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From the 11/19/2021 release of VAERS data:

Found 894,019 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 439 out of 8,941

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VAERS ID: 1762292 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Breast feeding, Chest discomfort, Chills, Cough, Fatigue, Injection site pain, Injection site reaction, Injection site swelling, Oropharyngeal pain, Pyrexia, Rash pruritic
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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)

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: Child Hood Asthma
Allergies: Allergic to Ibuprofin, Aspirin, and Mango
Diagnostic Lab Data:
CDC Split Type:

Write-up: The following day after receiving the vaccine, I experienced a tightness in my chest that has been on going. 3 Days after vaccine I experienced fever, sore throat, chills, extreme fatigue, and cough. I am breast feeding an infant and the infant also began to experience same symptoms of illness. On the 8th day after receiving the vaccine, I discovered a large, swollen, itchy and painful rash at the injection site.


VAERS ID: 1762375 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-22
Onset:2021-09-28
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cerebrovascular accident, Chest X-ray, Monoplegia, Oxygen saturation decreased, Patient isolation, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen. aspirin.atorvastatin clopidogrel dexamethason
Current Illness: No
Preexisting Conditions: Chronic hepatitis C, COPD.
Allergies: NoNone
Diagnostic Lab Data: COVID-test: positive. Chest-X-ray
CDC Split Type:

Write-up: F-ever:temperature is 101. -O2saturation 93%. -Right upper extremity hemiplegia due to acute cerebrovascular accident at 9/24. Plan: isolation. DVT prophylaxis. cefepime


VAERS ID: 1762510 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

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

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

Write-up: Patient received 2 primary dose of Moderna, then given a booster dose of Pfizer No adverse event noted


VAERS ID: 1762523 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Hives started at right arm of injection site. Moved down right side of chest and stomach next morning.


VAERS ID: 1763107 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-20
Onset:2021-09-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 RA / IM

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

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

Write-up: patient knowingly received two doses of moderna after already receiving J&J vaccine


VAERS ID: 1763953 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS X4J9R / N/A LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Dyspnoea, Injection site erythema, Injection site pain, Injection site swelling, Muscle contracture, Pain, Speech disorder
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Wellbutrin XL, Furosemide
Current Illness: None
Preexisting Conditions: History of Asthma Attention Deficit Disorder
Allergies: Allergic to contrast dye, Ramipril, gelatin, pork, beef, shellfish, brazil nuts, pistachios, hazelnuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: September 28: Presented with pain, redness, and swelling at injection site; body aches started that afternoon; slight fever (99.4); shortness of breath (used rescue inhaler once at work and later on that evening) September 29: Presented with pain, redness, and swelling at injection site; body aches; slight fever (99.6) that resolved by that afternoon; increased shortness of breath (used rescue inhaler multiple times that day at least 5 times); that evening difficulty speaking at times (straining to get words out/neck muscles started to contract when speaking) September 30: Presented with pain, redness, and swelling at injection site; body aches; no fever; increased shortness of breath; continue difficulty speaking September 30: Went to urgent care and was seen at 7:45 am due to increased shortness of breath and was prescribed Flovent HFA 110 mcg October 1-2: Continued symptoms as day prior October 3: Increased shortness of breath and difficulty speaking; only redness at injection site October 4: Returned to urgent care around 4pm due to shortness of breath and difficulty speaking; given triamcinolone acetonide injection and prescribed prednisone 50 mg and instructed to continue with Flovent October 5: shortness of breath is improving


VAERS ID: 1764540 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-04
Onset:2021-09-28
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, Condition aggravated, Hyponatraemia, Mental status changes, SARS-CoV-2 test positive
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL EXTRA STRENGTH) 500 MG tablet aspirin (HALFPRIN) 81 MG tablet Benzocaine-Menthol 15-2.3 MG LOZG benzonatate (TESSALON) 100 MG capsule brimonidine (ALPHAGAN P) 0.1 % ophthalmic solution bumetanide (BUMEX) 0.5 MG tablet
Current Illness: None known
Preexisting Conditions: Supplemental oxygen dependent Dementia CAD (coronary artery disease) BPH (benign prostatic hyperplasia) COPD (chronic obstructive pulmonary disease) Type 2 diabetes mellitus Hyponatremia
Allergies: Penicillins (hives), statins (hives)
Diagnostic Lab Data: COVID-19 test positive on 9/28/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 9/28/2021 due to altered mental status and hyponatremia. Patient was found to be COVID-19 positive during screening for hospital admission. He was asymptomatic for COVID-19 infection during admission and required no treatment for symptoms.


VAERS ID: 1764582 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-15
Onset:2021-09-28
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site discolouration, Injection site infection, Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: patient developed an infection on the injection site. she was given an antibiotic course per MD. Rash and discoloration present


VAERS ID: 1764620 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1764625 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1764630 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1764635 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (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: Acetaminophen.
Current Illness: None.
Preexisting Conditions:
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache, fatigue. pain in arm on the side of injection site, pain in shoulder up to the neck.


