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From the 10/8/2021 release of VAERS data:

Found 781,870 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 430 out of 7,819

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VAERS ID: 1591639 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-23
Onset:2021-08-16
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 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: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVI D


VAERS ID: 1591646 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: Reported to have began same day as injection and persisting at time of call


VAERS ID: 1591648 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Pruritus, Rash, Rash erythematous, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily Iron, Vitamin D, B-12
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin, Erythromycin, Tetracycline, Sulfa Meds
Diagnostic Lab Data: I discussed with the pharmacist today and she said it was an expected reaction, and to report it here as well.
CDC Split Type:

Write-up: About 24 hours after receiving the shot, I began to break out in red hives, with lots of itching covering my full body. My right arm and shoulder were even tighter hives, hot to the touch. I placed Calamine lotion on the skin, and it subsided in about 45 mins. The next day I had hives still on the insides of my arms, and tops of my feet. By Wednesday all was gone. I had no other side effects except for a very sore right arm, even after following protocol directions to drink plenty of water and use it as much as possible.


VAERS ID: 1591694 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-08-16
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: COVIC + on 08/18/2021


VAERS ID: 1591723 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient fainted in parking lot after vaccine administration


VAERS ID: 1591730 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-08-16
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure during pregnancy, Ultrasound antenatal screen abnormal, Uterine disorder
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Follow up anatomy Ultrasound 8/16/21 diagnosed my baby with bilateral clubfeet.
CDC Split Type:

Write-up: Pregnancy due date is 12-6-2021. Baby has bilateral clubfeet. This is my 4th child. No abnormalities with my precious three. Specialists do not believe this abnormaliry to be related to the vaccineas they believe it was due to a septum in my uterus but I wanted this reported.


VAERS ID: 1591803 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 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: Pt received a dose of this, instead of Moderna, which she received the previous 2 doses


VAERS ID: 1591857 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-07
Onset:2021-08-16
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril (PRINIVIL, ZESTRIL) 10 mg tablet TAKE 1 TABLET DAILY tamsulosin (FLOMAX) 0.4 mg capsule Take 1 capsule (0.4 mg) by mouth 1 time per day atorvaSTATin (LIPITOR) 20 mg tablet Take 1 tablet (20 mg) by mouth 1 time per day famotidine
Current Illness: N/A
Preexisting Conditions: Coronary atherosclerosis Acute myocardial infarction (HCC) Essential hypertension Hyperlipidemia Family history of prostate cancer Bee sting allergy
Allergies: bee
Diagnostic Lab Data: Covid PCR test
CDC Split Type:

Write-up: Patient contracted Covid


VAERS ID: 1591861 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-01
Onset:2021-08-16
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034V21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain of skin, Pruritus, Rash erythematous, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: adderall, fluvoxamine, gummy multivitamin, probiotic. occasional over the counter allergy medications (claritin).
Current Illness: none
Preexisting Conditions: fibromyalgia, celiacs
Allergies: gluten, penicillin, metals, -sulfas
Diagnostic Lab Data: Just an examination by my GP three days after they appeared (8/19/21)
CDC Split Type:

Write-up: I noticed a hive forming 4 weeks after second vaccine. it started small and grew almost to the size of my upper arm within a few days (left arm). I also grew an identical hive on the right arm where I had received my first vaccine. They are hot, itchy, swollen (one day), red, painful and sting like fire or glass. Took Benadryl, Claritin, cold hydrocortisone cream and ice packs for the first few days. Got an appointment with my doctor and was prescribed three days (2 pills at 40mg) of Prednisone (steroid) and was told to take 20 mg of Pepcid to tackle the itch and inflammation. I was also told to continue what I was already doing. I still have the hives and it is currently five days after initial sighting. They are also different than my first hives. My first hives were spots around my right elbow. These hives are small spots around the injection site with large areas of redness surrounding them.


VAERS ID: 1591955 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-15
Onset:2021-08-16
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: POSITIVE COVID PCR TEST 8/16/21
CDC Split Type:

Write-up: PATIENT CONTRACTED COVID DESPITE BEING FULLY VACCINATED AT TIME OF EXPOSURE/POSITIVE PCR TEST


VAERS ID: 1591995 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-02
Onset:2021-08-16
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalized with PE and COVID 19


VAERS ID: 1592012 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nausea, Skin burning sensation
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: headache, nausea, burning feeling under skull


VAERS ID: 1592079 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin d, vitamin c, heliocare with nictinamide(b3)
Current Illness: Sinus congestion and hayfever 1- 2 weeks prior. Clear at vaccination date.
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chest pain, having to take deep breaths starting approximately 8/16. As week went on it continued and increased. Crushing feeling, pain, especially in evenings. Worse with laying on back. Fatigue. Today is 8/20/21. Persist.


VAERS ID: 1592097 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066021A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Carditis, Chest pain, Computerised tomogram thorax, Echocardiogram, Magnetic resonance imaging, Scan with contrast, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Entyvio, Omeprazole, Aspirin
Current Illness: N/A
Preexisting Conditions: Crohn''s Disease, Factor V Leiden Blood Clotting Disorder
Allergies: Chlorohexidine, Phenergan, Shrimp
Diagnostic Lab Data: troponin levels, echocardiogram, MRI, chest CT with contrast
CDC Split Type:

Write-up: After 48 hours post-vaccine, I developed pain in the left shoulder blade region. After an additional 24 hours (72 hours post-vaccine), the pain had spread to the chest area and so I took aspirin. After an additional hour, there was no relief and it felt like I was having a heart attack so I went to the emergency. I was admitted to the hospital and they found elevated troponin levels which indicated inflammation of my heart. Additional tests confirmed this. I was released after one day and prescribed NSAIDs to treat inflammation events. I am still experiencing issues with chest pain whenever I walk for more than five minutes or do normal household tasks.


VAERS ID: 1592108 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-22
Onset:2021-08-16
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 PCR positive 8/16/21 after receiving 2-dose Pfizer series
CDC Split Type:

Write-up: Pt presented to ED 8/16/21 for URI symptoms - tested positive for COVID-19 on PCR


VAERS ID: 1592127 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Diarrhoea, Hypoaesthesia, Nausea, Peripheral coldness, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: metformin, Humulin N, amlodipine
Current Illness: none
Preexisting Conditions: DM type 2, HTN
Allergies: NKDA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Fever, chills, diarrhea & nausea two hours after vaccination. Left shoulder numbness radiating to the entire left arm, fingers are always cold up to date.


