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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 408 out of 8,010

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VAERS ID: 1663114 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
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: Shellfish
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: 1663126 (history)  
Form: Version 2.0  
Age: 28.0  
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: 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.


VAERS ID: 1663137 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
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 / 1 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.


VAERS ID: 1663146 (history)  
Form: Version 2.0  
Age: 54.0  
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: 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.


VAERS ID: 1663244 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Pennsylvania  
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 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Burning sensation, Injection site pain, Pain, Pain in extremity, Pain in jaw, Paraesthesia, Rhinorrhoea
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Osteonecrosis (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: These are the events that happened to the best of my recollection. None of the areas with pain have had swelling, discoloration, or were made worse by touching. Day1-2 - Sore arm at injection site. Day2 - Runny nose. Day3 - Pain in left lower back and left side of jaw at joint by ear. Day4-5 - Burning sensation on top of right hand occurring a couple of times each day for a short duration less than a minute. Day6-11 - Dull pain in back of left leg around knee height. Pain is relatively constant. Day8 - Stabbing pain in right big toe. Very painful and most painful of all events thus far. Pain was short in duration less than a minute. Pain repeated every 15 minutes or so for a couple of hours. Day9 - Tingling in all the toes of left foot. Occurred once and short in duration. Called PCP to make appointment to discuss. Day9-11 - Dull pain in both calves. Longer in duration. Day10-11 - Dull pain in the middle of left upper arm on the rib cage side. Longer in duration.


VAERS ID: 1663422 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
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 (MODERNA)) / MODERNA 002F21 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Injection site pain, Mouth breathing, Nasal congestion
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Patient states day after vaccine was given got soreness at injection site. Then about one week after vaccination she started feeling a tightness/heaviness in her chest. When she breathes through her nose she does not feel like she is getting enough air so then has to take a deep breath through her mouth to feel like she is getting enough air. This has continued up to the date of this report.


VAERS ID: 1663435 (history)  
Form: Version 2.0  
Age: 75.0  
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 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Paraesthesia, Vomiting
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: unknown
Current Illness:
Preexisting Conditions:
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: since the vaccine pt has been experiencing tingling in arms, hands and body. she also reported having weakness and episodes of vomitting. recommended pt follow up with prescriber


VAERS ID: 1665387 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Allergic reaction to antibiotics; Autoimmune disorder NOS; Celiac disease; Hypertension; Immunocompromised; Non-smoker (Quit in 1991); Penicillin allergy; Rheumatoid arthritis
Preexisting Conditions: Medical History/Concurrent Conditions: Hypothyroidism; Comments: The patient had no history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data: Test Date: 20210824; Test Name: Blood test; Result Unstructured Data: zero antibodies; Test Name: COVID-19 virus test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210854815

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned a 70 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included: hypothyroidism, and concurrent conditions included: hypertension, non-alcohol user, non-smoker (quit smoking in 1991), unspecified auto immune disease, celiac disease, immunocompromised, penicillin allergy (cardiac arrest), sulfa allergy (rash), and rheumatoid arthritis, and other pre-existing medical conditions included: The patient had no history of drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported and batch number: 1808980 expiry: 18-SEP-2021) dose was not reported, one total, administered on 07-APR-2021 to right arm for prophylactic vaccination. No concomitant medications were reported. On 24-AUG-2021, the patient experienced confirmed immunological vaccine failure. The patient had done antibody test and stated that did not known specific of the test that was done and whether the antibody was against the spike protein. Laboratory data included: Blood test (NR: not provided) zero antibodies. The patient further stated that had done COVID-19 virus test (NR: not provided) couple of months after vaccination result was Negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210854815-COVID-19 VACCINE AD26.COV2.S-confirmed Immunological vaccine failure. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1665463 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Incorrect route of product administration, Injection site mass, SARS-CoV-2 test, Vaccination site pain
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (natural transmission)
Allergies:
Diagnostic Lab Data: Test Date: 20190702; Test Name: COVID-19 antigen test; Result Unstructured Data: positive; Test Date: 20210709; Test Name: COVID-19 antigen test; Result Unstructured Data: negative; Test Date: 20210825; Test Name: COVID-19 antigen test; Result Unstructured Data: negative
CDC Split Type: USJNJFOC20210900791

Write-up: PATIENT EXPERIENCED SOME COVID-19 SYMPTOMS BUT THE CALLER WAS NOT SURE WHAT THE SYMPTOMS WERE SPECIFICALLY; A HUGE BUBBLE FORMED AND WENT DOWN ON THE AREA ADMINISTERED ON THE LEFT LOWER FOREARM DESCRIBED AS ON THE TOPSIDE WITH THE PALM FACING UP DUE TO BEING ADMINISTERED INTRADERMALLY; ACCIDENTAL ADMINISTRATION OF THE JANSSEN COVID-19 VACCINE INTRADERMALLY; IMMEDIATE PAIN SORENESS AT THE INJECTION SITE AND COMPLAINED THAT THE NEEDLE HURT WHEN IT WAS INSERTED INTRADERMALLY; This spontaneous report received from a parent concerned an 18 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included: covid-19 infection. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intradermal, batch number: Unknown) dose was not reported, administered on 24-AUG-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 02-JUL-2019, Laboratory data included: COVID-19 antigen test (NR: not provided) positive. On 09-JUL-2021, Laboratory data included: COVID-19 antigen test (NR: not provided) negative. On 24-AUG-2021, the patient experienced a huge bubble formed and went down on the area administered on the left lower forearm described as on the topside with the palm facing up due to being administered intradermally. On 24-AUG-2021, the patient experienced accidental administration of the janssen covid-19 vaccine intradermally. On 24-AUG-2021, the patient experienced immediate pain soreness at the injection site and complained that the needle hurt when it was inserted intradermally. On 25-AUG-2021, the patient experienced patient experienced some covid-19 symptoms but the caller was not sure what the symptoms were specifically. Laboratory data included: COVID-19 antigen test (NR: not provided) negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from a huge bubble formed and went down on the area administered on the left lower forearm described as on the topside with the palm facing up due to being administered intradermally on 24-AUG-2021, had not recovered from immediate pain soreness at the injection site and complained that the needle hurt when it was inserted intradermally, and the outcome of accidental administration of the janssen covid-19 vaccine intradermally and patient experienced some covid-19 symptoms but the caller was not sure what the symptoms were specifically was not reported. This report was non-serious.


VAERS ID: 1665963 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Vit C Vit D3
Current Illness: None
Preexisting Conditions: None
Allergies: Morphine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extremely sore arm 3 days Redness and swelling at injection site Lump at injection site 3 days of nausea 9days post vaccination return of swelling and lump at injection site Itchiness at injection site


VAERS ID: 1666139 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Feeling abnormal, Injection site swelling, Peripheral swelling, Respiratory tract congestion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Asthma like symptoms from recent wildfires in the areas, not debilitating.
Preexisting Conditions: Unknown
Allergies: Eggs, multiple antibiotics, talwin
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Patient came in to report today 9/2, that she had been experiencing lasting symptoms after receiving her Moderna shot a week and a half ago. Pt reports redness and a raised area around the injection site (4 inch diameter) and some swelling of the arm. Pt sounds congested and reports feeling absolutely miserable during this time. No change in symptoms over time. Patient has been on prednisone taper (40mg, now on 30mg) for unrelated condition, but it was unable to control symptoms. Recommended seeing regular provider since any minor discomfort should have resolved by now.


VAERS ID: 1666176 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-14
Onset:2021-08-24
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK - / -

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

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

Write-up: Tested positive for covid. Had exposure


VAERS ID: 1666203 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Blood test, Computerised tomogram head, Diarrhoea, Dyspnoea, Facial bones fracture, Fall, Hypotension, Injection site urticaria, Loss of consciousness, Nausea, Vision blurred, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: Toprimate Synthroid Adderall Aplenzin
Current Illness: None
Preexisting Conditions: None
Allergies: Cylindomycin Allergic to fragrances derm Allergic to mold, grass, pollen
Diagnostic Lab Data: CT, EkG, bloodwork, xrays
CDC Split Type:

Write-up: Shortmess of breath, bluriness, no balance, fractured nose from fall, passed out. Arm welt size of baseball hot above where shot was given, diarrhea, nausea, low blood pressure


VAERS ID: 1666205 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-25
Onset:2021-08-24
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Condition aggravated, Cough, Disturbance in attention, Dyspnoea, Dyspnoea exertional, Infusion, Oxygen saturation decreased, Painful respiration, Pyrexia, SARS-CoV-2 test positive, Sputum discoloured
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital COVID-19 Infection Non-Hospital Asthma NOS Granulomatous Idiopathic Disease (HCC) Vasculitis Pulmonary (HCC
Allergies: Amlodipine
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: The patient Is a 62-year-old man with history of COPD and granulomas disease, who presents with With trouble maintaining attention at home. Patient explains that he was diagnosed with COVID on the 30th of August. He received an antibody infusion yesterday. Today home monitoring RN noticed that his oxygenation was dropping that to 90, and recommended that he come in. The patient explains that he has been feeling very short of breath, especially when walking. He also reports that he has with 4/10 pain when he takes a deep breath. He has not been using any oxygen at home he, and he has been able to take in adequate oral intake. He has been coughing up white sputum without blood, and has some abd pain, fever


VAERS ID: 1666240 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-08
Onset:2021-08-24
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2
SMQs:, 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: Reports that she thinks she may have contacted Covid from mother-in-law that passed away


VAERS ID: 1666316 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-08-24
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / UNK - / -

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

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

Write-up: Covid positive due to contact at work


VAERS ID: 1666327 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-14
Onset:2021-08-24
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / UNK - / -

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

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

Write-up: Covid positive due to contact at work


VAERS ID: 1666333 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-12
Onset:2021-08-24
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / UNK - / -

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

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

Write-up: Covid positive due to contact with positive friend


VAERS ID: 1666477 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-15
Onset:2021-08-24
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / IM

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

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

Write-up: Positive Covid-19 test on 08/24/2021


VAERS ID: 1666484 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-06
Onset:2021-08-24
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / IM

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

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

Write-up: Positive COVID-19 Test on 08/24/2021


VAERS ID: 1666504 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-25
Onset:2021-08-24
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

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

Write-up: BREAKTHROUGH INFECTION


VAERS ID: 1666520 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Burning sensation, Feeling cold, Muscle fatigue, Pain in extremity, Paraesthesia, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Retinal detachment, previous surgery
Allergies: None
Diagnostic Lab Data: Went to my doctor and had blood work, X-rays and awaiting my ultrasound of both my legs to be completed.
CDC Split Type:

Write-up: 10 minutes after shot was administered, I had a very cold sensation in the middle of my chest and left arm tingling all the way down to my fingertips. Each day after I have had worsening symptoms of bilateral leg burning, tingling and left calf pain. Also extreme fatigue in both my legs after walking a few steps.


