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

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



Case Details (Reverse Sorted by Onset Date)

This is page 444 out of 8,010

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VAERS ID: 1709631 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

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

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

Write-up: Numbness in both hands continuously


VAERS ID: 1710889 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-21
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: fever; chills; headache; fatigue; severe pain; body aches; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (severe pain), PAIN (body aches), PYREXIA (fever), CHILLS (chills) and HEADACHE (headache) in a 20-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Aug-2021, the patient experienced PAIN (severe pain), PAIN (body aches), CHILLS (chills), HEADACHE (headache) and FATIGUE (fatigue). On an unknown date, the patient experienced PYREXIA (fever). At the time of the report, PAIN (severe pain), PAIN (body aches), PYREXIA (fever), CHILLS (chills), HEADACHE (headache) and FATIGUE (fatigue) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Patient called and said she and her other two sons already got the vaccine. Her youngest son side effects included fever chills, severe pain, trebles, headache. No Concomitant drugs were reported. No Treatment information was reported. Reporter did not allow further contact


VAERS ID: 1710893 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-03
Onset:2021-08-21
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006021A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: nausea; bad headache; sore arm; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (sore arm), NAUSEA (nausea) and HEADACHE (bad headache) in a 36-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 006021A) for COVID-19 vaccination. No Medical History information was reported. On 03-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Aug-2021, the patient experienced NAUSEA (nausea) and HEADACHE (bad headache). On an unknown date, the patient experienced PAIN IN EXTREMITY (sore arm). The patient was treated with ACETYLSALICYLIC ACID, DIPHENHYDRAMINE CITRATE, PARACETAMOL (EXCEDRIN PM HEADACHE) for Headache, at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (sore arm) and NAUSEA (nausea) outcome was unknown and HEADACHE (bad headache) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant medications were reported


VAERS ID: 1710936 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-21
Onset:2021-08-21
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Myalgia, Oropharyngeal pain, Pain, Pain in extremity, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Food allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Knee injury (Patient injured her right knee 15 years ago.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Achiness all over her body / More pain allover her body with the 2nd dose compared to the 1st dose; pain in my left foot, pain in fingers; Sore throat every morning; Fatigue; Both knees ache really bad; Aching, soreness in right foot; Sore arm of injection; extreme fatigue; Myalgia; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (Achiness all over her body / More pain allover her body with the 2nd dose compared to the 1st dose), PAIN IN EXTREMITY (pain in my left foot, pain in fingers), OROPHARYNGEAL PAIN (Sore throat every morning), FATIGUE (extreme fatigue) and MYALGIA (Myalgia) in a 44-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 939902 and 048C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Knee injury (Patient injured her right knee 15 years ago.). Concurrent medical conditions included Food allergy. On 21-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 21-Aug-2021 at 7:00 AM, the patient experienced FATIGUE (extreme fatigue) and MYALGIA (Myalgia). On an unknown date, the patient experienced PAIN (Achiness all over her body / More pain allover her body with the 2nd dose compared to the 1st dose), PAIN IN EXTREMITY (pain in my left foot, pain in fingers), OROPHARYNGEAL PAIN (Sore throat every morning), FATIGUE (Fatigue), ARTHRALGIA (Both knees ache really bad), MYALGIA (Aching, soreness in right foot) and VACCINATION SITE PAIN (Sore arm of injection). The patient was treated with PARACETAMOL (TYLENOL) for Pain, at a dose of UNK dosage form. At the time of the report, PAIN (Achiness all over her body / More pain allover her body with the 2nd dose compared to the 1st dose), PAIN IN EXTREMITY (pain in my left foot, pain in fingers), OROPHARYNGEAL PAIN (Sore throat every morning), FATIGUE (Fatigue), ARTHRALGIA (Both knees ache really bad), MYALGIA (Aching, soreness in right foot) and VACCINATION SITE PAIN (Sore arm of injection) outcome was unknown and FATIGUE (extreme fatigue) and MYALGIA (Myalgia) had not resolved. No relevant concomitant medications were reported. This case was linked to MOD-2021-304918 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 09-Sep-2021: Follow-up document received on 09-Sep-2021, events and facility information were reported - significant


VAERS ID: 1711342 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-15
Onset:2021-08-21
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Colon injury, Dehydration, Feeling abnormal, Malaise, Muscle spasms, Nausea, Pain, Pruritus, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Dementia (broad), Dystonia (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: No, Comment: No
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101099885

Write-up: Feeling unwell; Nausea; Vomiting; Itching head to toe; Joint pain head to toe; Rash/ on her feet/ on her tummy/She also had the same rash on her armpits, and intermittent spasms in her armpits. /rash on her feet that subsided, and a rash that reappeared on her abdomen last night; Rash/ on her feet/ on her tummy/She also had the same rash on her armpits, and intermittent spasms in her armpits. /rash on her feet that subsided, and a rash that reappeared on her abdomen last night; Sensation of being severely dehydrated even though I drink plenty of water; It hurts to walk; Colon issues; I am miserable right now; This is a spontaneous report from a contactable consumer (patient). A 68-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Formulation: Solution for injection, Lot number: EW0198, Expiration Date: not reported), via an unspecified route of administration on 15Aug2021 as dose 2, single for COVID-19 immunization (at the age of 68-year-old). Previously patient took BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Formulation: Solution for injection, Lot number: EW0176, Expiration Date: not reported), via an unspecified route of administration in left shoulder on 24Jul2021 as dose 1, single for COVID-19 immunization and subsequently experienced severe joint pain, dizziness and nausea. Medical history and family medical history relevant to AE(s) was none. There were no concomitant medications. Additional Vaccines Administered on same date of the Pfizer Suspect was none. Prior Vaccinations within 4 weeks and AE(s) following prior vaccinations was none. Patient stated that, she got through it, but by the time she did it was time for the second dose. She received her second dose of the vaccine on 15Aug2021 and on Saturday, 21Aug2021, she began feeling unwell, experienced nausea/vomiting, itching head to toe, joint pain head to toe, a rash that appeared on her feet and went away, a rash on her tummy that was itching rash on her feet that subsided and a rash that reappeared on her abdomen last night. She also had the same rash on her armpits and intermittent spasms in her armpits. She also had some colon issues and a sensation of being severely dehydrated even though she drink plenty of water/fluids. She was miserable right now. She had constant itching head to toe. She woke up in the middle of the night scratching. All it took is a sharp U-turn and se was nauseated and vomiting. It hurts to walk. This was making her nuts. It felt like someone had severely beat her to a pulp. She never had a temperature. Patient called her doctor earlier in the afternoon but she had not heard back from them yet. Hopefully she would hear from them tomorrow. She could not hardly deal with this anymore and could hardly get anything done. She was fortunate enough not to had work. This reaction had been really bad, but then again she was knocking on the door of 70 years old, and nobody would know it. Patient was very active and a very healthy person and took no medications. Patient wanted to know recommendations for how to get over this. AE(s) did not require a visit to emergency room or physician office. Patient received time frames for negative reactions to go away and she enquired if there any other recommendations or did she just had to ride this out. Patient was suggested that, these might not be all the possible side effects of the Pfizer-BioNTech COVID-19 Vaccine. Serious and unexpected side effects might occur. Pfizer-BioNTech COVID-19 Vaccine was still being studied in clinical trials. The safety evaluation of participants was still ongoing. Participants were asked about local and systemic events and use of fever reducing medication after each vaccination. Participants continued to be monitored for non-requested adverse events, including serious adverse events up to 6 months after the last vaccine dose. Among the Pfizer-BioNTech COVID-19 Vaccine recipients, mild-to-moderate pain at the injection site within 7 days after an injection was the most commonly reported local reaction, with less than 1% of participants across all age groups reporting severe pain. In general, local side effects; the ones patient got on the arm where patient got the shot (such as injection site redness and injection site swelling) were mostly mild-to-moderate in severity and resolved within 1 to 2 days. Side effects that patient might experience throughout the rest of body; (systemic side effects) including fever and chills were observed with the first 1 to 2 days after vaccination and resolved shortly thereafter. Swollen lymph nodes (lymphadenopathy), which generally resolved within 10 days, is likely to have resulted from a robust vaccine-elicited immune response. The Centers for Disease Control and Prevention (CDC) provided information regarding Possible Side Effects After Getting a COVID-19 Vaccine. The response below was copied on 23Apr2021. COVID-19 vaccination will help protect patient from getting COVID-19. Patient might have some side effects, which are normal signs that body is building protection. These side effects might affect ability to do daily activities, but they should go away in a few days. Some people had no side effects. If patient received a second shot Side effects after second shot might be more intense than the ones patient experienced after first shot. These side effects were normal signs that patient body was building protection and should go away within a few days. And it was suggested to call the vaccination provider or healthcare provider if had any side effects that bother patient or did not go away. Patient called to ask for recommendations for treating everything. This was ongoing and she was miserable. Patient received treatment with Tylenol, ibuprofen, rubbed asper cream and bengay, nothing made it go away. Relevant tests was none. The outcome of the events it hurts to walk and joint pain head to toe was not recovered and for rest of the events it was unknown.