VAERS ID: 1592133 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Patient had a fever, chills, and cold feet


VAERS ID: 1592141 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 immunisation
SMQs:, COVID-19 (narrow)

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

Write-up: Moderna administered when patient reported that his first dose was Moderna, and intake personnel wrote "M" at top of sheet indicating this was to be a Moderna vaccine. Personnel then filled in info at the bottom of intake form that first dose was Pfizer, administered at another location. Nurse (myself) did not verify by seeing at the bottom of intake form that first dose had been Pfizer. Patient was notified and voiced understanding.


VAERS ID: 1592149 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Impaired work ability, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Pt took vaccine on 8/16 @vaccine event, she started to have symptoms couple hours after administration of Headache, dizziness, nausea, heart racing. She went to urgent care on 8/19 still dizziness and headache was prescribed Zofran, had been out for work 8/18-8/20. Feels better since urgent care visit returns on 8/23


VAERS ID: 1592356 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Migraine, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: First dose: Chest pain 5 days. SOB. Second dose: Chest pain 3 days. Migraine 5 days. SOB 1 day. Tx? None.


VAERS ID: 1592357 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-01
Onset:2021-08-16
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid 8/19
CDC Split Type:

Write-up: Client was vaccinated with Moderna vaccine for Covid on or about April 1 and May 1, 2021. Developed Covid symptoms (mild) on 8/16. Tested PCR + on 8/19. Reported as a breakthrough Covid case in a fully vaccinated person.


VAERS ID: 1592536 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: don''t know
Current Illness: none
Preexisting Conditions: none
Allergies: don''t know
Diagnostic Lab Data: not sure
CDC Split Type:

Write-up: patient fainted minutes after shot administered. emergency services called after it was determined patient hit her head during fall.


VAERS ID: 1592548 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 688DZIA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Inflammation, Myalgia, Neuralgia, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rabies vaccine age 45, May 2016
Other Medications: Prednisone Cymbalta Ibuprofen Propranolol
Current Illness: Sinusitis
Preexisting Conditions: POTS Migraine
Allergies: Diphenhydramine Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Inflammatory reaction in various nerves in head and neck causing pain and numbness myalgia in legs and arms numbness and tingling in hands and feet Lasting 5 days as of this report Treated with nsaids, acetaminophen, flexeril


VAERS ID: 1592555 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Nausea, Peripheral swelling, Swelling face, Throat tightness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Shellfish, peanuts
Diagnostic Lab Data: None. I did not go to hospital or Doctor and symptoms are much less.
CDC Split Type:

Write-up: I had severe chest pain and could not breathe. I also experienced swelling in my face, hands and feet. My throat felt like it closed and I also felt like I needed oxygen. I had to stand up and was breathing very hard for several minutes and nauseous. This went on for three days, on and off throughout each day. I almost went to emergency room


VAERS ID: 1592561 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin Vitamin D2 2000 IU three times a week
Current Illness: Tested positive for covid 7/26/2021. Out of quarantine and symptom free at time of vaccination. Mandated by work.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Approximately 7 hours after receiving the vaccine experienced chills and fever accompanied with headache for 36 hours. Severe body aches started 12 hours post vaccine


VAERS ID: 1592569 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Hyperhidrosis, Nausea, Neck pain, Pain in extremity, Pyrexia, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Within 5 minutes of injection, I was sweating profusely, black/blurry vision, immediate headache, felt faint, and nauseated. I vomited once at minute 5, and after that all symptoms subsided. By minute 15, I was fine. I had a mild headache all day, lowgrade fever (98-99, usual temp is 96), and fatigued, but otherwise felt ok. That night, I had a severe headache with neck pain and a fever of 101-103 with chills. Took tylenol and drank water all night. The following morning, temp was 99-101, moderate headache. By the afternoon, all symptoms were gone except a minor headache and sore arm. Today is day 5 and all that''s left is a sore arm and fatigue.


VAERS ID: 1592994 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood glucose, Electrocardiogram, Feeling abnormal, Headache, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Went to get my Pfizer covid shot. Thought it be best to do since I?ll be traveling again more. Within 2-3 minutes of getting it (they told me to stay for 15 minutes to just hang out) I felt super weird and then faint. I?ve passed out several times before and knew it was coming on quick. I sat down and propped myself up in a corner of the room and knocked loudly on the back room to the pharmacy. I was in some small waiting room back there. The pharmacist came out and I told her I wasn?t feeling good and needed water. She went to get water and that was all I remember. I was out. Started dreaming then my head started hurting really bad and realized she was over me talking to me and my head was wedged in the corner as I had slumped down and back. I even seemed to feel my body shaking like I was seizuring. I sat up and came to and texted my husband then started vomiting. Non stop. They called an ambulance. Paramedics came and checked my blood pressure and oxygen and heart ekg and did a dizzy test by having me stand. I was just so weak from losing all my food contents.


VAERS ID: 1594369 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-08-16
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Antibody test, HIV test, Therapy non-responder
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:
Current Illness: Abstains from alcohol; Cigarette smoker (cigarettes occasionally); HIV infection; Immunocompromised; Irritable bowel syndrome
Preexisting Conditions: Comments: The patient had no known allergies nor history of drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Date: 20210816; Test Name: Antibody test; Result Unstructured Data: undetected/negative; Test Name: HIV test; Result Unstructured Data: positive
CDC Split Type: USJNJFOC20210832913

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned an 18 year old male. Initial information was processed along with the additional information received on 17-AUG-2021. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: cigarette smoker, human immunodeficiency virus (HIV) positive, irritable bowel syndrome (IBS), immunocompromised, and non-alcohol user. The patient had no known allergies nor history of drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 1808609 expiry: UNKNOWN) dose was not reported, 1 total administered to left deltoid on 09-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 16-AUG-2021, the patient got tested for the antibody and the results came back as undetected or negative (coded as confirmed immunological vaccine failure). The patient was not sure if the vaccine was working or whether he would need a booster. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition). The case is associated with Product Quality Complaint number 90000189821.; Sender''s Comments: V0:20210832913-COVID-19 VACCINE AD26.COV2.S-Confirmed immunological vaccine failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1594414 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-16
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Oropharyngeal pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Bell''s palsy (long time ago she had bells palsy); Comments: Patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210835446

Write-up: SLIGHT SORE THROAT; SLIGHT ARM NUMBNESS; TINGLY ARM, FELT LIKE ARM IS ASLEEP; This spontaneous report received from a patient concerned a 61 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included: bells palsy, and other pre-existing medical conditions included: Patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821281, expiry: 06-SEP-2021) dose was not reported, administered on 16-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 16-AUG-2021, the patient experienced slight sore throat. On 16-AUG-2021, the patient experienced slight arm numbness. On 16-AUG-2021, the patient experienced tingly arm, felt like arm is asleep. Treatment medications included: diphenhydramine hydrochloride. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from slight sore throat on AUG-2021, was recovering from slight arm numbness, and the outcome of tingly arm, felt like arm is asleep was not reported. This report was non-serious.