VAERS ID: 1764653 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Chest discomfort, Diarrhoea, Dyspnoea, Electrocardiogram normal, Fatigue, Feeling abnormal, Headache, Injection site pain, Injection site swelling, Injection site warmth, Lymph node pain, Lymphadenopathy, Mobility decreased, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), 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), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin 300mg, Sam-E 400mg, Loratadine 10mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Went to Urgent Care on day 4 - blood oxygen level was good, blood pressure was 120/78 and lungs were clear. Performed EKG test due to chest tightness and results were normal.
CDC Split Type:

Write-up: Headache, tiredness, brain fog and joint pain that still persist over 1 week later. Fever for the first 3 days, highest 100 degrees on day 2 all day. Injection site pain, site was hot & swollen for 5 days, also had intense shooting pain down injection site arm on day 2 from shoulder to fingertips for most of the day. Swollen, burning and painful lymph nodes initially in injection site armpit the first 3 days then both until day 6, unable to put injection site arm down by my side on days 2-5 due to the pain it caused. Diarrhea on day 4. Tightness in chest on day that 4 that felt like a 10 pound weight on my sternum making it hard to take deep breaths so I went to Urgent Care. I occasionally still feel chest tightness over 1 week later. Have been taking 800 mg Ibuprofen at 8 hour intervals to help alleviate symptoms ever since I received the vaccine. Tried a warm compress on injection site armpit for painful lymph nodes on days 2 & 3 but it did not seem to help so discontinued.


VAERS ID: 1764671 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Pt reported that he felt faint and found himself to be shaking approx 10 min after receiving vaccine; pt was brought back and placed on abed; EMS was activated and pt was transferred to nearest ER


VAERS ID: 1764683 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

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

Write-up: Injection site swollen, red, itchy and painful to the touch. Redness has not went away it periodically will change between painful and itchy. So far its been a little over a week and been consistently.


VAERS ID: 1764802 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 RA / IM

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

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

Write-up: Patient received a third booster dose of Pfizer but his first two doses Moderna. No adverse reaction known.


VAERS ID: 1764905 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-09-28
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinated for covid and then got covid


VAERS ID: 1764959 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-09-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (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: blood clot in lung within 30 days of vaccine booster


VAERS ID: 1765016 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-30
Onset:2021-09-28
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Back pain, COVID-19, Dizziness, Dyspnoea, Fall, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertention, hyperlipidemia, dementia, dizziness, shingles, neuropathy, temporal arteritis, TIA, DM, C diff
Allergies: codeine, penicillin
Diagnostic Lab Data: CoV 2PCR COVID19 detected on 9/29/21
CDC Split Type:

Write-up: She completed vaccines in January, 2021. She fell at the local assisted living facility and complained back pain, and she was sent to the emergency department at Hospital on 9/28/21. She also complained dizziness since 9/24/21 after she was given Flu shot, but no details of vaccine was given by the facility. She complained intermittent shortness of breath, and COVID was positive. She was admitted on 9/28/21. She was given one dose of Remdesivir, but she remained afebrile during her hospitalization. She was discharged to the skilled nursing facility on 10/5/21. At one point, she was required 3 L O2, but she did not need oxygen supplemental O2 upon discharge from hospital.


VAERS ID: 1765027 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-26
Onset:2021-09-28
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray, Computerised tomogram, Cough, Dyspnoea, Hypoxia, Infection, Pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM, HTN, CKD
Allergies:
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) on 10/5/2021 Detected CXR and CT showed findings consistent with covid pneumonia on 10/5/21
CDC Split Type:

Write-up: Breakthrough symptomatic case with body aches, fever, cough, SOB, hypoxia. currently in Emergency center on 2L O2 (10/6) Symptom onset 9/28/2021


VAERS ID: 1765062 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-09-28
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Exposure to SARS-CoV-2, Oropharyngeal pain, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Wixela; Flecainide; Simvastatin; Warfarin; Alprazolam; Metoprolol; Toprol
Current Illness: none
Preexisting Conditions: paroxysmal a-fib; incomplete RBBB; seasonal allergies; chronic anticoagulation; anxiety; thrombocytopenia
Allergies: tetanus; pencillin v- potassium
Diagnostic Lab Data:
CDC Split Type:

Write-up: sinus congestion, sore throat, little nonproductive cough, shortness of breath starting on 9/28/21, significant other recently tested positive and he was hospitalized


VAERS ID: 1765396 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Bone pain, Burning sensation, Chest pain, Chills, Condition aggravated, Feeding disorder, Gait disturbance, Headache, Myalgia, Nausea, Paraesthesia oral, Taste disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None until vaccine
Preexisting Conditions: Degenerative neck disease, on and off high blood pressure, chronic pain
Allergies: Sulfa,Amoxaclav,Codine, Vicadin,Iodine,Meclazine,Compazine,Wel
Diagnostic Lab Data: None yet. Went to doctor and he said it was neurological and asked if I read side effects before getting vaccines, I said there was no literature. I was leaving n he was laffing
CDC Split Type:

Write-up: 2ND VACCINE WAS ILL ABOUT 5 - 6 HOURS AFTER - MODERATE ACHES IN JOINTS AND MUSCLES WITH MODERATE HEADACHE. 3RD VACCINE 4 - 5 hrs Bad nausea w headache. Around Wednesday 12:30 - 1:00 am extreme chills, bone joint muscle pain I could hardly walk to urinate lasted til about 8:30 am. Followed by tingling tongue and lips as well as feeling of burning when breathing in like bronchitis. Still had severe nausea and headache. Nothing got rid of headache. Unable to eat until Friday, October 1, 2021. As of today, October 6, 2021, I still have on/off nausea. Foods and drinks don''t taste the same. My lips and front of tongue still tingle and there is still burning sensation when breathing.


