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

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



Case Details (Reverse Sorted by Onset Date)

This is page 422 out of 8,010

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VAERS ID: 1683208 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Dysphagia, Dyspnoea, Electrocardiogram, Immediate post-injection reaction, Loss of consciousness, Pallor, Seizure, Throat tightness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (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), Anaphylactic/anaphylactoid shock conditions (narrow), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Patient was administered the COVID 19 vaccine at 4:50 p.m. At 5:15 p.m. he started going into anaphylaxis. EKG was performed at emergency room
CDC Split Type:

Write-up: Patient went into anaphylaxis. Immediately after the shot the patient started to convulse and then passed out briefly. The patient was advised to wait until the color came back into his lips and then asked to wait 15 minutes after the shot to watch for adverse effects. After waiting the 15 minutes the patient left with his mother. Approximately 10 minutes later the patient began experiencing his throat closing. He has having problems swallowing and breathing. 911 was called and epinephrine was administered. Patient was taken to Hospital via ambulance. Patient was seen by ER doctor and administered Dexamethasone and a Pediatric EKG was performed. After four (4) hours after the epinephrine was administered, patient was released from the hospital and advised to follow up with his pediatrician.


VAERS ID: 1683573 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-01
Onset:2021-08-23
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Illness, Lung disorder, Pruritus, Rash, SARS-CoV-2 test, Vaccination site pain, Viral rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Medical history was not provided.
Allergies:
Diagnostic Lab Data: Test Name: SARS-CoV-2 test; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: VACCINATION SITE PAIN; tiredness; viral rash; very sick; lung issues; Weird rash all over my body/around my trunk area at the top of my butt/on the top of my foot; itching; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (itching), VACCINATION SITE PAIN (VACCINATION SITE PAIN), FATIGUE (tiredness), VIRAL RASH (viral rash) and ILLNESS (very sick) in a 40-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011D21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Medical history was not provided. In April 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 23-Aug-2021, the patient experienced PRURITUS (itching). On an unknown date, the patient experienced VACCINATION SITE PAIN (VACCINATION SITE PAIN), FATIGUE (tiredness), VIRAL RASH (viral rash), ILLNESS (very sick), LUNG DISORDER (lung issues) and RASH (Weird rash all over my body/around my trunk area at the top of my butt/on the top of my foot). The patient was treated with PREDNISONE at a dose of 1 dosage form and TRIAMCINOLONE (AMCORT [TRIAMCINOLONE]) at a dose of 1 dosage form. At the time of the report, PRURITUS (itching), VACCINATION SITE PAIN (VACCINATION SITE PAIN), FATIGUE (tiredness), VIRAL RASH (viral rash), ILLNESS (very sick), LUNG DISORDER (lung issues) and RASH (Weird rash all over my body/around my trunk area at the top of my butt/on the top of my foot) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: positive (Positive) Positive. No concomitant medication was reported. This case was linked to MOD-2021-294347, MOD-2021-294347 (Patient Link).


VAERS ID: 1683595 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-21
Onset:2021-08-23
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: Diarrhea; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (Diarrhea) in an 82-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 088O21A) for COVID-19 vaccination. No Medical History information was reported. On 21-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced DIARRHOEA (Diarrhea). At the time of the report, DIARRHOEA (Diarrhea) had not resolved. No concomitant medication was reported by the reporter. No treatment was reported by the reporter. About 4-5 hours after getting vaccinated, the patient developed diarrhea with no gas pain/stomach pain. He mentioned that it just flowed. It was still on going at the time report.


VAERS ID: 1683620 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-20
Onset:2021-08-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Mouth ulceration
SMQs:, Severe cutaneous adverse reactions (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Mouth ulcers; This spontaneous case was reported by a consumer and describes the occurrence of MOUTH ULCERATION (Mouth ulcers) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On 20-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Aug-2021, the patient experienced MOUTH ULCERATION (Mouth ulcers). At the time of the report, MOUTH ULCERATION (Mouth ulcers) outcome was unknown. The concomitant medications were not reported. The treatment information was not provided.


VAERS ID: 1684130 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-07
Onset:2021-08-23
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder, Menstruation delayed
SMQs:, 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: None
Current Illness: Hoshimotos
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Late menstrual cycle. And when it did come it was extremely lighter than normal.


VAERS ID: 1684815 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin occasional use of Tylenol or ibuprofen for arthritis pain
Current Illness: chronic arthritis
Preexisting Conditions: arthritis
Allergies: none
Diagnostic Lab Data: none, told to deal with it.
CDC Split Type:

Write-up: Pfizer BioNTech Covid 19 Vaccine EUA. After about 45 minutes I experienced lightheadedness/ dizziness then an intense ringing in my ears, which as of date is not as intense but still present constantly.


VAERS ID: 1685021 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-08-23
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Vaccinated-got covid


VAERS ID: 1685108 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-06
Onset:2021-08-23
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1809022 / N/A LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Oropharyngeal pain, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Truvada, bupropion, Vit D , multi vitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid 19
CDC Split Type: vsafe

Write-up: It started with sore throat days 2-5 I had a dry cough and a low grade fever and congestion, I got the regeneron treatment and felt better within 3 days.


VAERS ID: 1685394 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-01
Onset:2021-08-23
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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 arrived for first dose of Pfizer COVID 19 vaccine. Signed written consent for first dose of Pfizer vaccine. Patient registered. First dose administered. When signing off on first dose administration, provider noticed Janssen vaccine had been administered on 4/9/21. Patient insisted she never received first dose. Patient instructed to contact registry to correct error. 9/9/21-Received phone call from registry confirming patient was vaccinated 4/9/21 with Janssen. No adverse reaction.


VAERS ID: 1685493 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-10
Onset:2021-08-23
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, COVID-19, Fatigue, Malaise, Nasal congestion, Oropharyngeal pain, Pain, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol 25mg QD Sertraline 50mg QD Vit D 5000 IU QD Vit C with Zinc 500mg QD Multivitamin QD Super B Complex QD
Current Illness: None
Preexisting Conditions: HTN, Anxiety, Depression
Allergies: IVP contrast dye
Diagnostic Lab Data: Rapid Diagnostic Test for SARS-CoV-2 positive on 8/26/21 @ 1427
CDC Split Type:

Write-up: Was in close contact with my 22 month old who had been exposed to a positive Covid 19 case. I developed symptoms 8/23/21 of aches, malaise, fatigue, nasal congestion, sore throat. Only ran a temp of 101 once. Was taking all my medicines/supplements as listed in beginning of this form. Tested positive 8/26/21. I do feel the vaccine prevented me from getting sicker.


VAERS ID: 1685524 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-18
Onset:2021-08-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Breast enlargement, Breast pain, Breast swelling, Depression, Rash, Skin exfoliation, Skin warm, Suicidal ideation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Suicide/self-injury (narrow), Depression (excl suicide and self injury) (narrow), Lipodystrophy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alavert Vitamins C and D
Current Illness: Anemic
Preexisting Conditions: Seasonal allergies Adenomyosis Anemia
Allergies: Unknown
Diagnostic Lab Data: Seeing dr on September 22, 2021 to discuss if I should get second shot
CDC Split Type:

Write-up: Left breast doubled in size, two painful lumps over two inches in size, each directly behind nipple and one on left side, rash all over chest, hot to touch and lasted two weeks followed by skin sloughing off all over chest. Then right arm developed painful rash that felt like I had come into contact with fiberglass insulation which lasted two days. Over all had a feeling of severe anxiety and depression with suicidal idealizations for three weeks. Completely fine and no symptoms now.


VAERS ID: 1686437 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-20
Onset:2021-08-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site discharge
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: Unknown
Current Illness: N/A
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported vaccine coming out of arm 3 days post vaccination. Patient was working out and noticed white substance coming out of injection site.


VAERS ID: 1686615 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-09
Onset:2021-08-23
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Laboratory test, Vaccination complication
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: Guiana barre
Other Medications: Vitamins, Wellbutrin, Klonpin Clyndamycin
Current Illness: Cancer
Preexisting Conditions: Cancer
Allergies: None
Diagnostic Lab Data: Yes
CDC Split Type:

Write-up: Shingles like reaction. P.A suggest I wait to get the second dose IF I don?t start more cancer treatments soon.


VAERS ID: 1686727 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-19
Onset:2021-08-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Eye pruritus, Pain of skin, Pruritus, Tenderness, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prozac losartin lasix potassium celebrex
Current Illness: None
Preexisting Conditions: borderline bp/fluid retention arthritis
Allergies: lisinopril/cough
Diagnostic Lab Data: treated per pharmacy advice with benadryl, oral and cream, consulting PCP 9/13/21
CDC Split Type:

Write-up: Hives, terrible itching all over for about 2 weeks now, bumps and welts, stinging sensations on skin, itchy eyes, some joint body aches, arm still tender after 3 weeks


VAERS ID: 1688930 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Cold sweat, Feeling hot, Musculoskeletal chest pain, Nausea
SMQs:, Acute pancreatitis (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:
Other Medications: zinc, vitamin d.
Current Illness: Nome
Preexisting Conditions: Asthma
Allergies: Mucinex
Diagnostic Lab Data: None. Staff had her lay down, wait a total of 30 min before releasing her. She felt better by the end of 30 min.
CDC Split Type:

Write-up: Stomach pain underneath base of ribs, slight nausea. June walked around the treatment room holding her stomach. She was classy, said she was hot. Staff had her lay down and wait an additional 15 min on top of the first 15 min wait.


VAERS ID: 1689431 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 1 LA / IM

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

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

Write-up: pt administered a dose of Moderna covid-19 vaccine; at time of administration pt is 15 years old. no adverse reactions reported


VAERS ID: 1689503 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-21
Onset:2021-08-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest X-ray, Chest pain, Computerised tomogram thorax, Condition aggravated, Dyspnoea, Dyspnoea exertional, Electrocardiogram, Exercise tolerance decreased, Heart rate increased, Mobility decreased, Muscle fatigue, Musculoskeletal chest pain, Musculoskeletal stiffness, Myalgia, Pain, Pain in extremity, Painful respiration, Pulmonary pain, Respiratory rate increased, SARS-CoV-2 test negative, Scan with contrast
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu (severe flu symptoms that last multiple days, multiple years, multiple types); Varicella (hives, fever, age 5-6); vaccines i
Other Medications: Buspirone; LEXAPRO; QSYMIA; norethindrone; ZYRTEC; multivitamin; probiotic; fish oil; magnesium; vitamin D3; FLONASE
Current Illness: Flu B (Active illness 08/06-08/12, symptoms continued until 08/18); multiple allergic reactions to unknown allergens
Preexisting Conditions: IBS; leaky gut/nutrient deficiencies; osteopenia; mold toxicity; insulin resistance; PMDD; menstrual irregularity; anxiety; depression
Allergies: Z-pack; sulfa (family history); penicillin (family history); formaldehyde; egg; gluten; dairy; peanut; mold
Diagnostic Lab Data: Urgent Care Visit 08/27- Chest X-ray; nebulizer treatment, COVID test (neg); Urgent Care Visit 09/02- Chest X-ray; COVID test (neg); CT chest w/ contrast; EKG; IV steroids/fluids
CDC Split Type: vsafe

Write-up: Within 48hrs of receiving the vaccine, I experienced severe joint pain in limb joints, ribs, and back, and noticed a sharp decrease in stamina and a sharp increase in heart and respiration rate upon mild exertion. The severe joint pain consisted of achy, throbbing pain and stiffness with movement, in between and along the bones of the affected joint. This continued for two weeks before dulling away, except in joints with previous injuries, where pain has dulled to a moderate-severe flare up and has not resolved. Breathing became more troublesome, I struggled to take a deep breath or hold a breath, walk more than a flight of stairs before becoming winded, or talk long without running out of air. Chest muscles become easily fatigued and achy, and I sometimes experience lancing pain through my chest and lungs while trying to breath deeply, especially after exertion. Nebulizer treatments, inhalers, and steroids do not help for more than an hour or two before the shortness of breath return. The issue has not been resolved but referred to cardiology and pulmonology.


VAERS ID: 1689515 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Pain, Pain in extremity, Tinnitus
SMQs:, Hearing impairment (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Initial humming in ears about 6 hours after dose and odd joint pain. Day 2 dull throbbing pain in my left foot regardless of weight-bearing. The pain symptoms subsided after about 72 hours, but the ear symptoms quickly evolved into persistent and loader ringing (tinnitus) in both ears that persists to this day.


VAERS ID: 1689564 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-01-25
Onset:2021-08-23
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Asthma, Electrocardiogram ST segment depression, Electrocardiogram abnormal, Pericarditis, Ultrasound scan abnormal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG: PR depression US: Hyperechoic pericardium
CDC Split Type:

Write-up: Pericarditis Asthma Pt developed pericarditis and asthma 8 months after vaccine, requiring medication and hospitalizations.