VAERS ID: 1594422 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-16
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Burning sensation, Confusional state, Dizziness, Feeling abnormal, Headache, Heart rate increased, Injection site pruritus, Movement disorder, Nausea, Pruritus, Speech disorder, Vaccination site pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210835654

Write-up: FELT LIKE CRAP; UNABLE TO MOVE AND GET UP FOR WORK; NAUSEOUS; TERRIBLE HEADACHE; ACHE IN LEFT ARM WHERE VACCINE WAS GIVEN; DIZZY; CONFUSED; HARD TIME GETTING WORDS OUT; RAPID HEARTBEAT; ITCHING ON LEFT ARM AT VACCINATION SITE; ITCHING IN SCALP SHOULDER AREA AND WHOLE BACK; WHOLE BACK BURNING; This spontaneous report received from a patient concerned a 47 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A, and expiry: UNKNOWN) dose was not reported, administered on 16-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 16-AUG-2021, the patient experienced dizzy. On 16-AUG-2021, the patient experienced confused. On 16-AUG-2021, the patient experienced hard time getting words out. On 16-AUG-2021, the patient experienced rapid heartbeat. On 16-AUG-2021, the patient experienced itching on left arm at vaccination site. On 16-AUG-2021, the patient experienced itching in scalp shoulder area and whole back. On 16-AUG-2021, the patient experienced whole back burning. On 16-AUG-2021, the patient experienced nauseous. On 16-AUG-2021, the patient experienced terrible headache. On 16-AUG-2021, the patient experienced ache in left arm where vaccine was given. On 18-AUG-2021, the patient experienced felt like crap. On 18-AUG-2021, the patient experienced unable to move and get up for work. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the nauseous, dizzy, confused, hard time getting words out, rapid heartbeat, terrible headache, ache in left arm where vaccine was given, itching on left arm at vaccination site, itching in scalp shoulder area and whole back, whole back burning, felt like crap and unable to move and get up for work was not reported. This report was non-serious.


VAERS ID: 1594443 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-08-16
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Bedridden, Body temperature, Chills, Disorientation, Fatigue, Feeding disorder, Feeling abnormal, Feeling cold, Feeling hot, Hypersomnia, Illness, Malaise, Nausea, Pain, Pyrexia
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), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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
Preexisting Conditions: Medical History/Concurrent Conditions: Knee operation; Comments: The patient had no known allergies and no history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data: Test Date: 20210817; Test Name: Body temperature; Result Unstructured Data: 101 to 102 degrees
CDC Split Type: USJNJFOC20210837430

Write-up: STARTED BEING SICK; FELT DISORIENTATED; STAYED IN BED; WHOLE BODY FELT WEIRD/FELT SO BAD; FEELING HOT; FELT LIKE ACHY IT''S HARD TO EXPLAIN; PRETTY MUCH ASLEEP; CHILLS; NAUSEATED; FEELING TIRED; HIGH FEVER; REALLY DID NOT FEEL WELL; FEEL COLD; HAD NOTHING TO EAT, DRANK GATORADE, AND WATER/UNABLE TO EAT; This spontaneous report received from a patient concerned a 47 year old male. The patient''s weight was 167 pounds, and height was 71 inches. The patient''s past medical history included: couple knee surgeries a couple years ago, and concurrent conditions included: non-alcohol user, and non-smoker, and other pre-existing medical conditions included: The patient had no known allergies and no history of drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808980 expiry: UNKNOWN) dose was not reported, administered on 16-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 16-AUG-2021, the patient experienced had nothing to eat, drank gatorade, and water/unable to eat. On 16-AUG-2021, the patient experienced really did not feel well. On 16-AUG-2021, the patient experienced feel cold. On 16-AUG-2021, the patient experienced feeling tired. On 16-AUG-2021, the patient experienced high fever. On 17-AUG-2021, the patient experienced started being sick. On 17-AUG-2021, the patient experienced felt disorientated. On 17-AUG-2021, the patient experienced stayed in bed. On 17-AUG-2021, the patient experienced whole body felt weird/felt so bad. On 17-AUG-2021, the patient experienced feeling hot. On 17-AUG-2021, the patient experienced felt like achy it''s hard to explain. On 17-AUG-2021, the patient experienced pretty much asleep. On 17-AUG-2021, the patient experienced chills. On 17-AUG-2021, the patient experienced nauseated. Laboratory data included: Body temperature (NR: not provided) 101 to 102 degrees. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from chills, really did not feel well, whole body felt weird/felt so bad, felt like achy it''s hard to explain, felt disorientated, feeling tired, nauseated, started being sick, feeling hot, stayed in bed, feel cold, and pretty much asleep, and the outcome of high fever and had nothing to eat, drank gatorade, and water/unable to eat was not reported. This report was non-serious.


VAERS ID: 1594480 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-08-16
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Hypersomnia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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: ALBUTEROL [SALBUTAMOL]
Current Illness: Asthma
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210840427

Write-up: SLEEP MORE THAN USUAL; CHILLS; STABBING JOINT PAIN; FEVER; This spontaneous report received from a consumer concerned a 40 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: asthma. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 16-AUG-2021 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included salbutamol for asthma. On 16-AUG-2021, the patient experienced sleep more than usual. On 16-AUG-2021, the patient experienced chills. On 16-AUG-2021, the patient experienced stabbing joint pain. On 16-AUG-2021, the patient experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from sleep more than usual, and stabbing joint pain, and the outcome of fever and chills was not reported. This report was non-serious.


