung disease (CMS/HCC) Obstructive sleep apnea Occipital neuralgia Papillary carcinoma of thyroid (CMS/HCC) Peripheral neuropathy PND (post-nasal drip) Primary localized osteoarthritis of left knee Primary localized osteoarthritis of right knee Seasonal allergic rhinitis Malignant neoplasm of skin Solitary thyroid nodule Spondylolisthesis Thyroid lump Weakness of left lower extremity Spinal stenosis of lumbar region with neurogenic claudication Primary osteoarthritis of right knee Chronic right shoulder pain Arthritis of right acromioclavicular joint Tendinitis of right rotator cuff Left shoulder pain, unspecified chronicity Tendinitis of left rotator cuff Spinal stenosis of lumbar region with radiculopathy Chronic pain in left shoulder Nontraumatic complete tear of left rotator cuff Acute pain of right knee S/P lumbar fusion Nontraumatic complete tear of right rotator cuff Right hand pain Right wrist pain Right knee pain, unspecified chronicity Right shoulder pain, unspecified chronicity Carpal tunnel syndrome, right Chronic pain of right knee Rotator cuff tear arthropathy of right shoulder Sprain of shoulder and upper arm Benign neoplasm of mouth Contusion of hand Enthesopathy Interphalangeal osteoarthritis Lateral epicondylitis Localized primary osteoarthritis of wrist Sensorineural hearing loss, bilateral Skin sensation disturbance Sprain of elbow or forearm Strain of trapezius muscle Degeneration of cervical intervertebral disc Degeneration of lumbar intervertebral disc Low back pain Neck pain Pain in limb Hand joint pain Wrist joint pain Disorder of shoulder Acquired trigger finger Brachial neuritis Spinal stenosis in cervical region Thoracic and lumbosacral neuritis Osteoarthritis of elbow Contusion of left knee, initial encounter AKI (acute kidney injury) (CMS/HCC) Cervical radiculopathy Acute pain of left shoulder Glenohumeral arthritis, left TIA (transient ischemic attack) Atrial tachycardia (CMS/HCC) GERD (gastroesophageal reflux disease) Atrial flutter, unspecified type (CMS/HCC) Brady-tachy syndrome (CMS/HCC) DOE (dyspnea on exertion) Moderate malnutrition (CMS/HCC)
Allergies: NKA
Diagnostic Lab Data: 08/29/21 2235 Respiratory virus detection panel Collected: 08/29/21 1842 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected 08/27/21 1131 POCT COVID-19 PCR Collected: 08/27/21 1130 | Final result | Specimen: Swab from Nares POC COVID-19 PCR DetectedAbnormal Lot # 1000277892 Point of Care COVID-19 PCR Testing Method Cepheid Lot Expiration Date 07/24/2022
CDC Split Type:

Write-up: Suspected COVID-19 virus infection With cough, shortness of breath, fever, headache sore throat and nasal congestion ED to Hosp-Admission Current 8/29/2021 - present (3 days) Hospital for COVID Chief Complaint Patient presents with ? Fatigue 1. COVID-19 pneumonia with weakness?patient be hospitalized. His ambulatory pulse ox was 90%. Because of that we will start him on dexamethasone along with remdesivir. I also consented him for convalescent plasma. He did receive both doses of Pfizer vaccine the last 1 approximately 6 months ago. Will check inflammatory markers. He does not have a pneumonia on chest x-ray. 2. History of COPD?not in exacerbation, he will continue with his home inhalers. 3. History of atrial fibrillation he status post pacemaker placement. Is currently not anticoagulated, unsure of the reason behind that he will need to follow with cardiology regarding that.