VAERS ID: 1689681 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-26
Onset:2021-08-23
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Mental status changes, Peritoneal dialysis, SARS-CoV-2 test positive
SMQs:, Acute renal failure (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, atorvastatin, calcifediol, famotidine, furosemide,
Current Illness:
Preexisting Conditions: ESRD ON PD, HTN, CHF and DM
Allergies:
Diagnostic Lab Data: tested positive for COVID-19 on 8/23/21.
CDC Split Type:

Write-up: 8/23/21: presented to the ED via EMS with complaints of generalized weakness and altered mental status. Pt is a poor historian and the history is taken mostly from review of chart and ED provider. Pt lives with his son who does the PD but he has COVID and is quarantined so pt''s last dialysis was 8/20/21. Pt tested positive for COVID-19 on 8/23/21. Note: previously received Pfizer Covid-19 vaccines on 3/5/21 & 3/26/21. Diagnosed and treated for covid-19 pneumonia. Condition improved and discharged on 9/2/21.


VAERS ID: 1689788 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-14
Onset:2021-08-23
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood urine present
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow)

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

Write-up: pass blood through urine, lumps of blood in urine,


VAERS ID: 1690664 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-17
Onset:2021-08-23
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Chorioretinopathy
SMQs:, Retinal disorders (narrow)

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

Write-up: Developed a CSCR in my right eye


VAERS ID: 1690676 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 3183 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Cheilitis, Lip swelling, Pain in extremity, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Auto-immune hemolytic anemia, hypothyroidism, hay fever
Allergies: Antibiotics.
Diagnostic Lab Data:
CDC Split Type:

Write-up: After vaccine, arm hurt, swollen for 3 days. Lips got swollen, rash on lips and surrounding lips, very itchy and burning, whole body itchy and rashy.


VAERS ID: 1691304 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Hawaii  
Vaccinated:0000-00-00
Onset:2021-08-23
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Body temperature, Chest pain, Chills, Diarrhoea, Fatigue, Gastrointestinal disorder, Headache, Laryngitis, Myalgia, Nasal congestion, Pharyngeal ulceration, Pyrexia, Rash erythematous, Rhinorrhoea, Skin discolouration, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: BNT 162
Current Illness: Alcohol use (1 glass, couple of ounces of red wine 3 times a week.); Arrhythmia (arrhythmias after Pfizer COVID-19 hormone cream / ointment.); Generalized rash (Patient had red spots over body for years and HCP following up.); Hepatobiliary disease (Biliary disease, controlled with diet.); Low blood pressure; Non-smoker; Urinary tract infection (hormone cream/oint, UTIs (once a year).)
Preexisting Conditions: Comments: Patient had no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Date: 20210824; Test Name: Body temperature; Result Unstructured Data: 99.8 F
CDC Split Type: USJNJFOC20210907969

Write-up: LARYNGITIS/ HOARSE VOICE; CONGESTION; RUNNY NOSE; DIARRHEA; 15 BRIGHT RED DOTS AROUND YELLOW CIRCLE, LATER DOTS WERE BROWN; YELLOW RING ON LEFT FOREARM SIZE OF A QUARTER; ERYTHEMA AND SORES ON THROAT, APPEARED BRIGHT RED WITH 3 INCH AREAS WITH LITTLE BLISTER IN BACK OF MOUTH; GASTROINTESTINAL SYMPTOMS; BAD ABDOMINAL CRAMPING AFTER EATING AND ABDOMINAL PAIN; CHILLS; MUSCLE PAIN; FEVER; TIREDNESS- FALLS ASLEEP WHILE SITTING, WORKING, NOT NORMAL; HEADACHE; RAPID HEART BEAT/ TACHYCARDIA SHORTLY AFTER VACCINATION; CHEST PAIN; This spontaneous report received from a patient concerned a 72 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: arrhythmias, urinary tract infection, low blood pressure, biliary disease, alcoholic, non smoker, and red spots over body, and other pre-existing medical conditions included: Patient had no drug abuse or illicit drug usage. The patient experienced drug allergy when treated with clindamycin, cyproheptadine hydrochloride, benzylpenicillin, sulfacetamide sodium/sulfadiazine/sulfadimidine/sulfamerazine, tetracycline, and vancomycin. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported and batch number: 201A21A expiry: UNKNOWN) dose was not reported, administered on 23-AUG-2021 for prophylactic vaccination. Concomitant medications included bnt 162 for prophylactic vaccination. On 23-AUG-2021, the patient experienced rapid heart beat/ tachycardia shortly after vaccination. On 23-AUG-2021, the patient experienced chest pain. On 23-AUG-2021, the patient experienced headache. On 24-AUG-2021, the patient experienced erythema and sores on throat, appeared bright red with 3 inch areas with little blister in back of mouth. On 24-AUG-2021, the patient experienced gastrointestinal symptoms. On 24-AUG-2021, the patient experienced bad abdominal cramping after eating and abdominal pain. On 24-AUG-2021, the patient experienced chills. On 24-AUG-2021, the patient experienced muscle pain. On 24-AUG-2021, the patient experienced fever. On 24-AUG-2021, the patient experienced tiredness- falls asleep while sitting, working, not normal. Laboratory data included: Body temperature (NR: not provided) 99.8 F. On 02-SEP-2021, the patient experienced yellow ring on left forearm size of a quarter. On 02-SEP-2021, the patient experienced 15 bright red dots around yellow circle, later dots were brown. On an unspecified date, the patient experienced laryngitis/ hoarse voice, congestion, runny nose, and diarrhea. Treatment medications (dates unspecified) included: ibuprofen, acetylsalicylic acid, and paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from rapid heart beat/ tachycardia shortly after vaccination on 23-AUG-2021, chest pain on 24-AUG-2021, gastrointestinal symptoms, bad abdominal cramping after eating and abdominal pain, diarrhea, chills, and muscle pain, headache on AUG-2021, and fever on 01-SEP-2021, was recovering from tiredness- falls asleep while sitting, working, not normal, and erythema and sores on throat, appeared bright red with 3 inch areas with little blister in back of mouth, had not recovered from laryngitis/ hoarse voice, yellow ring on left forearm size of a quarter, and 15 bright red dots around yellow circle, later dots were brown, and the outcome of congestion and runny nose was not reported. This report was non-serious.


VAERS ID: 1691438 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-23
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Joint swelling, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Left ankle/foot is swollen; Left ankle/foot is swollen; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (Left ankle/foot is swollen) and JOINT SWELLING (Left ankle/foot is swollen) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Aug-2021, the patient experienced PERIPHERAL SWELLING (Left ankle/foot is swollen) and JOINT SWELLING (Left ankle/foot is swollen). At the time of the report, PERIPHERAL SWELLING (Left ankle/foot is swollen) and JOINT SWELLING (Left ankle/foot is swollen) outcome was unknown. No concomitant products were reported. No treatment information provided.


VAERS ID: 1691451 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Body temperature, Bone pain, Chest pain, Facial pain, Influenza like illness, Pain of skin, Paraesthesia, Pyrexia, Skin tightness, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Osteonecrosis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MULTIVITAMIN [VITAMINS NOS]
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202108; Test Name: Body temperature; Result Unstructured Data: he had a 102 Fever for the past 24 hours; Test Date: 20210823; Test Name: Body temperature; Result Unstructured Data: 97F-102F.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of BONE PAIN, CHEST PAIN, FACIAL PAIN, INFLUENZA LIKE ILLNESS and PAIN OF SKIN in a 42-year-old male patient who received mRNA-1273 (MODERNA COVID-19 Vaccine) (batch nos. 036A21A and 005C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included MULTIVITAMIN [VITAMINS NOS] for an unknown indication. On 30-Jul-2021, the patient received first dose of mRNA-1273 (MODERNA COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Aug-2021, received second dose of mRNA-1273 (MODERNA COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Aug-2021, the patient experienced BONE PAIN (when he touches his bone there is physical pain), CHEST PAIN, FACIAL PAIN, INFLUENZA LIKE ILLNESS, PAIN OF SKIN, PARAESTHESIA, SKIN TIGHTNESS and ARTHRALGIA. 23-Aug-2021, the patient experienced SLEEP DISORDER (sleeping only 30 minutes intervals, he cannot get sleep. The sleep is a cycle.). 23-Aug-2021, the patient experienced PYREXIA (he states that immediately he had a fever within 5 minutes/the fever rotated from 97F-102F/he had a 102 Fever for the past 24 hours). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) for Fever, at an unspecified dose and frequency and Bed rest (He took Advil and has been laying in bed.) for Pyrexia. At the time of the report, BONE PAIN (when he touches his bone there is physical pain), CHEST PAIN (He also mentions that the bones in his chest hurt), FACIAL PAIN (the bones in his face hurts), INFLUENZA LIKE ILLNESS (It is similar to how he reacts from the flu), PAIN OF SKIN (his skins hurts as if there is charcoal), SLEEP DISORDER (sleeping only 30 minutes intervals, he cannot get sleep. The sleep is a cycle.), PARAESTHESIA (When he wets his hair, it feels like pins and needles), SKIN TIGHTNESS (He feels like he has a mask on his face/tightness on his face), ARTHRALGIA (If he moves, there is pain in his shoulder and joints) and PYREXIA (he states that immediately he had a fever within 5 minutes/the fever rotated from 97F-102F/he had a 102 Fever for the past 24 hours) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In August 2021, Body temperature: 102 (High) he had a 102 Fever for the past 24 hours. On 23-Aug-2021, Body temperature: 97f-102f (High) 97F-102F. This case was linked to MOD-2021-294777 (Patient Link).


VAERS ID: 1691486 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-02
Onset:2021-08-23
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 - / OT

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

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

Write-up: They gave a patient his 2nd dose yesterday, 23Aug2021 after giving him his first dose on 2Aug2021; This spontaneous case was reported by a pharmacist and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (They gave a patient his 2nd dose yesterday, 23Aug2021 after giving him his first dose on 2Aug2021) in a 26-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 939902 and 091D21A) for COVID-19 vaccination. No Medical History information was reported. On 02-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (They gave a patient his 2nd dose yesterday, 23Aug2021 after giving him his first dose on 2Aug2021). On 23-Aug-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (They gave a patient his 2nd dose yesterday, 23Aug2021 after giving him his first dose on 2Aug2021) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications were not provided by the reporter. Treatment information was not provided.


VAERS ID: 1691598 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-19
Onset:2021-08-23
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

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

Write-up: extreme under arm swelling; moderate pain; Second dose : 23 Feb 2021 and Booster dose : 23 Aug 2021; This spontaneous case was reported by a consumer and describes the occurrence of SWELLING (extreme under arm swelling), PAIN (moderate pain) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second dose : 23 Feb 2021 and Booster dose : 23 Aug 2021) in a 55-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 017C21A, 037K20A and 002A21A) for COVID-19 vaccination. Concurrent medical conditions included Asthma. Concomitant products included ALBUTEROL [SALBUTAMOL] for an unknown indication. On 19-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Aug-2021, the patient experienced SWELLING (extreme under arm swelling), PAIN (moderate pain) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second dose : 23 Feb 2021 and Booster dose : 23 Aug 2021). On 23-Aug-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second dose : 23 Feb 2021 and Booster dose : 23 Aug 2021) had resolved. At the time of the report, SWELLING (extreme under arm swelling) and PAIN (moderate pain) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The patient uses ice pack to relieve pain.


VAERS ID: 1691630 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939893 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling abnormal, Gait disturbance, Headache, Hypoaesthesia, Limb discomfort, Nasal congestion, Paraesthesia, Vaccination site anaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: pins and needles sensation on both her feet, toes and legs/She went to her chiropractor she improved a bit but the pins and needles; legs felt like jello; had a hard time going up the stairs; weird sensation on her legs; numbness on her lower back; numbness when she lies on the side where she got the injection; feeling tired; congested; chills; headache; This spontaneous case was reported by a consumer and describes the occurrence of NASAL CONGESTION (congested), PARAESTHESIA (pins and needles sensation on both her feet, toes and legs/She went to her chiropractor she improved a bit but the pins and needles), LIMB DISCOMFORT (legs felt like jello), GAIT DISTURBANCE (had a hard time going up the stairs) and FEELING ABNORMAL (weird sensation on her legs) in a 29-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939893) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 23-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Aug-2021, the patient experienced CHILLS (chills) and HEADACHE (headache). On 24-Aug-2021, the patient experienced NASAL CONGESTION (congested) and FATIGUE (feeling tired). On 25-Aug-2021, the patient experienced PARAESTHESIA (pins and needles sensation on both her feet, toes and legs/She went to her chiropractor she improved a bit but the pins and needles), LIMB DISCOMFORT (legs felt like jello), GAIT DISTURBANCE (had a hard time going up the stairs), FEELING ABNORMAL (weird sensation on her legs), HYPOAESTHESIA (numbness on her lower back) and VACCINATION SITE ANAESTHESIA (numbness when she lies on the side where she got the injection). At the time of the report, NASAL CONGESTION (congested), PARAESTHESIA (pins and needles sensation on both her feet, toes and legs/She went to her chiropractor she improved a bit but the pins and needles), LIMB DISCOMFORT (legs felt like jello), GAIT DISTURBANCE (had a hard time going up the stairs), FEELING ABNORMAL (weird sensation on her legs), HYPOAESTHESIA (numbness on her lower back), VACCINATION SITE ANAESTHESIA (numbness when she lies on the side where she got the injection), FATIGUE (feeling tired), CHILLS (chills) and HEADACHE (headache) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Relevant concomitant medications were not provided. Treatment information was not provided. This case was linked to MOD-2021-299954 (Parent-Child Link). See case MOD-2021-299954 for details regarding the child case.