VAERS ID: 1765600 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-01-14
Onset:2021-09-28
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM

Administered by: Other       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: methotrexate, prednisone, diclofenac gel, temazepam, ferrex, tylenol #3, folic acid, protonix, colace, calcium, hydroxychloroquine, spironolactone, irbesartan, carvedilol, atorvastatin,
Current Illness: none
Preexisting Conditions: rheumatoid arthritis, coronary artery disease, congestive heart failure, hypertension, sleep apnea, anemia
Allergies: amlodipine, brilinta, hydralazine
Diagnostic Lab Data: + covid test on 10/5/2021
CDC Split Type:

Write-up: The patient had a breakthrough case of covid despite getting the moderna vaccine on 1/14/2021, 2/10/2021 and a booster (due to immune-deficient status) on 8/17/2021. The patient''s symptoms started on 9/28/2021. She had a positive covid test on 10/5/2021.


VAERS ID: 1765611 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765616 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-20
Onset:2021-09-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765618 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765622 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-20
Onset:2021-09-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765625 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-23
Onset:2021-09-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765628 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-20
Onset:2021-09-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765630 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Chest discomfort, Chest pain, Coronavirus pneumonia, Dizziness, Dyspnoea, Hyperhidrosis, Hypersensitivity, Immediate post-injection reaction, Inflammation, Laboratory test abnormal, Pain, Pneumonitis, X-ray normal
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa drugs, aloe vera, tide detergent
Diagnostic Lab Data: Patient given toradol, benadryl, aspirin for immediate adverse reaction to pfizer shot on 28Sep21 lab results and xray normal findings patient given topical pain relief cream and tylenol for chest pain on 29Sep21 xray showed inflamed lungs patient given antibiotics on 30Sep21 lab results showed corona pneumonia
CDC Split Type:

Write-up: immediately after getting the pfizer shot, patient started to have chest pressure, difficulty breathing, lightheadedness, and sweating. pharmacist gave patient 1gm of acetaminophen and monitor for 30 minutes. patient went to ER right after and was given Toradol for pain, 324 mg of Aspirin for chest tightness, and 2 other medications for allergic reaction. Heart labs, and xray had no findings. the next day 29 Sep 21 patient followed up with clinic. work up given as patient had chest pain. xray showed inflamed bronchus and upper airway, labs had additional titers to Covid Pneumonia and patient was put on antibiotics x4 days. patient currently has chest pressure to lower lung area with mild difficulty breathing. patient has follow up scheduled for tomorrow 7 Oct 2021.


VAERS ID: 1765634 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-20
Onset:2021-09-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765641 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-23
Onset:2021-09-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error: Vaccine administered past its beyond use date. The vaccine stored in the freezer beyond the timeframe recommended by the manufacturer.


VAERS ID: 1765645 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-23
Onset:2021-09-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765650 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-20
Onset:2021-09-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765652 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No test were done.
CDC Split Type:

Write-up: A vaccine was given that had been expired by 4days .Pt was informed. Charge Nurse informed to reached out to Pfizer and was referred to agency.


VAERS ID: 1765659 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-23
Onset:2021-09-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765664 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-20
Onset:2021-09-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765672 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-23
Onset:2021-09-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765677 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-19
Onset:2021-09-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765684 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-23
Onset:2021-09-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765687 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-19
Onset:2021-09-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765694 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-22
Onset:2021-09-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1765731 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood folate, Blood glucose decreased, Blood potassium decreased, Blood thyroid stimulating hormone increased, Chest X-ray, Chills, Computerised tomogram head normal, Decreased appetite, Fatigue, Fibrin D dimer, Haematocrit decreased, Haemoglobin decreased, Haemolysis, Mental status changes, Pancytopenia, Platelet count decreased, Procalcitonin, Pyrexia, Serum ferritin increased, Thrombocytopenia, Urine analysis normal, Vitamin B12 normal
SMQs:, Haemolytic disorders (narrow), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations: He felt tired after the second dose. (no severe side effects)
Other Medications: Cholecalciferol (Vit D3), Levothyroxine, Magnesium oxide, Potassium chloride, Prednisone
Current Illness: None (Past medical history of Polychondritis, hypothyroidism)
Preexisting Conditions: Polychondritis, hypothyroidism
Allergies: No known allergies
Diagnostic Lab Data: Patient''s platelets decreased to nadir of 50,000 on 4th day of hospitalization and then increased to 66,000 on day 6 without any treatment. Last CBC before hospitalization was in 12/2020 Hb was 13.7 and PLT was 180 at that time.
CDC Split Type:

Write-up: Pancytopenia including platelet nadir of 50,000, Altered mental status, fever and chills. Patient received 3rd dose of Pfizer on Friday September 24th and has since been feeling more so fatigued, decreased appetite, and having fevers and chills. ED clinical summary: Vitals T 36.4 ?C, P 74, RR 18, BP 167/83, SPO2 95%. UA unremarkable. CBC remarkable for hemoglobin 9.9, hematocrit 20.9, platelets 84. CMP remarkable for potassium 3.3, glucose 105. Pro-Cal 0.56. CT head/brain showed no evidence of acute intracranial process. CXR showed parenchymal clear and left lungs obscured by patient and and cardiac silhouette. Patient given Rocephin/doxy and Tylenol in ED and admitted for further evaluation. Peripheral smear: Thrombocytopenia demonstrating, morphologically normal platelets. Hemolysis work up negative, folic acid and Vitamin B12 normal. Does not drink alcohol. TSH mildly elevated at 5.5 (patient has known history of hypothyroidism). Ferritin 554. D-Dimer elevated at 798. Last CBC was in 12/2020 Hb was 13.7 and PLT was 180 at that time. Patient''s platelets decreased to nadir of 50,000 on 4th day of hospitalization and then increased to 66,000 on day 6 without any treatment. patient''s mentation improved to baseline on 2-3 day of hospitalization.