VAERS ID: 1666544 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: escitalopram (LEXAPRO) 10 MG tablet estradiol-norethindrone (MIMVEY) 1-0.5 MG ondansetron (ZOFRAN-ODT) 4 MG disintegrating tablet
Current Illness: none
Preexisting Conditions: Endocrine Hypothyroidism Nervous and Auditory Left cervical radiculopathy Musculoskeletal and Integument Medial collateral ligament sprain of knee Genitourinary Submucous leiomyoma of uterus Cervical stenosis (uterine cervix) Anxiety and Depression GAD (generalized anxiety disorder) Other Left knee pain Neck fullness Vasomotor instability Atypical chest pain Postmenopausal bleeding Encounter for colorectal cancer screening
Allergies: Flu Virus Vaccine: Anaphylaxis Penicillins: Hives, Shortness Of Breath Sulfa Antibiotics: Swelling Levaquin [Levofloxacin]: achey joints Latex: Rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling in arm


VAERS ID: 1666718 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-13
Onset:2021-08-24
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Myalgia, Oropharyngeal pain, SARS-CoV-2 test positive, Sinus pain
SMQs:, Rhabdomyolysis/myopathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose12/23/21 2nd dose01/13/21 Diagnosed covid positive:08/27/21 Symptom onset:08/24/21 Exposure:Home Symptoms:muscle aches, sore throat, sinus pain


VAERS ID: 1666728 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-03
Onset:2021-08-24
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/12/21 2nd dose02/03/21 Diagnosed covid positive:08/25/21 Symptom onset:08/24/21 Exposure Symptoms:fever, chills.


VAERS ID: 1667144 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Developed acute shortness of breath and chest pressure after vaccine. Developed 2 minutes after vaccine was provided. Did not report to nurse.


VAERS ID: 1667387 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

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

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

Write-up: Fever with T $g 100F lasting 48hrs total, central 24hrs had 102F < T < 103F. Temperature measured via in ear sensor.


VAERS ID: 1667734 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Fatigue, Headache, Hypertension, Myalgia, Pain in extremity, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aluminum, magnesium acetaminophen alprazolam celecoxib domperidone fludrocortisone galcanezumab hydromorphone levothyroxine lorazepam omeprazole pregabalin
Current Illness: None
Preexisting Conditions: Danlos HT with aortic root dilation Limb Girdle atrophy, mild Left pleurectomy & pleurodesis (VATS) COPD w/ Left Diaphragm weakness Spinal arthritis and stenosis Adverse reactions to Antibiotics Undiagnosed illness, likely EA2 Neuropathy, dysautonomia, episodic hypertensive crisis Tachycardia, Raynaud?s, Bigeminy, POTS Dysphagia, palatal weakness, vocal fold paresis Gastroparesis, Esophageal reflux, Hx aspiration
Allergies: Mirapex Topiramate Botox Niacin Fluconazole Reglan Statins Zonegran Sulfa DS Fluoroquinolone Bactrim DS Amoxicillin Clavamox Erythromycin Azithromycin
Diagnostic Lab Data: CT Scan at hospital.
CDC Split Type:

Write-up: 2nd and 3rd day, severe muscular pain, headaches, fatigue, pain in right arm 3rd day, onset of acute hypertension, headaches, noise in ears. Average BP 175/125, pressures up to 251/155. Clonidine 0.1 mg once / twice daily is holding BP at 145/96


VAERS ID: 1670364 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Benadryl
Current Illness:
Preexisting Conditions: Rheumatoid arthritis
Allergies: Latex, rubber, PPD, Lidocaine, formaldehyde, betadine, tape, kiwi, saffron, acetone, and rum
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient informed nurse of her allergies before vaccination. After about five minutes, patient reported a burning sensation at the injection site. Nurse evaluated the patient and provided her a cold compress for the injection site. After 30 minutes, patient reported that the burning sensation persisted but she was fine to leave. Left a message for the patient around 2:30PM on 8/31, and the patient returned the call around 6PM to say that the burning sensation lasted for about one hour after vaccination before dissipating. She reported feeling fine since.


VAERS ID: 1670478 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

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

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

Write-up: tounge swelling treated with benadryl


VAERS ID: 1670578 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: Pt given 3rd dose of covid vaccine per primary care provider advice 1st dose J&J 5/11/2021 2nd Dose Pfizer 8/3/2021 3rd Dose Pfizer 8/24/2021


VAERS ID: 1670774 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-08-24
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 LA / 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? 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: Tested positive for COVID 19.


VAERS ID: 1670811 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Burning sensation, Full blood count, Hypoaesthesia, Metabolic function test, Paraesthesia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram
Current Illness: Sinus infection prior. Competed antibiotic on 8/20/21
Preexisting Conditions: Rheumatoid arthritis
Allergies: Sulfa
Diagnostic Lab Data: CBC, CMP, TSH on 8/31/21. All results were within normal ranges.
CDC Split Type:

Write-up: Hives on bilateral feet, top of feet, now having nerve symptoms of numbness and tingling, burning in soles of feet.


VAERS ID: 1670857 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Hypoaesthesia, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi vitamin super b telmistan zolpidem tyridostigmine omeprazole
Current Illness:
Preexisting Conditions: High blood pressure myasthenia gravis
Allergies: suda pac Medrol pac Norvasc amlodipine diprp Motrin Ramipril amotripolin cipro
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Arm hurting and burning after 12 days . Some numbness and nausea.


VAERS ID: 1670888 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A212A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Condition aggravated, Dizziness, Fatigue, Gait disturbance, Headache, Musculoskeletal stiffness, Respiratory rate decreased
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Respiratory failure (narrow), 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: tired and aches with flu vaccine
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chest pain and tired. Reports that on 8/25/21 his spouse woke him up panicked because his breathing was not visible and she thought he was dead. Reports headaches and dizziness at least 4 times a day. Walking is noticeably slow and stiff. Reports that at his visit to the doctor''s office that no measurable abnormalities were found.


VAERS ID: 1670898 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Missouri  
Vaccinated:2015-08-23
Onset:2021-08-24
   Days after vaccination:2193
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Dyspnoea, Dyspnoea exertional, Echocardiogram, Echocardiogram abnormal, Electrocardiogram ST segment elevation, Mitral valve incompetence, Myocarditis, N-terminal prohormone brain natriuretic peptide, Red blood cell sedimentation rate increased, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (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), 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: Celexa 10mg
Current Illness: None
Preexisting Conditions: Depression PTSD Autism
Allergies: None
Diagnostic Lab Data: Results completed on day of visit on 8/25: EKG showed diffuse ST segment elevations, Troponin T 29 (Normal <22), ESR 26 (high), CRP 5.53 (high), Pro-BNP 83 (normal), Transthoracic echo showed trivial mitral regurgitation, Normal LV and RV size and function. Peds cardiology seen in clinic same day on 8/25 and completed echo above and ordered MRI. At 1 week follow up on 9/1 peds cardiology plan was below: Assessment/Plan 1. Mitral regurgitation 2. Status post administration of all doses of COVID-19 vaccine series 3. Myocarditis 4. Chest pain Patient has myocarditis s/p second dose of mRNA COVID-19 vaccine. Over the past week, he denies any recurrence of chest pain. His EKG today continues to show subtle ST segment elevation which is now restricted to just his inferior leads. Holter monitor obtained last week demonstrated ST segment elevation. However, no rhythm abnormalities were noted. I had initially planned for repeat echocardiogram given his elevated troponins and mitral valve regurgitation on prior echocardiogram. However, despite doing a peer to peer review, this echocardiogram was denied by insurance. He is scheduled to get cardiac MRI on September 10. I will call family with results of this cardiac MRI and discuss further steps. For now, I will plan to see him back in 1 month with a repeat EKG and echocardiogram pending insurance approval. Of note, his prior echocardiogram demonstrated mitral valve regurgitation which is unknown manifestation of post Covid complications such as MIS-C.
CDC Split Type:

Write-up: Diagnosis: Myocarditi HPI on 8/25: 15-year-old male here with mother, little brother and little sister. Mother called this morning stating the patient start having chest pain last night. We called and added him into clinic today. Patient states that last night he was awakened from sleep with substernal chest pain. This has continued today. He states that he had the second Pfizer vaccine on 8/23. He is feeling some mild shortness of breath like he went out and exercised. He has had only one other vaccine outside of the Pfizer vaccine that was an influenza vaccine last year. Mother does not feel that he has had any fevers or body aches sweats etc. No sick contacts in the family.


VAERS ID: 1670938 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Body temperature increased, Chest discomfort, Chills, Diarrhoea, Dizziness, Dyspepsia, Fatigue, Full blood count normal, Headache, Hypoaesthesia, Hypotension, Impaired work ability, Nasal congestion, Nausea, Oropharyngeal pain, Pain, Pain in extremity, Palpitations, Presyncope, Pyrexia, SARS-CoV-2 test negative, Tinnitus, Tremor
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), COVID-19 (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin daily calcium with vitamin D3 daily flaxseed oil daily prn prescription for Maxalt 10mg, none taken at time of vaccine
Current Illness: none
Preexisting Conditions: migraine
Allergies: bactrim- hives, swelling minocycline- autoimmune response (lupus-like reaction) potassium iodide- joint pain, stiffness nubain- tinnitus
Diagnostic Lab Data: Covid nasal swab 8/25/21 - negative CBC 8/26/21 -negative
CDC Split Type:

Write-up: 8/23/21- at midnight after the shot, woke up with right arm numbness and pain, palpitations, shaking, chills, headache, temp=99.6 F temporal; took Advil 400mg PO 8/24/21- 0730am - right arm soreness, bilateral hand joints soreness, shaking, headache, diarrhea, temp 100.4 F temporal; took Tylenol 1 Gm PO 1030am- increased right arm soreness, soreness in upper extremities joints bilaterally, nausea, diarrhea, chills, headache, temp -100 F temporal Noon- same right arm soreness, same joint soreness, nausea, vomiting, diarrhea, shaking, chills, dizziness, low abdominal pain, headache, temp= 101 F; took Tylenol 1 Gm PO 1 PM- increased dizziness, nausea, diarrhea, tinnitus, near syncope, considered EMS, called spouse at work to come home for transport, temp= 100.4 F temporal Spouse transported me to medical facility; seen by clinic physician, given script for Zofran PO and instructed to hydrate due to low blood pressure 8/25/21- 0550am- woke up with chills, sore throat, abdominal pain, indigestion, diarrhea, temp= 102.7 F temportal; took Gaviscon PO, Advil 200mg PO and Tylenol 500mg PO 0700am- temp =101F temporal 0800am -temp=99.6F temporal 1100am-temp=99.6F temporal 1115am- phone appointment with my PCP''s PA, recommended ER for labs and covid swab 315pm-covid swab at hospital result= NEGATIVE; not seen by ER physician for further workup due to crowding in ER, 7 + hr wait 610pm- temp=101.3F temporal; took Tylenol 500mg PO and Advil 200mg PO Midnight- took Benadryl 25mg PO, suggested by friend for possibility of this being an allergic reaction to vaccine 8/26/21- called in sick for work; 0841am- PA ordered CBC; she reported by phone CBC was ''normal'' 0910am- temp= 100.3; took Benadryl 25mg PO, Tylenol 500mg PO, and Advil 200mg PO 4pm- temp=99.3F temporal 10pm- temp= 100.3 F temporal; took Benadryl 25mg PO, Tylenol 500mg PO, and Advil 200mg PO 8/27/21- 0800am- temp=99.3 F temporal; generalized achiness, headache, stuffy nose, right arm soreness minimal, left chest pressure/discomfort; took Tylenol 1 Gm PO 10pm- temp= 100.4 F temporal, took Tylenol 1Gm PO 8/28/21- 0800am- afebrile, temp=98.8F temporal; tired, achy, intermittent left chest discomfort, intermittent diarrhea 8/29/21- 9/2/21- have had intermittent low grade fever 99F-100.6F temporal every day; continued intermittent diarrhea; achiness; taking prn Tylenol, Advil, Gaviscon


VAERS ID: 1670947 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-10
Onset:2021-08-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Facial paralysis, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: Pins and needles on the left thumb and face, Subjective facial paralysis sent to ED for eval


VAERS ID: 1671364 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-22
Onset:2021-08-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site rash
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: LISINOPRIL, LIOTHYRONINE
Current Illness:
Preexisting Conditions: HYPERTENSION
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Raised red bump with bruising, raised bumps around injection site and along back of arm near injection site.


VAERS ID: 1671592 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lymphedema, peripheral neuropathy bilateral lower extremities.
Allergies: Nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe rash around chest & stomach.


VAERS ID: 1671897 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Dyspnoea, Heart rate increased, Paraesthesia, Pharyngeal swelling, Tonsillar ulcer
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loryna (birth control)
Current Illness: None
Preexisting Conditions: None
Allergies: Ceclor, phenergan, tamiflu
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of throat on left side, difficulty breathing/swallowing, heart rate more than doubled, ulceration of left tonsil, tingling in hand. Began management with antihistamines and NSAIDs ? symptoms persisted for ~36 hours.


VAERS ID: 1673394 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-05
Onset:2021-08-24
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-04
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, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210824; Test Name: Nasal Swab; Result Unstructured Data: Test Result:Positive
CDC Split Type: USPFIZER INC202101102902

Write-up: COVID-19 confirmed by positive COVID-19 test; Covid-19 Positive; This is a spontaneous report from a contactable other HCP (Nurse). A 50-year-old male patient received bnt162b2 (BNT162B2 Formulation; Solution for injection), dose 2 intramuscularly, administered in Arm Left on 05Feb2021 07:00 (Batch/Lot Number: EL3248) as DOSE 2, SINGLE (at the age of 49-year-old) for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. It was unknown if patient had covid prior vaccination. Historical vaccine included received first dose of bnt162b2 intramuscularly administered in Arm Left on 15Jan2021 07:00 (Batch/Lot Number: EL3248) as DOSE 1, SINGLE (at the age of 49-year-old) for COVID-19 immunisation. It was unknown if the patient receive any other vaccines within 4 weeks prior to the COVID vaccine. On 24Aug2021, the patient had fever, congestion and coughing. The patient underwent lab tests and procedures which included Nasal Swab which was positive on 24Aug2021 (COVID positive post vaccination). The patient visited physician office due to the event. It was unknown if patient received treatment for event or not. The outcome of the events reported as recovering. No follow-up attempts needed. No further information expected.; Sender''s Comments: Based on the known safety profile of the vaccine BNT162B2, a temporal relation between the events (Vaccination Failure, Covid-19) and the administration of the vaccine cannot be excluded.


VAERS ID: 1673426 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-07
Onset:2021-08-24
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Drug ineffective
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:
CDC Split Type: USPFIZER INC202101116044

Write-up: She was barely four months vaccinated when we got Covid; She was barely four months vaccinated when we got Covid; This is a spontaneous report from a contactable consumer. A 39 years old female patient received bnt162b2 (BNT162B2), dose 2 intramuscular on 07Apr2021 as DOSE 2, SINGLE, dose 1 via an unspecified route of administration on 17Mar2021 (Lot Number: EP7534) at age of 38 years old as DOSE 1, SINGLE for covid-19 immunisation . The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient was barely four months vaccinated when got covid on 24Aug2021. The outcome of events was unknown.


VAERS ID: 1674488 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Cold sweat, Dyspnoea, Electrocardiogram normal, Erythema, Palpitations, Throat tightness, Troponin I normal
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: zinc, Vitamin D3, Vitamin C
Current Illness: NA
Preexisting Conditions: NA
Allergies: Amoxicillin, Penicillin,
Diagnostic Lab Data: 8/24/21 12 lead electrocardiogram - result all within normal limits 8/24/21 Chest x-ray -Result normal, no airspace or pleural effusion 8/24/21 Troponin 1 - Normal
CDC Split Type:

Write-up: On 8/24/21 @ 7:30 pm Patient began taking deep breaths not thinking anything of it at first, by 8:30 Pm she was having trouble breathing and her throat felt as if was getting smaller, she was clammy, red in the face. She was transported to the ER via personal vehicle. By this time she said the left side of her chest was burning and heart were racing. Her Blood pressure was 135/82, no temperature and Oxygen level we 95. An ekg and blood work were preformed to check for myocarditis and was negative. All in normal limits. A Covid test was administered and was negative. No medications were given. She was discharged with diagnosis of Shortness of breath and Encounter after vaccination. By 1 am on 8/25 her breathing was coming down to normal. At 7 am vitals and breathing were bac to normal.


VAERS ID: 1674526 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-20
Onset:2021-08-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Dysmenorrhoea, Heavy menstrual bleeding, Menstruation irregular, Ultrasound scan, Urine analysis
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility 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: Zegrid, Advil pl
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa drugs
Diagnostic Lab Data: Ultrasound, urinalysis
CDC Split Type:

Write-up: Began menstrual cycle 4 days after first vaccine dose. I have had horrible unusual cramps , bleeding, stomach pain for two weeks and counting. I wish the cdc was more open about this side effect instead of not putting it out there with all others maids effects.


VAERS ID: 1674637 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW016 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Dysmenorrhoea, Fatigue, Headache, Heavy menstrual bleeding, Impaired work ability, Menstrual disorder, Mobility decreased
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: A few hours following vaccination, I got a headache followed by total body joint pain. I left work to go home and go to bed. The pain resided the following day but fatigue lasted over a week from the vaccine dose. I started my menstrual cycle the following Saturday evening, 8/28/20201, which is abnormal for me since I always get them in the mornings. The following morning I woke up with severe menstrual cramping to where I could not get out of bed the entire day of 8/29/20201. The bleeding was very heavy which is also abnormal for me, I have had regular cycles since having my child almost 3 years ago, without the use of hormonal birth control. I was dizzy and very drained the whole day with an unusual amount of blood clots in my menstrual blood. I went to the doctor on the following Thursday for a follow up of these symptoms and testing.


VAERS ID: 1674936 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Insomnia, Muscle spasms, Muscle strain, Night sweats, Restless legs syndrome
SMQs:, Dystonia (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bio identical hormones, liothyronine, tirosint, bupropion, phentermine, dymista, restasis, multi vitamins, vitamin d, zinc, vitamin c, Dhea, montelukast
Current Illness: None
Preexisting Conditions: HypoThyroid
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Insomnia, night sweats, pulled muscle or bad cramp in quadricep, restless leg.


VAERS ID: 1675100 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-21
Onset:2021-08-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chest pain, Dysphagia, Ear infection, Electrocardiogram normal, Fatigue, Neck pain, Pain in extremity, Palpitations, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Age 9, 2009/10 (date unknown), Flu Shot Skin Test, skin blew up due to egg anaphylaxis allergy so never got the actual shot
Other Medications: Singulair and Zyrtec
Current Illness: None
Preexisting Conditions: Asthma and anaphylaxis
Allergies: Food: Dairy, egg, seafood, nuts (except coconut), bee stings
Diagnostic Lab Data: Got EKG on Aug 31st (exactly a week later), couldn?t pick anything up as doctor stated may happen as it wasn?t acting up when walked in.
CDC Split Type:

Write-up: Day after had sweats and arm pain, then was fine. Tuesday night felt heart a little but didn?t think anything serious of it. Then Wednesday-Friday had immense heart pain. Was only getting 4 hours of sleep because it was hard to sleep as heart would not stop palpitating heavily all throughout the day and had to apply pressure to get that little amount of sleep on that side. Heavy fatigue. Wheezing. Would feel pain even more when laid down. Chest felt tight and pain on shoulder blade behind heart one day, left side of neck, and then ear infection on left ear by Friday (aug 27th) which I started antibiotics for just recently (sept 1st) as it lingered. Heart pain lingered as well but by that Saturday (aug 28th) slowly got better to stop the nonstop palpitations and sleep properly. A week later heart pain was a lot better, but hurting still slightly at moments. Especially when about to sleep. Now two weeks later I?m okay with heart, ear pain still there at moments though and cautious.


VAERS ID: 1675109 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-24
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Menstruation delayed
SMQs:, Fertility disorders (broad)

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

Write-up: Menstrual delayed for two weeks


VAERS ID: 1675149 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-21
Onset:2021-08-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Neuralgia, Pain, Polymenorrhoea
SMQs:, Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (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: Pertussis vaccine as a baby cause closing of airways and visit to ER
Other Medications: CBD Isolate Liver Detox - NAC, milk thistle, dandelion, artichoke
Current Illness: None.
Preexisting Conditions: None.
Allergies: Severe reaction to Pertussis vaccine age 6 months. Stopped breathing and revived at ER.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe aching and nerve pain in legs, back. hips Cramping in ovaries Polymenorrhea, menorrhagia, increasingly severe dysmenorrhea


VAERS ID: 1675178 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dizziness, Fatigue, Pain, Rash, Salivary hypersecretion, Tongue oedema, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Thyroid; Osteoarthritis; Irritable Bowel Syndrome; Colitis; Fatty Liver; Kidney Stones; HBP
Preexisting Conditions: Thyroids; Colitis; HBP
Allergies: Pepper
Diagnostic Lab Data: She went to Health Group the first time 3 days after the vaccine administration, they administered DECADRON 2mg IM and BENADRYL 25mg. BENADRYL every 4 to 6 hours and to continue treatment at home. The second was on September 2, 2021 she visit Health Group with edema in the tongue, DECADRON 4mg IM and to keep taking BENADRYL 25mg PO at home.
CDC Split Type:

Write-up: The patient reports that the following day of the vaccine administration, she saw a rash all over her body. The next day she had painful hives and urticaria that were like burns. The next day she had edema in her tongue, she could expand her lungs but could not remove saliva from her mouth. She had pain in the thorax posterior area. She also had fatigue and tiredness, dizziness that persists to this day.