VAERS ID: 1691706 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0Z0F21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Arm Pain; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Arm Pain) in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 0Z0F21A) for COVID-19 vaccination. Concomitant products included PARACETAMOL (TYLENOL) for an unknown indication. On 23-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Aug-2021, the patient experienced PAIN IN EXTREMITY (Arm Pain). At the time of the report, PAIN IN EXTREMITY (Arm Pain) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. treatment drugs were not provided Reporter did not allow further contact


VAERS ID: 1692085 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101102338

Write-up: Itching; This is a spontaneous report from a contactable consumer or other non hcp. A patient of unspecified age and gender received BNT162b2 (CONMINTARY, Solution for injection, Lot No was not reported, NDC and UPC number was unknown), via an unspecified route of administration on 23Aug2021 as dose number unknown, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced itching on 23Aug2021.Outcome of the event was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1692091 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-08-21
Onset:2021-08-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Computerised tomogram, Pancreatic disorder
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OMEPRAZOLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high
Allergies:
Diagnostic Lab Data: Test Date: 20210823; Test Name: CAT scan; Result Unstructured Data: Test Result:inflamed pancreas; Comments: inflamed pancreas
CDC Split Type: USPFIZER INC202101103388

Write-up: Abdominal pain resulting in hospital visit. CAT scan showed inflamed pancreas; Abdominal pain resulting in hospital visit. CAT scan showed inflamed pancreas; This is a spontaneous report from a contactable consumer (reported for himself). A 43-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration, administered in arm right on 21Aug2021 at 11:00 (at the age of 43-years-old) as dose number unknown, single for COVID-19 immunisation at Workplace clinic. Medical history included hypertension from an unknown date and unknown if ongoing. Concomitant medication(s) included omeprazole (OMEPRAZOLE), high blood pressure med and advanced, taken for an unspecified indication, start and stop date were not reported. The patient did not receive any other vaccines within four weeks prior to the vaccination. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient previously received benadryl and experienced drug hypersensitivity, wellbutrin and experienced drug hypersensitivity. On 23Aug2021 at 07:00, the patient experienced abdominal pain resulting in hospital visit. cat scan showed inflamed pancreas. The event assessed as serious (hospitalization). The reporter stated the events result in Emergency room/department or urgent care visit. The patient underwent lab tests and procedures which included computerised tomogram: inflamed pancreas on 23Aug2021 (inflamed pancreas). Therapeutic measures were taken as a result of events included treatment with CAT scan, morphine, pancreatic diet. The outcome of the events was resolving. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.


VAERS ID: 1693040 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-01
Onset:2021-08-23
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Full blood count, Hypokalaemia, Hyponatraemia, Metabolic function test, SARS-CoV-2 test positive
SMQs:, Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Infective pneumonia (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, lisinopril -hctz, rosuvastatin, Phenergan, wellbutrin, zoloft
Current Illness: None
Preexisting Conditions: Depression anxiety hypertension hyperlipidemia
Allergies: None
Diagnostic Lab Data: Bmp, cbc
CDC Split Type:

Write-up: I had gotten sick with covid and developed hyponatremia and hypokalemia and had to be hospitalized.


VAERS ID: 1693204 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-11
Onset:2021-08-23
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zinc, vit C, D3, Montelukast, hydrochlozide, zonisamide, potassium chloride, inhaler,
Current Illness:
Preexisting Conditions: COPD, past cancers
Allergies: Sithro
Diagnostic Lab Data: Covid 19 test- positive
CDC Split Type: vsafe

Write-up: I started with a cough the doctor gave me doxycycline before I knew I had a covid. On a wednesday I started coughing more and sneezing and it progressively getting worse So Sunday I went and I got tested for Covid and Monday it came back positive. On Wednesday I got monoclonal antibodies.


VAERS ID: 1693222 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthritis, Blood creatine phosphokinase normal, Joint effusion, Pain in extremity, Ultrasound joint
SMQs:, Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Knee dislocation
Allergies: None
Diagnostic Lab Data: CK 150 units/L
CDC Split Type:

Write-up: The patient presents with left leg pain, arthritis of L knee and hip after receiving covid vaccine. US of the hip showed mild effusion. Labwork obtained was resassuring, no elevated CK here. No concern for GBS or septic joint. Overall her presentation seems most consistent with reactive arthritis which has been described in the literature following COVID vaccine. Improved following toradol. Recommended ongoing ibuprofen at home. Return precautions discussed. Complication reported to pharmacy who will report the vaccine complication. Patient will followup with their PCP.


VAERS ID: 1693389 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-18
Onset:2021-08-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Dizziness, Electrocardiogram normal, Lymphadenopathy, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hyperacusis, tinnitus, hemochromatosis
Allergies: Penicillin
Diagnostic Lab Data: Chest xray (normal), ECG (normal), physical exam, enlarged lymph nodes in throat.
CDC Split Type:

Write-up: Chest pressure, lightheaded, tightness around throat


VAERS ID: 1693394 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac discomfort, Chills, Diarrhoea, Dizziness, Dysphonia, Hypoaesthesia, Menstruation irregular, Muscle tightness, Musculoskeletal stiffness, Nausea, Neck pain, Pain in extremity, Pharyngeal swelling, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Fertility disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: 1 day - dizzy and trembling 2 days - left arm very sore 3 days - left neck very stiff / sore 1 day - right heal pain 1 day - diarrhea, nausea, chills, fever, left facial numbness 2 day - hoarseness / throat inflammation menstrual cycle - 7 days early 1 day - left back muscle tightness / clenching - heart attack symptoms


VAERS ID: 1693466 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-08
Onset:2021-08-23
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Cough, Hyperhidrosis, Productive cough, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: nethadaphine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid 19 positive
CDC Split Type: vsafe

Write-up: I did not lose smell or taste, I would go from 104 to 94 every few hours with no meds, sweating, constant cough, mucus phlegm in lungs, could not sleep on stomach or back if I laid down I would wheeze. I had constant cough for 4-5 days


VAERS ID: 1693629 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-22
Onset:2021-08-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Decreased appetite, Pyrexia, Somnolence
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Other Medications: None
Current Illness: None
Preexisting Conditions: Stroke survivor, nerve pain of unknown origin
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills and low grade fever present upon waking in the morning. Slept most of the day. No breakfast. Reduced appetite was noted at lunch and throughout the rest of the day. Stomach cramps appeared following a lunch of chicken noodle soup. Symptoms were not noticed the following day.


VAERS ID: 1693668 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt faint after receiving his vaccine. EMS was called since the patient stated he felt like he was "blacking out". EMS arrived shortly afterwards and examined the patient. The Patient mother arrived shortly afterwards and took the patient home after EMS examined him.


VAERS ID: 1693725 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-19
Onset:2021-08-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram spine, Gait disturbance, Hypoaesthesia, Nerve injury, Peroneal nerve palsy
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: None
Diagnostic Lab Data: CT scan of back Routine bloodwork you rule out stroke, vitamin deficiency, or virus/infection No abnormal blood results
CDC Split Type:

Write-up: Right foot numbness grew to right foot,ankle, and leg numbness. Currently have a foot drop making it difficult to walk or even move my right foot. Neurologist says i have ?unexplained? nerve damage in right leg and it is irreversible. Usually caused by an injury he said or in elderly adults. Said it was unusual that my lower right leg just went numb and lost function at 25 years old. This began 3 days after getting my 2nd dose.


VAERS ID: 1694059 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-11
Onset:2021-08-23
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 805029 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, COVID-19, Computerised tomogram, Dyspnoea, Magnetic resonance imaging, SARS-CoV-2 test positive
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metformin
Current Illness: none
Preexisting Conditions: diabetes, COPD
Allergies: none
Diagnostic Lab Data: MRI, CAT scan, blood work- I do not know the results Covid test- positive
CDC Split Type: vsafe

Write-up: I was at home in bed and I was very lucky to wake up. I told my wife I needed medical attention right away because I could not breathe. We got in the car and drove to the hospital. They did a whole bunch of tests. MRI, CAT scan, blood work, Covid test. I do not know the results of the tests, only the Covid test, which was positive. Once I was admitted they did 2 treatments through IV. I was only there for one day and a half. They gave me a steroid for 5 days.


VAERS ID: 1694117 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-28
Onset:2021-08-23
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Blood test, Computerised tomogram head, Electrocardiogram, Feeling abnormal, Ischaemic stroke, Magnetic resonance imaging head, Memory impairment, Urine analysis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg daily Atorvastatin 40mg daily Aspirin 81mg daily
Current Illness: High blood pressure High cholesterol Adenoidcystic carcinoma
Preexisting Conditions: See abovw
Allergies: NKDA
Diagnostic Lab Data: On 8/23/2021 she was taken to Hospital ER where EKG, Blood work, urinalysis and Head CT were performed. And later transferred to Hospital. On 8/24/2021 she had Brain MRI and head CT performed.
CDC Split Type:

Write-up: On 8/23/2021 at 8am different from a ischemic stroke. She has expressive aphasia and became altered and forgetful.


VAERS ID: 1694265 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-13
Onset:2021-08-23
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 LA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fibrin D dimer, Thrombosis, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: Sertaline, Mirtazapine, Rosvustatin, Metphormin
Current Illness: Appendicitis 2/21
Preexisting Conditions: PTSD, Axiety, Depression, high cholesterol, high triglycerides
Allergies: None
Diagnostic Lab Data: See Notes from doctor
CDC Split Type:

Write-up: D dimer showed possible blood clot. Doppler was not showing clot


VAERS ID: 1694370 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-13
Onset:2021-08-23
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acoustic stimulation tests, Sudden hearing loss, Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion, Sertraline, Lamotragine, L-Methylfolate, Quetiapine, Zyrtec, Melatonin, Multivitamin, Cal/Mag/D, concentrated fruits/vegetables, hair/skin/nail health
Current Illness:
Preexisting Conditions: Chronic Depression
Allergies: Shellfish, pollen
Diagnostic Lab Data: Audiology test 8/27/2021.
CDC Split Type:

Write-up: Sudden hearing loss/loud ringing in right ear about 1 week to 10 days after 2nd injection


VAERS ID: 1694540 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-20
Onset:2021-08-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: HIGH BLOOD PRESSURE


VAERS ID: 1694629 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Electrocardiogram abnormal, Pruritus, Sinus tachycardia, Troponin normal
SMQs:, Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Pfizer COVID-19 vaccine, given 5/10/21, throat tightness, dypsnea. Patient received allergy testing in July, was cleared to rec
Other Medications: aspirin, albuterol, propranolol, metformin, lisinopril, ferrous sulfate
Current Illness:
Preexisting Conditions: hypertension, diabetes, iron deficiency anemia, severe obesity
Allergies: erythromycin, tetracycline, sulfa
Diagnostic Lab Data: troponin normal, EKG showed sinus tachycardia but otherwise normal
CDC Split Type:

Write-up: chest tightness, itching, dyspnea


VAERS ID: 1694794 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-04
Onset:2021-08-23
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood magnesium, Blood phosphorus, Chest X-ray, Chest pain, Differential white blood cell count, Electrocardiogram, Fibrin D dimer, Hypertension, Influenza A virus test, Influenza B virus test, Metabolic function test, Palpitations, Respiratory syncytial virus test, SARS-CoV-2 test, Troponin I
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pain in head, muscular, chest, palpitations, pression disorder
Other Medications: Tamoxofen
Current Illness: N/A
Preexisting Conditions: Follow up and medication for cancer prevention
Allergies: N/A
Diagnostic Lab Data: Basic metabolic panel, CBC w/differential, CBC/Diff, Coronavirus (CoVID-19)+/-influenza a/b or RSV viral RNA, Coronavirus, CoVID-19, NAA, D-Dimer, Magnesium, Phosphorus, Troponin I (2times), XRAY CHEST, Routine electrocardiogram (EKG) (3times)
CDC Split Type:

Write-up: Palpitations, chest pain, high blood pressure disorder


VAERS ID: 1694968 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-09
Onset:2021-08-23
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, SARS-CoV-2 test negative, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLARITIN; omeprazole; rosuvastatin
Current Illness: No
Preexisting Conditions: Asthma - allergy induced
Allergies: Food cooked in banana leaves; had reaction to some vegetables in the past - that seems to have gone away now; cooked tuna; Allergies to pollens and grass
Diagnostic Lab Data: I got a COVID test - came back negative.
CDC Split Type: vsafe

Write-up: Breathing troubles - Was having some difficulty breathing and having some wheezing. Treatment - I used an inhaler - I already a prescription for. It helped some. I had these for about 3 weeks.