VAERS ID: 1765903 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxin, Estradiol, Metoprolol, Women''s Multi-vitamin, Prevagen, Biotin, B-12, Goli Apple Cider Vinegar gummies, Calcium
Current Illness: none
Preexisting Conditions: Type 2 diabetes, under control, no meds last ten years
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: sudden feeling faint, followed by a head-to-toe red, itchy rash


VAERS ID: 1766149 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Feeling hot, Limb discomfort, Mobility decreased, Pain, SARS-CoV-2 test negative
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot
Other Medications: Nexium
Current Illness:
Preexisting Conditions:
Allergies: Shellfish, Percocet
Diagnostic Lab Data: I am not sure what medical tests I can get done or what doctor to see. I have been tested for Covid-19 twice after my vaccination and they were both negative on 09/30/2021 and 10/05/2021.
CDC Split Type:

Write-up: Since 09/28/2021 I have felt extremely tired. My body has been aching and I constantly have the chills. After I received the vaccine on Monday 09/27/2021 I was in bed for 3 days and could not get up to do anything. The fourth and fifth day I was extremely fatigued after I tried to do any simple activity like wash dishes or cook. My legs feel extremely heavy and my feet hurt and feel hot all the time. I am an active person and I have never been so fatigued and tired. Headache lasted for 4 days and got better with Motrin.


VAERS ID: 1766941 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-16
Onset:2021-09-28
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020M21A / 2 - / OT

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

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

Write-up: expired dose; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (expired dose) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 031B21A, 020M21A and LOT 027A21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 24-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 28-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (expired dose). At the time of the report, EXPIRED PRODUCT ADMINISTERED (expired dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. No treatment information was provided.


VAERS ID: 1766973 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-30
Onset:2021-09-28
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / OT

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

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

Write-up: Diarrhea; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (Diarrhea) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 050E21A and 004F21A) for COVID-19 vaccination. No Medical History information was reported. On 30-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 28-Sep-2021, the patient experienced DIARRHOEA (Diarrhea). The patient was treated with LOPERAMIDE HYDROCHLORIDE (IMODIUM AD) for Diarrhea, at an unspecified dose and frequency. At the time of the report, DIARRHOEA (Diarrhea) outcome was unknown. No concomitant medications was reported. This case was linked to MOD-2021-335070 (Patient Link).


VAERS ID: 1766985 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dysgeusia, Fatigue, Pain in extremity
SMQs:, Taste and smell disorders (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: slight soreness in the left arm; tired; really strong chemical state in the mouth; This spontaneous case was reported by a consumer and describes the occurrence of DYSGEUSIA (really strong chemical state in the mouth), PAIN IN EXTREMITY (slight soreness in the left arm) and FATIGUE (tired) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062E21A) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced DYSGEUSIA (really strong chemical state in the mouth). On an unknown date, the patient experienced PAIN IN EXTREMITY (slight soreness in the left arm) and FATIGUE (tired). The patient was treated with MACROGOL 3350 (MIRALAX) for Adverse event, at an unspecified dose and frequency. At the time of the report, DYSGEUSIA (really strong chemical state in the mouth), PAIN IN EXTREMITY (slight soreness in the left arm) and FATIGUE (tired) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient was taking other unknown medication. 2 to 3 minutes after receiving the first dose, the patient had the reaction. MiraLax made her nauseous because of the polyethylene glycol.


VAERS ID: 1767021 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-24
Onset:2021-09-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 RA / OT

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

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

Write-up: expired dose; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (expired dose) in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 031B21A) for COVID-19 vaccination. No Medical History information was reported. On 24-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 28-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (expired dose). On 28-Sep-2021, EXPIRED PRODUCT ADMINISTERED (expired dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medication was reported. No Treatment medication was reported.


VAERS ID: 1767023 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Emotional distress
SMQs:, Depression (excl suicide and self injury) (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: USMODERNATX, INC.MOD20213

Write-up: This spontaneous case reported by a consumer, describes the occurrence of emotional distress (started feeling an emotional choked-up feeling that lasted for an hour) and anxiety (she has very bad anxiety) in a 30-year-old female patient who received mRNA-1273 (Moderna COVID-19 vaccine, batch/lot# 039D21A and 93990Y) for COVID-19 immunization. No medical history reported. On Aug 31, 2021, patient received the first dose of mRNA-1273 (Moderna COVID-19 vaccine), intramuscular; 1 dosage form. On Sep 28, 2021, patient received the second dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On Sep 28, 2021, patient experienced emotional distress (started feeling an emotional choked-up feeling that lasted for an hour). On an unknown date, patient experienced anxiety (she has very bad anxiety). At the time of the report, emotional distress (started feeling an emotional choked-up feeling that lasted for an hour) and anxiety (she has very bad anxiety) outcome: unknown. Concomitant product use and treatment information not provided.