VAERS ID: 1711343 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-19
Onset:2021-08-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Nausea, Panic attack
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101102298

Write-up: Never had panic attacks or anxiety untill received first dose. With nausea. Now won''t go away. Life is hell.; Never had panic attacks or anxiety untill received first dose. With nausea. Now won''t go away. Life is hell.; Never had panic attacks or anxiety untill received first dose. With nausea. Now won''t go away. Life is hell.; This is a spontaneous report from a contactable consumer or other non-HCP (patient herself). A 68-year-old female patient received BNT162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number- UNKNOWN) via an unspecified route of administration in left arm (reported as left shoulder) on 19Aug2021 12:00 as dose number unknown, single (at the age of 68-years-old) for COVID-19 immunization. Vaccination facility type was reported as Pharmacy or Drug Store. Patient was not pregnant at the time of vaccination. Patient did not have COVID-19, prior to vaccination and was not tested for COVID-19 post vaccination. Patient did not receive any other vaccine in four weeks. Patient medical history included known allergies with Lopressor, effient and statins. The concomitant medications were not reported. Patient never had panic attacks or anxiety until received first dose, with nausea on 21Aug2021. Now would not go away. Life was hell. The adverse events resulted in Doctor or other healthcare professional office/clinic visit. The therapeutic measures taken as a result of the events included Anxiety medication. The outcome of the event was not resolved. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1711693 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Arthritis (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: Medical History/Concurrent Conditions: Hemorrhoids (He hasn''t had those in 3-4 years and he guesses that might be problematic.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101151666

Write-up: Bloody stools; Joint pain; This is a spontaneous report received from a contactable consumer (patient). A 32-year-old male (patient) received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number FD8448), administered in right side of arm (right arm) on 20Aug2021 (at the age of 32-year-old) as dose 1, single for COVID-19 immunization. Vaccination facility type was reported as pharmacy. Vaccine was not administered at military facility. The patient''s medical history included that he had hemorrhoid''s (he hadn''t had those in 3-4 years and he guesses that might be problematic). The patient''s concomitant medications were reported as vitamins. He thought the only thing that came close to it was about 1 month before he started a diet and he was losing weight and lost about 20 pounds of weight and with getting the shot he didn''t know if that would adversely affect it. Caller stated he hadn''t been taking any medication that would come close to it and he had been avoiding all the medications and he was taking vitamins and that was about it. Patient stated that he had been pretty much clean, no drugs or vaccines within 4 weeks prior vaccinations. Adverse events following prior vaccinations were reported as none before he took this, he double checked allergies in past, so no. History of all previous immunization with the Pfizer vaccine considered as suspect was reported as none. Additional vaccines administered on same date of the Pfizer suspect were reported as none. Patient reported that he had a side effect after the first dose of the vaccine. Caller (patient) was seeking information if he should get the second dose of the vaccine or not following his side effects after the first dose. Caller received his first dose of the PFIZER-BIONTECH COVID-19 VACCINE on Friday 20Aug2021. About 24 hours after (21Aug2021) he experienced bloody stools, he was seeking information if this was a rare or common occurrence. Caller also briefly mentioned he experienced joint pain also. Caller states he had a question about the COVID vaccine and he didn''t know as he didn''t see it listed. He stated he got the shot on Friday, 20Aug2021 and figured he would wait a couple weeks for other side effects. Caller stated he was wondering, and he was pretty sure he had never had this happen, he had a bloody stool 24 hours after the shot. He stated it was pretty bad and he was wondering if it was that consistent with the vaccine. Caller was asking if it was a side effect and if he should get a second shot. He stated that when he got the shot within 24 hours, he was fine but the next day he had bloody stool. Caller was asking if the vaccine do anything with the blood and if he should get the second shot. He stated he thought he had 1 more week before the second shot. Caller was asking if this was a rare occurrence that happened. Caller stated that on 21Aug2021 in the early morning he had bloody stool and on 22Aug2021 it was improving and on 23Aug2021 he had no bloody stool, it was just bad on 21Aug2021 and for a couple days. Caller stated that his next dose was 10Sep2021. When probed for dose caller stated he had been told about issues from over some other side of the country they gave a whole dose amount. He stated that to him it looked like everything was prefilled and injected and looked correct as much as he knew what was going on. Indication was reported as COVID. To protect his elderly parents experiencing the harsh death of it. He stated that he had heard that it was so close to the SARS that it might actually protect against SARS like the breakout from 5 years ago. About concomitant medications caller stated no, he thought the only thing that comes close to it was about 1 month before he started a diet and he was losing weight and lost about 20 pounds of weight and with getting the shot he didn''t know if that would adversely affect it. Caller stated he hadn''t been taking any medication that would come close to it and he had been avoiding all the medications and he was taking vitamins and that was about it. He stated his mother reminded him that growing up he had hemorrhoid''s but he hadn''t had those in 3-4 years and he guesses that might be problematic. The events did not require emergency room or physician office visit. The outcome of the events was resolved on 23Aug2021 for bloody stool and unknown for the other event. Follow-up (08Sep2021): Follow-up attempts are completed. No further information is expected.


VAERS ID: 1711716 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-18
Onset:2021-08-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Angiogram, Electrocardiogram ST segment, Electrocardiogram ST segment elevation, Thrombosis
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ATORVASTATIN; LISINOPRIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hyperlipidemia; Hypertension; Smoker
Allergies:
Diagnostic Lab Data: Test Name: angiograph; Result Unstructured Data: Test Result:other arteries angiographically fine; Test Name: ST segment; Result Unstructured Data: Test Result:elevated
CDC Split Type: USPFIZER INC202101152340

Write-up: anterior STEMI (ST segment elevated MI); ST segment elevated MI; Thrombus to mid LAD requiring stent; This is a spontaneous report from a contactable healthcare professional. A 50-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 18Aug2021 (Batch/Lot number was not reported) at the age of 50 years, as dose 1, single for COVID-19 immunisation. Medical history included hypertension (HTN), hyperlipidaemia (HLD), and being a smoker, all from an unknown date and unknown if ongoing. The patient had no known allergies and was not diagnosed with COVID prior to vaccination. Concomitant medication included atorvastatin and lisinopril, both taken for unspecified indications, start and stop dates were not reported (in two weeks). No other vaccine was administered in four weeks. On an unspecified date, the patient was admitted with anterior STEMI (ST segment elevated MI) within 72 hours of first Pfizer vaccine on 21Aug2021. Patient had thrombus to mid LAD requiring stent with other arteries angiographically fine. The patient had no prior cardiac history and timing from vaccine dose concerning. The events resulted in Emergency room/department or urgent care, Hospitalization for 2 days, Life threatening illness (immediate risk of death from the event). Treatment included Stent to mid LAD. Outcome of the events was recovered on an unspecified date. The lot number for the vaccine BNT162B2 was not provided and will be requested during follow-up.; Sender''s Comments: Based on known drug safety profile, there is reasonable possibility of causal association between the events myocardial infarction, thrombosis and electrocardiogram ST segment elevation and the suspect drug BNT162B2. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1711902 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-07
Onset:2021-08-21
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Dizziness, Drug ineffective, Feeling abnormal, Malaise, Pyrexia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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? 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: Test Date: 20210825; Test Name: Covid; Test Result: Positive.
CDC Split Type: USPFIZER INC202101176841

Write-up: tested positive for Covid on Aug 25th; tested positive for Covid on Aug 25th; feeling sick; weakness; fever; slight cough; dizziness; feeling not good; This is a spontaneous report from a contactable consumer or other non hcp. A 54-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/lot number was not reported) via an unspecified route of administration on 07Aug2021 (age at vaccination 54-year-old) as single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient experienced tested positive for covid on Aug25th and feeling sick, weakness, fever, slight cough, dizziness, feeling not good on 21Aug2021. The clinical course was reported as she works for the school system. She had her first Covid vaccine dose on 07Aug2021. She started feeling sick on 21Aug2021 with symptoms including weakness, fever, slight cough, dizziness, and feeling not good. She tested positive for Covid on 25Aug2021 and missed her second dose which was supposed to be on 28Aug2021. She has been symptom free since 04Sep2021. The patient underwent lab tests and procedures which included sars-cov-2 test positive on 25Aug2021. The clinical outcome of the event tested positive for covid was unknown and other events was recovered on an unspecified date in 2021. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1711980 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-18
Onset:2021-08-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Conjunctivitis, Fatigue, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE BESILATE; VALSARTAN; HYDROCHLOORTHIAZIDE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101189822

Write-up: I had pink eye maybe 3 days after the vaccine; Fever; Fatigue; This is a spontaneous report from a contactable consumer. A 53-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot number and Expiration date was not reported), via an unspecified route of administration, administered in Arm Left on 18Aug2021 (age at vaccination 53 years) as dose number unknown, single for covid-19 immunisation. Medical history included High blood pressure. Concomitant medication(s) included amlodipine besilate (AMLODIPINE BESILATE); valsartan (VALSARTAN); hydrochloorthiazide (HYDROCHLOORTHIAZIDE). The patient had no known drug allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. On 21Aug2021 the patient experienced he had pink eye maybe 3 days after the vaccine, fever, fatigue. Patient visited doctor or other healthcare professional office/clinic visit. Patient reported, he was told that this is a common side effect and should end within 10 days. he still has fever and fatigue about twice that long. The patient received treatment of eye Rx. The outcome of event was recovered. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.