VAERS ID: 1675233 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Fatigue, Lymphadenopathy, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Extreme swelling and pain in under arm/lymph node area especially the left side. Joint pain throughout entire body. extreme exhaustion. all symptoms lasting for over a week.


VAERS ID: 1675358 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (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: Eloquis atenelol
Current Illness: None
Preexisting Conditions: Pacemaker TIA
Allergies: None
Diagnostic Lab Data: She did not report this to her Doctor
CDC Split Type:

Write-up: First 2 shots no reaction; booster shot given because she is immune suppressed due to rheumatoid arthritis on Methotrexate. She had a 105.6 temperature overnight after the booster but returning to normal temp the next day after taking ibuprofen.


VAERS ID: 1675560 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Limb discomfort, Lymphadenopathy, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Had the typical reactions that are said to be expected. However, by 3rd day, glands swelled up, especially the one under my arm pit on the arm where I received the shot. It became the size of a golf ball and was so painful. Then the rest of my glands became swollen. A week later, my right foot/ankle/leg is giving me problems. It swells up pretty bad. I keep it propped up which to help, but I can''t live in bed as I have to work and function. Everyone is saying I should get checked for a blood clot, but this seems lymphatic in nature. I don''t know what to do or who to see for it and have no desire to wait 8 hours at the ER, then pay a $600.00 copay.


VAERS ID: 1675649 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Olmesartan 40mg
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cough, chills, shortness of breath.


VAERS ID: 1677084 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Body temperature, Body temperature increased, Fatigue, Gait inability, Hypokinesia, Injection site pain, Lymphadenopathy, Mobility decreased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Allergic reaction to antibiotics; Asthma; Non-smoker; Penicillin allergy; Seafood allergy; Thyroid disorder
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: 99.5 F
CDC Split Type: USJNJFOC20210905848

Write-up: ARM PAIN AROUND THE INJECTION SITE; FEELING TIRED; TEMPERATURE OF 99.5 FAHRENHEIT; LYMPH NODES SWOLLEN AND HURT; UNABLE TO WALK; COULD NOT MOVE; COULD NOT BEND; BAD LOWER BACK PAIN RADIATING TO LEGS; This spontaneous report received from a patient concerned a 50 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: thyroid disorder, asthma, sulfa allergy, levaquin allergy, seafood/shellfish allergy, penicillin allergy, non-alcohol user, and non-smoker. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808609, expiry: 07-SEP-2021) dose was not reported, administered on 24-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 24-AUG-2021, the patient experienced unable to walk. On 24-AUG-2021, the patient experienced could not move. On 24-AUG-2021, the patient experienced could not bend. On 24-AUG-2021, the patient experienced bad lower back pain radiating to legs. On 25-AUG-2021, the patient experienced lymph nodes swollen and hurt. On an unspecified date, the patient experienced arm pain around the injection site, feeling tired, and temperature of 99.5 fahrenheit. Laboratory data (dates unspecified) included: Body temperature (NR: not provided) 99.5 F. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from could not move, and could not bend on 27-AUG-2021, and temperature of 99.5 fahrenheit, was recovering from bad lower back pain radiating to legs, had not recovered from lymph nodes swollen and hurt, and the outcome of feeling tired, arm pain around the injection site and unable to walk was not reported. This report was non-serious.


VAERS ID: 1677096 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Disturbance in attention, Dizziness, Feeling abnormal, Paraesthesia, Presyncope
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: Patient has no significant medical history, no known allergies and patient was not pregnant at the time of reporting.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210907722

Write-up: SENSATION OF INTERMITTENT PINS AND NEEDLES IN FINGERTIPS; EXTREME LIGHT HEADEDNESS INTERMITTENTLY; BRAIN FOG/NOT FEELING LIKE MYSELF; UNABLE TO CONCENTRATE; IT FEELS ALMOST LIKE GOING TO FAINT, BUT DON''T, IT''S NOT DIZZINESS, IT''S WORSE WHEN STAND UP FROM SITTING; This spontaneous report received from a patient concerned a 57 year old female. The patient''s weight was 155 pounds, and height was 64 inches. The patient''s concurrent conditions included: non alcohol user, and non-smoker, and other pre-existing medical conditions included: Patient has no significant medical history, no known allergies and patient was not pregnant at the time of reporting. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 205A21A expiry: 21-SEP-2021) dose was not reported, administered on 16-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 24-AUG-2021, the patient experienced extreme light headedness intermittently. On 24-AUG-2021, the patient experienced brain fog/not feeling like myself. On 24-AUG-2021, the patient experienced unable to concentrate. On 24-AUG-2021, the patient experienced it feels almost like going to faint, but don''t, it''s not dizziness, it''s worse when stand up from sitting. On 01-SEP-2021, the patient experienced sensation of intermittent pins and needles in fingertips. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from extreme light headedness intermittently, brain fog/not feeling like myself, sensation of intermittent pins and needles in fingertips, and unable to concentrate, and the outcome of it feels almost like going to faint, but don''t, it''s not dizziness, it''s worse when stand up from sitting was not reported. This report was non-serious.


VAERS ID: 1677246 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site reaction
SMQs:

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

Write-up: Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE REACTION (magnetic at the injection site/ messed around with their name badges and anything that was magnetic, and it would stick to the injection site) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Aug-2021, the patient experienced VACCINATION SITE REACTION (magnetic at the injection site/ messed around with their name badges and anything that was magnetic, and it would stick to the injection site). At the time of the report, VACCINATION SITE REACTION (magnetic at the injection site/ messed around with their name badges and anything that was magnetic, and it would stick to the injection site) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No relevant concomitant medications were reported. No Treatment information were reported. They messed around with their name badges and anything that was magnetic, and it would stick to the injection site, not the whole arm.


VAERS ID: 1677265 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-01
Onset:2021-08-24
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cognitive disorder, Condition aggravated, Dementia Alzheimer's type, Dysphagia, Glassy eyes, Urinary tract infection, Vital signs measurement
SMQs:, Anticholinergic syndrome (broad), Dementia (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: COUMADIN; LISINOPRIL
Current Illness: Alzheimer''s disease (beginning stages may be stage 3 to 4); Dementia; Pain legs (pain in both legs); Short-term memory loss (bad short-term memory); Wheelchair user
Preexisting Conditions: Medical History/Concurrent Conditions: Broken hip (broke her hips years ago)
Allergies:
Diagnostic Lab Data: Test Name: vitals; Result Unstructured Data: normal
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: her eyes glazed over; Her cognition was 98% worse /The vaccine did something to her mental cognition; could not swallow /would not open her mouth to eat; urinary tract infection; yesterday, she was at a stage 6 Alzheimer''s; yesterday, she was at a stage 6 Alzheimer''s; This spontaneous case was reported by a nurse and describes the occurrence of DEMENTIA ALZHEIMER''S TYPE (yesterday, she was at a stage 6 Alzheimer''s), CONDITION AGGRAVATED (yesterday, she was at a stage 6 Alzheimer''s), GLASSY EYES (her eyes glazed over), COGNITIVE DISORDER (Her cognition was 98% worse /The vaccine did something to her mental cognition) and DYSPHAGIA (could not swallow /would not open her mouth to eat) in an 87-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Broken hip (broke her hips years ago). Concurrent medical conditions included Dementia, Alzheimer''s disease (beginning stages may be stage 3 to 4), Wheelchair user, Pain legs (pain in both legs) and Short-term memory loss (bad short-term memory). Concomitant products included WARFARIN SODIUM (COUMADIN) and LISINOPRIL for an unknown indication. In February 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. In March 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 24-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 24-Aug-2021, the patient experienced DEMENTIA ALZHEIMER''S TYPE (yesterday, she was at a stage 6 Alzheimer''s) and CONDITION AGGRAVATED (yesterday, she was at a stage 6 Alzheimer''s). On an unknown date, the patient experienced GLASSY EYES (her eyes glazed over), COGNITIVE DISORDER (Her cognition was 98% worse /The vaccine did something to her mental cognition), DYSPHAGIA (could not swallow /would not open her mouth to eat) and URINARY TRACT INFECTION (urinary tract infection). At the time of the report, DEMENTIA ALZHEIMER''S TYPE (yesterday, she was at a stage 6 Alzheimer''s), CONDITION AGGRAVATED (yesterday, she was at a stage 6 Alzheimer''s), GLASSY EYES (her eyes glazed over), COGNITIVE DISORDER (Her cognition was 98% worse /The vaccine did something to her mental cognition), DYSPHAGIA (could not swallow /would not open her mouth to eat) and URINARY TRACT INFECTION (urinary tract infection) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Vital signs measurement: normal (normal) normal. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications included gummy worms that has cannabis in them to sleep.,which usually alters the person, but patient did not have it last night. She could not swallow, the caregiver crushed her pills and put it in apple sauce. no treatment medications reported. symptom text;acting strange,she was a whole different person,kept telling her to chew,She was just staring ahead,did not know who she was Life,asked if she had eaten, she would respond "zzztttt,Making no sense at all,From midnight to 3am it was all gibberish,it is kind of scary; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Concomitant medical conditions could be potentially confounders for the events.


VAERS ID: 1677270 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-02
Onset:2021-08-24
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Diarrhoea, Feeling abnormal, Vaccination site pain, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: felt badly; sore injection site right arm; vomiting; abdominal pain; weak; diarrhea; This spontaneous case was reported by a consumer and describes the occurrence of ABDOMINAL PAIN (abdominal pain), ASTHENIA (weak), DIARRHOEA (diarrhea), FEELING ABNORMAL (felt badly) and VACCINATION SITE PAIN (sore injection site right arm) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was provided by reporter. Concomitant products included MECLOZINE HYDROCHLORIDE (BONINE) for an unknown indication. On 02-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 24-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 24-Aug-2021, the patient experienced ABDOMINAL PAIN (abdominal pain), ASTHENIA (weak), DIARRHOEA (diarrhea), VACCINATION SITE PAIN (sore injection site right arm) and VOMITING (vomiting). On an unknown date, the patient experienced FEELING ABNORMAL (felt badly). At the time of the report, ABDOMINAL PAIN (abdominal pain), ASTHENIA (weak), DIARRHOEA (diarrhea), FEELING ABNORMAL (felt badly), VACCINATION SITE PAIN (sore injection site right arm) and VOMITING (vomiting) outcome was unknown. Treatment medications were not provided by reporter. This case was linked to MOD-2021-296556 (Patient Link).