VAERS ID: 1767024 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Severe stomach pain; This spontaneous case was reported by a consumer and describes the occurrence of ABDOMINAL PAIN UPPER (Severe stomach pain) in a 34-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025C21A) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Sep-2021, the patient experienced ABDOMINAL PAIN UPPER (Severe stomach pain). At the time of the report, ABDOMINAL PAIN UPPER (Severe stomach pain) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment using Pepto Bismuth was reported and it did nothing. No concomitant medication were provided.; Sender''s Comments: This case concerns a 34-year-old female patient with no medical history, who experienced the unexpected event of Abdominal pain upper. The event of Abdominal pain upper occurred on the same day after receiving the first dose of mRNA-1273 (Moderna COVID-19 Vaccine). The rechallenge was unknown. The information regarding the second dose was not provided. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.


VAERS ID: 1767035 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Unknown  
Location: South Carolina  
Vaccinated:2021-09-07
Onset:2021-09-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Chest discomfort, Fatigue, Head discomfort, Influenza, Nasopharyngitis, SARS-CoV-2 test, Sinus headache, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; VITAMINS NOS
Current Illness: Non-smoker; Vaccination adverse reaction
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: Had temperature; Test Date: 20210909; Test Name: COVID-19 PCR; Test Result: Negative ; Result Unstructured Data: Negative; Test Date: 20210915; Test Name: COVID-19 PCR test; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Felt like something in her chest like a bomb after getting 3rd dose; Had a cold; felt like a flu; she had sever reaction after receiving 3rd dose; Could lift her head up off the pillow this time; Patient is still experiencing little fatigue; little bit of a headache that is more toward sinus; This spontaneous case was reported by a consumer and describes the occurrence of CHEST DISCOMFORT (Felt like something in her chest like a bomb after getting 3rd dose), NASOPHARYNGITIS (Had a cold), INFLUENZA (felt like a flu), SINUS HEADACHE (little bit of a headache that is more toward sinus) and VACCINATION COMPLICATION (she had sever reaction after receiving 3rd dose) in a 67-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 026L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Non-smoker and Vaccination adverse reaction. Concomitant products included LEVOTHYROXINE SODIUM (SYNTHROID) and VITAMINS NOS for an unknown indication. On 07-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Sep-2021, the patient experienced SINUS HEADACHE (little bit of a headache that is more toward sinus). On an unknown date, the patient experienced CHEST DISCOMFORT (Felt like something in her chest like a bomb after getting 3rd dose), NASOPHARYNGITIS (Had a cold), INFLUENZA (felt like a flu), VACCINATION COMPLICATION (she had sever reaction after receiving 3rd dose), HEAD DISCOMFORT (Could lift her head up off the pillow this time) and FATIGUE (Patient is still experiencing little fatigue). The patient was treated with AZITHROMYCIN (Z-PAK) on 19-Sep-2021 for Adverse event, at an unspecified dose and frequency. At the time of the report, CHEST DISCOMFORT (Felt like something in her chest like a bomb after getting 3rd dose) and HEAD DISCOMFORT (Could lift her head up off the pillow this time) outcome was unknown and NASOPHARYNGITIS (Had a cold), INFLUENZA (felt like a flu), SINUS HEADACHE (little bit of a headache that is more toward sinus), VACCINATION COMPLICATION (she had sever reaction after receiving 3rd dose) and FATIGUE (Patient is still experiencing little fatigue) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 09-Sep-2021, SARS-CoV-2 test: negative (Negative) Negative and. On 15-Sep-2021, SARS-CoV-2 test: positive (Positive) Positive. On an unknown date, Body temperature: abnormal (abnormal) Had temperature. Patient went on PCR COVID-19 test on 28-Sep-2021. This case was linked to MOD-2021-334391, MOD-2021-335705 (Patient Link).


VAERS ID: 1767048 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 3 - / OT

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

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

Write-up: 8 patients got expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017B21A) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine). On 28-Sep-2021, EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication was not provided. Treatment information was not provided.


VAERS ID: 1767050 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-09-28
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: 8 patients got expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine) in a 56-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine). On 28-Sep-2021, EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment medication use was reported.


VAERS ID: 1767051 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 LA / OT

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

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

Write-up: patient under 18 years got a dose of the Moderna vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (patient under 18 years got a dose of the Moderna vaccine) in a 15-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939906) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 milliliter. On 28-Sep-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (patient under 18 years got a dose of the Moderna vaccine). On 28-Sep-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (patient under 18 years got a dose of the Moderna vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication details were not reported by the reporter. Treatment details was not reported by the reporter. This case was linked to MOD-2021-336648 (Patient Link).


VAERS ID: 1767054 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 - / OT

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

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

Write-up: administered a dose of the Moderna vaccine from the expired lot; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered a dose of the Moderna vaccine from the expired lot) in a 52-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017B21A) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered a dose of the Moderna vaccine from the expired lot). On 28-Sep-2021, EXPIRED PRODUCT ADMINISTERED (administered a dose of the Moderna vaccine from the expired lot) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. Treatment information was unknown.


VAERS ID: 1767294 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: Patient a few months under 18 got the Moderna vaccine; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Patient a few months under 18 got the Moderna vaccine) in a 17-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 28-Sep-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Patient a few months under 18 got the Moderna vaccine). On 28-Sep-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Patient a few months under 18 got the Moderna vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications reported. No treatment information reported.