VAERS ID: 1712006 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-19
Onset:2021-08-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / -

Administered by: School       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood creatine phosphokinase increased, Blood test, Myalgia, Rhabdomyolysis, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: VOLTAREN [DICLOFENAC]; NORVASC
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210821; Test Name: cpk levels; Result Unstructured Data: Test Result:Increased; Comments: cpk levels had spiked to 2300.; Test Date: 20210821; Test Name: blood tests; Result Unstructured Data: Test Result:Unknown results; Test Date: 20210910; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: USPFIZER INC202101191239

Write-up: my cpk levels had spiked to 2300; Rhabdomyolysis; abdomen muscles were very sore and hurting terrible; This is a spontaneous report from a contactable consumer (patient). A 37-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Right on 19Aug2021 16:00 (at the age of 37-years-old) (Batch/Lot Number: EW0167) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included none. Concomitant medications included diclofenac (VOLTAREN [DICLOFENAC]); and amlodipine besilate (NORVASC). After a day or two after vaccination on 21Aug2021, it was reported that the abdomen muscles were very sore and hurting terrible. The patient went to the doctor and described what was going on, they took blood tests and found that the cpk levels had spiked to 2300. The patient was sent to the emergency room and put on iv''s, he had to stay in the hospital overnight on iv''s as they monitored his cpk levels. They began to go down and he was released after 24 hours. The was diagnosed with Rhabdomyolysis. The patient was hospitalized for my cpk levels had spiked to 2300, and Rhabdomyolysis from 21Aug2021 to 22Aug2021, both assessed as Life-threatening. The patient underwent lab tests and procedures which included blood creatine phosphokinase: increased on 21Aug2021 cpk levels had spiked to 2300, blood test: unknown results on 21Aug2021, sars-cov-2 test: negative on 10Sep2021. Therapeutic measures were taken as a result of the events. The outcome of the events was recovering. The patient did not have COVID prior vaccination. The patient was covid tested post vaccination, nasal swab on 10Sep2021, negative.


VAERS ID: 1712712 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1713207 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1713311 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-11
Onset:2021-08-21
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Dyspnoea, Eye pain, Fatigue, Headache, Hyperhidrosis, Inhalation therapy, Nausea, Ocular discomfort, Ocular hyperaemia, Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norethindrone tablets - 0.35mg 1x/day, Aspirin - 81mg 1x/day, IBgard - 2 capsules 1x/day
Current Illness: None.
Preexisting Conditions: Allergies: dust, pollen, ragweed, mold, many different animals, smoke. Will take Fluticasone Propionate nasal spray as needed. Asthma: mild, controlled asthma since 1976: no daily medications needed, will use Pro-Air inhaler as needed.
Allergies: Penicillin
Diagnostic Lab Data: Covid 19 test on 8/23/2021.
CDC Split Type:

Write-up: Headache, pain and pressure behind eyes - blood shot eyes, nausea, fatigue for first few days after vaccine. Then, had headache, nausea and fatigue for several days. On 8/21/2021 had sweating, headache, congestion, body aches, nausea, fatigue which then progressed to low grade fever, difficulty breathing and coughing. Had telehealth visit with Dr. on 8/23/21 who prescribed medrol dose pack and Covid test. Tested positive for Covid on 8/24/2021. Symptoms progressed with difficulty breathing, coughing and decrease pulse oxygen level to 94%. also loss of taste and smell for 4 days. Doctor began Dulera inhaler and Z-pack. Have gradually improved since.


VAERS ID: 1713421 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-08-18
Onset:2021-08-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: no known
Allergies: no known allergies
Diagnostic Lab Data: unknown- pt has physical after vaccine on an unknown date
CDC Split Type:

Write-up: Patient came in for 2nd moderna covid 19 vaccine appointment. I was asking him if he had experienced any issues with the first shot. He stated he had intermittent chest pain starting a few days after the vaccine that was accompanied with mild shortness of breath which was not normal for him. The intermittent chest pain and SOB lasted about a week and has since resolved. Patient stated he had a physical after the vaccine. He mentioned the symptoms and his vaccination status to the doctor. He said the doctor listened to his heart and said he thought it was allergies. Patient stated he does not have allergies and didn''t think it was allergies. We decided to hold off on the 2nd vaccine until we could talk to the doctor (patient came in for 2nd vaccine on a saturday when md office was closed).


VAERS ID: 1713690 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1713717 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1713746 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1713753 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1713820 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1713853 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-19
Onset:2021-08-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

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

Write-up: Large raised rash on arm for about 10 days. The skin area still itches. Low pounding in right ear once every few days or so that sometimes leads to headache.


VAERS ID: 1714057 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1714092 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA FA6780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1714108 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1714309 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1714345 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1714482 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-01
Onset:2021-08-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hallucination, Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 104 fever with hallucinations and severe uncontrollable convulsions for almost 24 hours


VAERS ID: 1714705 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-18
Onset:2021-08-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chest pain, Cluster headache, Dizziness, Hypertension, Migraine, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: After 72 hours, terrible Migraine and cluster headaches started 24 hours a day non- stop since 2nd vaccine. With Dizziness, nausea & pain in stomach, left upper chest pains off & on, and high blood pressure(never had before)


VAERS ID: 1714901 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-16
Onset:2021-08-21
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / SYR

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: Probiotics Women''s Multivitamin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Binax at-home test 8/24/21 Binax at-home test 8/26/21 RiteAid (ProjectBaseline) test 8/28/21
CDC Split Type:

Write-up: Breakthrough positive COVID case (tested positive 8/24/21 after being contacted that a coworker I had been in contact with had tested positive on 8/23/21)


VAERS ID: 1715148 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: the first covid vaccine
Other Medications: thyroid, progesterone, Calsium, esteadial, growth hormone, vit D3,
Current Illness: no
Preexisting Conditions: no
Allergies: np
Diagnostic Lab Data: none
CDC Split Type:

Write-up: My lips and my tounge swelled. Also around my face swelled one day. I''m not sure but it felt like my throat might have swelled a little one night.


VAERS ID: 1715426 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-16
Onset:2021-08-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Echocardiogram, Electrocardiogram ambulatory, Electrocardiogram normal, Fatigue, Headache, Hyperhidrosis, Limb discomfort, Nausea, Peripheral coldness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: Hysingla ER 30mg daily, Calcium 600mg, Vitamin D3 1000 unit, Vitamin B12 100mcg, Diclofenac topical gel 1%, Lexapro 20mg, Efzopiclone 3mg, Flonase, Simponi injection 50mg/.5ml monthly, Hydroxychloroquine 20mg 2x daily, Loratadine 10mg dail
Current Illness: no
Preexisting Conditions: Lupus Lupus Anticoagulant Rheumatoid Arthritis.
Allergies: Duloxetine, Nsaids, Cyclobenzaprine, Erythromyzyn, Hydroxyzine, Milnacipran, Morphine, omeprazole, Seasonal Allergies
Diagnostic Lab Data: EKG- normal Echocardiogram- Mild left ventricle thickening Holter Monitor- Tachycardia 8mins, Avg heart rate 82 BPM, Max was 139 BPM, I haven''t been given the results from the dr. yet. I don''t know what the rest of the report means on my portal.
CDC Split Type: vsafe

Write-up: 21st of August I started perspiring easily. I was only pining fabric together and was sweating and was short breath. Had a bit of chest discomfort and nausea along with a headache. I emptied bowels as well. My hands and feet were very cold. Felt like my arms were achy almost like the circulation was cut off. All the symptom lasted for a week and gradually got better. Worst was the following Wed -Friday. The 27th I had a telehealth appt. She ordered an EKG, echocardiogram, a Holter monitor and a list of warning signs to look for to go to ER. Monday the 30th felt a little better but had my EKG. 1st had the echocardiogram. Saturday the 4th I thought I was all better. Then the 5th and 6th I felt horrible again, chest discomfort, exhaustion and SOB. Then lessened slightly. Felt bad again the 12th. Holter monitor 15th.


VAERS ID: 1715476 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FWO217 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Cardiac flutter, Chest discomfort, Electrocardiogram, Headache, Musculoskeletal discomfort, Nausea, Palpitations
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (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: 51 yrs. had muscle switching for 6 mos. following a flu shot
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies: Latex, penicillin
Diagnostic Lab Data: had an EKG
CDC Split Type: E101411791

Write-up: I was fine right after the shot....Woke up the next morning with heart flutters and palpitations. 2nd day after....I started feeling nausea and fullness in upper stomach and chest and back along with heart palpitations and headaches continually for 3 weeks. I went to get the 2nd one and told vaccinators and they suggested I wait until after seeing a doctor. I am presently scheduled for Echocardiogram and cardiologist appt. Have not yet received the 2nd dose.