VAERS ID: 1677500 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-08-24
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 antibody 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: 20210824; Test Name: Covid-19; Test Result: Positive ; Comments: diagnosed with Covid-19 infection today (24 Aug)
CDC Split Type: USPFIZER INC202101098213

Write-up: got diagnosed with Covid today; got diagnosed with Covid today; This is a spontaneous report from a contactable consumer or other non hcp (reporters sister-in-law). A 42-years-old female patient received BNT162B2 (BNT162B2, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on Feb2021 as single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient got diagnosed with COVID today on 24Aug2021. Caller stated, the patient actually have several questions and the patient also recording for information internet channel to help clear up a lot of misinformation about COVID vaccination hopefully this can help some people, the patient know a lot of people afraid to take it. The patient know the FDA approved Monday vaccination for 16 and older, totally different vaccination than the one that was produced back in Feb/Mar. Can you confirm or deny that. Caller continued, Pfizer initially did their preliminary tests the vaccination was about 95% effective from people getting Covid versus the placebo in the 22000-some people that they did and now the patient believed its around 38% with the breakthrough cases but with those 72% that have broke through the patient believed that those cases were considered mild compared to those that have not had their vaccination so yes there may be breakthrough cases but those tend to be less severe than those that have not had the vaccination if could confirm that as well. The last question would be on the breakthrough cases do you have research as far as how many of those breakthrough cases that had the vaccination were actually continuing to also wear the mask at the same time or did they get the vaccination and think okay we are good we do not need to wear masks anymore and that was how they got it you know if you could come up with those kinds of information it sure would help clear up a lot of misinformation that was out there. The patient underwent lab tests and procedures which included sars-cov-2 antibody test: positive on 24Aug2021 diagnosed with COVID-19 infection today. The outcome of the event was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1678158 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 43B21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Feeling hot, Pain in extremity, Peripheral swelling, Pruritus, Rash, Vaccination complication, Vaccination site erythema, Vaccination site rash, Vaccination site urticaria
SMQs:, Cardiac failure (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; ELIQUIS; FLECAINIDE; NORVASC; CIALIS; HYDROCHLOROTHIAZIDE; BYSTOLIC
Current Illness: Atrial fibrillation; Blood pressure high; BPH; Hypothyroidism; Monoclonal B-cell lymphocytosis (Monoclonal B-cell Leukocytosis (MBL)); Sleep apnea
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: hives around his injection arm; a rash around his injection arm; 12 inches of redness that wraps around his injection arm; rash with hives and redness extension to the other side of body; arm swollen; arm hot; arm red; almost a typical covid arm/It is giving him a little bit of problem; itching; A sore arm; This spontaneous case was reported by a pharmacist and describes the occurrence of PAIN IN EXTREMITY (A sore arm), PERIPHERAL SWELLING (arm swollen), FEELING HOT (arm hot), ERYTHEMA (arm red) and VACCINATION COMPLICATION (almost a typical covid arm/It is giving him a little bit of problem) in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 43B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Blood pressure high, Hypothyroidism, BPH, Sleep apnea, Monoclonal B-cell lymphocytosis (Monoclonal B-cell Leukocytosis (MBL)) and Atrial fibrillation. Concomitant products included LEVOTHYROXINE SODIUM (SYNTHROID), APIXABAN (ELIQUIS), FLECAINIDE, AMLODIPINE BESILATE (NORVASC), TADALAFIL (CIALIS), HYDROCHLOROTHIAZIDE and NEBIVOLOL HYDROCHLORIDE (BYSTOLIC) for an unknown indication. On 24-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 24-Aug-2021, the patient experienced PAIN IN EXTREMITY (A sore arm). On 25-Aug-2021, the patient experienced PERIPHERAL SWELLING (arm swollen), FEELING HOT (arm hot), ERYTHEMA (arm red), VACCINATION COMPLICATION (almost a typical covid arm/It is giving him a little bit of problem) and PRURITUS (itching). On 27-Aug-2021, the patient experienced RASH (rash with hives and redness extension to the other side of body). On an unknown date, the patient experienced VACCINATION SITE URTICARIA (hives around his injection arm), VACCINATION SITE RASH (a rash around his injection arm) and VACCINATION SITE ERYTHEMA (12 inches of redness that wraps around his injection arm). The patient was treated with HYDROCORTISONE (topical) for Itching, at an unspecified dose and frequency and ALOE VERA, CANNABIDIOL, MAGNESIUM CHLORIDE, MATRICARIA RECUTITA, MENTHA X PIPERITA OIL (CBD & MAGNESIUM) (topical) for Itching, at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (A sore arm) and PRURITUS (itching) was resolving, PERIPHERAL SWELLING (arm swollen), FEELING HOT (arm hot), ERYTHEMA (arm red), VACCINATION COMPLICATION (almost a typical covid arm/It is giving him a little bit of problem), VACCINATION SITE URTICARIA (hives around his injection arm), VACCINATION SITE RASH (a rash around his injection arm) and VACCINATION SITE ERYTHEMA (12 inches of redness that wraps around his injection arm) outcome was unknown and RASH (rash with hives and redness extension to the other side of body) had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. This case was linked to MOD-2021-297099, MOD-2021-297112 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 27-Aug-2021: follow up document received on 27-AUG-2021 contains Additional information received , includes new events and outcome.


VAERS ID: 1678266 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-13
Onset:2021-08-24
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site pruritus, Vaccination site rash, Vaccination site reaction, Vaccination site warmth
SMQs:, Hypersensitivity (narrow)

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

Write-up: COVID arm; Arm of injection is warm to touch; A rash appeared at the site of injection. The rash is red and a little itchy.; A rash appeared at the site of injection. The rash is red and a little itchy.; A rash appeared at the site of injection. The rash is red and a little itchy.; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE REACTION (COVID arm), VACCINATION SITE WARMTH (Arm of injection is warm to touch), VACCINATION SITE PRURITUS (A rash appeared at the site of injection. The rash is red and a little itchy.), VACCINATION SITE RASH (A rash appeared at the site of injection. The rash is red and a little itchy.) and VACCINATION SITE ERYTHEMA (A rash appeared at the site of injection. The rash is red and a little itchy.) in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 003F21A) for COVID-19 vaccination. No medical history was reported. On 13-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 24-Aug-2021, the patient experienced VACCINATION SITE REACTION (COVID arm), VACCINATION SITE WARMTH (Arm of injection is warm to touch), VACCINATION SITE PRURITUS (A rash appeared at the site of injection. The rash is red and a little itchy.), VACCINATION SITE RASH (A rash appeared at the site of injection. The rash is red and a little itchy.) and VACCINATION SITE ERYTHEMA (A rash appeared at the site of injection. The rash is red and a little itchy.). The patient was treated with LORATADINE (CLARITIN [LORATADINE]) on 24-Aug-2021 for Adverse event, at a dose of 1 dosage form. At the time of the report, VACCINATION SITE REACTION (COVID arm), VACCINATION SITE WARMTH (Arm of injection is warm to touch) and VACCINATION SITE RASH (A rash appeared at the site of injection. The rash is red and a little itchy.) outcome was unknown and VACCINATION SITE PRURITUS (A rash appeared at the site of injection. The rash is red and a little itchy.) and VACCINATION SITE ERYTHEMA (A rash appeared at the site of injection. The rash is red and a little itchy.) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant product use was provided by the reporter.


VAERS ID: 1678696 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-22
Onset:2021-08-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blister, Pain in extremity, Paraesthesia, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 2 days after receiving the Pfizer vaccine, I started experiencing a fever and tingling in the arms and legs with some shooting pains in the extremities and knees (with a general constant discomfort in the arms and legs). The following day, large painful unexplained blisters started to appear on my feet, particularly at the heels (both feet) and some smaller ones on my hand fingertips. Due to the pain and fever, I visited a local urgent care center who recognized the symptoms as having occurred recently on some other patients receiving the same vaccine. I received a steroid injection and a prescription for an antibiotic. This treatment generally helped with the condition.


VAERS ID: 1678698 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dysmenorrhoea, Eczema, Heavy menstrual bleeding, Immune-mediated adverse reaction, Impaired work ability, Odynophagia, Oropharyngeal pain, SARS-CoV-2 test negative, Streptococcus test negative, Tonsillar inflammation, Tonsillitis, Vaccination complication
SMQs:, Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

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

Write-up: The day after the vaccine, I woke up feeling a sore throat and painful when swallowing. I went to an Urgent Care on 8/26/2021 and was diagnosed with tonsillitis. My tonsils were inflamed and the doctor said it was an immune response to the vaccine. I was instructed to rest, take Tylenol and the tonsilitis did resolve after 2 days. They also did Covid and strep test which were negative. I have an history of eczema and I have also noticed my eczema flared up after the first dose. It did resolve a week later. A week later, my period started on 8/30/2021 and the cramping was more severe than normal and I had to take a day off from work and take pain medication. I also noticed my menstrual flow was much heavier than normal the 1st 2 days.


VAERS ID: 1678975 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular 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: "15mins post vaccination, pt c/o mild dizziness. Vitals: @15:40 BP 135/89, HR 78, RR 16, SPO2 99% -- $g @15:55 141/93, 67, 18, 100%. Pt stable and released from the vaccination site."


VAERS ID: 1678981 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

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

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

Write-up: Shingles


VAERS ID: 1679172 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-18
Onset:2021-08-24
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Pneumonia, SARS-CoV-2 test positive
SMQs:, Eosinophilic pneumonia (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, diclofenac gel, furosemide, isosorbide mononitrate, levothyroxine, mometasone-formoterol, multivitamin, sertraline, simvastatin
Current Illness:
Preexisting Conditions: anemia, anxiety, arthritis, CAD, chronic diastolic heart failure, costochondritis, depression, diverticulitis, diverticulosis, exertional dyspnea, hyperlipidemia, HTN, hypothyroidism, insomnia, lower extremity edema, HX MI, obstructive chronic bronchitis, osteoporosis, asthma, hx urothelial carcinoma of bladder, vaginal atrophy.
Allergies: Iodinated diagnostic agents
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was fully vaccinated with the Pfizer COVID-19 vaccine (on 1/28/2021 and 2/18/2021). Pt tested positive for COVID at her LTC facility on 8/24/2021. She was then subsequently seen in the ED on 8/28/2021. On 9/5/2021, she was seen again in the ED and admitted for COVID 19 complications and pneumonia. She was discharged on 9/7/2021


VAERS ID: 1679175 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-30
Onset:2021-08-24
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol inhaler; allopurinol; amiodarone; acetaminophen; ascorbic acid; benzonatate; cefdinir; diltiazem; eliquis; furosemide; levothyroxine; metformin; multivitamin; nystatin oral suspension; omeprazole; oragel; vitamin E;
Current Illness: unknown
Preexisting Conditions: DVT; GERD; Renal Cell Carcinoma; atrial fibrillation; CKD stage 2; T2DM; HTN; Diffuse large B-cell lymphoma, stage IIb; CHF
Allergies: Sulfonamide antibiotics
Diagnostic Lab Data: First positive SARS-CoV-2 test was 8/17/21 and admitted to the hospital on 8/24/21
CDC Split Type:

Write-up: None-hospitalized as covid positive and vaccinated.