VAERS ID: 1662284 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-12
Onset:2021-08-24
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP534 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Ageusia, Anosmia, Blood lactic acid increased, Body temperature increased, Bordetella test negative, COVID-19, Cardiomegaly, Chest X-ray, Chlamydia test negative, Computerised tomogram abnormal, Computerised tomogram thorax, Coronavirus test negative, Cough, Decreased appetite, Dehydration, Diarrhoea, Electrocardiogram, Enterovirus test negative, Fatigue, Glucose tolerance test, Heart rate increased, Human metapneumovirus test, Human rhinovirus test, Hypoxia, Influenza A virus test negative, Influenza B virus test, Intensive care, Lung opacity, Malaise, Mycoplasma test negative, Nausea, Palpitations, Pleural effusion, Procalcitonin, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Scan with contrast abnormal, Sepsis, Troponin increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Taste and smell disorders (narrow), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin (ECOTRIN LOW STRENGTH) 81 mg tablet; furosemide (LASIX) 20 mg tablet; levothyroxine (SYNTHROID) 25 mcg tablet; lisinopriL (ZESTRIL) 5 mg tablet; metoprolol succinate XL (TOPROL-XL) 25 mg 24 hr tablet; nitroglycerin (NITROSTAT) 0.4 m
Current Illness:
Preexisting Conditions: Chronic atrial fibrillation (CMS/HCC); Stage 3 chronic kidney disease; Controlled type 2 diabetes mellitus with complication, without long-term current use of insulin (CMS/HCC); Coronary artery disease involving native coronary artery without angina pectoris; Dyslipidemia; Essential hypertension
Allergies: HydrocodoneNausea And Vomiting, Nausea Only; Hydrocodone Hcl
Diagnostic Lab Data: 08/29/21 1452; Respiratory virus detection panel; Collected: 08/29/21 1354 | Final result | Specimen: Swab from Nasopharynx; Adenovirus Not Detected; Mycoplasma pneumoniae Not Detected; Chlamydophila pneumoniae Not Detected; Parainfluenza Not Detected; COVID-19 SARS-CoV-2 Overall Result Detected Critical; Enterovirus/Rhinovirus Not Detected; Coronavirus Not Detected; Respiratory Syncytial Virus Not Detected; Influenza A Not Detected; Bordetella pertussis Not Detected; Influenza B Not Detected; Bordetella parapertussis Not Detected; Metapneumovirus Not Detected; Procedure Component Value Ref Range Date/Time; CT angiogram chest pulmonary embolism with and without contrast [3300476698] (Abnormal) Resulted: 08/31/21 2249 Order Status: Completed Updated: 08/31/21 2250; Narrative: PROCEDURE INFORMATION: Exam: CTA Chest Without And With Contrast; Exam date and time: 8/31/2021 9:38 PM; Age: 85 years old; Clinical indication: Shortness of breath; Prior surgery; Surgery type: Cardiac; surgery, unsure type; Additional info: Acute change in respiratory status of covid positive patient; TECHNIQUE: Imaging protocol: Computed tomographic angiography of the chest without and with contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. Contrast material: OMNIPAQUE; Contrast volume: 100 ml; Contrast route: INTRAVENOUS (IV); COMPARISON: DX XR CHEST 1 VW 8/29/2021 1:35 PM; FINDINGS: CT ANGIOGRAM: The main, right, and left pulmonary arteries and their visualized branches show normal enhancement. Atherosclerotic disease of the aorta without aortic aneurysm. LUNGS/PLEURA: Extensive confluent airspace opacities predominantly in the subpleural lungs bilaterally. Trace LEFT pleural effusions/thickening. MEDIASTINUM: Cardiomegaly without pericardial effusion. Severe coronary arterial atherosclerotic calcification with evidence of CABG. Mild to moderately enlarged mediastinal/hilar lymph nodes. OTHER STRUCTURES: Osteopenia with chronic degenerative changes in the visualized spine and shoulder joint(s). IMPRESSION: 1. No evidence of acute pulmonary thromboembolism. 2. Extensive MULTIFOCAL PNEUMONIA consistent with COVID-19 INFECTION. 3. Other nonemergent/incidental findings as described. X-ray chest 1 view, Portable [3300219940] Resulted: 08/29/21 1428; Order Status: Completed Updated: 08/29/21 1428; Narrative: XR CHEST 1 VW; IMPRESSION: 1. No acute cardiopulmonary abnormality. 2. Chronic and postoperative changes of the chest. 3. No significant change from 3/20/2010 END OF IMPRESSION: INDICATION: Suspected sepsis Suspected sepsis.TECHNIQUE: Portable view(s) of the chest are provided. COMPARISON: 3/20/2010; FINDINGS: EKG leads overlie the chest. The patient is status post median sternotomy. The lungs are adequately inflated with the exception of chronic elevation of the left hemidiaphragm. There is no effusion, consolidation or pneumothorax identified. The cardiac silhouette, pulmonary vasculature and bony thorax are within normal limits for age.
CDC Split Type:

Write-up: ED to Hosp-Admission; 8/29/2021 - present (3 days); Hospital Sepsis due to COVID-19; Patient presents with Cough, Diarrhea; Patient is a 85 y.o. male with PMH listed who presents from home complaining of feeling ill since Tuesday 8/24. He states that his worst symptom has been severe fatigue. Also admits to nausea/poor appetite, loss of taste and smell, diarrhea, and dry cough. No CP, not particularly SOB. He has not vomited, but he''s wanted to. The only elevated temp that he knows of was on Friday, 100.3F. He was found to be hypoxic in the ER. Heart is racing. Plan: Admit to IMCU for continuing care of sepsis due to COVID-19. Respiratory symptoms are fairly mild, but he is hypoxic. Start Decadron and remdesivir, titrate O2 as needed. Given that he has been vaccinated, should not progress to ICU-level care. Need for IMCU at this point is primarily due to elevated HR and mild elevation of trop/lactate. Cont to trend these levels. Check procalc to rule out a bacterial co-infection. Cardizem gtt for Afib/RVR, continue IV fluids for another day (likely a little dehydrated due to diarrhea). Hold home BP meds and Lasix. Diet as tolerated, antiemetics as needed.


VAERS ID: 1662298 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2580 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Fatigue, Gait disturbance, Headache, Joint swelling, Loss of personal independence in daily activities, Myalgia, Nausea, Pharyngeal swelling, Rash, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Within a couple hours I started breaking out in a rash that turned into hives and throat was closing. All my joints are swollen, headache, pain in my chest, nausea, muscles ache, can''t hardly walk, short winded. That doesn''t go away. I can''t function and very fatigued.


VAERS ID: 1662318 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buproprion, Progesterone, Estrogen, Proair
Current Illness: NOne
Preexisting Conditions: Asthma
Allergies: Fruits, tree nuts, latex sensitivity
Diagnostic Lab Data: None
CDC Split Type:

Write-up: While sleeping my heart rate rose as high as 146 bpm. My heart beat stayed above 120 bpm for several hours, 24 hours after I received the vaccine. I was either sleeping, laying down or sitting. The nurse at my doctor''s office advised that I push fluids. I drank 40 + oz of water and hours later my bpm eventually came down. By the following morning, resting bpm was back to normal -- 68 average. Outside of elevated heart rate, I had no symptoms. No fever. Only being tired.


VAERS ID: 1662570 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-19
Onset:2021-08-24
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Headache, Nausea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline Vallarta?s Levothyroxine Pantoprazole
Current Illness: None
Preexisting Conditions: Blood Pressure Thyroid
Allergies: Codeine
Diagnostic Lab Data: COVID test at home- positive
CDC Split Type:

Write-up: August 24th I tested positive for COVID. Headache, nausea, cough, shortness of breath, Dr. Called in steroids


VAERS ID: 1662599 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Itching and hives on neck, back, hips, arms, palms and feet.