VAERS ID: 1595214 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeding disorder, Flushing, Headache, Hyperhidrosis, Injection site pain, Lethargy, Lymphadenopathy, Nausea, Neck pain, Pain, Sleep disorder, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Chills-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium, Systemic: Lymph Node Swelling-Medium, Systemic: Nausea-Medium, Systemic: Unable to Sleep-Medium, Additional Details: Patient states symtoms started 2 days after receiving vaccination. This caused him to be unable to eat. At this time, he then started to have pain on one side of his neck. He noticed over the next couple of days that he had increased swelling and pain. It has stayed the same size/pain level. He does not have a PCP and is going to wait until the following week to seek care, if needed.


VAERS ID: 1602592 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-08-16
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: On 8/16/2021 tested PCR positive for COVID @ an Urgent Care Facility
CDC Split Type:

Write-up: received the 2 doses of Pfizer vaccine on 12/30/2020 and 01/20/2021 and tested positive for COVID-19 on 08/16/2021


VAERS ID: 1602633 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Incorrect route of product administration, Pain
SMQs:, Anaphylactic reaction (broad), Drug abuse and dependence (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Injection was given in the tricep area of the arm. Unknown if given subcutaneous or intramuscular. When questioning the Pharmacist, he stated ?I read somewhere it?s less painful in the tricep area so that?s why I did it there?. Our concern is CDC and monderna states deltoid is most recommend place to give vaccine. Pharmacist was unable to show confidence if he gave it intramuscular or subcutaneous. He lied to us and changed his story when confronted about our concerns. Pt developed redness and pain for 4 days. More over, there are serious concerns if vaccine was given wrong and will result in being ineffective.


VAERS ID: 1602724 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-30
Onset:2021-08-16
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chest pain, Chills, Cough, Diarrhoea, Dyspnoea, Fatigue, Headache, Nausea, Pyrexia, Rhinorrhoea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZPack, Sudogest, Zofran
Current Illness: No
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Chills, Runny Nose, Lost taste and smell, Headache, Fatigue, Cough, Shortness of Breath, Chest Pain, Nausea & Vomiting, Diarrhea


VAERS ID: 1602797 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-08-16
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Headache, Oropharyngeal pain, Pyrexia, Rhinorrhoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (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: plaquenil, imuran,prednisone, Synthroid
Current Illness: No
Preexisting Conditions: Rheumatoid Athritis
Allergies: none
Diagnostic Lab Data: Quidel
CDC Split Type:

Write-up: Fever, Chills, Runny Nose, Sore Throat, Headache, Fatigue, Cough, Wheezing


VAERS ID: 1602829 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthma, Condition aggravated, Injection site reaction, Rash, Rash erythematous, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Breo Elipta Inhaler, Spira Rspimat Inhaler, Albuterol Rescue Inhaler, Montelukast, Duoneb Nebulizer breathing treatment , Fasenera Injection every 8 weeks, Fluticasone Propinate, Bupropion HCL Tab, Alprazolam, Esomepra, Estradial,
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Penicillin, Aspirin, Morphine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 8-16-21 Asthma symptoms got worse, starting improving 8-20-21. On 8-20-21 5:00 AM woke up with rash on injection arm, left arm. The rash was on the inside of the arm, covered most of the area from the wrist to the elbow, and from the elbow to the shoulder there were a couple of areas. The rash was large red welts and the skin around the welts was red also. 8-21-21 rash was showing improvement


VAERS ID: 1602873 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-09
Onset:2021-08-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Dermal cyst, Injection site erythema, Injection site nodule, Injection site warmth, Pain in extremity, Pruritus, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pneumovax (age in mid to late 40''s) redness, swelling of arm, warm to touch
Other Medications: Zyrtec 10 mg nightly. Nasonex 2 squirts each nostril nightly. Vitamin D 1,000 IU daily. Albuterol inhaler when needed (rarely used, only when I have a respiratory infection). Symbicort (only used when needed, when I have a respiratory in
Current Illness: no acute illnesses
Preexisting Conditions: asthma, psoriasis
Allergies: No known allergies to food. Had a local reaction to the Pneumovax vaccine with redness (warm to touch) area around injection site noticed about a week after the injection.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Within a week, my right arm began itching and hurting periodically. At first, there was redness at the injection site about the size of a penny and warm to the touch. The next day, it was the size of a quarter and still warm to the touch. Then, the redness grew to about the size of a half-dollar and was still warm to the touch so I returned to the place I had the vaccine to have the nurse, look at it. She had the manager, over the clinic look at. The told me it was a common reaction to the Moderna vaccine and that I didn''t need to be concerned about getting the second vaccine on 9-7-21. I went to see my own Internal Medicine doctor, about it that day, but was only able to see the nurse. I reminded them I had a similar reaction to Pneumovax. The nurse at my internal medicine doctor''s office measured it to be about 4.1 centimeters. She gave me Tylenol to take and told me to use an icepack for it. She had me return the next day to make sure it had not grown any more. I had the doctor also looked at it because I also had a nodule or something that could be felt under the skin next to the injection site. He said he felt it was unrelated to the redness area and vaccine itself. He said it was a sebaceous cyst. He advised me to go ahead with the second vaccine. He did not feel this would indicate a possible more severe reaction to the second vaccine.


VAERS ID: 1603807 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray normal, Condition aggravated, Dyspnoea, Electrocardiogram normal, Herpes zoster, Injection site erythema, Injection site swelling, Injection site warmth, Insomnia, Pain, Pruritus, Rash
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nothing
Current Illness: Haven''t been ill since Jan 2020
Preexisting Conditions: Possible TIA''s in 2016 and 1989
Allergies: Penecillian., Erythrimiacin, Codeine
Diagnostic Lab Data: Chest xray, EKG, Pulmonary embolism, blood tests all done on 8/18/2021
CDC Split Type:

Write-up: Shots were performed at Clinic, Had the 1st shot on 7/26/2021 had alot of fatigue, sore arm and felt very feverish for 2 days started having some itching on my back however the following week andwhen I looked at back in the mirror I had two spots that looked like misquito bites so just let it go Had 2nd shot on 8/16/2021 within a couple hours my arm had a baseball size, red, raised, warm circle below the shot about 1/2 inch. Within about 4 hours, itching on back worsened and a rash developed on the left side of my back and under my left breast and around my chest cavity. That night I had trouble sleeping and my breathing became short. The next day 8/17 the rash seemed to be spreading and the breathing especially while laying down worsened. I finally could not stand the pain that was developing and the breathing had me concerned I went into the ER on 8/18 about 9am. Chest xrays were done, pulmonary embolism test was performed as well as an EKG. They couldn''t find anything wrong. (the Dr listed on my paper work must have been physician on call because a woman didn''t get her name was the one ordering tests etc...) they briefly looked at my rashes and sent me on my way and said use benadryl cream. The following day I ended up at Doctors office and was diagnosed with Shingles.


