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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 42 out of 8,753

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VAERS ID: 1837712 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Feeling cold, Hypersensitivity, Injection site pruritus, Pyrexia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: CEPHALOSPORINS, CODEINE, DEMEROL, MORPHINE, MACROLIDES, KETOLIDES,PENICILLIN
Diagnostic Lab Data: Patient went to urgent care and they told her has allergy to covid vaccine and to never take another one. She was given EpiPen, Benadryl, inhaler, steroid.
CDC Split Type:

Write-up: Patient stated that she had fever, chills, extreme itching at site of injection, itchy throat and short of breath.


VAERS ID: 1837883 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Confusional state, Dyskinesia, Fall, Fear of injection, Head injury, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: mom states patient has had seizures in the past, 1 seizure every 2-5 years. is not medicated for seizures
Preexisting Conditions: none known
Allergies: None known
Diagnostic Lab Data: No tests or labs were done. Pulse ox was 95% and pulse was 86 BPM.
CDC Split Type:

Write-up: The patient received the vaccine, stood up, said he felt fine, walked out of the clinic room about 20-50 feet and he fell to the floor. He hit his head, was pale, had body irregular movements and confused when he came to. If there was loss of consciousness it was less than a minute. Staff tended to him immediately, there was no apparent physical injury, he was breathing and had a pulse. called 911. took vitals and talked to patient while EMS arrived. While waiting for EMS to arrive patient was completely alert and oriented. He laid on the ground with his head and neck protected until EMS arrived. EMS evaluated him, cleared him to go home and patient agreed and declined to go to the hospital. Mom said he has passed out after a vaccine before from fear of needles.


VAERS ID: 1837894 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30125BA / 3 LA / IM

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

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

Write-up: A pfizer booster shot (3rd shot) was administered to the pt even though patient is under 18 years old. The booster shot has not been approved for under 18 years old yet.


VAERS ID: 1838056 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Skin laceration
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Pt sitting down after a shot. got light headed, woozy, and likely passed out. Patient wore glasses, and hit his face. Glasses caused a minor cut on his face. Pharmacist went to patient, stayed with G.I. until stable. Prior to shot... Pt expressed anxiety before requesting a shot. Was asked to sit for a period after the shot. Patient did not sit down, but wanted "fresh air" and went outside.


VAERS ID: 1838057 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-18
Onset:2021-11-02
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Dysmenorrhoea, Frequent bowel movements, Menstruation irregular
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ortho-Novum Birth Control ( taken for over 20 years without problems), generic Allegra, Magnesium, Vitamin C, Calcium with Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Augmentin, iceberg lettuce, fermented rice
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Irregular menstrual cycle - more painful cramping, more bloating, more frequent bowel movements


VAERS ID: 1838059 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-21
Onset:2021-11-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: TETANUS SHOT, AGE 30
Other Medications: TIAZAC 360MG, 1 DAILY, PEPCID 20MG, 2X DAILY, HYDRODIURL 25MG, 1 DAILY, NORCO 5-325MG, 1 EVERY 8 HRS AS NEEDED, INDERAL 60MG, 1 DAILY, XARELTO 20MG 1 DAILY. SELENIUM 100mcg, 1 DAILY, B-COMPLEX 1 DAILY, VITAMIN E 67MG, 1 DAILY, VITAMIN C 10
Current Illness:
Preexisting Conditions: HYPERTENSION, UNDER CONTROL WITH MEDICATION
Allergies: TETANUS, IPUPROFEN, ASPIRIN,
Diagnostic Lab Data: NONE YET
CDC Split Type:

Write-up: LARGE RASH ADJACENT TO INJECTION SITE.


VAERS ID: 1838060 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

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

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

Write-up: PATIENT REQUESTED PFIZER I ADMINISTERD MODERNA AS THE THIRD DOSE IN ERROR


VAERS ID: 1838064 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Nausea at 8pm, extreme chills at 830pm, fever of 101.4 at 1030pm taken Tylenol pill.


VAERS ID: 1838066 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: MIXED SERIES. PATIENT HAD PREVIOUSLY RECEIVED MODERNA VACCINE FOR FIRST DOSE.


VAERS ID: 1839217 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

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


VAERS ID: 1839228 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Wrong technique in product usage process
SMQs:, Medication errors (narrow)

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

Write-up: vaccine given from vial that was punctured 21 times


VAERS ID: 1839237 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Echinacea, Zyrtec, fish oil, elderberry
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on inner right forearm


VAERS ID: 1839240 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-29
Onset:2021-11-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 LA / 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: On 10/29/21, Pt received Booster dose of Moderna 0.25ml. Then Pt went to see Dr on 11/02/21. Dr told pt to get additional full dose of 0.5ml Since she is on Humira. Pt came to the Pharmacy and got another dose of 0.25ml as per her Dr''s request on 11/02/21.