VAERS ID: 1662708 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-18
Onset:2021-08-24
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 MG tablet ASPIRIN Take 81 mg by mouth Daily. cholecalciferol (VITAMIN D-3) 5000 UNITS TABS Take 5,000 Units by mouth Daily. clotrimazole-betamethasone (LOTRISONE) cream doxylamine (SLEEP AID) 25 mg tablet Take 25 mg
Current Illness: Controlled type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin Depression Goiter Hyperlipidemia Hypertension OSA (obstructive sleep apnea)
Preexisting Conditions: See section 11
Allergies: No Known allergies
Diagnostic Lab Data: SARS-CoV-2 RNA Resp Ql NAA+probe DETECTED Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Specimen Source: SOFT TISSUE SAMPLE Specimen Site: ENTIRE NASOPHARYNX
CDC Split Type: 917116

Write-up: Case completed Moderna vaccine series on 2/18/21, then was admitted to hospital on 8/24/21 for Covid pneumonia


VAERS ID: 1662731 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-20
Onset:2021-08-24
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Hypercoagulation, Hypokalaemia, Hypoxia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: patient was noted to be COVID-19 positive at her long term care facility
CDC Split Type:

Write-up: Admission Diagnoses: Hypokalemia [E87.6] Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Discharge Diagnoses:COVID-19 pneumonia resolved Hypercoagulability secondary to Covid infection Alzheimer''s dementia Chronic systolic heart failure Diabetes mellitus controlled Obstructive sleep apnea Hospital Course: She was admitted last week she had developed some hypoxia was tested positive for Covid on 24 August was started on remdesivir and Decadron has completed the course of remdesivir she is no longer needing supplemental oxygen will have her continue with 4 more days of Decadron will give her 15 units of NPH for 4 days with the Decadron to keep her blood sugars from going over 300. Consults: IP CONSULT TO PHARMACY IP CONSULT TO DIETITIAN Discharge Exam: Blood pressure (!) 155/74, pulse 73, temperature 98.7 ?F (37.1 ?C), temperature source Oral, resp. rate 16, height 5'' (1.524 m), weight 64.3 kg (141 lb 12.1 oz), SpO2 94 %. She is alert oriented to herself in no distress not in any oxygen lungs are clear to auscultation Disposition: Home or Self Care (Routine Discharge)


VAERS ID: 1662733 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO173 / 1 LA / IM

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

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

Write-up: Under-age administration of Pfizer vaccine (11 years old, Pfizer EUA approved only for 12-17yo minors). Error discovered AFTER VACCINATION when data entry of DOB was BLOCKED by system for DOB ERROR. Signs and symptoms: None Diagnosis and treatment: Patient accompanied by parent. Patient observed for 15 minutes per CDC protocol, no adverse reaction observed. Patient released from mobile vaccination clinic in unremarkable, stable condition around 11 AM. No treatment required. Diagnosis: vaccine error related to age of minor child. Supervisor reported event to site manager RN for VAERS reporting.


VAERS ID: 1662767 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Bladder spasm, Blood test, Computerised tomogram thorax, Electrocardiogram, Gait disturbance, Genito-pelvic pain/penetration disorder, Hypertension, Magnetic resonance imaging spinal, Pyrexia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypertension (narrow), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ocrevus Immunosuppressant, Vitamin D and C
Current Illness: Multiple Sclerosis, Idiopathic thrombocytopenic purpura (in remission) Eosinophilic esophagitis
Preexisting Conditions: Multiple Sclerosis, Idiopathic thrombocytopenic purpura (in remission) Eosinophilic esophagitis
Allergies: Comanzine, mango
Diagnostic Lab Data: blood work 8/27, blood work 8/29, EKG 8/29, chest CT 8/29. spinal MRI 9/2 and will be having upcoming brain MRI
CDC Split Type:

Write-up: 102.8 fever, blurry vision, trouble walking, bladder and vaginal spasms night of shot , severe back pain started day 3 to current day 7 very high blood pressure day 1-day 5. still experiencing side effects a week later


VAERS ID: 1662794 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Monoplegia, Muscular weakness, Neuralgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chronic nerve pain in entire left arm resulting in pain, numbness, muscle weakness


VAERS ID: 1662839 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: Vaccine was reconstituted incorrectly. 0.8ml instead of 1.8ml of diluent was used. 3 patients received the higher concentrated doses. patients were notified. No adverse reactions have been reported.