VAERS ID: 1679189 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-21
Onset:2021-08-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Nausea, Vertigo, 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), Vestibular disorders (narrow)

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

Write-up: Severe vertigo, nausea and vomiting 3 days later. persistent balance issue.


VAERS ID: 1679291 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site inflammation, Injection site pain, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (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:
Other Medications: Losartan 25 mg,, Zoloft,25 mg, Topiramate 25 mg, Pantoprazole Sodium 40 Mg, Fiber 1 tab a day, Oxybutynin 10 mg,, Vitamin D3 125 mcg,
Current Illness: NONE
Preexisting Conditions: asthma an arthritis
Allergies: Ethroymycin Itch reaction
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SORE MUSCLES, ACHES STARTED APROX 6 TO 8 HRS AFTER SHOT AT 11;30 A.,M. I STARTED TAKING TYLENOL EVERY 3 HRS THRU THE NIGHT AND THE NEXT DAY EVERY 4 HRS. THE SORE MUSCLES SOON STARTED TO SUBSIDE APPRPOX 2 DAYS AND I THEN NOTICED MY INJECTION SITE WAS ANGRY AND RED. IT WAS TENDER AND FEVERISH BUT NOT BAD. THAT STAYED WITH ME UNTIL MONDAY AUGUST 30. FINALLY IT SUBSIDED.


VAERS ID: 1679293 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-04
Onset:2021-08-24
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Chest pain, Pain, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Intense paid in the left side of my chest, radiating through the entirety of the left side of my body. This includes down my left arm to the fingertips. The pain doubled me over for around 2-3 minutes but I was able to remain on my feet. The pain subsided over the next few minutes and then was gone entirely. It was serious enough that if it hadn''t let up I was going to the hospital. This was the first time I''ve experienced this type of even and I have not experienced another one since this date.


VAERS ID: 1679356 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-24
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Hives that move to different parts of body. Worse with warm shower or itching. Antihistamines help. Slightly better but still present two weeks later. Only got hives after booster


VAERS ID: 1679398 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-21
Onset:2021-08-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Coordination abnormal, Inflammation, Migraine, Nausea, Neck pain, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-vitamin Magnesium
Current Illness:
Preexisting Conditions: Periodic migraines, usually with cycle, but only occuring every few months. Manageable with magnesium supplementation, no prior need for prescription meds to control.
Allergies: Amoxicillin gluten-intolerant
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed persistent migraine symptoms three days after shot. Nausea, dull neck ache, vertigo/coordination issues. These persisted at a low level until examined by nurse practitioner at chiropractor office on September 2nd when they found my whole upper right back/neck inflamed and gave me dexamethasone injections. NP and also now my general practioner, believe vaccine caused a significant inflammatory response in my neck and upper back. Steroid shots worked for a few days but low level migraine has returned and CT/neuro consult is pending.


VAERS ID: 1679547 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-06
Onset:2021-08-24
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Hypoxia, Lung infiltration, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby aspirin, atorvastatin, calcium carbonate PRN, vitamin D, clopidogrel, ezetimibe, Humalog pen, Lantus Pen, lisinopril, metformin, omega-3 fish oil, ranitidine PRN
Current Illness:
Preexisting Conditions: type 2 diabetes, hypertension, chronic kidney disease, coronary artery disease, chronic congestive heart failure, and hypercholesterolemia
Allergies: NKDA
Diagnostic Lab Data: COVID status positive on 8/24/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 3/16/21 and 4/6/21. Patient tested COVID positive on 8/24/21, came to our ED, received a dose of remdesivir, was not requiring oxygen, and was discharged home. On 8/31/21, patient came back to the hospital and found to be hypoxic on room air with bilateral infiltrates on chest x-ray. He was admitted from 8/31/21 to 9/4/21 for COVID-19 pneumonia and received dexamethasone during admit.


VAERS ID: 1681928 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: No
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101098410

Write-up: Just very bad headaches; This is a spontaneous report received from a non-contactable consumer(patient). A 27-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE- solution for injection; lot number and expiry date were not reported) via an unspecified route of administration into left arm, on 23Aug2021,11:00, at age of 27-year-old at dose 1,single for covid-19 immunisation in a school or student health clinic. The patient did not have any medical history and concomitant medications. The patient is not pregnant at the time of vaccination. The patient did not receive other vaccine in four weeks. The patient did not have prior COVID vaccination and was not tested post vaccination. The patient experienced just very bad headaches on 24Aug2021 12:00. The patient did not receive treatment in response to the events. The outcome of the events was not recovered at the time of the report. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected


VAERS ID: 1681957 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-01
Onset:2021-08-24
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, 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: 20210824; Test Name: rapid Covid test; Test Result: Positive
CDC Split Type: USPFIZER INC202101103055

Write-up: 5 months after their 2nd dose, they both tested positive for Covid; 5 months after their 2nd dose, they both tested positive for Covid; This is a spontaneous report from a Pfizer sponsored program regulatory authority Support via contactable nurse (patient) via medical information team . A 61-years-old female patient received BNT162B2 (COMIRNATY, Solution for injection) via an unspecified route of administration on an unspecified date in Mar2021 (at the age of 61 years old, Batch/lot number, NDC number, Expiry Date: Not provided) as dose 1, single and dose 2 via an unspecified route of administration on an unspecified date in Mar2021 (at the age of 61 years old, Batch/lot number, NDC number, Expiry Date: Not provided) as dose 2, single both taken for COVID-19 immunisation. The patient medical history and other products were not provided. The patient stated yesterday, 5 months after their 2nd dose, they both; she and her husband tested positive for COVID (24Aug2021), she was a nurse, and spent some years in research and data collection, she went to get a rapid COVID test, her doctor told her that the only information they report to the county was a positive test, they do not report a person''s vaccination status, she questioned how was Pfizer gathering data in terms of immune response, and efficacy of the vaccine, if none of this information was being collected on the local level, how can the vaccine be improved to further benefit the patient, they were not testing for variants on the local level, how Pfizer was approaching new variants that are developing, on a local level, they were not doing genomic type testing to differentiate the variants, how Pfizer was getting the information on the variants and she explained information about the flu vaccine for each season. She wanted to know how Pfizer was getting information about the different variants coming out, how Pfizer was following breakthrough cases, how they are gathering information about it, and how Pfizer was keeping the vaccine up to date moving forward. The patient further stated that if local health professionals are not capturing data, how can the pharmaceutical companies move forward with improving their vaccines, she had no adverse events with the vaccine, she wanted to know if there was a 2nd breakthrough susceptibility even after people have been fully vaccinated and are COVID positive and they forward her question to someone from their team so that they can research about it further. The patient underwent lab tests and procedures which included rapid COVID test: positive on 24Aug2021. The outcome of the events was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Sender''s Comments: Based on the information available in the case, a contributory role of the suspect product bnt162b2 to the reported events cannot be excluded. Case will be reassessed upon receipt of additional information.


VAERS ID: 1681986 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris, Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (if covid prior vaccination: Yes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101110898

Write-up: Severe chest pain, particularly the heart.; Severe chest pain, particularly the heart.; This is a spontaneous report from a Non-contactable Other HCP (patient herself). A 25-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, formulation: solution for injection, lot number: unknown, expiry date: unknown) via unspecified route of administration on 19Aug2021 13:15 (age at vaccination: 25-years) as dose number unknown, single for covid-19 immunisation. Patient was not pregnant at the time of vaccination. Patients medical history included covid-19 prior to vaccination, from an unspecifed date and unknown if ongoing. Concomitant medications were not reported. The patient was not tested for covid post vaccination. On 24Aug2021, patient experienced severe chest pain, particularly the heart. The adverse events resulted in doctor or other healthcare professional office/clinic visit. No treatment regimen was given as a result of the adverse events. The outcome of event was recovering. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1681993 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea, Fibrin D dimer, Haematemesis, Malaise, Nausea, Pain, Pain in extremity, Sluggishness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Asthma; Clot blood; Heart disorder (I have heart problem)
Allergies:
Diagnostic Lab Data: Test Name: D dimer test; Result Unstructured Data: Test Result:don''t have a clotting
CDC Split Type: USPFIZER INC202101112737

Write-up: It''s more nausea and thrown out blood and cough, and coughing; Body ache; Just feeling unwell, Just feeling like sluggish; My legs are so hurting; Shortness of breath; Just feeling unwell, Just feeling like sluggish; Nausea; Coughing; This is a spontaneous report from a contactable consumer (patient herself). A 30-year-old female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection) via unknown route of administration on 23Aug2021 (lot number: FD8448) (age at vaccination 30-year-old) as dose 1, single for COVID-19 immunisation at pharmacy. The patient medical history included asthma, anxiety, heart problem and blood clot history from an unknown date and unknown if ongoing. The patient take tylenol for asthma. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient had no prior vaccinations. The patient would like to report the side effects, as taken the COVID-19, the Pfizer first dose. The patient experienced as It''s more nausea and thrown out blood and cough, and coughing, nausea, body ache, shortness of breath, just feeling unwell, just feeling like sluggish, legs are so hurting on 24Aug2021. I don''t take the second one into the 13th of next month. The patient laboratory investigation included D-dimer test which revealed no clotting. The patient stated she had no body aches no more. She wanted to know, Why her legs were so hurting but it was not like persisting. It''s more nausea and thrown out blood and cough, and coughing. The outcome of the event It''s more nausea and thrown out blood and cough, and coughing, shortness of breath, just feeling unwell, just feeling like sluggish, nausea was unknown, legs are so hurting was recovering, body ache was recovered. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1682004 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Dizziness, Headache, Neck pain, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101117934

Write-up: Fever; Chills; Headache; loss of appetite; dizziness; tingling in extremity; cervical soreness; This is a spontaneous report received from a contactable consumer(patient). A 53-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; lot number: FC3180 and expiry date not reported) via an unspecified route of administration, at the age of 53-year-old, on 24Aug2021 12:15, at the right arm, at dose1, single for covid-19 immunisation in a Pharmacy/drug store. Relevant medical history included COVID prior vaccination. The patient no known allergies. Concomitant medications was reported as none. The patient is not pregnant at the time of vaccination. The patient did not have other vaccine in four weeks. The patient did not have other medications in two weeks. It was unknown if the patient was tested for covid post vaccination. On 24Aug2021, 20:45, the patient experienced fever, chills, headache, loss of appetite, dizziness, tingling in extremities, cervical soreness. It was unknown whether the patient took any treatment. The outcome of the event was unknown at the time of report.