VAERS ID: 1839249 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

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

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

Write-up: Patient had previously received the Pfizer COVID vaccine for doses #1 and #2. The patient requested to receive the Pfizer COVID vaccine for her booster dose today as well (dose #3). The pharmacist administered a booster dose (0.25 ML) of Moderna to the patient, thinking the patient wanted Moderna (not Pfizer) for her booster dose. No adverse events or symptoms developed during the observation period and unaware of any that have developed since. The patient''s primary care doctor was contacted and informed of the situation.


VAERS ID: 1839250 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-10-27
Onset:2021-11-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Bronchoscopy, Chest X-ray, Mechanical ventilation, Pneumonia, Respiratory failure, Swallow study abnormal
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad)

Life Threatening? Yes
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: Acute hospitalization for West Nile encephalitis with respiratory failure
Preexisting Conditions: ITP Immunosuppression Recent diffuse NM weakness due to West Nile encephalitis
Allergies: PCN, metals
Diagnostic Lab Data: CXR Bronchoscopy She did have a swallow study that she failed on 11-1-21
CDC Split Type:

Write-up: Six days after receiving vaccine, she developed worsening hypoxemic respiratory failure and pneumonia requiring non-invasive vent support and bronchoscopy for pulmonary toilet.


VAERS ID: 1839251 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, 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: Metformin tab 500mg; Glipizide tab 5mg; Lisinopril tab 20mg; Simvastatin tab 10mg
Current Illness: N/A
Preexisting Conditions: Type II diabetes; hypertension
Allergies: Ragweed
Diagnostic Lab Data: None required. I feel the symptoms are temporary.
CDC Split Type:

Write-up: On Monday, November 1, 2021, at 2:34 pm, I was given Moderna booster. Next morning around 9:30 am, I noticed my head was hurting. I never have headaches. The headache was strong enough that it required something for relief. I took 2 Tylenol tablets, which provided some relief. The headache did not go away completely; but subsided enough to provide some temporary relief. There was soreness at the injection site, and I had fatigue.


VAERS ID: 1839541 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Neck pain, Pain in extremity
SMQs:, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Second dose. Aching left arm. Aching neck in left side. Sore and swollen lymph nodes left side of face. Shot was in right arm.


VAERS ID: 1839614 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Hypotension, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Hypotension-Mild, Systemic: Vomiting-Medium, Additional Details: Patient received vaccination within 10 minutes, she felt lightheaded and fell to the ground. She did not fiant, but did vomit.


VAERS ID: 1839615 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood test abnormal, Computerised tomogram abnormal, Dyspnoea, Electrocardiogram abnormal, Fibrin D dimer increased, Hyperhidrosis, Hypoxia, Lymphadenopathy, Pyrexia, Sinus tachycardia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: Flagyl
Diagnostic Lab Data: EKG, CT scan, bloodwork. EKG showed sinus tachycardia, CT was normal except swollen lymph nodes on chest wall. bloodwork showed elevated D-Dimer
CDC Split Type:

Write-up: tachycardia up to 190 bpm, shortness of breath, hypoxia, fever, sweat, weakness.


VAERS ID: 1839617 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Hypotension, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Hypotension-Mild, Systemic: Vomiting-Medium, Additional Details: Patient received vaccination. Within 10 minutes, she felt lightheaded and fell to the ground. She did not faint, but vomited.


VAERS ID: 1839620 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Muscle rigidity, Mydriasis, Seizure, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting/Unresponsive-Medium, Systemic: Seizure-Medium, Systemic: Vomiting-Mild, Additional Details: Approximately 5 minutes after 0.5mL Moderna was given, patient''s pupils fully dilated and arm muscles rigid. She came to but did not know where she was. EMS called; patient declined to be taken to hospital.


VAERS ID: 1839625 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-10-22
Onset:2021-11-02
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 LA / IM

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

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

Write-up: Systemic: mom only said pt got sick and nothing in detail.-Mild, Additional Details: mom was nondescriptive about pt.''s status /condition


VAERS ID: 1839626 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pruritus, Injection site urticaria, Pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 50mg daily, Claritin 10mg daily.
Current Illness: N/A
Preexisting Conditions: Obesity, High Blood Pressure, Depression & Anxiety
Allergies: Sulfa medications. None other known.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Half dollar sized hive with itching at site of Covid 19 booster injection. Fatigue and mild body aches.


VAERS ID: 1839643 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Additional Details: PATIENT FELT DIZZY, PHARMACIST KEPT PATIENT UNDER OBSERVATION INSIDE THE IMMUNIZATION ROOM. SHE RECOVERED QUICKLY, DRANK SOME WATER AND STAYED IN THE AREA FOR ABOUT 30 MINUTES WITH A FAMILY MEMBER.


VAERS ID: 1839652 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect 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: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1839655 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Lethargy
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness/Lightheadness-Medium, Systemic: Exhaustion/Lethargy-Medium, Systemic: Weakness-Medium, Additional Details: Per dad he thinks it just nerves. Patient looks better and feels better.