VAERS ID: 1695030 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-02-19
Onset:2021-08-23
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Aphthous ulcer, Lethargy, Pain, Pyrexia, Respiratory disorder, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine, duloxetine, wellbutrin, propranolol, omeprazole, Losartan, estrodial. clonazepam prn OTC- Vit D, Multi-vit, Cranberry, menopausal med,
Current Illness: none
Preexisting Conditions: current - fatty liver disease, HTN, GERD, migraines, chronic urinary issues, lethargy daily, - and mental health issues I have been sick with head and upper respiratory issues. Tonsilitis, ear issues, clusters of canker sores under my tongue, some mild chest congestion, and cough. Have tested negative for COVID but the symptoms lasted a month. Still struggle with chronic lethargy and fatigue.
Allergies: none
Diagnostic Lab Data: COVID and Strep swabs, both negative
CDC Split Type:

Write-up: With the first dose, I had severe lethargy, body aches, and low-grade fever. Second dose just the lethargy and mild body aches. Lethargy has persisted since that time. About a month ago, I developed an upper respiratory issue. It involved my ears, tonsils, throat, clusters of canker sores under my tongue, body aches, and still severe lethargy. That lasted about a month and just now getting over it. I tested negative for COVID in my doc office.


VAERS ID: 1695359 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-26
Onset:2021-08-23
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Chills, Feeling abnormal, Flushing, Heart rate, Hypertension, Hypotension, Lethargy, Sluggishness
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; T3; SODIUM NITRATE; MONTELUKAST; ROSUVASTATIN; REST ZZZ
Current Illness: Contrast media allergy (anaphylaxis); Food allergy (mushroom-under dr care for 5 days)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210827; Test Name: blood pressure; Result Unstructured Data: 92/62 low; Test Date: 20210827; Test Name: blood pressure; Result Unstructured Data: 90/57; Test Date: 20210827; Test Name: blood pressure; Result Unstructured Data: 89/52 low; Test Date: 20210827; Test Name: blood pressure; Result Unstructured Data: 92/56 low; Test Date: 20210827; Test Name: blood pressure; Result Unstructured Data: 110/70 low; Test Date: 20210827; Test Name: body temperature; Result Unstructured Data: 101 F High; Test Date: 20210827; Test Name: Heart rate; Result Unstructured Data: 89 high; Test Date: 20210827; Test Name: Heart rate; Result Unstructured Data: 76 high; Test Date: 20210827; Test Name: Heart rate; Result Unstructured Data: 72; Test Date: 20210827; Test Name: Heart rate; Result Unstructured Data: 68 normal; Test Date: 20210827; Test Name: Heart rate; Result Unstructured Data: 76 normal
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Feels sluggish, like I don''t want to do anything; lethargic feeling; mental lapse; Systolic blood pressure 90 mmHg; Flushing; chills; low blood pressure for several days/top number 90-96/bottom number in the 50s; lethargic feeling; didn''t feel like sleeping; This spontaneous case was reported by a consumer and describes the occurrence of HYPOTENSION (low blood pressure for several days/top number 90-96/bottom number in the 50s), SLUGGISHNESS (Feels sluggish, like I don''t want to do anything), the second episode of LETHARGY (lethargic feeling), FEELING ABNORMAL (mental lapse) and HYPERTENSION (Systolic blood pressure 90 mmHg) in a 71-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 088D21A and 054C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Food allergy (mushroom-under dr care for 5 days) since 1980 and Contrast media allergy (anaphylaxis) since 1981. Concomitant products included MONTELUKAST for Allergy, SODIUM NITRATE for Chest heaviness, ROSUVASTATIN for Cholesterol, LEVOTHYROXINE SODIUM (SYNTHROID) and LIOTHYRONINE SODIUM (T3) for Hypothyroidism, REST ZZZ for Sleep disorder NOS. On 26-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Aug-2021, the patient experienced the first episode of LETHARGY (lethargic feeling) and FEELING ABNORMAL (didn''t feel like sleeping). On 24-Aug-2021, the patient experienced HYPOTENSION (low blood pressure for several days/top number 90-96/bottom number in the 50s). On an unknown date, the patient experienced SLUGGISHNESS (Feels sluggish, like I don''t want to do anything), the second episode of LETHARGY (lethargic feeling), FEELING ABNORMAL (mental lapse), HYPERTENSION (Systolic blood pressure 90 mmHg), FLUSHING (Flushing) and CHILLS (chills). On 28-Aug-2021, FEELING ABNORMAL (didn''t feel like sleeping) had resolved. At the time of the report, HYPOTENSION (low blood pressure for several days/top number 90-96/bottom number in the 50s), SLUGGISHNESS (Feels sluggish, like I don''t want to do anything), the last episode of LETHARGY (lethargic feeling), FEELING ABNORMAL (mental lapse), HYPERTENSION (Systolic blood pressure 90 mmHg), FLUSHING (Flushing) and CHILLS (chills) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 27-Aug-2021, Blood pressure measurement: 24-aug-2021 (Low) 92/62 low, 25-aug-2021 (Low) 90/57, 26-aug-2021 (Low) 89/52 low, 27-aug-2021 (Low) 92/56 low and 28-aug-2021 (Low) 110/70 low. On 27-Aug-2021, Body temperature: 101 f (High) 101 F High. On 27-Aug-2021, Heart rate: 24-aug-2021 (High) 89 high, 25-08-2021 (High) 76 high, 26-08-2021 (normal) 72, 27-aug-2021 (normal) 68 normal and 28-aug-2021 (normal) 76 normal. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No treatment was provided by reporter. Take it easy used as treatment on 23-08-2021 and stopped on 28-08-2021. Most recent FOLLOW-UP information incorporated above includes: On 01-Sep-2021: Follow-up with patient information added, concomitants were added and allergic reactions are added


VAERS ID: 1695364 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia
SMQs:, Taste and smell disorders (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy (Norco allergy)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: could not taste the coke/ lost sense of taste; lost sense of smell; This spontaneous case was reported by a consumer and describes the occurrence of AGEUSIA (could not taste the coke/ lost sense of taste) and ANOSMIA (lost sense of smell) in a 76-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017C21A) for COVID-19 vaccination. Concurrent medical conditions included Drug allergy (Norco allergy). On 23-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Aug-2021, the patient experienced AGEUSIA (could not taste the coke/ lost sense of taste) and ANOSMIA (lost sense of smell). At the time of the report, AGEUSIA (could not taste the coke/ lost sense of taste) and ANOSMIA (lost sense of smell) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported. No treatment was reported.


VAERS ID: 1695779 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-23
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Metformin, Lipitor, Feldene, Solifenacin
Current Illness: None
Preexisting Conditions: Bronchiecstasis
Allergies: Percoset, fosamax, Polymicin ointment
Diagnostic Lab Data: None. I did not go to a clinic. I called my daughter who is an RN and is almost finished with her Nurse Practitioner program to get advice. She suggested I report the side effects to the CDC.
CDC Split Type:

Write-up: I felt fine for the first 9 days after receiving the first inoculation, but after 10 days I had an area around the injection site that my skin was bumpy, like a lot a mosquito bites type of bumps. It was an area approximately 2" wide X 3" long on my arm. The next day it was the same. The third day, that area of my arm turned red and got warm and a little swollen. The 4th day it remained red, warm, and swollen. On the 5th day, my arm went back to normal and I had no other side effects. I received my second Moderna shot this afternoon. I''ll let you know if I have side effects from it.


VAERS ID: 1696150 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: sore arm/shoulder for a couple days


VAERS ID: 1696476 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-18
Onset:2021-08-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cognitive disorder, Computerised tomogram, Confusional state, Depressed mood, Disorientation, Dizziness, Fatigue, Fear, Feeling abnormal, Feeling drunk, Headache, Impaired work ability, Insomnia, Loss of personal independence in daily activities, Mental impairment, Myalgia, Nausea, Panic reaction, Slow response to stimuli, Speech disorder, Tinnitus, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Hearing impairment (narrow), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, caffeine
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Blood work/ CT scan, PCP and ER visits (both agree that this is a response to the vaccine but have no clue how to fix it) Doctors have tried to prescribe me Diazepam, Ambien, and Nortriptyline to help with my sleep and anxiety/depression. All these medications seem to worsen my cognitive symptoms and I cannot take them.
CDC Split Type:

Write-up: after getting the first dose of moderna on 8/18/21, I had muscle soreness and a little fatigue that night. On Monday morning 8/23 I woke up having trouble speaking, otherwise I felt fine. Tuesday (the next day) I woke up with vertigo, a headache, a very vague sense of disorientation, nausea, ringing in my ears, confusion and slow responsiveness. I felt intoxicated to the point that I couldn''t work or complete daily tasks. On Wednesday 8/25 I went to see my primary care physician and he gave me a methyprednisalone taper. Over the course of the next week after the taper I felt no better, and I still felt very intoxicated, confused, lightheaded, constant headaches, I space out constantly and I generally feel like I''m about 20% of my typical mental baseline. Its hard to even function properly. I cannot handle more than one thing at a time and I have become very scared and depressed that I will never return to normal. I have a constant ringing in my ears and I have a lot of difficulty sleeping, its like my mind begins to panic when I start to doze off. I have been out of work for almost a month and I''m not seeing any improvement in my cognitive disability. I have been a work from home software developer for almost 2 years now and I have never had any health problems, or psychiactric issues before this. I didnt start becoming depressed until a week or so after this started and hearing multiple doctors tell me that they dont know whats causing this or how long I will be like this.


VAERS ID: 1696719 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-19
Onset:2021-08-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Novolog, Tresiba, Metformin, Vit D, Vit B12, Losartan, Metoprolol, Omeprazole, Fish Oil, Coconut Oil. Vit E, Biotin, Keratin
Current Illness:
Preexisting Conditions: Type 1 Diabetic (have had pancreatitis) with Hypertension
Allergies: Lortab and Lantus
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 4 day after the injection I developed a rash/hives on both arms and the tops or hands. Approximately a week later my injection site became red and very itchy and I also developed a rash/hives on the backs of my legs at the knee bend. It has now been 25 days since the injection and I stillo have the rash/hives on the back of my legs but the ones on my arms are gone.


VAERS ID: 1697012 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207421A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest discomfort, Chest pain, Confusional state, Dizziness, Fatigue, Feeling abnormal, Headache, Injection site pain, Memory impairment, Pain in extremity, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood work the 20th , to hard to list it all
CDC Split Type:

Write-up: Dizzy after shot, was shaking in the middle of the night 24hrs after about an hour had no temp, fever hours later, arm where shot burned for a week, few days in pain in left leg up into thigh for days, headache few days in and off and on throughout and still having, chest pain a few days in for atleast a week and a half, feel like chest is heavy, walking a short distance and I can?t breathe , use to hike 6-8 miles can?t do much exercise anymore , very tired, head was foggy for over a week, seem very confused , forgetful , not energy, definitely wasn?t a good choice for me to get the shot, over 3 weeks and some days I feel awful. Headaches scare me and don?t seem to go away, got bloodwork after a week was alittle elevated , definitely changed me , and I work in a hospital frontline the whole time and never got it, or got it and didn?t know, I get the shot and feel awful since


VAERS ID: 1697198 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-16
Onset:2021-08-23
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Pruritus, Skin warm, Urticaria
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine
Current Illness: None
Preexisting Conditions: Depression, anxiety
Allergies: None Seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: Huge raised hive about the size of an apple maybe. Arm very sore/extremely itchy/hot feeling. Took Benadryl and applied ice. Hive lasted around 24 hours.


VAERS ID: 1700114 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-08-23
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Therapeutic product effect decreased
SMQs:, Lack of efficacy/effect (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: Birth Control Bupropion
Current Illness: N/A
Preexisting Conditions: Depression/Anxiety
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: My anti-depression medication is less effective than it was prior to receiving the vaccination.


VAERS ID: 1700188 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-22
Onset:2021-08-23
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 UN / ID
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Dyspnoea, Fatigue, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: Gabapentin, Allopurinol, Prozac, Citalopram, HCTZ, Tizanidine, Metformin, Pioglitazone, Cranberry capsules, Omega 3, Bisoprolol, Rosuvastatin, Zetia, Triamcinolone topical, Iron
Current Illness: Unknown
Preexisting Conditions: DM, Esophagel ulceration with esophagitis, Asthma, B12 deficiency Diabetic neuropathy
Allergies: Augmentin, HIbiclens, Hyrocodone
Diagnostic Lab Data: SARS COV2 COVID 19 PCR 08/23/2021
CDC Split Type:

Write-up: The patient presents with 64 year old female with hx of DM presents to the ED with c/o weakness, with associated fatigue, cough, fever, SOB, x2 weeks ago. Pt states she was diagnosed with Covid 2 weeks ago, and sx have been worsening the past 3 days. Per husband, her sx have been declining since she was diagnosed with Covid, but is worse the last 3 days. Pt is vaccinated for Covid. Pfizer. Pt is aaox4 but feeling very weak all over. No focal weakness. Pt denies cp, nausea, vomiting, abdominal pain, diarrhea . Risk factors consist of diabetes mellitus. Associated symptoms: shortness of breath, fever, fatigue , cough, denies chest pain, denies abdominal pain, denies nausea, denies vomiting, denies chills, denies HA


VAERS ID: 1700321 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-13
Onset:2021-08-23
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Cough, Dyspnoea, Peripheral swelling, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol, Levaquin, Amlodipine, ASA, Lipitor, Cymbalta, Diabetic Tussin Ex Syrup, Diff-Stat, Colace, Dulcolax, Folic acid, Duoneb, Synthroid, MOM, Iron, Zofran, MiraLax, Protonix, Vit B6, Senna
Current Illness: Unknown
Preexisting Conditions: Lung CA, Chemotherapy, HTN, Kidney disease, Thyroid disease
Allergies: Contrast dye, Iodine, contrast medium
Diagnostic Lab Data: SARS COV2 COVID 19 PCR (negative 08/24/2021) SARS COV2 COVID 19 PCR (POSITIVE 08/28/2021)
CDC Split Type:

Write-up: ry of Present Illness The patient presents with worsening of chronic dyspnea over past 4 days which was said to have been ongoing for years. Has had to increase O2 from 2L baseline. Also reports some swelling of the LE BL and cough. Denies use of anticoagulants, denies fever, denies nausea, denies Hx DVT. Pt has a h/o lung cancer not currently on chemo. The onset was chronic. The course/duration of symptoms is worsening (over past 4 days). Risk factors consist of hypertension and Lung cancer. Therapy today: oxygen and emergency medical services.