VAERS ID: 1682010 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-20
Onset:2021-08-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Influenza virus test, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PROGESTERONE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma (Verbatim: Mild Asthma); Food allergy (and the list is very long); Ileostomy; Influenza B virus infection (Yes. She was diagnosed with flu B); Insulin resistance (Verbatim: Insulin resistance); Thyroid disorder; Comments: Relevant medical history PMPD couldn''t code in other relevant history of patient tab
Allergies:
Diagnostic Lab Data: Test Name: Flu test; Result Unstructured Data: Test Result:Positive; Test Name: Covid test; Result Unstructured Data: Test Result:Negative
CDC Split Type: USPFIZER INC202101120934

Write-up: Now she has diminished breathing.; This is a spontaneous report from a contactable consumer (patient''s mother). A 22-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection) via an unspecified route of administration in Arm Left on 20Aug2021 (last Friday, at the age of 22-years old) as dose 1, single for COVID-19 immunisation. Medical history included PMPD (unspecified), mild asthma, insulin resistance, ileostomy, thyroid disease, allergies to various foods (the list is very long) and flu B. Concomitant medication included progesterone taken for birth control and anti-anxiety (unspecified). The reporter stated that the patient did not took prior vaccination (4 weeks). The reporter stated that she believed her daughter had the severe reaction to the Pfizer vaccine. She (the patient) received it on last Friday (she did not know, what the time was; it was like after breakfast or before lunch) and now she diminished breathing (24Aug2021), she went to urgent care today. Reporter further stated she needs to know what to do, her daughter was having hard time breathing from their vaccination so, what the next step so far, how do she get medical help for her daughter, her school was making her mandatory vaccinate, how could she, get her medical assumption, she knew was am doing all the right things by reporting it but, Frankly, that was not very helpful and needed assistance. The due date for second shot for the patient was on Monday or Friday (must be on 03Oct2021). The patient was put on nebulizer 4 times a day as well as the rescue inhaler (intent treatment). The reporter stated that symptoms worsened, improved and were persisting. The patient underwent lab test which included covid test: negative and flu test: positive both on an unspecified date. The outcome of the event was not recovered. The lot number for the vaccine, [BNT162B2], was not provided and would be requested during follow up. Information on the lot/batch number has been requested.


VAERS ID: 1682037 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chromaturia, Pain, Pain in extremity, Rhabdomyolysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101133526

Write-up: Rhabdomyolysis/his muscles are deteriorating and he has high levels of protein that are developing into his body and are seeping into his bloodstream; Got a cola colored urine/his pee was the color of Pepsi- Cola; Excruciating pain/his body was achy but he thought that maybe that was possibly a regular side effect; At some time during that night he had pain and aches but they said that he might feel that in his arm; This is a spontaneous report from a contactable consumer. This consumer (patient''s mother) reported for a 23-year-old male patient (reporter'' son). A 23-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, formulation: Solution for injection, Batch/Lot number was not reported), dose 1 via an unspecified route of administration on 24Aug2021 (age at the time of vaccination was 23-year-old) as dose 1, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. It was reported that at some time during that night on 24Aug2021, the patient had pain and aches, but they said that the patient might feel that in his arm, that was Tuesday. Then on Wednesday, 25Aug2021, the patient body was achy, but the patient thought that maybe that was possibly a regular side effect and then by Thursday, 26Aug2021, the patient was having excruciating pain. On Friday, 27Aug2021, the patient thought that he had blood in his urine because his pee was the color of Pepsi- Cola but he still had the pain. The patient was told that this was a result of the COVID vaccine and that he had rhabdomyolysis on 28Aug2021. Then on Saturday, 28Aug2021, the patient went to the emergency room and was hospitalized on 28Aug2021. The patient was an otherwise healthy young man and now the patient muscles were deteriorating, and the patient had high levels of protein that were developed into his body and were seeping into the patient bloodstream. The patient was told that this could have caused renal failure if the patient had not gone to the emergency room when he did. They were currently flushing the patient. They said that the numbers were so high, they were like 300 something either in the millions or the thousands. It was reported that the patient was kept in the hospital and he now had circumstance that the patient did not have before he took the COVID vaccine.The patient had his own apartment, the patient worked every day, and his baby was due in November. The patient insurance just kicked in with his job, but the caller (patient''s mother) was unsure about any long-term care for him. The patient IVs had been changed and were flushing this stuff out of the patient system. The doctor said that the numbers were not going higher, but they were also not going down fast. The patient was recommended for her son to not take the second dose. Outcome of all the events was reported as Unknown at this time of the report. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1682065 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-03
Onset:2021-08-24
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAG780 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hot flush, Vaccination site pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OXYCODONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101138619

Write-up: sore arm; Hot flashes; This is a spontaneous report from a contactable consumer (Patient herself). A 65-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection and Lot Number: PAG780) via an unspecified route of administration in Left arm on 03Aug2021 as dose 1, single for COVID-19 immunisation. Patient medical history was reported as none. Concomitant medication included oxycodone taken for Medical Reasons. On 24Aug2021 patient experienced with sore arm and Hot flashes. Seriousness was reported as non-serious. Patient did not received any treatment for events. Outcome of events was recovering.


VAERS ID: 1682111 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Fatigue, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), 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: USPFIZER INC202101146076

Write-up: fatigue; nausea; no taste; headache; This is a spontaneous report from a contactable consumer (patient). A male patient of an unspecified age received bnt162b2 (Comirnaty, Formulation: solution for injection, Lot/Batch not provided, expiry date not provided), via an unknown route of administration, administered on 24Aug2021, as DOSE 1, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient received his first dose on 24Aug2021, Since then consumer confirms that since vaccination he has experienced fatigue, nausea, no taste and a headache. He was still experiencing these symptoms to date and he confirms he would like to know if this is normal. The patient also enquired whether should he got tested for the actual virus. The outcome of events was not recovered. That information on the Lot/batch number has been requested


VAERS ID: 1682786 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-08
Onset:2021-08-24
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram normal, Aphasia, Blood test normal, Computerised tomogram normal, Dizziness, Echocardiogram normal, Hypoaesthesia, Hypoaesthesia oral, Laboratory test normal, Magnetic resonance imaging normal, Nausea, SARS-CoV-2 test negative, Ultrasound Doppler, Venogram normal
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), COVID-19 (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? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: duloxetine 60mg daily Zyrtec daily estradiol 0.075% patch
Current Illness: None
Preexisting Conditions: Depression, GAD
Allergies: Sulfa antibiotics, doxycycline, avocado, banana, cantaloupe, watermelon
Diagnostic Lab Data: Covid negative, carotid ultrasound negative, MRI/MRA/MRV negative, Echo and bubble study negative, CT negative Blood tests negative
CDC Split Type:

Write-up: Tues: dizziness, nausea, numb lips Wed: dizziness, nausea, numb face Thurs: dizziness, nausea, numb face and all extremities, aphasia


VAERS ID: 1682818 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-18
Onset:2021-08-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pleural effusion, Rash
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: unknown, patient does not fill with our pharmacy
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: Patient states she spoke with a dermatologist for the rash
CDC Split Type:

Write-up: Patient states w/in a week (can''t remember number of days ) after receiving vaccine, she broke out in a rash around neck and felt like she had fluid in her lungs.


VAERS ID: 1682840 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

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

Write-up: ASSESSMENT AND PLAN: 1. Moderate persistent asthma, unspecified whether complicated (Primary) Assessment & Plan: Unfortunately she has been taking albuterol bid to tid and no flovent and noting wheezing. Now knows to take flovent bid and albuterol as needed. Discussed the rule of 2s. Resent 1 albuterol with 1 refill. This should last 6-12 months if well controlled. Will restart same dose of flovent and will f/u in 1 -2 months. If still wheezing or feeling like lung control is not ideal then would increase flovent dose. Will monitor. Return precautions discussed Orders: - fluticasone (FLOVENT DISKUS) 100 MCG/BLIST diskus inhaler; Inhale 1 puff into the lungs 2 times daily. Dispense: 60 each; Refill: 5 - albuterol 90 mcg/puff inhaler; Inhale 2 puffs into the lungs every 4 hours as needed for Wheezing, Shortness of Breath or Increased Work of Breathing (RESCUE). Dispense: 8.5 g; Refill: 1 2. Nausea after vaccination Comments: start zofran as needed for n/v related to covid 19 vaccination. will monitor. push fluids. get rest. Orders: - ondansetron (ZOFRAN ODT) 4 mg disintegrating tablet; Take 1 tablet by mouth every 8 hours as needed for Nausea. Dispense: 24 tablet; Refill: 0


VAERS ID: 1682926 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure, Cardiac failure congestive, Cardiomyopathy, Chest pain, Dyspnoea, Electrocardiogram, Fatigue, Full blood count, Metabolic function test
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: losartan, carvedilol, furosemide, buspirone
Current Illness:
Preexisting Conditions: HTN, CARDIOMYOPATHY, CHF, hyperlipidemia
Allergies: NKA
Diagnostic Lab Data: EKG, CBC, CMP
CDC Split Type:

Write-up: Chest pain, shortness of breathing and fatigue. decompensation of previously well managed cardiomyopathy, CHF


VAERS ID: 1682979 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-19
Onset:2021-08-24
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Angiogram pulmonary, Blood magnesium, Brain natriuretic peptide, Chest X-ray, Chest pain, Differential white blood cell count, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count, Influenza virus test, International normalised ratio, Metabolic function test, Prothrombin time, Pulmonary embolism, Respiratory syncytial virus test, SARS-CoV-2 test, Troponin
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), COVID-19 (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BNP, BMP, D-Dimer, CBC with diff, magnesium, Protime/INR, PTT, Sars-COV-2, influenza, and/or RSV panel, troponin (repeated), CTA chest, EKG, xray chest portable
CDC Split Type:

Write-up: Pulmonary embolus, shortness of breath, chest pain, D-Dimer


VAERS ID: 1683148 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKA
Diagnostic Lab Data: EKG 8/25
CDC Split Type:

Write-up: PATIENT REPORTED TACHYCARDIA AND CHEST PAIN STARTING AROUND 10 PM THAT NIGHT (~6 HOURS POST DOSE). CALLED 8/25 AM AND I DIRECTED HIM TO ER, WAS CLEARED WITH A CLEAN EKG. HAS FOLLOW UP APPOINTMENT THIS MONTH TO DETERMINE IF HE SHOULD GET DOSE 2.