VAERS ID: 1839863 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever headache body aches 66 yrs old 2/10/2020 & 3/11/2020 Moderna
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fever, fatigue, body aches


VAERS ID: 1839869 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-12
Onset:2021-11-02
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: CAD, hyperlipidemia, GERD, HTN
Allergies: milk/dairy
Diagnostic Lab Data: COVID +
CDC Split Type:

Write-up: Patient admitted to hospital with positive breakthrough case. Complaining of SOB x 1 week. Diagnosed with COVID on 10/23/21. Resp rate 26 and pulse ox 87 on RA.


VAERS ID: 1839880 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient passed out 10 mins after receiving vaccine. Pharmacist stated that 911 was called, also said patient was sweating profusely.


VAERS ID: 1839893 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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:
Other Medications: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had a seizure, then passed out about 20 minutes after having the shot with no prior history of seizures


VAERS ID: 1839901 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-11-02
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / -

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

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

Write-up: Fully vaccinated, vaccine breakthrough with inpatient hospital stay, medical unit


VAERS ID: 1839905 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-29
Onset:2021-11-02
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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? 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: covid positive test on 11/2/21
CDC Split Type:

Write-up: covid vaccine breakthrough case


VAERS ID: 1839907 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-05
Onset:2021-11-02
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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? 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: covid positive test on 11/2/21
CDC Split Type:

Write-up: covid vaccine breakthrough event


VAERS ID: 1839912 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-11-02
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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? 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: covid positive test on 11/2/21
CDC Split Type:

Write-up: covid vaccine breakthrough case


VAERS ID: 1839916 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 3 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glipizide ER, Doxycycline Hyclate, Metronidazole, Jentadueto, Lisinopril, Atorvastatin
Current Illness:
Preexisting Conditions: Type 2 Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse event noted. Covid booster dose was given too early, 3 months & 11 days after 2nd dose was given.


VAERS ID: 1839917 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal faeces, Asthenia, Chills, Condition aggravated, Discomfort, Hyperhidrosis, Hypoaesthesia, Hypotension, Nausea, Pain, Pallor, Paraesthesia, Presyncope, Raynaud's phenomenon, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow), 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: Viibryd 20mg q am, Nasonex nasal spray q am, Pm meds are prn : xanax 0.25-0.5 mg q hs prn, Ambien 5-10mg q ha prn. (I took 0.25 Xanax at around 10:00pm on injection day, so 4 hours before vasovagal episode that occurred at 2:22 am
Current Illness: No. Have been stable.
Preexisting Conditions: H/o developing autoimmune symptoms after getting breast implants. Raynaud?s was main. Explanted 2018 and have been stable w/o developing autoimmune symptoms until I got this vaccine and hands went numb & tingled, turned white and I had vasovagal episode of near-syncope.
Allergies: Celexa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Inj was admin with proper technique. I Felt well until 13? after inoculation. I developed chills and rigors and slight body aches which I expected some. Hands went numb and tingled and turned white(Raynaud?s). Then sudden onset of severe nausea came on followed by pallor, abdominal Pressure, hypotension-vasovagal, near-syncope then stooling and diaphoresis and profound weakness. Lasted maybe 10? Minutes then BP went up to 99/64 and O2 sats were good at mid-90?s.


VAERS ID: 1839918 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Loss of consciousness, Myalgia, Nausea, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Lipitor, Calcium, MVI, levothyroxine, Metoprolol,
Current Illness: None
Preexisting Conditions: Osteoporosis, post CABG,
Allergies: NKA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Severe generalized muscle pain, headaches, chills, fever, nausea, dizzy with passing out for short time.


VAERS ID: 1839926 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-14
Onset:2021-11-02
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Cough, Diarrhoea, Nausea, Sneezing, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow)

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

Write-up: This case meets criteria for vaccine breakthrough review. SxS include 1month PTA of coughing and sneezing, weakness, abdominal pain, N/V, intermittent diarrhea.


VAERS ID: 1839930 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Hyperaesthesia, Hypoaesthesia, Myalgia, Pain in extremity, Paraesthesia, Renal pain, Testicular pain, Testis discomfort
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: Patient age: 46, Covid-19 Moderna, Lot Number: 002F21A, Dose 1, 10/5/2021, fever, chills, nausea, muscle pain
Other Medications:
Current Illness: None
Preexisting Conditions: TBI - combat related
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: kidney pain, painful numbness in hands, severe sensitivity to touch, hair tingling, muscle pain, testicles feel swollen (they are not) and painful,


VAERS ID: 1839942 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-18
Onset:2021-11-02
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Acute hypoxemic respiratory failure due to COVID-19; SEPSIS due to COVID-19 Pneumonia


VAERS ID: 1839944 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Immunodeficiency, Influenza like illness
SMQs:

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: Valsartan-HCTZ 160-25 mg, Atorvastatin 40 mg, Nadolol 20 mg, Biotin 5000 mg, Multi-vitamin women 50+, Aspirin 81mg
Current Illness: Tennis elbow, Methylprednisolone 4 mg for a 6 day regimen (completed prior to vaccination).
Preexisting Conditions: HBP and high cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu like symptoms for about 3 hours starting at 26 hours post vaccine. I took Ibuprofen at about 3 hours from onset of symptoms and symptoms were gone within 30 minutes.