VAERS ID: 1767296 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-31
Onset:2021-09-28
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Feeling hot, Vaccination site pain
SMQs:

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

Write-up: He is feeling warm right now (today); The area of injection site started getting sore.; On same day after receiving 2nd dose, at night he started with chills.; This spontaneous case was reported by a consumer and describes the occurrence of FEELING HOT (He is feeling warm right now (today)), VACCINATION SITE PAIN (The area of injection site started getting sore.) and CHILLS (On same day after receiving 2nd dose, at night he started with chills.) in a 50-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 032B21A and 011F21A) for COVID-19 vaccination. No Medical History information was reported. On 31-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 milliliter. On 28-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 28-Sep-2021, the patient experienced VACCINATION SITE PAIN (The area of injection site started getting sore.) and CHILLS (On same day after receiving 2nd dose, at night he started with chills.). On 29-Sep-2021, the patient experienced FEELING HOT (He is feeling warm right now (today)). At the time of the report, FEELING HOT (He is feeling warm right now (today)), VACCINATION SITE PAIN (The area of injection site started getting sore.) and CHILLS (On same day after receiving 2nd dose, at night he started with chills.) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. No treatment information was provided.


VAERS ID: 1767307 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: 8 patients got expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine) in a 51-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 28-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine). On 28-Sep-2021, EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications was not provided by the reporter. Treatment information was not provided. Reporter, Certified Medical Assistant stated that on 28SEP2021, she was administering the Moderna COVID-19 vaccine to a patient. When she went to get the vial to administer, she noticed that the lot number (Lot #: 017B21A, Expiration date: Unknown) was different than the lot number on the other vials in the same box. She says that they receive the Moderna vaccine vials in boxes, from the state. When she called the health department to talk about this discrepancy, she found out that a few of their vials was taken out and vials of a different lot number were mixed in the box before being sent to them. The vials that had the different lot number had expired at least 2-3 weeks prior. However, by the time she found that out, 8 patients had been administered a dose of the Moderna vaccine from the expired lot on 28SEP2021 and no adverse reactions reported yet.


VAERS ID: 1767310 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 - / OT

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

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

Write-up: 8 patients got expired vaccine; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine) in a 22-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017B21A) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine). On 28-Sep-2021, EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were mentioned. No treatment details were reported. Reporter stated patient has not reported any adverse reactions to the dose so far.


VAERS ID: 1767311 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 RA / OT

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

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

Write-up: Patient under 18 years got a dose of the Moderna vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Patient under 18 years got a dose of the Moderna vaccine) in a 13-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939906) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 milliliter. On 28-Sep-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Patient under 18 years got a dose of the Moderna vaccine). On 28-Sep-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Patient under 18 years got a dose of the Moderna vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant drug was not reported. Treatment medication was not reported. This case was linked to MOD-2021-336661 (Patient Link).


VAERS ID: 1767604 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-09-28
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Fatigue, Fibromyalgia, Myalgia, Myocarditis, Palpitations, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210915; Test Name: Nasal Swab; Test Result: Negative ; Comments: Covid test type post vaccination: Nasal swab
CDC Split Type: USPFIZER INC202101286644

Write-up: Myocarditis; Fibromyalgia development; Chest pain; palpitations; Joint pain; Fatigue; Muscle aches; This is a spontaneous report from a non-contactable consumer (the patient). A 24-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number was unknown due to misplaced/discarded) via an unspecified route of administration on 25Aug2021 08:30 at age of 24-year-old at single dose for COVID-19 immunisation. The patient had no medical history (reported as "None never"). No known allergies. The patient had no COVID prior vaccination. The patient''s concomitant medications were not reported. There were no other vaccine in four weeks. On 28Sep2021, the patient experienced myocarditis, fibromyalgia development, chest pain, palpitations, joint pain, fatigue and muscle aches. The events resulted in: Doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care, Life threatening illness (immediate risk of death from the event), Disability or permanent damage. No treatment received for the events. COVID-19 test=Nasal Swab was taken on 15Sep2021 with negative result. The outcome of the events was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1767606 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Immunisation, Insomnia, Off label use
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101287591

Write-up: Headache; She received her booster dose; She received her booster dose; She tossed and turned all night last night; This is a spontaneous report from a contactable consumer(patient). An 80-year-old female patient received bnt162b2 (COMIRNATY, Solution for injection, Batch/Lot number was not reported, Expiry date: unknown, at the age of 80 years), dose 3 via an unspecified route of administration on 28Sep2021 as dose 3 (booster), single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Historical vaccine included bnt162b2 (COMIRNATY, Solution for injection, Batch/Lot number was not reported, Expiry date: unknown) as dose 2, single and first dose of bnt162b2 (COMIRNATY, Solution for injection, Batch/Lot number was not reported, Expiry date: unknown) as dose 1, single via an unspecified route of administration on an unspecified date for covid-19 immunisation. She had no issues with the first two doses. The patient reported she tossed and turned all night last night and received her booster dose on 28Sep2021 and experienced headache on 29Sep2021. Therapeutic measures were taken as a result of headache. The outcome of the events was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1767607 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Immunisation, Insomnia, Off label use, Pain, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101288256