VAERS ID: 1715619 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-03-18
Onset:2021-08-21
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9807 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, SARS-CoV-2 test positive, Sinus disorder
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: Diagnosed with covid 19 and only had mild symptoms for covid-19 on 24 Aug2021. It started with sinus, loss of sense of taste and smell.


VAERS ID: 1715624 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-18
Onset:2021-08-21
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Urinary tract infection, Urine analysis
SMQs:

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: escitalopram 10 mg tablet cholecalciferol 1,000 unit tablet cyanocobalamin 1,000 mcg tablet atenoloL 25 mg tablet
Current Illness: none
Preexisting Conditions: GAD (generalized anxiety disorder) Class 3 severe obesity due to excess calories without serious comorbidity with body mass index (BMI) of 45.0 to 49.9 in adult Primary osteoarthritis of both knees Anxiety
Allergies: none
Diagnostic Lab Data: All on 09/07/2021 CULTURE - URINE Urogenital microbiota isolated. General Information Collected on 09/07/2021 1:18 PM (Urine) Resulted on 09/08/2021 2:58 PM Result Status: Final result WBC, URINE 22 /HPF <=5 /HPF H WBC CLUMPS Occasional RBC, URINE 1 /HPF <=2 /HPF SQUAMOUS EPITH Occasional BACTERIA 10-50 /HPF None, <10 /HPF A General Information Collected on 09/07/2021 1:18 PM (Urine) Resulted on 09/07/2021 2:06 PM Result Status: Final result Component Your Value Standard Range Flag COLOR Yellow Yellow, Colorless, Light Yellow, Dark Yellow CLARITY Slightly Cloudy Clear, Cloudy, Slightly Cloudy LEUKOCYTE ESTERASE 2+ Negative A NITRITES Negative Negative OCCULT BLOOD 1+ Negative A SPECIFIC GRAVITY <=1.005 1.005 - 1.025 KETONE Negative Negative BILIRUBIN Negative Negative GLUCOSE, URINE Negative Negative ALBUMIN, URINE Negative Negative PH - URINE 5.5 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0 General Information Collected on 09/07/2021 1:18 PM (Urine) Resulted on 09/07/2021 1:45 PM Result Status: Final result
CDC Split Type:

Write-up: Beginning approx. 08/21/2020 I started having bladder infection or kidney stone symptoms which lasted straight thru until I saw the doctor finally on 09/07/2021. I was treated for an injection with sulfamethoxazole-trimethoprim 800-160 mg tablet for 3 days and that seems to have cleared up the problem. Was only tested for infection, not kidney stones at that time.


VAERS ID: 1719117 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-14
Onset:2021-08-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, 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? Yes
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: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: reported swelling redness and itch at injection site for 3 days occurred 1 week after vaccination


VAERS ID: 1719210 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Appendicectomy, Appendicitis, Gait inability, Infection, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received the vaccination and within 24 hours started having extreme stomach pain and a fever with NO prior history of any stomach pains or issues before the vaccine. By the next day my pain was so extreme that I could not walk. I went to the hospital and was diagnosed with acute appendicitis and had an infection. Following my diagnosis I underwent surgery to have an emergency appendix removal.


VAERS ID: 1719614 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Angina pectoris, Blood test, Chest pain, Echocardiogram normal, Electrocardiogram normal, Heart rate increased, Magnetic resonance imaging normal
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Had a cold prior, was tested for Covid but negative
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: EKG - Normal Echo - Normal MRI - Normal Blood work
CDC Split Type:

Write-up: Patient experience rapid heart beating and heart hurting, chest pain the next day after first dose.


VAERS ID: 1719816 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase increased, Basophil count abnormal, Blood albumin normal, Blood alkaline phosphatase increased, Blood bilirubin abnormal, Blood calcium normal, Blood chloride increased, Blood creatinine normal, Blood glucose abnormal, Blood immunoglobulin G, Blood potassium increased, Blood sodium normal, Blood urea decreased, Carbon dioxide decreased, Chest discomfort, Electrocardiogram, Electrocardiogram QT interval, Electrocardiogram abnormal, Eosinophil percentage abnormal, Full blood count, Glomerular filtration rate normal, Haematocrit normal, Haemoglobin decreased, Heart rate increased, Laboratory test, Lymphocyte count, Lymphocyte percentage abnormal, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin increased, Mean cell volume increased, Metabolic function test, Monocyte count, Monocyte percentage decreased, Neutrophil count, Neutrophil percentage abnormal, Platelet count, Protein total decreased, QRS axis, Red blood cell count decreased, Red cell distribution width normal, Sinus tachycardia, Troponin I increased, White blood cell count increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Biliary system related investigations, signs and symptoms (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Differin Cream, Aimovig Sureclick, Lamotrigine, Memantine, Prilosec, Pristiq, Synthroid, Trazodone, Wellbutrin XL
Current Illness: No illnesses at the time of vaccination. Recent upper resp infection symptoms onset 7/31, saw dr 8/3, Covid negative 8/3
Preexisting Conditions: Depression, hypothyroidism, migraine
Allergies: isometh-dichloral-acetaminophen, prochlorperazine, polymyxin B
Diagnostic Lab Data: 2-Lead ECG [632317643] Collected: 08/21/21 1349 Order Status: Completed Updated: 08/21/21 1401 VENTRICULAR RATE EKG/MIN 103 bpm ATRIAL RATE 103 bpm PR-INTERVAL (MSEC) 130 ms QRS-INTERVAL (MSEC) 78 ms QT-INTERVAL (MSEC) 330 ms QTC 432 ms P AXIS 21 degrees R AXIS 17 degrees T AXIS 15 degrees Impression: Sinus tachycardia Otherwise normal ECG When compared with ECG of 30-OCT-2020 12:38, PREVIOUS ECG IS PRESENT CBC: WBC 7.5 K/mcL 3.4 - 11.0 K/mcL RBC 4.14 M/mcL 3.98 - 5.25 M/mcL HGB 12.7 g/dL 11.9 - 15.3 g/dL HCT 37.6 % 37.3 - 46.7 % MCV 91 fL 81 - 100 fL MCH 31 pg 26 - 33 pg MCHC 33.8 g/dL 31.0 - 36.0 g/dL RDW 12.4 % 11.7 - 14.9 % Platelet Count 207 K/mcL 150 - 425 K/mcL nRBC 0.0 /100 WBCs 0 /100 WBCs Preliminary Abs Neut 5.36 K/mcL 1.50 - 7.40 K/mcL Neutrophils % 71.9 % 38.0 - 74.0 % IG% 0.4 % 0.0 - 1.2 % Lymphocytes % 15.7 % 16.0 - 48.0 % Monocytes % 11.5 % 4.9 - 12.5 % Eosinophils % 0.0 % 0.0 - 9.5 % Basophils % 0.5 % 0.0 - 1.6 % Absolute Neutrophils 5.36 K/mcL 1.50 - 7.40 K/mcL IG# 0.03 K/mcL 0.00 - 0.10 K/mcL Absolute Lymphocytes 1.17 K/mcL 0.90 - 3.10 K/mcL Absolute Monocytes 0.86 K/mcL 0.26 - 0.87 K/mcL Absolute Eosinophils 0.00 K/mcL 0.00 - 0.51 K/mcL Absolute Basophils 0.04 K/mcL 0.00 - 0.09 K/mcL Troponin I <0.012 ng/mL <0.035 ng/mL The decision limit value of 0.035 ng/mL is based on the established 99th percentile upper reference limit in a healthy reference population. This patient''s result is considered normal. However, clinical correlation is suggested to determine whether serial measurements are necessary for further evaluation. High dose biotin supplementation ($g1 mg/day) may falsely decrease results. Comprehensive Metabolic Panel: Sodium 137 mmol/L 137 - 145 mmol/L Potassium 4.1 mmol/L 3.5 - 5.1 mmol/L Chloride 105 mmol/L 98 - 107 mmol/L CO2, Total 27 mmol/L 22 - 30 mmol/L Glucose 114 mg/dL 70 - 125 mg/dL Urea Nitrogen 12 mg/dL 7 - 17 mg/dL Creatinine 0.7 mg/dL 0.5 - 1.0 mg/dL Osmolality Calculated 285 mOsm/kg H20 280 - 305 mOsm/kg H20 Albumin 4.3 g/dL 3.5 - 5.0 g/dL Total Protein 7.2 g/dL 6.3 - 8.2 g/dL Calcium 9.4 mg/dL 8.4 - 10.2 mg/dL Alkaline Phosphatase 83 Units/L 38 - 126 Units/L AST 20 Units/L 14 - 36 Units/L Bilirubin, Total 0.3 mg/dL 0.2 - 1.3 mg/dL Anion Gap 5 mmol/L 6 - 14 mmol/L ALT 21 Units/L <=34 Units/L GFR Calculation, African American $g60 mL/min/1.73m*2 $g60 mL/min/1.73m*2 GFR Calculation, Non-African American $g60 mL/min/1.73m*2 $g60 mL/min/1.73m*2
CDC Split Type:

Write-up: 41 y.o. female with history of selective IgA deficiency presented to urgent care with tachycardia after the third Covid vaccine that she received yesterday. At home she noticed resting heart rate of 115. She get up and exerting herself is 130.to 140. Patient is otherwise have no fever, chills, nausea, vomiting, headache, dysuria change in bowel habit. Complaining of a tachycardia give her chest pressure. No history chest pain shortness of breath or diaphoresis on exertion. Prior to the vaccine. Assessment 41-year-old female presented to urgent care with tachycardia after thorough Covid vaccine. After interview and examination of electronic health record review and nursing note reviewed. Discussed with patient recommend EKG which showed tachycardia no ST changes. Patient had TSH and T4 ordered by primary physician yesterday the result was normal. I discussed with patient I recommend for her to have the CBC CMP troponin all unremarkable. I explained to patient that while in urgent care she received a liter of normal saline her heart rate went down to 90 I feel comfortable patient be discharged home her tachycardia most likely secondary to Covid vaccine side effect is not an allergic reaction normal EKG normal troponin unlikely to be acute myocardial infarction. Unlikely to be pulmonary embolism with no tachypnea with normal O2 saturation no leg swelling. Patient have in no distress no active chest pain unlikely of acute myocardial infarction. I emphasized the need follow-up close with primary physician within 1 week for further evaluation. Return to urgent care or go the nearest emergency department immediately if she develop fever, chills, nausea, vomiting, headache, chest pain, shortness of breath, weakness or numbness. Patient acknowledged understanding agree with the plan discharged in stable condition.


VAERS ID: 1722535 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-18
Onset:2021-08-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Culture stool, Diarrhoea, Extra dose administered, Illness, Immediate post-injection reaction, Mobility decreased, White blood cell count
SMQs:, Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carbamazperine, estradiol, escitalopram, leviraletam,
Current Illness: NO
Preexisting Conditions: Mast cell activation syndrome, IGG deficiency, transverse myelitis , w/chronic pain lower body.
Allergies: PCN, Venofer, avelox, companzine, Ferrfecit, Vancomycin.
Diagnostic Lab Data: 9/21/21 Fecal luekocytes-negative.
CDC Split Type:

Write-up: Immediately after Moderna #3 booster she said she was sick for three day "was so sick and could not get out of bed" then on day three she started with diarrhea so bad that she feels she can''t make it to toilet. The problem persists to this day. She visited her PCP and was given a round of cipro for presumed gastroenteritis she said that the antibiotics did not help the problem at all.


VAERS ID: 1722653 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

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

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

Write-up: no symptoms


VAERS ID: 1722963 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder, Menstruation irregular
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi-vitamin, vitamin D3, acid reflux prescription
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The day after my first shot i got my period. I am regular as clockwork. My period came a full week early. I have a short cycle, so it was late when it came the day before my second COVID shot. I am past child bearing years and do not want children, so reproduction is not a concern for me. But i know a lot of women who are in child bearing years and are concerned about their reproductive health with the vaccine. Many women i know have had their periods fluctuate due to vaccination. from what i have read, this is just beginning to be looked into. Unfortunately, this should have been looked into in the very first trials performed. But i can understand how hard that would be to find women willing to do a trial that could potentially cause them to not be able to conceive. Only time will tell how the vaccine truly affects women''s reproductive health. But what i can tell you is there will not be a large increase in women getting vaccinated until this issue has been shown to actually be throughly reseached. Just saying there appears to be no problems is not good enough when women talk and know there are problems. There needs to be legitimate scientific study done to show that while the vaccine disrupts a cycle short term it has no long term effects. until that can be proven there will be continued vaccine hesitancy.


VAERS ID: 1723037 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dysmenorrhoea, Fatigue, Headache, Heavy menstrual bleeding, Injection site pain, Insomnia, Intermenstrual bleeding, Malaise, Menstrual disorder, Pyrexia, Sleep disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The night of the second vaccine, there was intense pain at the injection site, to the point I was awakened from my sleep, could not sleep comfortably and had to take ibuprofen. The following day I experienced extreme fatigue/malaise, headache, fever, and chills. I have also had an abnormal menstrual cycle following the vaccine, with break through heavy bleeding and painful cramping.


VAERS ID: 1723300 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-09
Onset:2021-08-21
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Blood fibrinogen abnormal, Blood gases abnormal, Blood lactate dehydrogenase abnormal, COVID-19, Chest X-ray abnormal, Chills, Condition aggravated, Dyspnoea, Fibrin D dimer increased, Full blood count abnormal, General physical health deterioration, Hypertension, Metabolic function test abnormal, Oxygen saturation decreased, Pain, Pneumonia, Positive airway pressure therapy, Pyrexia, SARS-CoV-2 test positive, Type 2 diabetes mellitus
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 33 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported
Preexisting Conditions: diabetes type II, GERD, HTN, obesity, and sleep apnea
Allergies: No known allergies
Diagnostic Lab Data: CBC, CMP, ABG''s, D Dimer, Fibrinogen, LDH, CXR, all labs abnormal and showing severe COVID, acute respiratory failure with hypoxia, pneumonia, AKI, DM II, HTN.
CDC Split Type:

Write-up: He saw his PCP on 08/15/2021 and was tested + for Covid, He has been on an albuterol inhaler and Decadron and mucinex at home with minimal relief. His oxygen saturation has been dropping slowly over the last the 2 days prior to his admission. The patient''s oxygen saturation was 84% and he called EMS; however, when EMS arrived it was 75%. He was placed on a nonrebreather at 15 liters per minute. And in the ER admitted he was having to work hard to breath. He has also continued to have fever, chills, and bodyaches. The patient did state he completed the Moderna Vaccine in May 2021. After admission to the hospital. He was given Remdesivir and steroids and breathing treatments. He continued to deteriorate and required placement on BiPAP. And the patient was transferred to this facility due to no ICU beds in their facility. .


VAERS ID: 1725371 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dry mouth, Inappropriate schedule of product administration, Insomnia, Pollakiuria
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Medication errors (narrow), Dehydration (broad)

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

Write-up: Frequent urination; Dry mouth; Disrupting her sleep; Injections 21 days apart; This spontaneous case was reported by a consumer and describes the occurrence of POLLAKIURIA (Frequent urination), DRY MOUTH (Dry mouth), INSOMNIA (Disrupting her sleep) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Injections 21 days apart) in a 35-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 017E21A and 011D21A) for COVID-19 vaccination. No Medical History information was reported. On 01-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Aug-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Injections 21 days apart). On an unknown date, the patient experienced POLLAKIURIA (Frequent urination), DRY MOUTH (Dry mouth) and INSOMNIA (Disrupting her sleep). On 21-Aug-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Injections 21 days apart) had resolved. At the time of the report, POLLAKIURIA (Frequent urination), DRY MOUTH (Dry mouth) and INSOMNIA (Disrupting her sleep) outcome was unknown. The patient developed side effects of frequent urination and dry mouth that were actually disrupting her sleep she can not go anywhere without water. No concomitant medications were reported. No treatment information was reported. This case was linked to MOD-2021-319687 (Patient Link).


VAERS ID: 1725395 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Malaise, Pneumonia
SMQs:, Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

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

Write-up: pneumonia; cough; feel sick; This spontaneous case was reported by a consumer and describes the occurrence of PNEUMONIA (pneumonia) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 20-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Aug-2021, the patient experienced MALAISE (feel sick). On 29-Aug-2021, the patient experienced PNEUMONIA (pneumonia) (seriousness criterion medically significant) and COUGH (cough). At the time of the report, PNEUMONIA (pneumonia) and MALAISE (feel sick) outcome was unknown and COUGH (cough) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by reporter. Treatment information was not provided. Company Comment: This case concerns a female patient of an unknown age with no relevant medical history who experienced unexpected event of pneumonia. The event occurred 10 days after the first dose of mRNA-1273. The rechallenge was not applicable, as the event happened after the first dose. The benefit-risk relationship of mRNA-1273 is not affected by this report. The event pneumonia is marked serious by the auto-seriousness tool. Case downgraded to non-serious due to the lack of evidence of seriousness from a clinical or regulatory standpoint, and reporter assessed the case as non-serious.; Sender''s Comments: This case concerns a female patient of an unknown age with no relevant medical history who experienced unexpected event of pneumonia. The event occurred 10 days after the first dose of mRNA-1273. The rechallenge was not applicable, as the event happened after the first dose. The benefit-risk relationship of mRNA-1273 is not affected by this report. The event pneumonia is marked serious by the auto-seriousness tool. Case downgraded to non-serious due to the lack of evidence of seriousness from a clinical or regulatory standpoint, and reporter assessed the case as non-serious.