VAERS ID: 1839948 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-11
Onset:2021-11-02
   Days after vaccination:295
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: high blood pressure, mild asthma, gluten intolerance, atrial fibrillation
Allergies: Penicillins, Sulfa Drugs, Compzine, Egg white, tylenol with codeine
Diagnostic Lab Data: Positive SARS-CoV2 Vrisus PCR multiplex nasopharyngeal test
CDC Split Type:

Write-up: Shortness of breath, cough, nausea, loss of taste and smell.


VAERS ID: 1839951 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 RA / IM

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

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

Write-up: First Covid vaccine given. Patient came in with family. Brother acted as interpreter, but needed to leave the room before the 3 women would remove clothing to expose injection site.. Patient had adult paperwork, and it was not noted that she was not 18 until later.


VAERS ID: 1839967 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Erythema, Injection site rash, Injection site reaction, Lymphadenopathy, Rash papular, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: my first two covid vaccines were full body hives
Other Medications: Levothyroxine, Oxybutin
Current Illness: none
Preexisting Conditions: interstitial cystitis, polycystic ovarian, currently in work up for ulcerative colitis
Allergies: Sulfa based antibiotics, iodine contrast, eggs, dairy, shell fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on upper left arm, raised surface with increased redness and warmth measuring 2 inchx2 inch, bean 12 hours after, continuing to increase in size and worsen, swollen lymph nodes under L arm.


VAERS ID: 1839975 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 1 LA / IM

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

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

Write-up: Tingling and pins/ needles everywhere. Mostly in feet and hands. Also in legs.


VAERS ID: 1839988 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole 20mg, Vitamin D, Wellbutrin
Current Illness:
Preexisting Conditions: Asthma
Allergies: Bactrium (antibiotic), nickel
Diagnostic Lab Data: Heart monitor - 4/16/2021
CDC Split Type:

Write-up: I have experienced heart palpitations after my second shot that I received (4/7/2021, symptoms began 4/9/2021) and the same with my booster received on (11/1/2021).


VAERS ID: 1839992 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / SYR

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

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

Write-up: Lymph node pain and swelling near left clavicle.


VAERS ID: 1839998 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-15
Onset:2021-11-02
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Decreased appetite, Diarrhoea, Dyspnoea, SARS-CoV-2 test positive, Taste disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), 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: unknown
Current Illness: unknown
Preexisting Conditions: Hydrocele, CVA, right bundle branch block, cerebral vascular diseaser, enlarged prostate, coronary artery disease, stented coronary artery, asthma, GERD, arthritis, essential hypertension, carotid stenosis, dysnea
Allergies: Contrast Dye
Diagnostic Lab Data: SARS-CoV2 PCR test positive
CDC Split Type:

Write-up: Shortness of breath, diarrhea, decreased appetite and abd pain, "food doesnt taste good"


VAERS ID: 1840007 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Loss of consciousness, Pallor, Palpitations
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: None
Current Illness: None
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: Moderna shot #1.
CDC Split Type:

Write-up: 10 minutes after receiving the shot, my heart started racing and I lost consciousness. Once the paramedic saw me wake up, my heart was still racing. I was pale, and the fast heart beating continued. My heart still feels a slight pressure the day after.


VAERS ID: 1840008 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-11-02
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility 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: Escitalopram 20mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am currently experiencing the heaviest period of my life! I have never seen this much menstruation. It started yesterday. Normally I have light periods so this was quite a surprise. I got a news notification this morning that people have been reporting period irregularities possibly connected to the COVID vaccine, so I thought I would report my experience too.


VAERS ID: 1840019 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-17
Onset:2021-11-02
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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? 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: Covid + 11/02/2021
CDC Split Type:

Write-up: BREAKTHROUGH CASE


VAERS ID: 1840026 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM

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

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

Write-up: A booster dose of the Pfizer vaccine was accidentally administered to Teodorico.


VAERS ID: 1840031 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-30
Onset:2021-11-02
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: intracranial atherosclerotic disease with diffuse severe intracranial stenosis, bilateral MCA/PCA/ACA, and chronic bilateral subcortical lacunar infarcts
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: WEAKNESS


VAERS ID: 1840036 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: booster was given 2 weeks and 5 days early


VAERS ID: 1840037 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 1 LA / IM

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

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

Write-up: pt was given moderna brand instead of pfizer


VAERS ID: 1840039 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (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: Ist Pfizer covid vaccine. tingling of middle bottom lip 45 min after first injection into left arm. Lasted 5 min. Pfizer 3/30/2
Other Medications: ativan
Current Illness: no other illnesses
Preexisting Conditions: colitis
Allergies: zero
Diagnostic Lab Data:
CDC Split Type:

Write-up: evening of day two (Nov 2nd) noticed soreness under left arm with armpit swelling .