VAERS ID: 1700328 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-13
Onset:2021-08-23
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Cardiac monitoring abnormal, Chest discomfort, Chest pain, Dyspnoea, Fibrin D dimer normal, Headache, Heart rate irregular, Myocarditis, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine in December 2020, large knot on injection site
Other Medications: Phentermine, Buspirone, Blisovi
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: September 13th I received my test results. Heart monitor showed 2 extra beats, D-Dimer Test did not show clots but the other blood test showed inflammation on my heart. Myocarditis
CDC Split Type:

Write-up: 1-9days had headaches, 10th day heart palpitations , 11th and 12th day chest tightness and pains, 13th air felt thick, alittle hard to breath. Wore a heart monitor and blood drawn


VAERS ID: 1700483 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-03
Onset:2021-08-23
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT RECORDED / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT RECORDED / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Flank pain, Nausea, Nephrolithiasis, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Iron, ASA, D3, Neurontin, Lopid, Zinc, Tamulosin, Carvedilol, Coumadin, Gabapentin, Singulair, Enoxaparin, Cardizem, Losartan, Amitriptyline, Vit D2, Calcitriol
Current Illness: Unknown
Preexisting Conditions: CAD s/p CABG, CHR, MVD s/p valve replacement, HTN, HLD, DM, Renal Stones, Chronic renal insufficienty, Ostomyelitis, Atrial flutter, BPH, Hearing loss, MVRR, MV insufficiency, Myringotomy, Polypectomy, Vitrectomy
Allergies: No know allergies
Diagnostic Lab Data: SARS COV2 COVID 19 PCR 08/23/21
CDC Split Type:

Write-up: The patient presents with Left flank pain x5 days with associated nausea since 2pm. Pt who was here on 8/19 for the same complaint reports he presents to the ED due to worsening pain from an 8.5mm stone on his left that hasn''t been able to pass on its own. Pt states he tried to get an appointment with his urologist but was unable to. Associated symptoms: nausea, denies chest pain, denies vomiting, denies diarrhea, denies back pain, denies shortness of breath, denies fever, denies chills, denies headache and denies dizziness. (Covid 19 incidental finding)


VAERS ID: 1700525 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-08
Onset:2021-08-23
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Cough, Diarrhoea, Headache, Heart rate increased, Nausea, Pain, Palpitations, SARS-CoV-2 test, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin, Omega 3, Trulicity, Ropinirole, Glimepiride,
Current Illness: Unknown
Preexisting Conditions: DM, Thyroid disease, Afib
Allergies: No known allergies
Diagnostic Lab Data: SARS COV2 COVID 19 PCR 08/24/2021
CDC Split Type:

Write-up: The patient presents with palpitations. Pt states today she has experiencing nausea, cough, headache, body aches, abdominal pain with vomiting and diarrhea. Notes she feels as if her heart is going to beat out of her chest it is going so fast. Pt has hx of a-fib and tried taking her medication but vomited it up shortly after due to the nausea. She denies chest pain, shortness of breath or fevers. The onset was today. The course/duration of symptoms is fluctuating in intensity. Risk factors consist of atrial fibrillation. Associated symptoms: nausea, vomiting, denies syncope, denies dyspnea, denies shortness of breath and denies headache.


VAERS ID: 1700576 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-21
Onset:2021-08-23
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Patient is fully vaccinated. Hospitalized due to COVID-19.


VAERS ID: 1700653 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

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

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

Write-up: Dose error Patient aged 16 yrs Moderna Vaccine product not indicated for use in persons under age 18 yrs


VAERS ID: 1700707 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO171 / UNK RA / -

Administered by: Public       Purchased by: ?
Symptoms: Autoimmune disorder, Condition aggravated, Fatigue, Lip swelling, Migraine, Paraesthesia, Paraesthesia oral, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazol, unithroid, Liothyronine, zofran as needed, B-12, Magnesium, low dose aspirin,
Current Illness:
Preexisting Conditions: asthma, RA, adrenal issues, Thyroid, autoimmune disease, seizures,
Allergies: Pnc, Cipro, Helcion,- life threating. ASA (low dose seems to be ok) Ibuprofen, Hydrocortisone, Cortisporin- Breathing issues Phenergan, Compazine- Drops BP Very low Erythromycin ? allergy when I was a kid but, have been on low dose z-packs without issue. Food allergies: Shellfish, Gluten, Black Pepper, Aspartame, Garlic
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lips, tongue, and face tingling , lips and face swelled. with in 45 mins, after the first dose of vaccine. lasting about an hour. 3 weeks later still dealing with fatigue, migraines, autoimmune flare


VAERS ID: 1701138 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-03-01
Onset:2021-08-23
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 RA / UN

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, COVID-19, Diarrhoea, Ear discomfort, Headache, Nasal congestion, Nasal discomfort, Oropharyngeal pain, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Covid test PCR at Pharmacy on august 25, did Abbott BiNax Now home test same day, both positive
CDC Split Type:

Write-up: Got breakthrough Covid infection. Lasted a week, sore throat, very tickly nose, clogged ears, headache, nasal congestion, periodic sharp pain in my lower left side front stomach area, diarrhea.


VAERS ID: 1701914 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH T-C3182 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Anger, Anxiety, Depression, Energy increased, Feeling abnormal, Feeling hot, Insomnia, Mood altered
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (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: daily vitamen
Current Illness:
Preexisting Conditions:
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shot # 1: Day 1- 7 Sleepy hardly can keep eyes open. Sharp burning pain on right shoulder blade within 30 minutes of shot. highlighted all pain areas ie: I have a bad knee.. wasn''t hurting that day till after the shot. It was alright durable. I also got alot of hotflashes.. even fans werent keeping me cool Shot #2 Day one felt fine till 30 minutes after my hands weren''t my hand felt felt like i had no control over them only my nubs (all i could see were nubs and my hands were see through" I don''t really remember the ride home. The rest of the day i wasn''t tired but felt like my body wasn''t my body. at night i got a-lot of energy and couldn''t go to sleep. (I could run a maraton with my energy). Day 2 my anxitey and mood level were at an all time high freaked out over everything and was ready to say something if someone said something wrong to me. At the end of this day i was burning up room tempure water felt like ice cubes on me. sat outside in the cold to cool down. Day 3 Im feeling alright still in the afternoon i feel like i get over heated. So far my close ones around me have noticed that I have a short temper since the first shot and my depression came back. I have a hard time remember things like i use to. like my phone number in times that i need to remember it, spelling and remembering what i was doing and where i just sat things down. Feels like early demetia. well see how day for goes


VAERS ID: 1703939 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-05
Onset:2021-08-23
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 UN / SYR

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

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

Write-up: I contracted COVID-19 virus after being fully vaccinated.


VAERS ID: 1703977 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #EWO187 / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blister, Blood pressure increased
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hypersensitivity (broad)

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

Write-up: Blisters on back side of arm down to wrist and raise in blood pressure for about a week.


VAERS ID: 1704545 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-18
Onset:2021-08-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase normal, C-reactive protein normal, Chest X-ray normal, Chest discomfort, Chest pain, Dyspnoea, Fibrin D dimer normal, Full blood count normal, Lymph node pain, Red blood cell sedimentation rate normal, Troponin normal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Ventolin HFA, citalopram 10mg daily, amlodipine 10mg daily, vitamin C, Multivitamin
Current Illness:
Preexisting Conditions: Anxiety with depression, elevated blood sugar, hypertension, migraine headaches, tobacco use, likely COPD
Allergies: Seasonal allergies
Diagnostic Lab Data: Normal chest xray, normal troponin, CK, d-dimer, ESR, CRP. CBC largely normal, done 9/13/21
CDC Split Type:

Write-up: Chest pain, chest tightness, shortness of breath, sore neck glands


VAERS ID: 1704775 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-21
Onset:2021-08-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

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

Write-up: Received vaccine on 08/21/2021, felt symptomatic on 08/23/2021. Patient experienced extreme pain on injection site on the left arm. Developed swelling on arm and swollen lymph nodes on the armpit. Was off of work for 1 week. Took Tylenol and applied an unknown balm to relieve swelling and pain.


VAERS ID: 1704825 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-18
Onset:2021-08-23
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthenia, Atrial fibrillation, Blood culture negative, Blood gases, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Computerised tomogram thorax, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Crepitations, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Fibrin D dimer increased, Lung disorder, PO2 decreased, Pyrexia, Rhonchi, SARS-CoV-2 test positive, Sputum culture, Troponin increased, Urine analysis normal
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, allopurinol, atorvastatin, carvedilol, diclofenac gel, aspirin, exemestane, gabapentin, glipizide, levothyroxine, losartan, metformin, omega-3 acid and metolazone
Current Illness:
Preexisting Conditions: PMH of CAD s/p MI, Dilated Cardiomyopathy, Combined HF with EF of 30-35%, HTN, HL, DM, Hypothyroidism, Gout, Obesity, Left Breast cancer, s/p left mastectomy, history of appendectomy, PVD s/p stents in legs, s/p hysterectomy and OA
Allergies: lisinopril, prednisone, pregabalin, ceftaroline, morphine
Diagnostic Lab Data: 8/25/21 COVID19: positive 8/27/21 Chest xray: Significant enlargement of the cardiac silhouette. Associated pulmonary vascular congestion is seen. Airspace disease is likely at least partially to CHF. Superimposed changes of COVID-19 pneumonia not excluded. Further evaluation as clinically indicated. 8/27/21 CTA chest: congestive failure and COVID-19 pneumonia. No PE
CDC Split Type:

Write-up: presented to the ED on 8/27/21 for evaluation of weakness, cough and SOB since 8/22/21. Pt tested positive for COVID 19 on 8/25/21. Pt has received both doses of Moderna vaccine. While in the ED, pt with SpO2 of 93-94% on RA. ABG showed a pO2 of 74.2. D-dimer elevated at 1.63. CT angio chest done showed no PE, but changes consistent with combination of CHF and COVID-19 pneumonia. Pt had crackles and rhonchi on exam. She was started on IV Lasix. Pt admitted for CHF exacerbation. She was started on Azithromycin as well. She had been started on 2 L oxygen because of slightly low PO2 on ABG. Pt with Fever of 101.9 on 8/28. No fever for the last 48 hours. Ordered Urinalysis, Sputum and blood cultures. Blood cultures without growth so far. U/A not suggestive of UTI. No report of sputum culture. IV Azithromycin switched to PO on 8/29. Will discharge with PO Azithromycin; per nurse she has been off of oxygen for over 24 hours and doing well. Cardiology was consulted on admission given elevated troponin. Troponin initially trended up from 0.048 to 0.076, but went down to 0.066. Pt denies any chest pain. Elevation of troponin thought to be likely related to CHF and COVID infection. Troponin has been elevated since March. ECHO showed EF of 30-35% and pseudonormal pattern of LV diastolic filling; no changes from ECHO in June. Nurse reported that pt had new onset Afib on 8/28, so Cardiology has started Xarelto. Discharged 8/30/21


VAERS ID: 1704851 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-07
Onset:2021-08-23
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray normal, Laboratory test normal, Mobility decreased, SARS-CoV-2 test positive
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: He has a past medical history of Brown-Sequard syndrome (1995), Drinks three beers per day, ED (erectile dysfunction), Hernia of scrotum, High blood pressure, High cholesterol, and Tobacco dependency.
Allergies: Aspirin, probiotic, atorvastatin, calcium carbonate-vitamin D, Lotrisone cream, lisinopril, tadalafil
Diagnostic Lab Data: 8/23/21 COVID19: positive 8/24/21 chest xray: negative
CDC Split Type:

Write-up: Presented to ED on 8/23/21 with weakness and struggling to get around the house. Not short of breath and afebrile. Did receive his COVID vaccine with Johnson and Johnson in May 2021. He was found to have COVID positive. He is not hypoxic at this time. He is just weak and debilitated. He is agreeable to hospitalization at this time.Patient XR chest and lab work was unremarkable. Patient did not require any respiratory support and vitals were stable. Patient reported feeling better. Patient was advised to qurantine at home and monitor his symptoms and seek medical care with any changes. Patient is medically stable to be discharge Home on 8/24/2021


VAERS ID: 1704976 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-06
Onset:2021-08-23
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Bursitis
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Elbow bursitis in left arm


VAERS ID: 1705899 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-05
Onset:2021-08-23
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood test, Dysmenorrhoea, Heavy menstrual bleeding, Menstruation irregular, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Fertility disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit C, B complex, vit D, probiotics
Current Illness: A cold on 7/10/21
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: Blood work 9/14/2021, scheduling for MRI and EMG
CDC Split Type:

Write-up: Bilateral leg pain, tingling, and weakness, abnormal period- one week early, heavy, and painful


VAERS ID: 1706812 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-14
Onset:2021-08-23
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chest discomfort, Cough, Deafness, Drug ineffective, Ear pain, Fatigue, Hypersensitivity, Insomnia, Rhinorrhoea, SARS-CoV-2 test, Sinusitis, Sneezing, Toothache
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Lack of efficacy/effect (narrow), Taste and smell disorders (narrow), Hearing impairment (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210827; Test Name: COVID-19 virus test; Test Result: Positive ; Result Unstructured Data: COVID-19 virus test positive
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Coughing; Tightness in chest; Exhaustion; COVID-19; Lack of drug effect; Lost hearing; Sinus infection / Head congestion; Allergy attack; Sneezing; Blowing her nose al the time; Really bad ear pain; Pain in her teeth; Lost sense of taste; Lost sense of smell; Insomnia; This spontaneous case was reported by a consumer and describes the occurrence of DEAFNESS (Lost hearing) in a 44-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 047A21A and 032M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 14-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Aug-2021, the patient experienced DEAFNESS (Lost hearing) (seriousness criterion medically significant), SINUSITIS (Sinus infection / Head congestion), HYPERSENSITIVITY (Allergy attack), SNEEZING (Sneezing), RHINORRHOEA (Blowing her nose al the time), EAR PAIN (Really bad ear pain), TOOTHACHE (Pain in her teeth), AGEUSIA (Lost sense of taste), ANOSMIA (Lost sense of smell) and INSOMNIA (Insomnia). On 27-Aug-2021, the patient experienced COVID-19 (COVID-19) and DRUG INEFFECTIVE (Lack of drug effect). On 29-Aug-2021, the patient experienced COUGH (Coughing), CHEST DISCOMFORT (Tightness in chest) and FATIGUE (Exhaustion). At the time of the report, DEAFNESS (Lost hearing), SINUSITIS (Sinus infection / Head congestion), HYPERSENSITIVITY (Allergy attack), SNEEZING (Sneezing), RHINORRHOEA (Blowing her nose al the time), EAR PAIN (Really bad ear pain), TOOTHACHE (Pain in her teeth), AGEUSIA (Lost sense of taste), ANOSMIA (Lost sense of smell), INSOMNIA (Insomnia), COUGH (Coughing), CHEST DISCOMFORT (Tightness in chest), COVID-19 (COVID-19), DRUG INEFFECTIVE (Lack of drug effect) and FATIGUE (Exhaustion) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 27-Aug-2021, SARS-CoV-2 test: positive (Positive) COVID-19 virus test positive. Concomitant product use was not provided by the reporter. No treatment information was provided.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.


VAERS ID: 1706885 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, Fatigue, Grip strength decreased, Headache, Tinnitus, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hearing impairment (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: Allergy to antibiotic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210823; Test Name: Blood pressure; Result Unstructured Data: Blood pressure increased
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: She drops things; Kind of a headache; Felt tired for the first couple of days; Got tinnitus, can only hear whistles and noise; Shaking, hands are shaking / hand shaking; This spontaneous case was reported by a consumer and describes the occurrence of TINNITUS (Got tinnitus, can only hear whistles and noise), TREMOR (Shaking, hands are shaking / hand shaking), GRIP STRENGTH DECREASED (She drops things), HEADACHE (Kind of a headache) and FATIGUE (Felt tired for the first couple of days) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 049E21A) for COVID-19 vaccination. Concurrent medical conditions included Allergy to antibiotic. On 23-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Aug-2021, the patient experienced TREMOR (Shaking, hands are shaking / hand shaking). On 27-Aug-2021, the patient experienced TINNITUS (Got tinnitus, can only hear whistles and noise). On an unknown date, the patient experienced GRIP STRENGTH DECREASED (She drops things), HEADACHE (Kind of a headache) and FATIGUE (Felt tired for the first couple of days). At the time of the report, TINNITUS (Got tinnitus, can only hear whistles and noise), TREMOR (Shaking, hands are shaking / hand shaking), GRIP STRENGTH DECREASED (She drops things), HEADACHE (Kind of a headache) and FATIGUE (Felt tired for the first couple of days) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 23-Aug-2021, Blood pressure measurement: increased (High) Blood pressure increased. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient did not take any medication for the adverse events and does not take any concomitant medications. Most recent FOLLOW-UP information incorporated above includes: On 05-Sep-2021: Patient medical history and lab data were added. Event verbatim was changed and hand shaking event date was added.


VAERS ID: 1706940 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Product administration error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: patient received a 3rd dose from a vial in which rubber stopper broke and fell into the vial; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT ADMINISTRATION ERROR (patient received a 3rd dose from a vial in which rubber stopper broke and fell into the vial) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 088D21A) for COVID-19 vaccination. No Medical History information was reported. On 23-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Aug-2021, the patient experienced PRODUCT ADMINISTRATION ERROR (patient received a 3rd dose from a vial in which rubber stopper broke and fell into the vial). At the time of the report, PRODUCT ADMINISTRATION ERROR (patient received a 3rd dose from a vial in which rubber stopper broke and fell into the vial) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant and no treatment medication was provided Most recent FOLLOW-UP information incorporated above includes: On 07-Sep-2021: non significant follow up appended


VAERS ID: 1707380 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Myalgia, SARS-CoV-2 test, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEXAPRO; VITAMIN D3
Current Illness:
Preexisting Conditions: Comments: No Medical History was provided by the reporter.
Allergies:
Diagnostic Lab Data: Test Date: 20210906; Test Name: SARS CoV-2 test; Test Result: Positive ; Result Unstructured Data: Positive; Test Date: 20210907; Test Name: SARS CoV-2 test; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (Ache and pain all over her body, muscle pain), ARTHRALGIA (Joint pain), HEADACHE (Headache), FATIGUE (A few days later she felt tired all the time, A few days later she felt tired all the time) and SARS-COV-2 TEST POSITIVE (She took two at home COVID test, which came out positive both times) in a 44-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 052E21A) for COVID-19 vaccination. No Medical History was provided by the reporter. Concomitant products included ESCITALOPRAM OXALATE (LEXAPRO) and COLECALCIFEROL (VITAMIN D3) for an unknown indication.On 23-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Aug-2021, the patient experienced MYALGIA (Ache and pain all over her body, muscle pain). On 24-Aug-2021, the patient experienced ARTHRALGIA (Joint pain) and HEADACHE (Headache). On an unknown date, the patient experienced FATIGUE (A few days later she felt tired all the time, A few days later she felt tired all the time) and SARS-COV-2 TEST POSITIVE (She took two at home COVID test, which came out positive both times). The patient was treated with IBUPROFEN for Myalgia, at a dose of Unknown. At the time of the report, MYALGIA (Ache and pain all over her body, muscle pain), ARTHRALGIA (Joint pain), HEADACHE (Headache), FATIGUE (A few days later she felt tired all the time, A few days later she felt tired all the time) and SARS-COV-2 TEST POSITIVE (She took two at home COVID test, which came out positive both times) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 06-Sep-2021, SARS-CoV-2 test: positive (Positive) Positive. On 07-Sep-2021, SARS-CoV-2 test: positive (Positive) Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.


VAERS ID: 1707465 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-01
Onset:2021-08-23
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Adnexa uteri pain, Amenorrhoea, Complication of pregnancy, Ectopic pregnancy, Inappropriate schedule of product administration, Maternal exposure during pregnancy, Menstrual disorder
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Fertility disorders (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:
Current Illness: Asthma
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: missed her period after vaccination; her period turned completely different; lower ovarian pain/Her pain didn''t go away; she received her 1st dose of Moderna COVID 19 vaccine on 1Jul2021. She believed she got her 2nd dose in July as well, and she thinks she got it 2 weeks after; Maternal exposure during pregnancy; ectopic pregnancy/pregnancy was in her fallopian tube; she was pregnant, but she had complication; This spontaneous retrospective pregnancy case was reported by a consumer and describes the occurrence of ECTOPIC PREGNANCY (ectopic pregnancy/pregnancy was in her fallopian tube) in a 30-year-old female patient (gravida 2, para 1) who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 in January 2021. Concurrent medical conditions included Asthma. On 01-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In July 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. Last menstrual period and estimated date of delivery were not provided. On 23-Aug-2021, the patient experienced ECTOPIC PREGNANCY (ectopic pregnancy/pregnancy was in her fallopian tube) (seriousness criterion medically significant) and COMPLICATION OF PREGNANCY (she was pregnant, but she had complication). On an unknown date, the patient experienced AMENORRHOEA (missed her period after vaccination), MENSTRUAL DISORDER (her period turned completely different), ADNEXA UTERI PAIN (lower ovarian pain/Her pain didn''t go away), INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (she received her 1st dose of Moderna COVID 19 vaccine on 1Jul2021. She believed she got her 2nd dose in July as well, and she thinks she got it 2 weeks after) and MATERNAL EXPOSURE DURING PREGNANCY (Maternal exposure during pregnancy). The delivery occurred on an unknown date, which was reported as Elective Termination. For foetus 1, The outcome was reported as Ectopic pregnancy. induce a miscarriage. At the time of the report, ECTOPIC PREGNANCY (ectopic pregnancy/pregnancy was in her fallopian tube) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (she received her 1st dose of Moderna COVID 19 vaccine on 1Jul2021. She believed she got her 2nd dose in July as well, and she thinks she got it 2 weeks after) had resolved and COMPLICATION OF PREGNANCY (she was pregnant, but she had complication), AMENORRHOEA (missed her period after vaccination), MENSTRUAL DISORDER (her period turned completely different), ADNEXA UTERI PAIN (lower ovarian pain/Her pain didn''t go away) and MATERNAL EXPOSURE DURING PREGNANCY (Maternal exposure during pregnancy) outcome was unknown. Patient had a Depo shot on18Aug2021 for birth control. No Treatment information was reported. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Causality for the maternal exposure during pregnancy is not applicable; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Causality for the maternal exposure during pregnancy is not applicable.


VAERS ID: 1707611 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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 Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1708044 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-15
Onset:2021-08-23
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Description of events from Patient Message sent through our patient portal: "On August 15th I got the Pfizer vaccine. I have been on birth control for probably 4-5 years now and I?ve always had a little nausea if I forget it and then double up to make up for it but never anything weird or out of the ordinary has happened the entire time I?ve been on birth control. I missed two days of birth control, Friday and Saturday, I doubled up on Sunday (22nd) and Monday (23rd). I received my allergy immunology shot on Monday 23rd (I?m building up still, so I get them every Monday). My tongue swelled on Monday 23rd and got incredibly sore to the point where it was painful to speak. Internet said it could be hormonal.. so I called the pharmacy where I got my birth control ask if that can be a hormonal reaction involving birth control, they said no. I contacted my allergist since I received that the same day, before she was in the allergy department she was an OBGYN, and said that it?s more likely to be hormone related since, I had doubled up. Since the swelling started toward the evening, and not following immediately after the shot, she said it?s very likely to be hormone related. I have never had anything weird like that happen, and it was followed by an entire week of miserable nausea. Out of my female family and female friends who received a covid vaccine, most have had hormonal/heavy/clotted menstrual reactions to the covid vaccines. Since hormones effect menstrual cycles, and my tongue swelling was followed by an entire week of incredible nausea, I figured it might be helpful to report."