VAERS ID: 1683268 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 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? Yes
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: Anemia, overweight, arthralgia of bilateral temporomandibular joint, striae, acanthosis nigricans.
Allergies: Amoxicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccination error identified on 08/24/21 afternoon that an expired vaccine was given to the patient in the morning. Provider received advices from manufacturer that repeating 2nd dose is required. Patient received another dose on 08/28/2021.


VAERS ID: 1683285 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratadine 10 mg
Current Illness: N/A
Preexisting Conditions: Eczema, adjustment disorder, behavioral problems, hyperlipidemia, obesity.
Allergies: N/A
Diagnostic Lab Data: Vaccination error identified on 08/24/21 afternoon that an expired vaccine was given to the patient in the morning. Provider received advices from manufacturer that repeating 2nd dose is required. Patient received another dose on 08/28/2021.
CDC Split Type:

Write-up: None stated.


VAERS ID: 1683286 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (narrow)

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

Write-up: Metallic taste coating my mouth. I went to urgent care and they said it would last a few days and it?s going on 2 weeks and it hasn?t changed. It sometimes either taste like metal or a battery


VAERS ID: 1683299 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Fatigue, Pain, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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: Flu-1973 ,2004, 2007-flu like symptoms
Other Medications: I was taking Mycardis, Xanex, Estrodol, Hydrocodone, Vit c and Vit D
Current Illness: Allergies
Preexisting Conditions: COPD
Allergies: I am allergic to Ibuprophin
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: 08/24/2021 I was very tired, low fever, chills, aches all over, lower back hurt, my nose runny all the time, lasted for about 6 days.


VAERS ID: 1683302 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-04
Onset:2021-08-24
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anaemia, Bladder catheterisation, Bladder irrigation, COVID-19, Haematuria, Malaise, SARS-CoV-2 test positive
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus Test: 8/23/2021 - positive
CDC Split Type:

Write-up: Pt admitted on 8/24/2021: He recommended he come to the ER for admission and for bladder irrigation. The patient has a history of neurogenic bladder and does self catheterization. He is fully vaccinated for COVID, but did get diagnosed with COVID, I believe on August 13. It sounds like he has had symptoms for about 2 weeks and about completely resolved. It appears that he has finished up his 10 days of dexamethasone. Pt discharged on 8/26/2021: Patient was admitted to the hospital medicine service and Neurology consulted for his gross hematuria. Foley catheter placed and was started on continues bladder irrigation. His hematuria improved and resolved and therefore his CBI was turned off. Neurology recommends continue antibiotics for 5 more days at discharge and aortic has a prescription for cefdinir and I recommended continuing this for 5 more days. He will follow up in Neurology Clinic soon for further management of his hematuria. He did have some anemia which is expected from his hematuria and he has follow-up with PCP early next week have a CBC checked. Overall the patient did well during hospital stay and will be discharged home in stable condition.


VAERS ID: 1683580 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: rash on my legs, no itching; head is feeling numb, no pain, but something I can not describe but with numbness and it is going down lower on my head; This spontaneous case was reported by a consumer and describes the occurrence of RASH (rash on my legs, no itching) and HYPOAESTHESIA (head is feeling numb, no pain, but something I can not describe but with numbness and it is going down lower on my head) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 23-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Aug-2021, the patient experienced RASH (rash on my legs, no itching) and HYPOAESTHESIA (head is feeling numb, no pain, but something I can not describe but with numbness and it is going down lower on my head). At the time of the report, RASH (rash on my legs, no itching) and HYPOAESTHESIA (head is feeling numb, no pain, but something I can not describe but with numbness and it is going down lower on my head) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications was reported. No treatment drug details was reported.


VAERS ID: 1683586 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 - / OT

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

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

Write-up: Punctured vial greater than 12 hours in refrigerator; punctured vial greater than 12 hours in refrigerator; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (punctured vial greater than 12 hours in refrigerator) and PRODUCT STORAGE ERROR (Punctured vial greater than 12 hours in refrigerator) in a 48-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 016C21A) for COVID-19 vaccination. No Medical History information was reported. On 24-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 24-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (punctured vial greater than 12 hours in refrigerator). On an unknown date, the patient experienced PRODUCT STORAGE ERROR (Punctured vial greater than 12 hours in refrigerator). On 24-Aug-2021, EXPIRED PRODUCT ADMINISTERED (punctured vial greater than 12 hours in refrigerator) had resolved. At the time of the report, PRODUCT STORAGE ERROR (Punctured vial greater than 12 hours in refrigerator) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product was not provided by the reporter Treatment information was not provided. Cross-Linked with Case Numbers: MOD21-134712, MOD21-134781, MOD21-134783, MOD21-134784, MOD21-134785, MOD21-134787.


VAERS ID: 1683617 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anosmia, Body temperature, Dizziness, Ear pain, Illness, Limb discomfort, Mobility decreased, Nasal congestion, Nausea, Oropharyngeal pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: 101.5
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: From the bottom of her elbow all the way to her shoulder blade she could not move; ears are hurting; legs were like jelly; fever 101.5; arm is hurting from her shoulder to her elbow; nauseated; getting sick; sore throat; plugged up nose; can''t smell anything; light-headed; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (getting sick), OROPHARYNGEAL PAIN (sore throat), NASAL CONGESTION (plugged up nose), ANOSMIA (can''t smell anything) and DIZZINESS (light-headed) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetes. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Aug-2021, the patient experienced ILLNESS (getting sick), OROPHARYNGEAL PAIN (sore throat), NASAL CONGESTION (plugged up nose), ANOSMIA (can''t smell anything), DIZZINESS (light-headed), PAIN IN EXTREMITY (arm is hurting from her shoulder to her elbow) and NAUSEA (nauseated). On an unknown date, the patient experienced MOBILITY DECREASED (From the bottom of her elbow all the way to her shoulder blade she could not move), EAR PAIN (ears are hurting), LIMB DISCOMFORT (legs were like jelly) and PYREXIA (fever 101.5). At the time of the report, ILLNESS (getting sick), OROPHARYNGEAL PAIN (sore throat), NASAL CONGESTION (plugged up nose), ANOSMIA (can''t smell anything), DIZZINESS (light-headed), MOBILITY DECREASED (From the bottom of her elbow all the way to her shoulder blade she could not move), EAR PAIN (ears are hurting), LIMB DISCOMFORT (legs were like jelly), PAIN IN EXTREMITY (arm is hurting from her shoulder to her elbow), NAUSEA (nauseated) and PYREXIA (fever 101.5) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 101.5 (High) 101.5. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Symptoms: It was reported that the patient could not take any food and water down, she took a sleeping pill and she fell down and broke her left side toe. Treatment medication was taken but not specified. No concomitant medications were reported


VAERS ID: 1683638 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-13
Onset:2021-08-24
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049EL1A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Vaccination site erythema, Vaccination site pain, Vaccination site pruritus
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: MAGNESIUM; MULTIVITAMIN [VITAMINS NOS]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Ankylosing spondylitis; Rheumatoid arthritis
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: headache; gotten red; painful, tender; site of injection started itching; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (site of injection started itching), VACCINATION SITE ERYTHEMA (gotten red), VACCINATION SITE PAIN (painful, tender) and HEADACHE (headache) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 049EL1A) for COVID-19 vaccination. The patient''s past medical history included Rheumatoid arthritis in 1990 and Ankylosing spondylitis in 1990. Concomitant products included MAGNESIUM and MULTIVITAMIN [VITAMINS NOS] for an unknown indication. On 13-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Aug-2021, the patient experienced VACCINATION SITE PRURITUS (site of injection started itching). On 27-Aug-2021, the patient experienced VACCINATION SITE ERYTHEMA (gotten red) and VACCINATION SITE PAIN (painful, tender). On an unknown date, the patient experienced HEADACHE (headache). At the time of the report, VACCINATION SITE PRURITUS (site of injection started itching), VACCINATION SITE ERYTHEMA (gotten red), VACCINATION SITE PAIN (painful, tender) and HEADACHE (headache) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant medication was provided. No Treatment medication was provided. Most recent FOLLOW-UP information incorporated above includes: On 31-Aug-2021: Non Significant Follow up appended. Concomitant medications were updated. Medical history was updated.


VAERS ID: 1683663 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Allergy to vaccine, Chest pain, Chills, Cough, Diarrhoea, Erythema, Headache, Illness, Myalgia, Pain, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 Virus test; Test Result: Negative ; Result Unstructured Data: COVID-19 Virus test was negative
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: When she coughs, it has her chest sore; Aches/body ache; Diarrhea; Running nose; Arm is really red; Had an allergic reaction; coughs; Arm is really sore; Real bad headache; chills; Got really sick; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (Got really sick), CHEST PAIN (When she coughs, it has her chest sore), PAIN (Aches/body ache), DIARRHOEA (Diarrhea) and RHINORRHOEA (Running nose) in a 46-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 052E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 24-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 24-Aug-2021, the patient experienced ILLNESS (Got really sick). On an unknown date, the patient experienced CHEST PAIN (When she coughs, it has her chest sore), PAIN (Aches/body ache), DIARRHOEA (Diarrhea), RHINORRHOEA (Running nose), ERYTHEMA (Arm is really red), ALLERGY TO VACCINE (Had an allergic reaction), COUGH (coughs), MYALGIA (Arm is really sore), HEADACHE (Real bad headache) and CHILLS (chills). The patient was treated with ACETYLSALICYLIC ACID, CAFFEINE, PARACETAMOL (EXCEDRIN EXTRA STRENGTH) at a dose of 1 dosage form; FLUTICASONE PROPIONATE (FLONASE ALLERGY RELIEF) for Allergy, at a dose of 1 dosage form; HYDROCORTISONE at an unspecified dose and frequency and CODEINE PHOSPHATE, GUAIFENESIN (GUAIATUSSIN AC) at a dose of 1 dosage form. At the time of the report, ILLNESS (Got really sick), CHEST PAIN (When she coughs, it has her chest sore), PAIN (Aches/body ache), DIARRHOEA (Diarrhea), RHINORRHOEA (Running nose), ERYTHEMA (Arm is really red), ALLERGY TO VACCINE (Had an allergic reaction), COUGH (coughs), MYALGIA (Arm is really sore), HEADACHE (Real bad headache) and CHILLS (chills) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: negative (Negative) COVID-19 Virus test was negative. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. She went to the ER on 28AUG2021 around 8pm and was discharged at 2:30am. No Concomitant medications was provided. she uses inhalers for her Bronchitis.


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