VAERS ID: 1840042 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: booster was given 2 weeks and 5 days early


VAERS ID: 1840048 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F88841 / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Feeling cold, Headache, Lethargy, Mobility decreased, Somnolence, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CoQ10 Vitaman D Crestor 40mg Amlodipine 5mg Esomeprazoel 40mg Ezetimibe 10mg
Current Illness:
Preexisting Conditions:
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Exactly 12 hours later.....sever headache...freezing to the point of shaking...upset stomach...all over lethargy... Stayed in bed for 36 hours, mostly sleeping. Better after 36 hours, still have a low grade headache and absolutely no energy


VAERS ID: 1840065 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 - / IM

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

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

Write-up: patient and family misrepresented age of individual 2 times in vaccination process


VAERS ID: 1840074 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-11-02
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, Nucleic acid test, 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: pancreatic cancer, COPD, diabetes, hypertension
Allergies:
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) by NAA, Micro 11/2/21 Detected
CDC Split Type:

Write-up: patient tested positive in a routine test for placement at a sub acute rehab facility. Patient is asymptomatic 11/2/21. Lot number was not recorded for the second dose in her medical record.


VAERS ID: 1840077 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Hypertension, Tachycardia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: Influenza - anaphylaxis
Other Medications: Albuterol, prednisone, montelukast, hydroxyzine, levothyroxine, pantoprazole, famotidine, ketotifen oph soln, meclizine,
Current Illness: GERD, chronic vertigo, eczema, fibromyalgia, asthma
Preexisting Conditions:
Allergies: Anaphylaxis to Pfizer 1st dose, sumatriptan, influenza, Percocet, latex, saccharin, aspartame,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came in for 2nd Pfizer vaccine. Pt had previously had anaphylactic reaction to 1st Pfizer vaccine. During first dose visit, pt was administered epinephrine, solu-medrol and diphenhydramine by staff and MD. Pt was then transported to ER. Upon return for 2nd visit 21 days later, the pt stated to LPN that she had experienced an anaphylactic reaction to the 1st dose, which is a direct contraindication to receive the second dose. Pt also stated to LPN that ER doctor during her first visit, had said to receive the 2nd dose regardless of reaction. Per protocol, any anaphylaxis history needs to be reported to charge RN for closer observation. LPN administered 2nd dose of vaccine without informing charge RN. Approximately 5 minutes after administration, pt began to have severe shortness of breath and chest tightness. RN, and Charge RN, proceeded to recognize pt distress and began to take vital signs. Pt exhibited hypertension of 139/110, tachycardia of < 135 beats per minute, and expiratory wheezes bilaterally in all lung field posteriorly. Pt was transferred to wheel chair and moved to secluded area for further medical treatment. Occupational MD was called and arrived approximately 5 minutes later. Pt did take one puff of her prescribed albuterol inhaler in those minutes. Occupational Health MD arrived and 0.3ml of Epinephrine was administered. Repeat vital signs were taken 5 minutes later and vital signs showed improvement. Pt stated she experienced a decrease in shortness of breath and expiratory wheezes decreased upon auscultation. Pt was taken to ER for further evaluation and observation and instructed by health MD not to receive the 3rd dose due to severe anaphylaxis. LPN was pulled aside after incident and re-educated on POD protocol and CDC guidelines with anaphylaxis reactions to COVID shots. Follow up email was sent to rest of POD nurses with POD guidelines and protocols.


VAERS ID: 1840085 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Injection site pain, Myalgia, 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), Hypoglycaemia (broad)

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

Write-up: Muscle aches and tendernes of the injection site all day chills from 5:45am-1:30pm fever of 99.8 to 103.7 from 7:26am-1:53pm heavy perspiration from 2:00pm-3:17pm (this all took place the day after the injection and only lasted that day.)


VAERS ID: 1840103 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

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

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

Write-up: Vaccine was administered after the expiration time limit


VAERS ID: 1840105 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-29
Onset:2021-11-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood magnesium, Blood thyroid stimulating hormone, Full blood count, Heart rate increased, Metabolic function test, Tachycardia, Troponin I
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion, Atorvastatin, Amlodipine, Multi-Vitamin, Fish Oil, Calcium, Magnesium
Current Illness: N/A
Preexisting Conditions: Obesity, High cholesterol, High blood pressure
Allergies: Penicillin
Diagnostic Lab Data: Basic metabolic panel, CBC, Magnesium, TSH, Troponin I- Time Zero #1
CDC Split Type:

Write-up: Tachycardia, sustained high heart rate between 140-200 for one hour


VAERS ID: 1840107 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, 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: metoprolol lisinopril atorvastatin multi-vitamin fish oil aspirin
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: tenderness, swelling near injection site


VAERS ID: 1840109 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Extra dose administered, Headache, Myalgia, Nausea, Skin burning sensation
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd shot Moderna
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nausea, chills, burning skin, pain in muscles and joints, headache. Similar to second dose but worse. Took tom Advil and finally got to sleep.