VAERS ID: 1604554 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Nausea, Unresponsive to stimuli
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: information not available
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: information not available/ unknown
Diagnostic Lab Data: No lab tests
CDC Split Type:

Write-up: Patient received Johnson & Johnson (#207A21A, exp 09/21) to the left deltoid. While reviewing instructions for post-vax the patient asked if he should be feeling nauseous and then immediately felt lightheaded. Told him it was possible, sit where he was (did not drive to post-vax), turn up AC & honk if felt any worse. Returned to check on the patient & found him unresponsive. Unable to arouse him to verbal command, touch, or sternal rub for 2-3 minutes. 911 was immediately called when the patient was found unable to arouse. Vitals of BP 105-82, pulse 60. Once he awoke he was unable to answer questions or remain awake. After nearly 5 minutes of re-awakening & questioning the patient, he gave his name.. Fire & EMT showed up with pressure 60, pulse 40, 02 90. Patient was moved to an ambulance, where he was evaluated and determined to be stable. Family was called and came to pick up the patient.


VAERS ID: 1606581 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3180 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhaler, losartan potassium, zyrtec, tylenol
Current Illness: None
Preexisting Conditions: Asthma, high blood pressure
Allergies: NSAIDS, shellfish,treenut, eggs, flu vaccine, sulfa medicine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Shortness of breath, chest tightening onset approximately and hr to an 1hr and 15 mins after Pfizer vaccine administered. Oral steroidal treatment prescribed Place on prednisone 50mg once a day for a total of 10 days


VAERS ID: 1617469 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-21
Onset:2021-08-16
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Agitation, Ammonia normal, Anaemia macrocytic, Atelectasis, Bladder catheterisation, Blood creatinine increased, Blood culture negative, Blood magnesium decreased, Blood sodium increased, Blood thyroid stimulating hormone normal, Blood urine present, COVID-19 pneumonia, Candida infection, Chest X-ray abnormal, Chronic kidney disease, Coma scale normal, Computerised tomogram abdomen, Computerised tomogram head abnormal, Computerised tomogram thorax, Culture urine positive, Full blood count normal, Haematuria, Haemoglobin decreased, Hypernatraemia, Hypomagnesaemia, Hypotension, Immobile, Incisional drainage, Mental status changes, Metabolic encephalopathy, Pain, SARS-CoV-2 test positive, Skin ulcer, Spinal fusion surgery, Urinary retention, Urinary tract infection, Urinary tract infection staphylococcal, Urine analysis abnormal, Urine leukocyte esterase positive, Vaccine breakthrough infection, Wound treatment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: clindamycin (CLEOCIN) 150 MG PO Capsule Take 3 capsules by mouth every 6 hours for 13 days. 3/15/18 3/28/18 dabigatran (PRADAXA) 150 MG PO Capsule Take 1 capsule by mouth 2 times daily. SrCr: 1.38* mg/dl (03/12 0417) [last value] 3/15/18
Current Illness:
Preexisting Conditions: HTN, Afib, Neuropathy, BPH, HLD, Sacral Ulcer
Allergies: NKDA
Diagnostic Lab Data: SARS-COV-2, NAA, Detected: 08/16/21.
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. He received Moderna vaccine (2nd dose in series) on 04/21/21. Hospitalized from 08/16/21 - 08/21/21. Below is copied from discharge summary: Acute metabolic encephalopathy on admission: resolved - GCS scale WNL - CT head wo acute process but with chronic WM changes - Ammonia WNL - TSH WNL - Haldol IV prn for agitation - last dose 8/18/2021 - no restrains - STR accepted Complicated UTI Urinary retention with chronic Foley: - BP 88/50s initially but now WNL s/p 1L IV fluids - CBC WBL - UA with positive LE; prior cultures review but no bacteria identified - BC x 2 no growth - U/C: Staph 1K colonies, Yeast not candida albicans 18 K colonies - CT A/P with no acute GI process - Vancomycin, Cipro empirically given while inpatient Atypical PNA COVID 19 pneumonia - Non septic - normal O2 sats at room air - Chest Xray with possible PNA - CT A/P showed possible atypical infection; recent hospitalization this month - COVID test negative - MRSA surveillance not taken - CT chest results reviewed - Duo nebs prn - Contact/ Droplet precautions Infected sacral ulcer present on admission: - unstageable - continue Vancomycin and Cipro empirically - CT A/P did not showed any bone erosions - Continue Vancomycin, Cipro and Flagyl empirically - Generale surgery signed off 8/20/2021 - s/p I+D 8/19/2021, no wound culture available - Hydrocodone prn for pain - ID consulted - wound care: Daily wet to dry dressing changes by nursing and WCT'' - Infectious Diseases recommendations noted , case discussed: augmentin + linezolid x 4 weeks - monitor CBC weekly while on linezolid AKI on CKD AKI resolved -Cr 1.6 $g 0.98 -Likely med induced -IV fluids given -Renally dose meds Macrocytic anemia/ Hematuria: - hemoglobin stable 9.3 -UA with hematuria, no blood seen on foley -CT A/P wo masses Hypernatremia: resolved -145 $g 139 Hypomagnesemia - 1.4 - replaced Atelectasis: - EZPAP Hx of HTN/ Hypotension: - BP soft s/p IV fluids - Hold amlodipine 5, HCTZ and Losartan (normotensive): re start as outpatient as needed / indicated Morbid Obesity, BMI of$g40: -would benefit from lifestyles modifications regarding low fat diet, weight loss and daily excercise -F/U OPD with PCP Chronic Afib on pacemaker: - On Pradaxa - SCDs - re start carvedilol 25 mg BID - Interrogate pacemaker - IV Metoprolol prn Chronic pain s/p lumbar fusion, inmobility: - Resume hydrocodone and gabapentin when feasible - Morphine Iv prn for pain - Hold amitryptiline due to AMS BPH/ urinary retention: - Resume flomax and terazosin - Foley in place HLD: - Resume rosuvastatin when feasible Patient is discharged in stable condition with stable vital signs. All questions rearding hospital course and plan of care after discharge have been answered to satisfaction. Prescriptions for medications needed to be taken after discharge have been given to patient. Patient has been instructed to follow up with PCP within the next 7 days after discharge. Patient verbalizes understanding all given instructions and has no further doubts regarding discharge.