VAERS ID: 1708591 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood test, Bradycardia, Electrocardiogram, Headache, Impaired work ability, Loss of consciousness, Sinus rhythm, Syncope
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), 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 1ST DOSE COVID HEADACHE RESOLVED
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ER HAD DONE ECG AND HEART AND BLOOD LABS
CDC Split Type:

Write-up: PATIENT CAME IN 9/17/21 MORNING TO ASK ABOUT IMMUNIZER WHO GAVE HER PFIZER VACCINE ON 8/23/2021 AND TO REPORT THE ADEVERSE REACTION THAT SHE HAD AFTER GETTING VACCINE. PATIENT REPORTED SHE WAS HEALTHY AND NEVER HAD HEART ISSUES UNTIL THE SEOCND DOSE OF VACCINE. SHE HAD BEEN DIAGNOSED WITH HEART PROBLEM AND NOW SHE HAS HEART RATE MONITOR AFTER VACCINE EVENT AND SHE IS NOT BACK TO NORMAL CANNOT GO BACK TO WORK SHE IS STILL LOW ENERGY. PATIENT MENTONED WITH 1 ST DOSE ON 7/28/21 SHE HAD BAD HEADACHE AND SHE TOOK 2 TYLENOL WHICH TOOK CARE AND SHE WAS FINE. ON 8/13/21 SHE HAD SECOND DOSE SHE HAD BAD HEADACHE AND SHE LEFT PHARMACY AFTER 20 MINUTES AND WHEN SHE WENT HOME 10 MINUTES AFTER SHE WAS ABOUT TO TAKE TYLENOL IN KITCHEN AND SHE HAD PASSED OUT. HER HUSBAND CALL 911 AND SHE WOKE UP IN EMERGENCY ROOM WITH HEART RATE MONITOR. AS PEPER FROM ER SHE HAD ABNORMAL ECG. DIAGNOSIS ON PAPER MENTIONED PATIENT HAD SYNCOPE, BRADY CARDIA WITH HEART RATE 30 AND SINUS RHYTUM BIGEMINY. PT NOW SEES CARDILOGIST AND HE IS MONITORING HER. PT WAS NOT HAPPY SINCE HER LIFE IS NOT NORMAL ANYMORE. SHE WANTS SOMEONE FROM CDC TO CALL HER. I INFORMED PATIENT THAT WE WILL BE REPORTING THIS ADR TO CDC , VAERS WEBSITE AS PER PHARMACY INTERNAL SYSTEM.


VAERS ID: 1708954 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-08-19
Onset:2021-08-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray, Computerised tomogram, Dehydration, Feeding disorder, Fluid intake reduced, Headache, Laboratory test, Loss of personal independence in daily activities, Lumbar puncture, Magnetic resonance imaging, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: 8/28/2021 ER visit which complete lab work, CT, chest x-ray, and spinal tap 9/1/2021 ER visit with fluids and meds 9/3/2021 ER visit with admission - COVID test, labs, MRI
CDC Split Type:

Write-up: Severe headache for three weeks which required three trips to the ER and on the third visit, he was admitted. Headache would be so severe that when he got up, he would be throwing up. He couldn''t eat or drink anything which caused severe dehydration. He missed two weeks of school. Although the headache has improved, it still has not completely gone away. He has an appointment with a neurologist in November which is the earliest we could get. It has now been over a month since he has received the vaccine.


VAERS ID: 1708955 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-23
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Emotional distress, Suppressed lactation
SMQs:, Depression (excl suicide and self injury) (broad), Functional lactation disorders (narrow)

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

Write-up: I was breastfeeding and my milk supply dropped to almost nothing a week after getting the vaccine. I am so upset about it. I also got my menstrual cycle back. I can no longer breastfeed my baby.


VAERS ID: 1709212 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-18
Onset:2021-08-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthritis, Chest pain, Condition aggravated, Constipation, Diarrhoea, Dyspnoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (narrow), Noninfectious diarrhoea (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dicyclomine, Advair, metoprolol, singulair
Current Illness:
Preexisting Conditions: asthma, irritable bowel disease, arthritis
Allergies: metronidazole
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe constipation followed by severe diarrhea 3-5 days after the constipation. Shortness of breath and chest pain when exercising or walking up steps. Worsening of arthritis. Severe fatigue


VAERS ID: 1709628 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Impaired work ability, 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: Multivitamins & minerals supplements
Current Illness: None
Preexisting Conditions: High cholesterol
Allergies: Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: High fever 101F started around 8:00 p.m. on 08/23/2021 and broke around 6:00 a.m. on 08/24/2021. When the fever broke I got a splitting headache and took 800 mg of ibuprofen and the headache subsided and never returned. For the rest of 08/24 and all of 08/25, I was very tired. On 08/26 I felt well enough to return to work.


VAERS ID: 1709636 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-19
Onset:2021-08-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Chest pain, Dyspnoea, Mobility decreased, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methadone; Aspirin; Benedryl
Current Illness: None
Preexisting Conditions: Closed head injury syndrome Stroke in 2014
Allergies: NSAIDS
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 3 or 4 days after Mr second shot I awoke to a sharp pain on the right side of my chest and underarm that I can only liken to a broken rib. It was excruciating and made breathing very painful for about five days. I could not stay out of bed and had to have my right arm raised over my head when I was not laying in bed. Only lying on my right side somewhat eased the pain. I could not lay in any other position without extreme pain. After about five days of this, the pain began to travel to the right side of my back, finally I was able to breathe without involuntary yelps of pain escaping from me. As more days passed, this severe pain slowly worked its way down my right side and then slowly down to my right thigh, then painfully behind the knee, eventually encompassing my entire leg. Now almost a month later, there are still remnants in my shin. But it''s almost gone now, a month later. It never went into my foot.


VAERS ID: 1710058 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal distension, Anaphylactic reaction, Blood test, Loose tooth, Palatal swelling, Swelling, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 25mg Hydrochlorothiazide Vitamin D once per week
Current Illness: none
Preexisting Conditions: Hereditary Angioedema Type 3, elevated blood pressure
Allergies: very slight to bananas, latex mild irritation
Diagnostic Lab Data: September 1, 2019 blood test for HAE, type 3 ++
CDC Split Type:

Write-up: ANAPHALAXIS, TONGUE SWELLING FOLLOWING INJECTION, REPEATED TONGUE, FACE, NECK CHEST ABDOMIN SWELLING, REPEATED LY HOURLY THROUGH sEPTEMBER 11, 2021, NOW CONSTANT ABDOMINAL SWELLING WITH HUGE SWELLS AND INTERMITTANT TONGUE SWELLS., FACE SWELLS, NECK AND CHEST SWELLS. Roof of mouth swells, causing loose teeth. Swelling made the patient unrecognizable. Patient began 150mg Orladeyo for type 3 HAE on September 3, 2021, which has slowed the swells and slightly lessened severity, but not eliminated them. High doses of Prednison, benedryl, and Pepsid did nothing to reduce or eliminate the swelling, anaphalaxis.


VAERS ID: 1710180 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-23
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms, Muscular weakness, Vaccination site reaction
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Frequent muscle spasm in the left arm (site of vaccine injection). Estimated to last 60% of the day. Weakness of muscles in left arm. Severe headache. Severe muscle cramps and pain in both legs.


VAERS ID: 1710609 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088DZ1A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blindness, Blister, Body temperature, Ear pain, Fatigue, Herpes zoster, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Shingles (Episodes shingles in 2014); Shingles (Episodes shingles in 2009)
Allergies:
Diagnostic Lab Data: Test Date: 20210823; Test Name: Body temperature; Result Unstructured Data: fever 103.8; Test Date: 20210824; Test Name: Body temperature; Result Unstructured Data: fever 100.5; Test Date: 20210825; Test Name: Body temperature; Result Unstructured Data: fever 100.5; Test Date: 20210826; Test Name: Body temperature; Result Unstructured Data: fever 100.5; Test Date: 20210827; Test Name: Body temperature; Result Unstructured Data: fever 100.5; Test Date: 20210828; Test Name: Body temperature; Result Unstructured Data: fever 100.5; Test Date: 20210829; Test Name: Body temperature; Result Unstructured Data: fever 100.5; Test Date: 20210830; Test Name: Body temperature; Result Unstructured Data: fever 100.5; Test Date: 20210831; Test Name: Body temperature; Result Unstructured Data: fever 100.5
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Vision loss; Nose blisters; Ear pain; Rash on right face above eye,scalp,chest; Extreme fatigue; Diagnosed shingles; Fever 103.8; This spontaneous case was reported by a consumer and describes the occurrence of BLINDNESS (Vision loss) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 088DZ1A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Shingles (Episodes shingles in 2009) in 2009 and Shingles (Episodes shingles in 2014) in 2014. Previously administered products included for Product used for unknown indication: Shingles vaccine (Shingles vaccine) in 2010. Past adverse reactions to the above products included Adverse event with Shingles vaccine. On 23-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Aug-2021, the patient experienced PYREXIA (Fever 103.8). On 24-Aug-2021, the patient experienced HERPES ZOSTER (Diagnosed shingles). On 25-Aug-2021, the patient experienced BLISTER (Nose blisters), EAR PAIN (Ear pain) and RASH (Rash on right face above eye,scalp,chest). 25-Aug-2021, the patient experienced FATIGUE (Extreme fatigue). On an unknown date, the patient experienced BLINDNESS (Vision loss) (seriousness criterion medically significant). At the time of the report, BLINDNESS (Vision loss) had not resolved, HERPES ZOSTER (Diagnosed shingles) and PYREXIA (Fever 103.8) had resolved and BLISTER (Nose blisters), EAR PAIN (Ear pain), RASH (Rash on right face above eye,scalp,chest) and FATIGUE (Extreme fatigue) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 23-Aug-2021, Body temperature: 103.8 (High) fever 103.8. On 24-Aug-2021, Body temperature: 100.5 (High) fever 100.5. On 25-Aug-2021, Body temperature: 100.5 (High) fever 100.5. On 26-Aug-2021, Body temperature: 100.5 (High) fever 100.5. On 27-Aug-2021, Body temperature: 100.5 (High) fever 100.5. On 28-Aug-2021, Body temperature: 100.5 (High) fever 100.5. On 29-Aug-2021, Body temperature: 100.5 (High) fever 100.5. On 30-Aug-2021, Body temperature: 100.5 (High) fever 100.5. On 31-Aug-2021, Body temperature: 100.5 (High) fever 100.5. The concomitant medications were not reported. The treatment information was not provided. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Some individuals have been known to develop autoimmune diseases following vaccines such as Herpes. Fever and fatigue are consistent with the product known safety profile Most recent FOLLOW-UP information incorporated above includes: On 03-Sep-2021: The follow up document was received and had no new information. On 10-Sep-2021: Follow-up document received contain patient new event (Vision loss) added and case upgraded to serious.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Some individuals have been known to develop autoimmune diseases following vaccines such as Herpes. Fever and fatigue are consistent with the product known safety profile


VAERS ID: 1710783 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-08-23
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Confusional state, Delirium, Dizziness, Feeling abnormal, Hypertension, Malaise, Migraine, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker; Traumatic brain injury (Approximately 2 years due to the car accident.)
Preexisting Conditions: Medical History/Concurrent Conditions: Automobile accident; Comments: The patient had no prior cardiac history and had no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210825; Test Name: Blood pressure; Result Unstructured Data: 176/100 mmHg, High; Test Date: 202109131400; Test Name: Blood pressure; Result Unstructured Data: 165/92 mmHg, High; Test Date: 202109131800; Test Name: Blood pressure; Result Unstructured Data: 165/100 mmHg, High
CDC Split Type: USJNJFOC20210926256

Write-up: NOT FEELING RIGHT; HIGH BLOOD PRESSURE; DIZZINESS, LIGHTHEADEDNESS; MILD CONFUSION; SEVERE MIGRAINE, HEADACHE; HEART POUNDING; NOT FEELING WELL; DELIRIOUS; This spontaneous report received from a patient concerned a 42 year old female of an unspecified ethnic origin. The patient''s weight was 173 pounds, and height was 67 inches. The patient''s past medical history included: car accident, and concurrent conditions included: traumatic brain injury approximately 2 years due to the car accident, non smoker, and non alcohol user. The patient had no prior cardiac history and had no known allergies. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A, and expiry: unknown) dose was not reported, 1 total administered at right deltoid on 23-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 23-AUG-2021, Since she had taken vaccination the patient experienced not feeling well ( for 3 weeks now), on the same day she experienced light headedness and it kept getting worst with other developing symptoms included dizziness, mild confusion, severe migraine, headache, delirious and heart pounding. On 25-AUG-2021, the patient experienced episode of high blood pressure (1.5 days after the vaccination). It was also reported that she was driving and she was not feeling well, an ambulance was called and took blood pressure which read 176/100 mmHg. On 13-SEP-2021, she experienced that she was not feeling well and her customer, who was a nurse, took her blood pressure and read 165/92 mmHg at 14:00. During her physical therapy session at 18:00, she mentioned that she was not feeling right, and her blood pressure read 165/100 mmHg. On 14-Sep-2021, patient also reported that she was having her first appointment with her primary health care provider (PHCP) regarding this concern. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from high blood pressure, dizziness, lightheadedness, mild confusion, severe migraine, headache, delirious, heart pounding, not feeling well, and not feeling right. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0:20210926256-JANSSEN COVID-19 VACCINE Ad26.COV2.S- delirious -This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1711136 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Feeling weak after second shot; Feeling tired after second shot/Spent time in bed after second shot; This spontaneous case was reported by a consumer and describes the occurrence of ASTHENIA (Feeling weak after second shot) and FATIGUE (Feeling tired after second shot/Spent time in bed after second shot) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 23-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Aug-2021, the patient experienced ASTHENIA (Feeling weak after second shot) and FATIGUE (Feeling tired after second shot/Spent time in bed after second shot). On 24-Aug-2021, ASTHENIA (Feeling weak after second shot) and FATIGUE (Feeling tired after second shot/Spent time in bed after second shot) had resolved. No treatment informations were reported.