VAERS ID: 1840120 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

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

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

Write-up: An expired dose was given to a patient


VAERS ID: 1840128 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

Administered by: Pharmacy       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? 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: He experienced lightheadedness within the first 5 minutes up until 20 minutes after. We urged him to stay for another 15 minutes after the symptom subsided. Recommended him for any other emergencies to call 911 or seek immediate medical attention for other symptoms such as fainting, chest pain, difficulty breathing, etc.


VAERS ID: 1840159 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Headache, Nausea, Pain, Paraesthesia, Pruritus, Respiratory tract congestion, Tremor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna COVID-19 Vaccine on 9/22/2021
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Approximately 10 minutes after receiving the Moderna COVID-19 vaccine dose #2, Patient began experiencing left arm itching/shaking/tingling followed by nausea and vomiting. Later in the day, Patient experienced a headache and back pain. The next day, Patient experienced headache, congestion, and body aches.


VAERS ID: 1840201 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anger, Arthralgia, Chills, Condition aggravated, Dizziness, Eye irritation, Fatigue, Feeling abnormal, Feeling of body temperature change, Gait disturbance, Headache, Impaired work ability, Mobility decreased, Pain, Pyrexia, Retching, Sleep disorder, Somnolence, Thinking abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Corneal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine in 2012 and 2011.
Other Medications: Aspirin 81mg, Vitamin E 400IU, multivitamin and multimineral
Current Illness: None
Preexisting Conditions: Stent to internal carotid artery that started in October of 2008. History of broken legs with extensive implants to left leg removed in 2013. Two other screws removed from the right ankle in 2015.
Allergies: Flu shot, Latex, Morphine
Diagnostic Lab Data: The doctor refused to order any.
CDC Split Type:

Write-up: Dizziness primarily after getting home. I got out of my car and stumbled. But I made it into the house after that. I went into the bathroom and stumbled trying to sit on the toilet. I just don''t get like this. After a while I was able to eat some supper. Early in the evening, I got very tired. I woke up at around 2:00 in the morning with no real explanation why; but after I woke, I just started shivering really, really badly. I have only ever done that when I was actually sick with the flu. By 07:30 this morning, I was running 102.2 fever. I was still shivering every time I took the blanket off. But I could tell it felt like a sauna under the blanket. My head was and is pounding. Every joint in my body feels achy and awful. I threw up. I kept dry heaving every time I tried to get up. I cannot raise my left arm. It is excruciating and painful. My eyes feel hot. And then I get shivery. And I''m sleepy! I called my doctor and notified him of every one of my symptoms. He said that the inability to function or think or go to work or do anything with this vaccine was normal.


VAERS ID: 1840203 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-13
Onset:2021-11-02
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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? 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: Covid + on 11/03/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1840213 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injection site pain, Joint range of motion decreased
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol 50 mg, Amlodipine 10 mg
Current Illness: none
Preexisting Conditions: none
Allergies: Sulfa, Antihistamines
Diagnostic Lab Data:
CDC Split Type:

Write-up: The injection site was ok at first but on Nov. 2nd I woke up in the middle of the night with my whole arm extremely painful. Can barely lift my left arm, have been taking Tylenol but it does not relief the pain.


VAERS ID: 1840222 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-13
Onset:2021-11-02
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 024C21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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? 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: Covid + on 11/02/2021.
CDC Split Type:

Write-up: Breakthrough Case.


VAERS ID: 1840242 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Influenza like illness, Nausea, Neuralgia, Pain
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (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:

Write-up: Feeling like I have the flu, aching, nausea and nerve pain


VAERS ID: 1840269 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chest pain, Extra dose administered
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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: Influenza vaccine same date but 1/2 hour later; Calcium 600jg Vit D 1000IU fish oil
Current Illness: No
Preexisting Conditions: Mitral valve insufficiency Osteopenia
Allergies: No
Diagnostic Lab Data: Pulse oximeter readings during the event: 63 pulse, 97 O2
CDC Split Type:

Write-up: Strong cramp-like feeling in front, below breaststroke, both sides of chest which moved to the back and located primarily between the scapula. Deep breaths and walking did not relieve the symptoms. Symptoms worsened while lying down. Similar symptoms occurred after the second dose but not with the first dose. Ibuprofen 200 MG (2 tablets) relieved the symptoms after 1 hour. Symptoms have not returned.