VAERS ID: 1726816 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-23
Onset:2021-08-21
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Exposure to SARS-CoV-2, Headache, Laboratory test, SARS-CoV-2 test positive, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Anastrozole, Atorvastatin, Gabapentin, Levothyroxine, Lisinopril- HCTZ, Diclofenac, Venlafaxine, 81 mg Aspirin, vitamin B12, super B complex, calcium, magnesium malate complex, vitamin D3, folic acid, fiber, multi vitamin, potassium citrat
Current Illness: None
Preexisting Conditions: Thyroid disease, I had breast cancer in December 2018 ,high blood pressure, high cholesterol
Allergies: None
Diagnostic Lab Data: 08/23/2021 Covid test- negative 08/27/2021 Covid test- positive
CDC Split Type: vsafe

Write-up: I live in a household with 2 other people. One of them was diagnosed with Covid on 08/20/2021. On 08/21/2021 I started having the same symptoms he had. I went to urgent department on 08/23/2021 and I got tested for Covid. It came back negative. I was still having the same symptoms, so I called my doctor. I was having some trouble breathing, coughing, and bad headache. They sent me to the ER. I tested positive on 08/27/2021 for Covid. I spent like 12 hours there. They ran every test in the world I think. They came back normal, but I had a urine infection and they gave me Regen-COV. I still have a cough but its not bad.


VAERS ID: 1726940 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-01
Onset:2021-08-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus, Vaccine positive rechallenge
SMQs:, Hearing impairment (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: Levothyroxine 100 mcg daily
Current Illness:
Preexisting Conditions: Hashimoto?s thyroiditis
Allergies: Amoxicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loud bilateral high-pitched ringing in ears began 5-10 minutes after first injection, diminishing in volume over the next 3-4 weeks. On 9/20/21 I received the second Pfizer injection and within the first few moments began experiencing the same symptoms, somewhat more intensely. As of today there is no improvement.


VAERS ID: 1727374 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SL3183 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Antibody test negative, Blood immunoglobulin G, Condition aggravated, Fibromyalgia, Illness, Mobility decreased, Osteoarthritis, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: New shingles vaccine 2 years ago, Covid vaccines dose 1 and 2
Other Medications: skip
Current Illness: no, In May I sick and I took prednisone and felt better in June 2021.
Preexisting Conditions: fibromyalgia. hypothyroidism, osteoarthritis . Chronic fatigue and cold intolerance
Allergies: gluten intolerance
Diagnostic Lab Data: IGG and IZA level has not improved. 1.2 percent.
CDC Split Type: vsafe

Write-up: prednisone in june sick .1st vaccine in january2021 and 2nd dose 22 Feb20212021. March saw the doctor and I had xray of my hand and osteoarthritis was diagnosed. In may , I was still sick. May2021, 3 way course of prednisone. fibromyalgia and anti bodies checked and no antibodies, 20 Aug2021 3rd dose and no change. IGG and IZA level has not improved. 1.2 percent. After 3rd dose, I got sick in the middle of the night. Had a low grade fever and entire body ached and fibromylya and osteoaritis flared up and been doing tele doctor. I am bedridden, cant drive and going to do PT rehab My doctor wanted to wait 3 weeks to get my antibodies tested on 13 sep2021


VAERS ID: 1728777 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-18
Onset:2021-08-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Dyspnoea, Palpitations, Panic attack, Vertigo
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mult Vitamin, Stress Gummies, Chloroxygen, antibiotics.
Current Illness: Eye infection.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness, Heart Racing, Panic attacks, High anxiety Breathing Problems, Vertigo (4 weeks)


VAERS ID: 1730353 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-08-21
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Product dose omission issue
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: USMODERNATX, INC.MOD20213

Write-up: Patient received her 1st dose on Jul 27th 2021, Patient was scheduled to receive her 2nd dose on Aug 21st 2021 but she missed her appointment; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Patient received her 1st dose on Jul 27th 2021, Patient was scheduled to receive her 2nd dose on Aug 21st 2021 but she missed her appointment) in a 25-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 27-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Aug-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (Patient received her 1st dose on Jul 27th 2021, Patient was scheduled to receive her 2nd dose on Aug 21st 2021 but she missed her appointment). On 21-Aug-2021, PRODUCT DOSE OMISSION ISSUE (Patient received her 1st dose on Jul 27th 2021, Patient was scheduled to receive her 2nd dose on Aug 21st 2021 but she missed her appointment) had resolved. concomitant medicines was not reported by reporter Treatment information was not provided


VAERS ID: 1730388 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Dyspnoea, Headache, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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 INC202101085648

Write-up: Headache; Vomiting; Stomach pain; She is not breathing; This is a spontaneous report from a contactable consumer. This consumer reported for a 16-year-old female patient (reporter''s sister) that: A 16-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number: Unknown), via an unspecified route of administration on 20Aug2021 as dose number unknown, single for COVID-19 immunisation at pharmacy. The patient medical history and concomitant medications were not reported. She was having some side effects. She was having headache; she has vomited and a lot of stomach pain. We only gave her Tylenol (Intent: treatment). She took the vaccine on Friday in the afternoon. She stated having them yesterday (21Aug2021) in the afternoon, but it got worse this morning. She said she was not breathing. We are going to send her to the hospital. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1730392 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, Pruritus, Vaccination site erythema, Vaccination site urticaria, Vaccination site warmth
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: Patient''s Medical History (including any illness at time of vaccination): None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101096461

Write-up: her arm on the backside at the top of her arm where she got the shot had hives, and they were hot and red; face started tingling and feeling numb; really itchy; they were hot and red; feeling numb; they were hot and red; This is a spontaneous report from a contactable consumer or other non hcp (patient). A 69-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for Injection, Batch/Lot Number: FC3180; Expiration Date: 31Oct2021), via an unspecified route of administration, administered in arm left (left upper arm) on 21Aug2021 (at the age of 69-year-old) as dose 1, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient did not receive any other vaccine prior vaccinations within 4 weeks. On 21Aug2021, the patient experienced her arm on the backside at the top of her arm where she got the shot had hives, and they were hot and red, face started tingling and feeling numb, really itchy, they were hot and red. Patient got the shot the Pfizer biontech, name as provided by the caller. Patient got the shot on 21Aug2021, she ended up getting first dose. Patient felt fine, but then her arm on the backside at the top of her arm where she got the shot had hives, and they were hot and red. Patient would like to know if its a normal side effect or if she needs to go to the doctor. Patient signed up with safe. Patient got the shot on the front side of arm. It makes her afraid to get the second one. Hives, and they were hot and red. Half an hour after her shot, it was really itchy. Treatment - antiitch medication. Face started tingling and feeling numb: About 10 mins after her shot her face started tingling and feeling numb. It went away after an hour and a half. It was around her cheek. Patient recovered completely. The patient received antiitch medication as treatment for the event really itchy. Outcome of the events her arm on the backside at the top of her arm where she got the shot had hives, and they were hot and red was not recovered; really itchy, they were hot and red was unknown; face started tingling and feeling numb recovered on an unspecified date in 2021. Follow-up attempts are completed. No further information is expected .


VAERS ID: 1730394 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Body temperature, Dizziness, Fatigue, Headache, Pain, Pyrexia, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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? 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: Dysautonomia; Ehlers-Danlos syndrome (Ehlers Danlos); Penicillin allergy (Known allergy :Penicillin: rash, hives)
Allergies:
Diagnostic Lab Data: Test Date: 20210821; Test Name: Body temperature; Result Unstructured Data: Test Result:102.9 Fahrenheit
CDC Split Type: USPFIZER INC202101102348

Write-up: Bright red itchy rash; Bright red itchy rash; Bright red itchy rash, resembling a sunburn; Other side effects: fever started Sat. night ended Tues. highest temperature 102.9; dizziness; weakness; headache; fatigue; body aches; This is a spontaneous report from a contactable consumer (patient) reported that a 53-years-old non pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number: fc3182), dose 1 via an unspecified route of administration, administered in Arm Left on 21Aug2021 14:45 (at the of 53 years old) as dose 1, single for covid-19 immunisation. Medical history included Ehlers Danlos and Dysautonomia, penicillin allergy. The patient Known allergy Penicillin: rash, hives. The patient previously took anaprox and experienced hypersensitivity. The patient did not received any other vaccines within 4 weeks prior to the COVID vaccine. Facility type vaccine: Pharmacy or Drug Store and facility country in US. Prior to vaccination patient had COVID-19. Post vaccination, the patient had not been tested for COVID-19. No treatment was received in response to the adverse events. On 21Aug2021, the patient experienced bright red itchy rash, resembling a sunburn, other side effects: fever started sat. night ended tues. highest temperature 102.9, dizziness, weakness, headache, fatigue and body aches. The patient underwent lab tests and procedures which included body temperature: 102.9 fahrenheit on an 21Aug2021. The outcome of the events was recovering. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1730449 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Movement disorder, Muscle tightness, Pain in extremity
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to molds; Dust allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101191916

Write-up: Left arm pain and muscle tightness. Unable to close left hand.; Left arm pain and muscle tightness. Unable to close left hand.; Left arm pain and muscle tightness. Unable to close left hand.; This is a spontaneous report received from a contactable consumer (patient) A 36-year-old male patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE Batch/Lot Number: EW0186) on 20Aug2021 at 16:00 , via an unspecified route of administration, in Arm Left as single dose for COVID-19 immunisation. Medical history included dust allergy and mycotic allergy. On 21Aug2021 at 04:00 p.m. the patient experienced left arm pain and muscle tightness, unable to close left hand with outcome of not recovered.