VAERS ID: 1711368 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Gout, Pain
SMQs:, Arthritis (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: ASPIRIN (E.C.)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101109697

Write-up: suffered from gout; I am in considerable pain; This is a spontaneous report from a contactable consumer (patient). A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot number was not reported, Expiry date: unknown) dose 2 via an unspecified route of administration on 23Aug2021 as dose 2, single for covid-19 immunization. The patient medical history was not reported. Concomitant medication(s) included acetylsalicylic acid (ASPIRIN (E.C.). The patient stated, just got the second vaccine (Covid-19 Vaccine) two days ago and the second one Pfizer and suffered from gout and was in considerable pain on 23Aug2021. Wanted to know if the patient can take an Aspirin. Outcome of events was unknown. The lot number for the vaccine, [BNT162B2] was not provided and will be requested during follow-up.


VAERS ID: 1711377 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Headache, Myalgia, Pain in jaw
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Osteonecrosis (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101110683

Write-up: bad headache; muscle pain in her jaw; Jaw pain; he went to withheld and got the 3rd pfizer vaccine; This is a spontaneous report from a contactable consumer. A 68-years-old female patient received bnt162b2 (Pfizer-BioNTech COVID-19 Vaccine, solution for injection), dose 3 via an unspecified route of administration on 23Aug2021 (at the age of 68-years-old) (Batch/Lot Number: FD8448) as dose 3, single for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. Patient previously took first dose of BNT162B2 (at the age of 68-years-old) (lot number: EL3246, vaccine location: Right arm) on 07Jan2021 and second dose of BNT162B2 (at the age of 68-years-old) (lot number: EL3246) on 26Jan2021 for covid-19 immunisation. Patient previously took Flu Shot 25 years ago reported to CDC. The patient experienced bad headache and muscle pain in her jaw on 24Aug2021. The patient was administered with 3rd dose of covid-19 vaccine and exposed to off label scenario. Patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient received treatment for the event bad headache. The outcome of the event bad headache and muscle pain in her jaw and jaw pain was not recovered. The outcome of all the other events was unknown.


VAERS ID: 1711440 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-05-07
Onset:2021-08-23
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Coagulation test, Computerised tomogram, Dizziness, Feeling abnormal, Magnetic resonance imaging
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: TIVICAY; DESCOVY
Current Illness: HIV disease
Preexisting Conditions: Medical History/Concurrent Conditions: Vertigo (3 years ago)
Allergies:
Diagnostic Lab Data: Test Date: 20210825; Test Name: Clotting test; Result Unstructured Data: Test Result:Unknown results; Test Date: 20210824; Test Name: CAT scan; Result Unstructured Data: Test Result:Unknown results; Test Date: 20210824; Test Name: MRI; Result Unstructured Data: Test Result:stroke; Test Date: 20210825; Test Name: MRI; Result Unstructured Data: Test Result:Unknown
CDC Split Type: USPFIZER INC202101128253

Write-up: had a mild stroke; Lightheadedness; Dull feeling under the skin; This is a spontaneous report from a Pfizer sponsored program COVAX US support. A contactable consumer (patient) reported that a 57-years-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration at the age of 57-years-old on 07May2021 (Lot Number: EW0165) as single dose for covid-19 immunisation. Medical history included HIV from 1991 and ongoing, vertigo from 2018 (3 years ago). Concomitant medications included dolutegravir sodium (TIVICAY) taken for HIV from 2013 and ongoing; emtricitabine, tenofovir alafenamide fumarate (DESCOVY) taken for HIV from 2013 and ongoing. The patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration at the age of 57-years-old on 16Apr2021 (Lot Number: EW0164) as single dose for covid-19 immunization and had the sore arm; meningitis vaccine at the age of 57-years-old in Aug2021 (2 weeks ago). On 23Aug2021, he had a mild stroke and he also had heavy shaking eyes and lightheadedness for 5 to 6 days after the stroke; dull feeling under the skin. Caller clarified and said that the rapid eye movements that he experienced lasted for 20 minutes and then the lightheadedness was after that and it had lasted for about 5 days; also where they shaved a spot on his head for the magnetic resonance imaging (MRI) that diagnosed it as a stroke, on top of his head a little to left, there was a spot and he didn''t really know how to explain it but he feels like there is something that happened there. There''s like a dull feeling under the skin like he can tell that something happened, he didn''t really understand. He was not in pain and he wouldn''t say there was pressure there but he doesn''t know how to explain it. But he can feel something and it has been that way since it happened. He could feel the spot and it doesn''t hurt when he pushes on it and he doesn''t have a headache or anything but he just feels like something is there. Caller clarified that this has been that way since he had the stroke. For the event mild stroke, this was around 6:30 PM on 23Aug2021. He said that the rapid eye movements and the lightheadedness were his symptoms of the stoke. He didn''t know if he was having a seizure or a stroke. He wasn''t sure what was going on because that has never happened before to him. He didn''t go to the doctor until the next morning at 10:20 on 24Aug2021. He clarifies and said that he called his regular doctor and they said to go to the hospital so he went right to the emergency room and they did all of the tests and kept him over night and then they released him the next evening around 6 PM. He Confirmed dates as populated within formal fields. He was admitted to the first floor. He was completely ambulatory and went to the bathroom if he needed to. He was inquired if he had recovered completely and he said that he was at about 97%, he still didn''t feel completely himself but he was back to work, today was his first day back to work. He confirmed he had improved. For the event dull feeling under the skin, he noticed it between 24Aug2021 and 25Aug2021 around 3:00 or 3:30 in the morning and he let them know about that and that he was slightly lightheaded. When he woke up there was a vent in front of the bed on the ceiling and when he looked at it, it had slightly moved to the left and that lasted for maybe 10 minutes. When he looked at something it would move and he still has that dull feeling. He also would say that he was still very slightly lightheaded but not to where he feels like he needs to sit down or stop, it has gotten better, like he said he was at 97% better. He also wanted to mention that he had a bout of vertigo 3 years ago. A week after he had gotten lightheaded they gave him some type of IV medication for that vertigo and it had been gone since then. He tried to take some motion sickness stuff and a prescription form of it and it didn''t do anything, but whatever they gave him in the IV did work. All he would say was that he didn''t drive home after that and he doesn''t remember getting home. The patient was hospitalized for a mild stroke from 24Aug2021 to 25Aug2021. Investigations: He had an MRI when he got there and then another when he was discharged. At first they did a CAT scan and then an MRI, both on 24Aug2021, Tuesday, and then before he left the hospital they gave him a second MRI which was on Wednesday, 25Aug2021. They also did a clotting test before the left the hospital and from what he heard it had came back fine. They took 15 vials of blood and did that clotting test. The patient underwent lab tests and procedures which included coagulation test: unknown results on 25Aug2021, computerised tomogram: unknown results on 24Aug2021, magnetic resonance imaging: stroke on 24Aug2021, magnetic resonance imaging: unknown on 25Aug2021. The outcome of the events was recovering.


VAERS ID: 1711604 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest discomfort, Chest pain, Electrocardiogram, Fatigue, Headache, Pain, Vaccination site pain
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high (Mother has a lot of issues high blood pressure and a lot of things going on with her.); Chromosomal anomalies; Endocrine disorder; Hypersensitivity; Immune status; Obesity; Respiratory disorder; Sleep apnea
Allergies:
Diagnostic Lab Data: Test Name: Blood Test; Result Unstructured Data: Test Result:Normal; Test Name: chest x-ray; Result Unstructured Data: Test Result:Normal; Test Name: EKG; Result Unstructured Data: Test Result:Normal
CDC Split Type: USPFIZER INC202101145044

Write-up: chest pain; Tired; Headache; Body aches; Left arm sore at injection site; having chest discomfort; This is a spontaneous report from a contactable consumer. This 45-year-old male consumer reported that. A 45-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot Number: FC3180), dose 1 via an unspecified route of administration, administered in Arm Left on 23Aug2021 18:30 as (At the age of 45-years) dose 1, single for covid-19 immunisation. Medical history included diagnosed allergies, compromised immune status, respiratory illness, genetic/chromosomal abnormalities, endocrine abnormalities (including diabetes) and obesity. Illness/AE: Sleep apnea (3-4 years ago. Doctor said to lose some weight. He is breathing like he has sleep apnea. It was reported that patient Mother has a lot of issues high blood pressure and a lot of things going on with her. It was reported that He got COVID virus last Dec2020. When he got it, it was not as bad as the COVID is now. He did not have any problems with his heart. He just had headaches and body aches and that is it. No Other Products, Patient History and no Investigation Assessment ware reported. No History of all previous immunization with the Pfizer vaccine considered as suspect (or patient age at first and subsequent immunizations if dates of birth or immunizations are not available). No Prior Vaccinations within 4 weeks. No AE prior vaccinations. The patient experienced chest pain on an unspecified date, patient having chest discomfort and left arm sore at injection site on 23Aug2021, patient experienced tired, headache, body aches on 24Aug2021. It was reported that patient having chest discomfort and chest pain after receiving his first dose of the vaccine. It has been 10 days and he is still experiencing chest discomfort. Caller has visited the ED and a cardiologist. The caller was prescribed Tylenol in the ED which he says it was not helping. Caller was nervous to receive his second dose of the vaccine. Caller is asking for other treatment recommendations. Caller said he doesn''t have insurance and is expecting the hospital bill. He asked ''who is going to pay for it. Caller reports have been prescribed Tylenol while in the ED to alleviate his chest pain/discomfort. Later reporter describes that patient got his first dose a week ago last Monday, more than 10 days, and has a feeling of pressure on his heart. He then said Chest Pain, and discomfort and he went to the ER. He never had problem in his life with his heart. Now he got vaccine and he is feeling these symptoms. He went to ER on Sunday and they did all these tests and checked everything, and it was all normal. Only thing they gave him was Tylenol. Sometimes, it is not helping. He wanted to know if there is something else, he can do for the chest pain and discomfort. It was reported that on this past Tuesday, he went to see a Cardiologist. Sometimes the chest pain feels like it the same. It comes and goes. The only thing they gave him was Tylenol and it does not provide relief. When he had that discomfort, he feels anxiety. He does not know what is going on with his heart. It is not a pleasant thing to feel, and he never had any problem. The following day he had headache, and body aches. The headache is gone. Sometimes he feels it for half a day, but he also had body aches and was tired. All of those have gotten better. The Tylenol manufacturer is Johnson and Johnson, and it is 500 mg each tablet. He was taking 2 tablets every 6 hours. Total count size 24 tablets. The Lot is ADA071 and expiration Feb2025. He first stated it was 100mg, but when he got the bottle, he confirmed it was 500mg each tablet. It was reported that on 29Aug2021 went to Hospital. They did all kind of test and everything was normal. EKG, blood test and chest x-ray were done, and all were normal. They gave him Tylenol and they said to go to his primary care doctor. He did an appointment with a cardiologist last week because he was not feeling well. He got an appointment on Tuesday. She did the same thing; the EKG, put electrodes on his chest and that is it. Everything looked normal. She suggested to do an Ultrasound of heart. The Ultrasound is 300 and he cannot afford it. The medical bill from his hospital, he does now know how much it will be either. It was reported that patient went to ER at 8pm and was out at 02:00. The patient underwent lab tests and procedures which included blood tests, cerebro-spinal fluid culture, pleural fluid culture, urine culture, diagnostic imaging, (e.g., chest X-ray, MRI). Test: EKG, Blood test and chest x-ray were all normal. The outcome of event chest discomfort was not recovered, outcome of event chest pain was unknown, and outcome of all other events was recovering at the time of report. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1711697 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-28
Onset:2021-08-23
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, Extra dose administered, Off label use, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210823; Test Name: COVID test; Test Result: Positive
CDC Split Type: USPFIZER INC202101151752

Write-up: TESTED POSITIVE FOR COVID; TESTED POSITIVE FOR COVID; bnt162b2 (BNT162B2), dose 3 on 21Aug2021; bnt162b2 (BNT162B2), dose 3 on 21Aug2021; This is a solicited report based on the information received by Pfizer (Mfr. Control Number: 21K-163-4054978-00) from a non-contactable consumer (patient). A 50-year-old female patient received bnt162b2 (BNT162B2), dose 3 intramuscular on 21Aug2021 (Batch/Lot number was not reported, at age of 50 years old) as single dose, dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose, dose 1 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for Covid-19 vaccination; risankizumab (SKYRIZI [RISANKIZUMAB]), via an unspecified route of administration from an unspecified date (Batch/Lot number was not reported) to 28Jun2021, at unspecified dose for moderate to severe chronic plaque. The patient medical history was not reported. The patient''s concomitant medications were not reported. On 23Aug2021, the patient experienced tested positive for COVID. The action taken in response to the events for risankizumab was temporarily withdrawn on 28Jun2021. The outcome of events drug ineffective and COVID-19 was not recovered. Causality for bnt162b2: The reporter''s causality for the event COVID-19 virus test positive was unrelated. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Sender''s Comments: Based on the temporal relation the events of Drug ineffective, COVID-19, off label use and extra dose administered are related to the suspect product of BNT162B2


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