Write-up: Her Pfizer booster shot was yesterday; Her Pfizer booster shot was yesterday; felt very tired; wasn''t able to sleep good; body aches; woke up with sore arm; diarrhea; vomiting; This is a spontaneous report from a Pfizer sponsored program. A contactable consumer (patient) reported for herself. A 75-year-old female patient received bnt162b2 (Pfizer-BioNTech COVID-19 Vaccine, solution for injection), dose 3 via an unspecified route of administration on 28Sep2021 10:30 (at the age of 75-year-old) (Batch/Lot number was not reported) as dose 3 (booster), single for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. Patient previously took first and second dose of BNT162B2 on an unspecified date for covid-19 immunisation and experienced sore arm in both doses. Patient previously took flu shot and she just got really sick, diarrhoea and vomiting but not same time, after some time got butter just colds sweat. She also added that it also happened years ago with her mom. The patient had her Pfizer booster shot 3 on 28Sep2021 at 10:30, which was an extra dose and was exposed to an off-label scenario, and experienced body aches, diarrhoea, vomiting, felt very tired, wasn''t able to sleep good and woke up with sore arm. Also stated she was unsure if maybe the side effects were really because of the booster shot or maybe there is something in your system beforehand, she would just talk to her doctor. The outcome felt very tired, wasn''t able to sleep good, body aches, woke up with sore arm, diarrhea and vomiting was not recovered. The outcome of all the other events was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1767733 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 062E21A / UNK - / OT

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

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

Write-up: Moderna Covid-19 vaccine administered 13 hours after first puncture; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Moderna Covid-19 vaccine administered 13 hours after first puncture) in a 28-year-old male patient who received mRNA-1273 (batch no. 062E21A) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received dose of mRNA-1273 (Intramuscular) 1 dosage form. On 28-Sep-2021, after starting mRNA-1273, the patient experienced EXPIRED PRODUCT ADMINISTERED (Moderna Covid-19 vaccine administered 13 hours after first puncture). On 28-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Moderna Covid-19 vaccine administered 13 hours after first puncture) had resolved. For mRNA-1273 (Intramuscular), the reporter did not provide any causality assessments. No concomitant treatment was provided. No treatment medication was provided. Patient had not experienced any adverse reactions after vaccination.


VAERS ID: 1767737 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-31
Onset:2021-09-28
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Neck pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Pneumonia.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: pain in his lower back; pain in his knee is "killing him"; fever of 103? F; if he gets up, he has extreme neck pain: "It''s killing me"; pain in the arm; This spontaneous case was reported by a consumer and describes the occurrence of NECK PAIN (if he gets up, he has extreme neck pain: "It''s killing me"), PAIN IN EXTREMITY (pain in the arm), BACK PAIN (pain in his lower back), ARTHRALGIA (pain in his knee is "killing him") and PYREXIA (fever of 103? F) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 020F21A and 052E21A) for COVID-19 vaccination. The patient''s past medical history included COVID-19 in March 2021 and Pneumonia in March 2021. On 31-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 28-Sep-2021, the patient experienced NECK PAIN (if he gets up, he has extreme neck pain: "It''s killing me"), PAIN IN EXTREMITY (pain in the arm), ARTHRALGIA (pain in his knee is "killing him") and PYREXIA (fever of 103? F). On an unknown date, the patient experienced BACK PAIN (pain in his lower back). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. At the time of the report, NECK PAIN (if he gets up, he has extreme neck pain: "It''s killing me"), PAIN IN EXTREMITY (pain in the arm), BACK PAIN (pain in his lower back), ARTHRALGIA (pain in his knee is "killing him") and PYREXIA (fever of 103? F) outcome was unknown. No Concomitant informations were reported. This case was linked to MOD-2021-335720 (Patient Link). Reporter did not allow further contact


VAERS ID: 1767751 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: 8 patients got expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine) in a 66-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 28-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine). On 28-Sep-2021, EXPIRED PRODUCT ADMINISTERED (8 patients got expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment medication use was reported.


VAERS ID: 1768014 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Gait disturbance, Loss of personal independence in daily activities, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 24 hours after receiving 3rd shot the typical symptoms of muscle aches and minor fever started. however, extreme lower back pain was noted unlike other times. by day 3 symptoms started to alleviate. by day 5 lower back pain increased exponentially. by day 7-10 pain is so severe i cannot put my socks on, get out of a car, or sometimes walking is difficult. an appointment with my primary is scheduled today shortly after this report. fear of GBS.


VAERS ID: 1768120 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-23
Onset:2021-09-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Dermatomal outbreak of possible herpes infection following second dose of Pfizer. Also viral xanthem rash reaction.


VAERS ID: 1768239 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-21
Onset:2021-09-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Axillary pain, Fatigue, Groin pain, Headache, Immediate post-injection reaction, Induration, Injection site pain, Injection site swelling, Lymphadenopathy, Mass, Migraine, Pain, Urine abnormality
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Proteinuria (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Have not seen a doctor for the symptoms, have no insurance.
CDC Split Type:

Write-up: The first symptoms were immediate pain and swelling in arm which lasted 5 days along with severe fatigue and body aches and headache which lasted two weeks before subsiding. About a week after the shot I started getting pain in my left armpit and could feel a hard painful lump. After doing research I found swollen glands in the armpits were a side effect of the shot. The swollen gland in the armpit went away after 4 days. But is still sensitive to the touch. Then I started to get migraines which have been continuously worse throughout the week with no way to ease the pain. Then I started getting hard painful lumps in my groin area and feeling a sharp pain in my lower stomach and today I noticed I have very cloudy urine but the only pain I have is in my lower stomach.