VAERS ID: 1731517 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-08-10
Onset:2021-08-21
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Unexplained rash (treatment non-responsive). Rash began days after 2nd Moderna vaccine and have gotten worse. Rash spread from groin, to flank, to back


VAERS ID: 1731537 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Erythema, Hypersensitivity, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Epi pen for emergency use Steroid & antibiotic from Urgent Care
Current Illness: unknown
Preexisting Conditions: GERD
Allergies: latex, bees, bee venom, shell fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 9/3/21: 50 yo Female reported to the EC c/o of allergic rxn. Patient reported increased redness/swelling to upper left extremity after receiving COVID-19 vaccine on the previous Wednesday. Also, notes lightheadedness with left wrist pain. She had gone to Urgent Care & given antibiotic ointment but states that it progressively worsened over time & it has double in size.


VAERS ID: 1732046 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-02-09
Onset:2021-08-21
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, COPD, Hyperlipidemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was fully vaccinated 2 weeks after the last dose of Moderna Covid vaccine given. Pt was subsequently diagnosed with COVID on 08/17/2021 and then admitted to the hospital for treatment on 08/21/2021.


VAERS ID: 1732241 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-19
Onset:2021-08-21
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Arthritis, Condition aggravated
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamins, calcium, D3, Retasis eye drops
Current Illness: none
Preexisting Conditions: Arthritis and osteopenia
Allergies: Dust, sheep and cats
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Severe arthritis pain in joints of feet, knees, wrists and fingers. More than normal and in more places than previously with no other physical impacts to any joints or injury. Cortisone shots in the knees were given but still severe flare ups after


VAERS ID: 1733875 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 3 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Dizziness, Dysstasia, Fall, Fatigue, Gait disturbance, Headache, Pollakiuria
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMINS;MINERALS;LYSINE; CALCIUM; RAPAMUNE
Current Illness: Drug allergy (ciprofloxacin)
Preexisting Conditions: Medical History/Concurrent Conditions: Liver transplant (12 year ago.)
Allergies:
Diagnostic Lab Data: Test Name: blood test; Result Unstructured Data: ALT-34,AGT-39, BUN-23,CREATINE-1.43, DIRECT BILLI..-40, MCH-31.3, MID-13.3; Test Name: Blood test; Result Unstructured Data: GRANULOCYTES-57.20, MPV-7.0
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Could hardly stand; headache; fatigue; little dizzy; barley walk; was falling in the walls; frequently urinate; This spontaneous case was reported by a patient and describes the occurrence of DIZZINESS (little dizzy), GAIT DISTURBANCE (barley walk), FALL (was falling in the walls), POLLAKIURIA (frequently urinate) and DYSSTASIA (Could hardly stand) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 049E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Liver transplant (12 year ago.) in November 2008. Concurrent medical conditions included Drug allergy (ciprofloxacin). Concomitant products included SIROLIMUS (RAPAMUNE) for Immunosuppressant drug level NOS, VITAMINS;MINERALS;LYSINE and CALCIUM for an unknown indication. On 21-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Aug-2021, the patient experienced DIZZINESS (little dizzy), GAIT DISTURBANCE (barley walk), FALL (was falling in the walls) and POLLAKIURIA (frequently urinate). On 22-Aug-2021, the patient experienced HEADACHE (headache) and FATIGUE (fatigue). On an unknown date, the patient experienced DYSSTASIA (Could hardly stand). The patient was treated with PARACETAMOL (TYLENOL) for Headache and Fatigue, at an unspecified dose and frequency. On 22-Aug-2021, DIZZINESS (little dizzy), GAIT DISTURBANCE (barley walk), FALL (was falling in the walls) and HEADACHE (headache) had resolved. At the time of the report, POLLAKIURIA (frequently urinate) and DYSSTASIA (Could hardly stand) outcome was unknown and FATIGUE (fatigue) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood test: 34,37,23,1.43, 40, 31.3,13.3 (High) ALT-34,AGT-39, BUN-23,CREATINE-1.43, DIRECT BILLI..-40, MCH-31.3, MID-13.3 and 57.20,7.0 (Low) GRANULOCYTES-57.20, MPV-7.0. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Reporter states that patient had blood test after 3 days of vaccination and liver and kidney level was elevated. patient will be going for another blood test after couple of days to see it return to normal. No treatment medications were provided. Most recent FOLLOW-UP information incorporated above includes: On 16-Sep-2021: Significant follow up events and new reporter and event outcome and tests are added , and I narrative updated.


VAERS ID: 1733994 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 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: vaccine given to underage patient; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (vaccine given to underage patient) in a 12-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 004F21A) for COVID-19 vaccination. No Medical History information was reported. On 21-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Aug-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (vaccine given to underage patient). At the time of the report, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (vaccine given to underage patient) 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 treatment and concomitant medications were provided.


VAERS ID: 1734126 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling abnormal, Hypoacusis, Lymphadenopathy
SMQs:, Dementia (broad), Hearing impairment (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: TESTOSTERONE
Current Illness: Multiple endocrine neoplasia Type 1 (diagnosed in 2015 when he was 21 years old.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101110855

Write-up: hard to hear out of his left ear; lymph nodes are swollen in neck and across clavicle; head is stuffy; This is a spontaneous report from a contactable consumer (patient). A 27-year-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Batch/Lot Number: EW0173), via an unspecified route of administration, administrated in left arm on 20Aug2021 10:45 (age at the time of vaccination 27-years-old), as a single dose for COVID-19 immunization. The patient''s medical history included Multiple endocrine neoplasia Type 1, diagnosed in 2015 when he was 21 years old, ongoing. The patient''s concomitant medications included testosterone, caller states he does get testosterone shots, states he got one two days prior to his first dose and one 1 week prior to his second dose. Patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Batch/Lot Number: EW0162), via an unspecified route of administration, administrated in left arm on an unspecified date 2021 (age at the time of vaccination 27-years-old), as a single dose for COVID-19 immunization. On 21Aug2021, the patient experienced hard to hear out of his left ear, lymph nodes are swollen in neck and across clavicle, and head is stuffy. Patient visited to physician office, did not visit to emergency room. The outcome for all the events was not recovered. Follow-Up (07Sep2021): Follow-up attempts are completed. No further information is expected.


VAERS ID: 1734948 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

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

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

Write-up: PATIENT IS 16 YEAR OLD AT THE TIME OF ADMINISTRATION


VAERS ID: 1735566 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-15
Onset:2021-08-21
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0153 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Decreased activity, Decreased appetite, Dyspnoea, Fatigue, Hypoxia, Leukocytosis, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: DIABETES; HYPERLIPEMIA; HYPERTENSION
Allergies: NO KNOW ALLERGIES
Diagnostic Lab Data: SARS- COV-2 PCR (8/21/2021) CHEST XRAY (8/21/2021)
CDC Split Type:

Write-up: PATIENT RECIEVED VACCINE DOES ON 3/15/21 & 4/12/21. CONTRACTED COVID AND WAS HOSPITALIZED FOR 19 DAYS. PATIENT WAS ATMITTED ON 8/21/21 AND DIAGNOSED WITH COVID PNEUMONIA + HYPOXIA + LEUKOCYTOSIS. PRESENTS WITH SOB, WEAKNESS, FATIGUE, DECREASED ACTIVITY, LOSS OF APPETITE, MUSCLE PAIN, PATIENT WAS EVENTUALLY TRANSFERED TO A EXTENDED CARE FACILITY.


VAERS ID: 1735572 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Blood test, Chest X-ray, Dyspnoea, Electrocardiogram, Gynaecological examination, Lip swelling, Palpitations, Urinary tract infection, Urine analysis, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: EKG, chest x-ray, pelvic exam, blood test, urine test all done August 26, 2021
CDC Split Type:

Write-up: Heart palpitations, wheezing, shortness of breath, swelling in upper lip, extreme lower abdominal cramps, urinary infection (visited urgent care a few days later for treatment)


VAERS ID: 1736043 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lumbar puncture, Magnetic resonance imaging, Muscular weakness, Myelitis transverse
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Progesterone, PMS supplement
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, mycin, sulfa
Diagnostic Lab Data: MRI 9/7/21 Lumbar puncture 9/7/21
CDC Split Type:

Write-up: Weakness in arms that moved to legs. Hospitalized and diagnosed with transverse myelitis after 2 weeks. Not leg function.