VAERS ID: 1840271 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR - / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: toporol protonix wellbutrin multiple vitamin Calcium and D3
Current Illness: 0
Preexisting Conditions: 0
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: feverish achiness tiredness


VAERS ID: 1840276 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Electrocardiogram, Extra dose administered, Paralysis, Speech disorder, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No medications being taken at the time of vaccination, no herbal remedies being taken at the time of vaccination
Current Illness: No illnesses at the time of vaccination booster or one month prior
Preexisting Conditions: No chronic or long standing health conditions
Allergies: No known allergies to medications or foods
Diagnostic Lab Data: They obtained my vitals in the ER , did a EKG, and did blood work this was done on 11/02/2021
CDC Split Type:

Write-up: I experienced being paralyzed for over two hours about 20 minutes after Moderna , my blood pressure shot up to 188/77 I was rushed from the vaccine clinic to the ER I experienced trimmers that I couldn?t stop , temporarily not being able to speak at times all of this happened in such a short period after Moderna booster .. please everyone if you gonna vaccinate make sure the drs care because when I had my reaction they left me to sit in the waiting room .. I received both shots without this reaction


VAERS ID: 1840283 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Extra dose administered, Product preparation issue
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Medication errors (narrow)

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

Write-up: Pfizer covid vaccine given without diluent, therefore resulting in higher than authorized dose (0.3ml of undiluted of pfizer vaccine given) Client notified of error. Discussed potential for local and systemic adverse side effects. Spoke with client on 11/3/2021 at 12:15pm, client stated she was lightheaded overnight, and feels fine today (11/3/2021)


VAERS ID: 1840290 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 RA / IM

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

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

Write-up: Moderna COVID?19 Vaccine EUA 21 doses were inadvertently drawn up from the 20 dose Moderna vials and subsequently administered to patients. No coring/leaking detected from vial at end of process. Vaccine preparation was not batched in order to prevent contamination/growth. Vaccines all drawn up within acceptable 12 hour time frame. Vaccine stored in bags to protect from exposure to light. Vaccines prepared using aseptic technique. No adverse event reports from patient.


VAERS ID: 1840292 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-22
Onset:2021-11-02
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 - / -

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

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

Write-up: Body aches, fever, chills, fatigue started on 11/2/2021


VAERS ID: 1840301 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-06
Onset:2021-11-02
   Days after vaccination:269
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness:
Preexisting Conditions: Hypertension Chronic Kidney Disease Coronary Artery Disease Diabetes Mellitus Sick Sinus Syndrome Atrial Fibrillation History of lung cancer s/p R. lung lobectomy
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Not sure if this an adverse event but I was told by my hospital to report this to VAERS. Patient completed moderna vaccination series (Dose 1: 2/6/21, Dose 2: 3/6/21). Patient now has tested covid positive as of 11/2/21.


VAERS ID: 1840302 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / UNK - / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 9XX32 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Hypoaesthesia, Hypoaesthesia oral, Pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Within 5 minutes of COVID vaccine shot, the fingers in that arm went numb. About 2 hours later around my mouth went numb. That night Both hands went numb as well as my feet. I also had chills, aches and pains and a fever that lasted into the next day.


VAERS ID: 1840307 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

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

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

Write-up: No adverse reaction, A 0.5ml dose was given for the booster dose instead of the correct 0.25ml dose.


VAERS ID: 1840313 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Diplopia, Fatigue, Incontinence, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu Vaccine 50+yrs (flu-like symptoms)
Other Medications: Calcium, Metamucil, Glucosamine
Current Illness: N/A
Preexisting Conditions: HBP
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd Booster of Moderna 11/01/2021, started experiencing symptoms 11/02/2021 of chills, fatigue, incontinence, double vision, and nausea. No noted Primary visit/communications. Fatigue remains, other side effects have subsided.


VAERS ID: 1840315 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-27
Onset:2021-11-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chills, Headache, Pain, Pain in extremity, Urticaria, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Moderna 2nd shot = Broke out in hives across my neck, up both ears and side of face. First onset of hives happened 7 days post 2nd shot. Moderna booster shot = Again broke out in hives across neck, up both ears and side of face. Also happened 7 days post shot. The pattern and placement of hives are exactly the same both times. Have had to take prednisone and benadryl. Other symptoms for both shots included headache, bodyache, chills and soreness on arm. But those symptoms went away after 24 hours. the hives are extremely severe and uncomfortable and I had to go to urgent care on both occasions.


VAERS ID: 1840318 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 RA / IM

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

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

Write-up: No adverse reaction, A 0.5ml dose was given for the booster dose instead of the correct 0.25ml dose.


VAERS ID: 1840319 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-24
Onset:2021-11-02
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 RA / 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alvesco, amlodipine, zoloft, trazodone, cosopt, aspirin, pepcid, durezol, colace, albuterol, multivitamin
Current Illness: SBO
Preexisting Conditions: perforated diverticulitis s/p sigmoidectomy with colostomy 1/2020, HTN, asthma, recurrent UTI, hx shoulder replacement
Allergies: iodine dye, shellfish, HCTZ, opiates
Diagnostic Lab Data: COVID PCR+ 10/28
CDC Split Type:

Write-up: Admitted for COVID


VAERS ID: 1840359 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-31
Onset:2021-11-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Influenza like illness, Injection site erythema, Injection site pruritus, Injection site urticaria, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: patient got immunization on 10/31/21. had fever and mild flu like symptoms the next day. Then on Tuesday 11/2/21 her injection site was red. Last night it started itching. As of today, the red spot has gotten somewhat larger but she now also has hives around the red spot. She called her dr''s office and they told her to use some oral benadryl and ibuprofen and to let the pharmacy know so it can be reported.