VAERS ID: 1617511 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-29
Onset:2021-08-16
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: PATIENT RECEIVED COVID-19 PFIZER VACCINE Dose 1 date: 12/29/2020 AND Dose 2 date: 1/19/2021. PT TESTED POSITIVE TO COVID ON 8/16/21


VAERS ID: 1617527 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

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

Write-up: Debilitating dizziness, vertigo & nausea occurring since the shot.


VAERS ID: 1617540 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, C-reactive protein increased, Chest X-ray normal, Dizziness, Electrocardiogram abnormal, Eosinophil count decreased, Fibrin D dimer normal, Heart rate increased, Hypertension, Hypoaesthesia, Inflammatory marker increased, Myocardial necrosis marker normal, Neutrophil count increased, Palpitations, Paraesthesia, Sinus tachycardia, Troponin, Urine analysis normal, White blood cell count increased
SMQs:, Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Shellfish, dust, mold, pet dander
Diagnostic Lab Data: 8/16: EKG - sinus tachycardia, trop <0.02, WBC 15.22, absolute neutrophils 12.66, absolute eosinophils 0.01, d-dimer <150, CXR - normal, UA - normal. 8/20: CRP - 1.60, WBC 13.7, absolute neutrophils 9.8, absolute eosinophils 0.10.
CDC Split Type:

Write-up: Palpitations, hypertension, lightheadedness, numbness/tingling from head to toe at 20-minute mark post-vaccination. Numbness/tingling resolved after 15 minutes, palpitations (HR 130-160) and feeling lightheaded persisted, went to ER for evaluation. Cardiac enzymes were normal. Inflammatory markers (WBC, etc.) elevated 6 hours post-vaccination. EKG showed sinus tachycardia. Received a 1L normal saline bolus, HR improved to 90''s-110''s, discharged home with a recommendation to follow up with a cardiologist for Holter monitor. An appointment made, has not occurred yet. Have continued to have issues with elevated HR post-vaccination, on day 4 post-vaccination, began to have burning sensations in my back intermittently, day 5 post-vaccination began to have generalized burning sensations, and numbness/tingling/burning in legs/feet. Went back to ER for evaluation. Strength remains equal and intact, the physician did not order imaging, sent home, and recommended follow up with neurologist if symptoms did not improve in 10 days. Still have paresthesias all over my body and tachycardia at rest.


VAERS ID: 1617542 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-08
Onset:2021-08-16
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Oropharyngeal cobble stone mucosa, Oropharyngeal pain, Pharyngeal erythema, Pharyngeal swelling, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative, Sneezing, Streptococcus test negative
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control - Norethindrone 0.35mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: On August 17, 2021: Strep throat test came back negative COVID-19 test came back negative
CDC Split Type:

Write-up: Throat: sore, red, and swollen; looks like cobblestone throat Nose: running and sneezing Headache Congestion Fatigue


VAERS ID: 1617551 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-10
Onset:2021-08-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Rash, Staphylococcal infection
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

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

Write-up: Patient experienced arm swelling and rash 6 days after the vaccine. She went to urgent care and was advised to go to the emergency room. At the emergency room, she told she had a staff infection and was prescribed two antibiotics. her condition has resolved.


VAERS ID: 1617576 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-30
Onset:2021-08-16
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Less than 3 months after the second shot, I have been diagnosed with shingles. I am incredibly healthy with no underlying health issues. I am 36 years old.


VAERS ID: 1617642 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D2IA / 1 LA / IM

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

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

Write-up: My supraclavicular lymph nodes swelled to the size of grapes. Still swollen. Haven''t been to dr


VAERS ID: 1617669 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Coronary artery thrombosis, Laboratory test
SMQs:, Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (Proventil) 2.5 mg /3 mL (0.083 %) nebulizer solution Inhale 2.5 mg as directed four(4) times daily as needed for wheezing or shortness of breath (sob) 04/03/2021 albuterol 2.5 mg /3 mL (0.083 %) nebulizer solution Indic
Current Illness: None
Preexisting Conditions: ADHD (attention deficit hyperactivity disorder) ? Asthma ? Cerebral palsy ? Depression ? Insomnia ? Kidney stones ? Migraine ? Opioid naive ? Sleep apnea
Allergies: PNC, RISPERDAL
Diagnostic Lab Data: Extensive stroke etiology workup which is negative thus far
CDC Split Type:

Write-up: L MCA stroke from a LCCA thrombus


VAERS ID: 1617737 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, 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: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: IT WAS A VERY BUSY DAY ON A MONDAY AND I WAS GIVING MANY VACCINES. I HAD GIVEN 2 MODERNA SHOTS BACK TO BACK AND I THOUGHT THAT THIS WAS ALSO MODERNA BUT IT WAS SUPPOSED TO BE THE 2ND DOSE OF PFIZER. I REALIZED IT AFTER I GAVE IT WHEN I WAS ABOUT TO GIVE THE CORRECT 2ND DOSE OF PFIZER TO HER MOM. MOMWAS NERVOUS AND A LITTLE UPSET. I IMMEDIATELY APOLOGIZED AND DOUBLE CHECKED WITH THE OTHER RPh ON DUTY TO CONFIRM THAT THEY''RE BOTH INTERCHANGEABLE AND IT''S THE SAME FORMULATION. MOM FELT BETTER AFTER HEARING THAT IT WAS OKAND NO HARM WOULD BE DONE TO HER DAUGHTER. I APOLOGIZED AGAIN AND SHE WAS FINE AFTER THAT.