VAERS ID: 1768257 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-17
Onset:2021-09-28
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202, EN6204 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cough, Dyspnoea, Fall, Head injury, Malaise
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Benign prostatic hyperplasia.
Allergies: No Known Allergies
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: SOB, cough and weakness. Feeling ill for about 1 week with cough, weakness and general malaise. So weak that he fell at home and hit his head.


VAERS ID: 1768293 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-27
Onset:2021-09-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Bacterial infection, Chills, Cough, Influenza like illness, Injection site pain, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: I had three negative Covid test over a two day period, one at home, one PRC test at pharmacy, and one at the Hospital testing site. All were negative. Went to the doctors on Tuesday and was treated with a diagnosis of bacterial infection and prescribed Bactrim for 10 days.
CDC Split Type:

Write-up: Body aches, chills, dry cough, severe pain in the hip, severe pain in the arm where injected, fever, generally achy flu like symptoms with severe hip joint pain in my left hip.


VAERS ID: 1768328 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-05
Onset:2021-09-28
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Hospitalisation, 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 hospitalized after testing positive for COVID 19


VAERS ID: 1768330 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: pt had a synconpe event, hitting head and being unconcious for a few minutes in which the pharmacist almost gave him a adreniline. 911 was called. Pt was assessed by emt and patient declined to be taken to hospital.


VAERS ID: 1768453 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: administered Pfizer 48 hours after refrigeration expiration


VAERS ID: 1768468 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-19
Onset:2021-09-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768478 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-23
Onset:2021-09-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768485 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-22
Onset:2021-09-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768488 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-19
Onset:2021-09-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768503 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-22
Onset:2021-09-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768510 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-19
Onset:2021-09-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768525 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-22
Onset:2021-09-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768532 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-22
Onset:2021-09-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768655 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-09-28
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / SYR

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

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

Write-up: Patient had positive COVID test on 9/28/2021


VAERS ID: 1768747 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-09-01
Onset:2021-09-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Blood creatinine increased, Brain natriuretic peptide increased, C-reactive protein increased, Chest X-ray abnormal, Chills, Diarrhoea, Dyspnoea, Echocardiogram, Ejection fraction, Fatigue, Hypotension, Immunoglobulin therapy, Malaise, Multisystem inflammatory syndrome in adults, Nausea, Pain, Polyuria, Pulmonary oedema, Pyrexia, Red blood cell sedimentation rate increased, SARS-CoV-2 antibody test, SARS-CoV-2 test positive, Serum ferritin increased, Troponin, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID pneumonia in early August
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data: 9/30 COVID PCR Positive 10/3 COVID PCR Negative 10/4 COVID PCR Negative 10/2 CHF peptide < 25 10/5 CHF peptide 2250 10/2 Cr 3.83 10/7 Cr 1.43 10/4 ferritin 6,090 10/7 ferritin 6,911 10/3 Sed rate 79 10/3 CRP 28.3 10/7 CRP 12.5 10/6 Troponin 0.16 10/3 COVID IgG Positive
CDC Split Type:

Write-up: Highly suspicious of MIS-A Initial Moderna dose received in early August, became ill three days later and tested positive for COVID, hospitalized for four days, required oxygen made full recovery, received second dose of Moderna around 9/16 (exact date unknown) and ten days later became sick with fever, chills, body aches, nausea/vomiting, diarrhea, abdominal pain, presented to ER 9/30, received monoclonal antibody 10/1, returned to ER 10/2 with worsening of above symptoms, found to be hypotensive to 80s systolic, new AKI Cr 3.8. Remained with intermittent fevers as high as 39 through 10/4. Received IV dexamethasone then IVIG 10/4 and 10/5, anakinra started 10/6. TTE with borderline EF at 50% on 10/3. New O2 requirement 10/4 with associated dyspnea at rest and increased interstitial infiltrates on CXR c/w pulmonary edema. Improved with diuresis, satting 95% on room air on 10/7. Afebrile since 10/5 with resolution of n/v/abdominal pain and improving malaise/fatigue/body aches.


VAERS ID: 1768834 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-19
Onset:2021-09-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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:
CDC Split Type:

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768838 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-18
Onset:2021-09-28
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Vaccination 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:
CDC Split Type:

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768844 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-22
Onset:2021-09-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768850 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-18
Onset:2021-09-28
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768853 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-22
Onset:2021-09-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768904 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-09-28
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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 HAD PFIZER VACCINE ON 02/26/2021 and 03/27/2021, AND TESTED POSITIVE TO COVID.


VAERS ID: 1768930 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-09-28
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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 HAD MODERNA VACCINE ON 04/23/2021 and 05/21/2021, AND TESTED POSITIVE TO COVID.


VAERS ID: 1768936 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-18
Onset:2021-09-28
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768940 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-21
Onset:2021-09-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768942 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-21
Onset:2021-09-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768948 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-18
Onset:2021-09-28
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768953 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-21
Onset:2021-09-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768959 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-18
Onset:2021-09-28
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768963 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-21
Onset:2021-09-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768966 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-21
Onset:2021-09-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


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