VAERS ID: 1840374 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

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

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

Write-up: No adverse reaction, A 0.5ml dose was given for the booster dose instead of the correct 0.25ml dose. No treatment needed.


VAERS ID: 1840375 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185-H / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Lethargy
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Per Father''s report no additional details regarding dates/vaccines/age
Other Medications: unknown
Current Illness: no known
Preexisting Conditions: unknown
Allergies: no known allergies
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient was observed to be lethargic after being seated with parent in observation area following vaccine administration at 1634. Parent stated that ?she always gets like this following any vaccine injection. We got lunch and made sure to drink plenty before arriving thinking it wouldn?t be as bad. I forgot to bring orange juice today because usually orange juice helps her feel better after shots.? Parent appears calm while communicating about child?s condition. Patient observed trying to rest head in lap and leaning on father?s shoulder, she reported feeling dizzy. RNs offered apple juice while getting 1643 (Sitting) VS BP 90/55 HR58-60, SPO2 98%, Staff assisted patient to wheelchair and transferred to cot to lay down with feet elevated 1649 (laying) BP90/61, HR 80, SPO2 98%, after laying down for a few minutes patient reports dizziness has passed and feels like she is ready to get up. Staff assisted patient to dangle at bedside encouraged drinking additional apple juice and sipping water. Sitting VS 93/63 HR 90 SPO2 97-98%. Patient reports feeling much better at this time. Observation period was complete and patient and parent report feeling ready to leave. Patient ambulated independently from clinic accompanied by parent.


VAERS ID: 1840379 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-13
Onset:2021-11-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Painful respiration, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Intermittent palpitations on 11/2/2021 followed by chest pain/discomfort on inspiration on 11/3/2021. Increased water intake and rested.


VAERS ID: 1840384 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: No adverse reaction, A 0.5ml dose was given for the booster dose instead of the correct 0.25ml dose. No treatment needed.


VAERS ID: 1840389 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-10-22
Onset:2021-11-02
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vasculitis
SMQs:, Vasculitis (narrow), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: PATIENT HAS VASCULITIS UP AND DOWN RIGHT AND LEFT LEG. WHEN OBSERVED THE PATIENT WAS SENT TO THE EMERGENCY ROOM TO BE EVALUATED ON 11/03/21


VAERS ID: 1840399 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

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

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

Write-up: No adverse reaction, A 0.5ml dose was given for the booster dose instead of the correct 0.25ml dose. No treatment needed.


VAERS ID: 1840406 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-02
Onset:2021-11-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

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

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

Write-up: No adverse reaction, A 0.5ml dose was given for the booster dose instead of the correct 0.25ml dose. No treatment needed.


VAERS ID: 1840422 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-18
Onset:2021-11-02
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Cough, Exposure to SARS-CoV-2, Headache, Neck pain, Rhinorrhoea, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Arthritis (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: naproxen; Folic acidl Methotrexatel Prednisone; humira; Lisinopril
Current Illness: none
Preexisting Conditions: giant cell tumor, history of psoriasis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient presents with URI symptoms for Yesterday after getting his booster shot. Symptoms include headache, cough, runny nose, chills, shoulder. neck and back pain. starting on 11/2/21. Received Moderna booster on 11/2/21. Wife recently tested positive for COVID (last week)


VAERS ID: 1840426 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Vaccine positive rechallenge, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 3/11/21 second Pfizer shot. Sweat, chills, vomiting 13 hrs
Other Medications: 6month Leflunomide /3 wks hydroxy chloroquine, Stopped Leflunomide 3 weeks before vaccination. Did not take anything day of vaccination. Have been on MSM, Curcumin, Vitamin D, Vitamin C,
Current Illness: Low thyroid, Rheumatoid arthritis,
Preexisting Conditions:
Allergies: Celebrex, mussels,
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had sweats, chills, and vomiting straight for 17 hrs. .. With 2nd shot, same thing chills, sweats, and vomited 13 hrs. Was on prednisone 2.5 weeks. But not on the day of vaccination.


VAERS ID: 1840451 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Headache, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: slight fever, 55, 4/18/21, Covid-Moderna 2nd dose.
Other Medications: Prozac Topomax lipitor Allegra D Pramapexol Xanax Magnesium
Current Illness: seasonal allergies
Preexisting Conditions: high cholesterol high blood sugar
Allergies: Lamictal
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme headache, 102 degree fever lasting less than 24 hours. Lethargy and headache lasting 2 days.


VAERS ID: 1840453 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

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

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

Write-up: pain and swelling in lymph node located in left armpit


VAERS ID: 1840457 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-01
Onset:2021-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8811 / 3 LA / IM

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

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

Write-up: 7 hours after shot feeling chill , when I found a temp by 4 the Fever 102.9t, chills , headache , body ache , tiredness , nausea . Day Two still have some low grade temp , light headache and tiredness .


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