VAERS ID: 1617743 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088021A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Electrocardiogram, Hypoaesthesia, Pain, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 20mg ER Progesteron, Estrogen 20 mg Trazodone Probiotics, Prebiotics Magnesium, multi-vitamins, Vitamin C, Zinc Quercitin, Vitamin D
Current Illness: Gut Health - bacteria imbalance (not enough good)
Preexisting Conditions: After having Covid in January of 2020 is when the gut health issues started.
Allergies: Food intolerances: dairy, gluten, corn
Diagnostic Lab Data: EKG and monitored heart pressure. They would not do labs. They gave steroids and pain meds and sent me home.
CDC Split Type:

Write-up: Extreme ache in neck, shoulders, upper back. Dizziness. Fingers tingling and numb in both hands. Heaviness on chest.


VAERS ID: 1617815 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chest discomfort, Dizziness, Electrocardiogram normal, Fatigue, Flushing, Heart rate increased, Hyperhidrosis, Hypoaesthesia, Pain, Palpitations, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: First Pfizer vaccine dose, minor issue 5-10 minutes after getting the shot. No issues experienced until getting this second dos
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: ER visit - 08/16/2021. EKG performed, bloodwork performed. No issues noted aside from a fast heartbeat. Dr visit - 08/20/2021. EKG performed. No issues noted. Referred to a cardiologist.
CDC Split Type:

Write-up: I received the second dose of the Pfizer vaccine. Similar to my first shot, around 5-10 minutes after the shot I felt lightheaded, sweaty, and flush. I lied down and that issue subsided after about 20 minutes (my doctor noted that it was likely a vagal response). I had minor aches and tiredness the next couple of days, which I was expecting. I have also had periodic chest tightness, dizziness, numbness in arms, and a fast heartbeat / palpitations. These symptoms come and go in waves and last about 20-30 minutes at a time. They seem to be worse in the early evening. My most concerning episode was on Aug 18 when they did not seem to go away. I went to the ER and had tests, no major issues were noted. I followed up with a doctor visit on Aug 20, no major issues were noted and I was referred to a cardiologist. These issues are persisting but do not appear to be getting worse. I have seen online on forums on website where other people have reported side effects very similar to mine. I would like to get information on what is causing these issues and how to best treat them. Everything I have been told is that my issues are not life threatening but I would like information on what is happening. That information should be readily available for vaccines that are being rolled out for general use.


VAERS ID: 1617817 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-08-16
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies: Almonds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very late menstrual cycle


VAERS ID: 1617827 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Lip swelling, Nasopharyngitis, Pharyngeal swelling, Pruritus, Rhinorrhoea, Skin reaction, Speech disorder, Swelling, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), 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? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had a runny nose and cold-like symptoms over the weekend. Monday night (16Aug21) I started to get extremely itchy. By 0100 on 17Aug21, my entire waistline was swollen, I took OTC Benedryl and went to bed. When I woke up the next morning my entire face was swollen and my lips were triple the size. I went to see my (medical provider), he documented the situation and diagnosed it as potentially being hives. He prescribed me Prednisone and Atarax and gave me calamine lotion. I continued seeing the same symptoms and kept up the same treatment. On Thursday I went to meet my medical provider again and during the exam, I said my throat felt swollen. He had me go to the ER at the medical center. By the time I got there, it was hard to talk. They immediately brought me into a room at the ER and stuck me with an EPI pen. My throat started to clear up and so did some of my symptoms. They started an IV about an hour after the EPI pen and gave me fluids with Benedryl. I was discharged from the hospital three hours later. I experienced the same skin reaction until Sunday morning (22Aug21).


VAERS ID: 1618519 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-08-16
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anaemia, Biopsy bone marrow abnormal, C-reactive protein increased, COVID-19, Chest X-ray normal, Condition aggravated, Haemoglobin decreased, Myelodysplastic syndrome, SARS-CoV-2 test positive, Serum ferritin increased, Transfusion
SMQs:, Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Blood premalignant disorders (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Malignant lymphomas (broad), Myelodysplastic syndrome (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is an 87 year old male with a history of dementia, COPD, anemia, duodenal ulcer due to meloxicam use 11/2020, s/p hemoclips, injection with epinephrine, and argon plasma coagulation, s/p IR embolization of gastric duodenal artery, vitamin B12 deficiency, childhood asthma, hearing impairment, hypertension, hyperlipidemia, coronary Artery Disease s/p coronary stent, prostate CA, thoracic aortic aneurysm, who returns to hospital on 8/16/21 with anemia requiring blood transfusion. Hgb was 6.8 upon admission. He is on ASA. There is no reports of hematemesis, melena, or hematochezia. Patient was seen last month by Hematology because of the same anemia but no GI bleeding was identified. Bone marrow biopsy as outpatient was considered before he was released. He underwent bone marrow biopsy this time and it showed MDS. Only supportive measures are recommended currently. He had COVID infection in January 2021, s/p remdesivir and dexamethasone. He is also fully vaccinated with Pfizer, first dose 1/23/21 and second dose 2/13/21. Patient was tested positive x 2 positive (8/18/21 and 8/19/21) before transferring back to SNF. CRP and ferritin are also elevated. However, patient had not required increase in oxygen from baseline line, and CXR clear. He currently does not require treatments. Patient is cleared to be discharged pending placement.


VAERS ID: 1622737 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-09
Onset:2021-08-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Dizziness, Electrocardiogram, Electroencephalogram, Fall, Gait disturbance, Head injury, SARS-CoV-2 test negative, Scan with contrast, Walking aid user
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: 2015 - Aneurysm with subarachnoid hemorrhage
Preexisting Conditions: neurological disorder
Allergies:
Diagnostic Lab Data: 8/19/21 bloodwork, CTscan, CTscan with contrast, EKG, EEG COVID test (negative)
CDC Split Type:

Write-up: 1 week (8/16/21) after vaccine had onset of dizziness causing a fall. On 8/19/21 had another fall hitting head and had to go to the ER. Hospitalized for 1 night with numerous testing. Continues to be dizzy -walking with walker along with assistance.


VAERS ID: 1623077 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega 3 oil Vitamin b complex Men''s daily multivitamin
Current Illness: COVID-19 positive 7/30/21
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Have not sought treatment. The bumps appeared 2 days after the vaccine and do not itch. They aren''t getting worse but they also aren''t getting better.


VAERS ID: 1623285 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-17
Onset:2021-08-16
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), 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: Covid test completed. Date collected was 08/16/2021 and results where 08/18/2021 - results 2019-nCoV_N1 and 2019-nCoV_N2 both detected
CDC Split Type:

Write-up: Resident was being tested at prior community for Covid due to staff and residents having Covid. She had a temperature of 100 degrees yesterday 08/22/2021. She also has a cough and no taste or smell.