VAERS ID: 1662847 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: Vaccine was reconstituted incorrectly. 0.8ml instead of 1.8ml of diluent was used. 3 patients received the higher concentrated doses. patients were notified. No adverse reactions have been reported.


VAERS ID: 1662850 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

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

Write-up: Vaccine reconstituted incorrectly. 0.8mL instead of 1.8mL of diluent used. 3 patients received the higher concentrated doses. Patients notified. No adverse reactions reported.


VAERS ID: 1662880 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blood test normal, Burning sensation, Cardiac imaging procedure normal, Cardiomegaly, Computerised tomogram thorax abnormal, Echocardiogram normal, Feeling abnormal, Lumbar puncture, Magnetic resonance imaging head normal, Magnetic resonance imaging spinal normal, Muscular weakness, Pain in extremity, Pulmonary hypertension, Scan with contrast
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: flu because I''m allergic to eggs
Other Medications: antibiotics azithromycin
Current Illness: infection from wisdom teeth being removed
Preexisting Conditions: PVC, congenital defect coronary artery fistula
Allergies: sulfonamides, latex, eggs
Diagnostic Lab Data: total CT scan with contrast, came back with an enlarged heart with pulmonary hypertension. CT Scan and echocardiogram of heart both came back normal. mRI head and spine both came back normal and next step is a spinal tap. blood work- stable
CDC Split Type: vsafe

Write-up: That night I started feeling weird pain in my left legs as days went by it went to both legs and traveled upward into my abdomen. Burning sensations in my arms , weakness in my legs and arms. I went to the ER, and was admitted to hospital.


VAERS ID: 1662944 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

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

Write-up: The patient came in to get the flu shot. The pharmacist administering the vaccine misunderstood which vaccine the patient wanted and administered the Janssen COVID vaccine instead.


VAERS ID: 1662948 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccine administered at 22 days interval from the first dose, instead of at 28days.


VAERS ID: 1663002 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-08-17
Onset:2021-08-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Productive cough
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sinus infection 08/05/2021
Preexisting Conditions: Crohn?s disease Endometriosis
Allergies:
Diagnostic Lab Data: We
CDC Split Type:

Write-up: Excessive phlegm, shortness of breath, severe persistent cough


VAERS ID: 1663023 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 RA / IM

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

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

Write-up: Employee gave vaccine to patient from a vial from the fridge that had been punctured greater than 12 hours. Vaccine remained in the fridge so there was not a temperature excursion, only the vial being punctured longer than 12 hours.


VAERS ID: 1663058 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / IM

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

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

Write-up: Employee gave vaccine to patient from a vial from the fridge that had been punctured greater than 12 hours. Vaccine remained in the fridge so there was not a temperature excursion, only the vial being punctured longer than 12 hours.


VAERS ID: 1663089 (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: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Patient stated that he does not have a primary care prescriber
CDC Split Type:

Write-up: Patient received the vaccine on 8/24/21. He came back on 9/1/21 complaining of swelling and redness at the injection site. No rash was reported. The rash size was about 2 inch diameter. He said the area was swelling and had a lump like for about a week. Advised patient to take Benadryl liquid 20ml (50mg) , use compress, and possibly take ibuprofen or Tylenol if he has pain.


VAERS ID: 1663098 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / IM

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

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

Write-up: Employee gave vaccine to patient from a vial from the fridge that had been punctured greater than 12 hours. Vaccine remained in the fridge so there was not a temperature excursion, only the vial being punctured longer than 12 hours.


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