VAERS ID: 1623327 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Night sweats, Pyrexia, SARS-CoV-2 test negative, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HYPOTHYROIDISM
Preexisting Conditions:
Allergies: APPLES, PEARS, KIWI, BERRIES, SOY MILK, ALMONDS CAUSES ORAL PURITUS CLARITIN REDI TABS HIVES
Diagnostic Lab Data: pcr COVID TEST 06/16/2021 NEGATIVE
CDC Split Type:

Write-up: SHORTNESS OF BREATH, EXCESSIVE TIREDNESS, HEADACHE, BLURRY VISION, FEVER, NIGHT SWEATS LASTING 3 DAYS.


VAERS ID: 1623404 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026021A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthritis, Formication, Lymphadenopathy, Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Hypersensitivity (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Hospital 8/23/21
CDC Split Type:

Write-up: Lymph nodes swollen left side arm and underneath arm Inflamed left hand joints Leg pain more severe in the right side with itchiness / sensation of bugs crawling in my legs.


VAERS ID: 1623494 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/16/21. No adverse events have been reported by patient. Error discovered on 8/16/21.


VAERS ID: 1623497 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/12/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623500 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/12/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623506 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-11
Onset:2021-08-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/11/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623510 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/16/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623511 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-10
Onset:2021-08-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/10/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623512 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/12/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623515 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-05
Onset:2021-08-16
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/5/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623518 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/13/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623520 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/13/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623522 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-09
Onset:2021-08-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/9/21. No adverse events have been reported by patient. Error discovered on 8/16/21.


VAERS ID: 1623537 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-18
Onset:2021-08-16
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 - / -

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

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: None stated.


VAERS ID: 1623562 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-08-16
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Public       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: Case positive for COVID-19


VAERS ID: 1623652 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-25
Onset:2021-08-16
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies: UNK
Diagnostic Lab Data: POSITIVE PCR ON 8/16/21.
CDC Split Type:

Write-up: POSITIVE FOR COVID AFTER BEING FULLY VACCINATED- ASYMPTOMATIC


VAERS ID: 1623658 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/16/21. No adverse events have been reported by patient.


VAERS ID: 1623660 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-11
Onset:2021-08-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/11/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623661 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/12/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623663 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-04
Onset:2021-08-16
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/4/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623684 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-04
Onset:2021-08-16
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/4/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623686 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-04
Onset:2021-08-16
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/4/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623688 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Unknown  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/12/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623689 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/12/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623695 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/12/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623697 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

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

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/12/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623698 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/12/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623704 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/13/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623719 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/12/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623722 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/16/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623723 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-09
Onset:2021-08-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Lymph node pain, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (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: Adderall 20mg; Suboxone 8mg, Lorazepam .5mg, Aloe Supplement
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen lymph node on left side next to collar bone. Tender and the size of a grape. First noticed on 8/16 and after 7 days it is still there. The only other symptoms I''ve had are fatigue and sore arm where injection was given.


VAERS ID: 1623725 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-04
Onset:2021-08-16
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/16/21. No adverse events have been reported by patient. Error discovered on 8/16/21.


VAERS ID: 1623727 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/16/21. No adverse events have been reported by patient. Error discovered on 8/16/21


VAERS ID: 1623731 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was maintained at proper refrigeration temperatures, but for longer than 31 days. 7/29/21 was day 31 at refrigeration temps and vaccine was given on 8/13/21. No adverse events have been reported by patient. Error discovered on 8/16/21.


VAERS ID: 1623790 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-12
Onset:2021-08-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac stress test, Catheterisation cardiac, Chest discomfort, Chest pain, Chills, Electrocardiogram normal, Left ventricular end-diastolic pressure, Myocarditis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: MVI Albuterol Amitriptyline 10 mg TRICO 145 mg UBRELVY 50 mg Valsartan 80 mg COLCRYS 0,6 mg
Current Illness:
Preexisting Conditions: HTN Asthma Migraines Hypertriglyceridemia Sinus Arrhythmia
Allergies: NKA
Diagnostic Lab Data: EKG normal Stress test BSA 2.29 8/17 Cardiac Cath no obstructive CAD , normal LVEPP, likely myocarditis 2nd to COVID vaccine
CDC Split Type:

Write-up: Received vaccine 8/12 on 8/16 contacted PCP stated had fever , chills and temp at home 101 now having chest pain. Instructed to call 911..patietn refused and wife took to ED In Ed described chest pain as pressure and heaviness in center of chest VS Temp 36.1, pulse 102, BP 144/96 Patient admitted to hospital and discharged 8/19


VAERS ID: 1623798 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-23
Onset:2021-08-16
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies: UNK
Diagnostic Lab Data: positive antigen test on 8/16/21
CDC Split Type:

Write-up: tested positive for covid, after being fully vaccinated. asymptomatic.


VAERS ID: 1623825 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-09
Onset:2021-08-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / IM

Administered by: Military       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Duloxetine 60mg daily Viagra 50mg prn
Current Illness: None. However COVID infection in April 2021
Preexisting Conditions: Sleep apnea
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted to hospital on 16AUG21 with bilateral pulmonary emboli. Received dose #2 of Pfizer COVID vaccine on 09AUG21. No history of coagulation disorder or previous emboli


VAERS ID: 1623838 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Blood pressure decreased, Dizziness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Amlodipine (twice daily) Hydralazine (twice daily)
Current Illness: None
Preexisting Conditions: High Blood Pressure
Allergies: All cillins Keflex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Blood pressure dropped, became increasingly dizzy, abdominal pains upper left quadrant that lasted for 3 days.


VAERS ID: 1623856 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-25
Onset:2021-08-16
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

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

Write-up: Positive COVID mild symptoms, had infusion treatment symptoms improving. had contact to positive case


VAERS ID: 1623857 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-18
Onset:2021-08-16
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Herpes zoster, Skin burning sensation
SMQs:, Peripheral neuropathy (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: REBOUNDING HEADACHES, LIGHT HEADED
Preexisting Conditions: DIABETES, GRAVES DISEASE, HIGH BLOOD PRESSURE
Allergies: FLU VACCINE, AUGMENTIN, SULFA
Diagnostic Lab Data: PCP DIAGNOSE
CDC Split Type:

Write-up: SHINGLES, BURNING SKIN


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