VAERS ID: 1737041 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-03
Onset:2021-08-21
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: PCR collected on 8-24-2021, positive result on 8-28-2021
CDC Split Type:

Write-up: Runny Nose, loss of taste and smell


VAERS ID: 1737053 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-22
Onset:2021-08-21
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Endotracheal intubation, Extubation, Incomplete course of vaccination, Malaise
SMQs:, Angioedema (broad), Respiratory failure (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Alprazolam, lamotrigine, topiramate, ondansetron, hydroxychloroquine, sumatriptan, methotrexate, folic acid, prednisone, humalog, restasis, hydromorphone, tizanidine, diclofenac
Current Illness: None
Preexisting Conditions: Addison Disease Anxiety Asthma Depression Type 2 Diabetes Diabetic peripheral neuropathy Diarrhea Migraine Lupus erythematosus Non-intractable vomiting with nausea Periumbilical pain Rheumatoid arthritis
Allergies: Penicillin - not specified Latex/natural rubber - rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted with covid-19 symptoms. According to records, patient only received one dose of Moderna vaccine in March. If patient received second dose it was not documented with the immunization registry. Patient ultimately had to be intubated during stay. Patient was successfully extubated and discharged home from the hospital after a stint in inpatient rehab.


VAERS ID: 1737226 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-13
Onset:2021-08-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Pain in extremity, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhaler, aspirin 81 mg, cholecalciferol, citalopram, fish oil, fluticasone nasal spray, fluticasone-salmeterol oral inhalation, levothyroxine, melatonin, multivitamin
Current Illness: Tendonitis (in walking boot), history of COVID infection in January 2021
Preexisting Conditions: Prothrombin gene mutation (heterozygous), depression, hypothyroidism
Allergies: Ciprofloxacin
Diagnostic Lab Data: Duplex US positive for DVT on 8/21/21
CDC Split Type:

Write-up: Patient received the first dose of the COVID-19 Moderna vaccine. One week later developed left calf pain. At the time was in a boot for tendonitis. Described pain as new and aggravated by ambulation or pressure. No alleviating factors. She was sent by podiatrist for vascular study which was positive for DVT to the left distal popliteal vein and posterior tibial veins. Patient was seen at the ED and prescribed rivaroxaban.


VAERS ID: 1737542 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023(21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023(21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: Crab
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Non stop ringing in both ears day after my second dose.


VAERS ID: 1738269 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acupuncture, Albumin urine absent, Angiogram pulmonary abnormal, Anion gap, Aortic arteriosclerosis, Arteriogram carotid abnormal, Arteriosclerosis, Arteriosclerosis coronary artery, Basophil count increased, Basophil percentage decreased, Bilirubin urine, Blood albumin normal, Blood calcium normal, Blood chloride normal, Blood creatine phosphokinase MB, Blood creatine phosphokinase normal, Blood creatinine increased, Blood glucose increased, Blood magnesium normal, Blood phosphorus normal, Blood potassium increased, Blood sodium normal, Blood test, Blood urea increased, Blood urine absent, Brachiocephalic artery occlusion, Carbon dioxide normal, Carotid artery occlusion, Carotid artery stenosis, Chest pain, Condition aggravated, Differential white blood cell count, Electrocardiogram QT interval, Electrocardiogram ST segment abnormal, Eosinophil count normal, Eosinophil percentage increased, Fatigue, Full blood count, Gastrooesophageal reflux disease, Glomerular filtration rate decreased, Glucose urine absent, Glycosylated haemoglobin, Haematocrit normal, Haemoglobin decreased, Hiatus hernia, Hypertension, Immature granulocyte count, Impaired work ability, Insomnia, Listless, Lymphocyte count, Lymphocyte percentage decreased, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin decreased, Mean cell volume normal, Mean platelet volume normal, Metabolic function test, Monocyte count, Monocyte percentage increased, Myocardial infarction, Neck pain, Nervousness, Neutrophil count, Neutrophil percentage increased, Nitrite urine absent, Non-24-hour sleep-wake disorder, Oesophagitis, Pain, Platelet count normal, Protein urine absent, Pulmonary calcification, Pulmonary mass, QRS axis, Red blood cell count normal, Red cell distribution width normal, Renal atrophy, Renal cyst, Renal function test, Respiratory tract ulceration, Scan with contrast, Specific gravity urine, Specific gravity urine normal, Spinal osteoarthritis, Troponin T increased, Urine analysis, Urine ketone body absent, Urine leukocyte esterase, Urine protein/creatinine ratio, White blood cell count normal, pH urine
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (narrow), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Carvedilol 12.5 mg 2x/day
Current Illness: N/A
Preexisting Conditions: Kidney Dx Stage 4 with controlled High Blood pressure with Meds
Allergies: Penicillin
Diagnostic Lab Data: See continuation page
CDC Split Type:

Write-up: Second Maderna shot done 08/20/2021. By 24 hours patient began experiencing heighten nervousness. Began having trouble sleeping. During the next week, patient experienced increased nervousness, listlessness, exhaustion with sleep cycle disrupted and loss of time from work due to exhaustion. Patient averaged 3 to 5 hours per night sleep. By the following Friday (08/27/2021) patient experienced additional severe pain lower cervical, upper thoracic spinal areas. Patient visited Urgent Care on Monday August 30, due to alarming high blood pressure, severe pain. Urgent care did blood work, ekg, BP.....over 210/110 with St changes on EKG. BP did not respond to BP meds....recommeded Emergency Room. Clonidin


VAERS ID: 1738601 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Flushing, Headache, Inappropriate schedule of product administration, Joint stiffness, Pyrexia, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same effects after first Pfizer COVID vaccine 3/15/2021, though not as severe as after the second shot. I survived COVID and pn
Other Medications: pirfenidone, bisoprolol fumarate, lisinopril, vesicare, eplerenone, carbidopa/levo, aspirin, Xyzl, lipitor, mega men 50 plus vitamin supplement
Current Illness:
Preexisting Conditions: pulmonary fibrosis, miocardiopothy
Allergies: sulfur
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: fever like feeling with only a 1 degree rise in temperature, severe chills, headache, upset stomach, flush feeling in face, stiffness in knee and ankle joints, very drowsy. Drowsiness started 20-24 hours after the shot and lasted for 36-48 hours. More severe side effects lasted 6-8 hours. Ibuprofen and tylenol together were very effective.


VAERS ID: 1740127 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Body temperature, Chills, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pfizer, Inc. EUA 027034; Pfizer, Inc. EUA 027034; Pfizer, Inc. EUA 027034
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; Blood pressure high; Fruit allergy; Heart murmur; Polycystic ovarian syndrome; Prediabetes
Allergies:
Diagnostic Lab Data: Test Date: 20210821; Test Name: Fever; Result Unstructured Data: Test Result:100.4
CDC Split Type: USPFIZER INC202101093889

Write-up: severe hip right hip and lower back pain; severe hip right hip and lower back pain; Chills; body aches; fever of 100.4; This is a spontaneous report from a contactable Other HCP (patient herself). A 33-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, formulation: solution for injection, lot number: unknown, expiry date: unknown) via unspecified route of administration, in left arm on 20Aug2021 17:30 (age at vaccination: 33-years) as dose 2, single for covid-19 immunisation. Historical vaccine included first dose of BNT162B2 via unspecified route of administration, on an unspecified date as dose 1, single for covid-19 immunisation. The patient was not pregnant at the time of vaccination. Facility where the most recent COVID-19 vaccine was administered was pharmacy or drug store. Medical history included asthma, heart murmurs, prediabetes, high blood pressure, pcos, known allergies: Avocados, from an unspecified date and unknown if ongoing. Other medications the patient received within 2 weeks of vaccination was multivitamin, hydrochlorothiazide, metformin, which were concomitant medications, taken for unspecified indication, start and stop date not reported. On 21Aug2021 13:00, patient experienced chills, body aches, severe hip right hip and lower back pain, fever of 100.4. No treatment was received as a result of the adverse events. Patient had not been diagnosed with COVID-19 prior to vaccination and had not been tested since the vaccination. Device date was reported as 23Aug2021. The patient underwent lab test which included fever, with results: 100.4, on 21AUg2021. The outcome of event was recovering. Follow-up attempts have been completed. Batch/lot number not available for BNT162B2. No further information is expected.


VAERS ID: 1741879 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-18
Onset:2021-08-21
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Dyspnoea, Influenza A virus test, Influenza B virus test, Productive cough, Pyrexia, SARS-CoV-2 test positive, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acid reducer, albuterol, Lipitor, Symbicort, Sinemet, Flexeril, Cardizem, Tricor, Vistaril, Motrin, Isordil, Remeron, Ocuflox, Zofran, Protonix, Lyrica, propranolol, Seroquel, Requip, Zoloft, Carafate, Spiriva, Desyrel, Ambien
Current Illness:
Preexisting Conditions: Activity extremely limited, asthma, COPD, depression, dysphagia, GERD, hypertension, history of MI, blind in left eye, on home O2 (4L NC, 24/7), peripheral vascular disease, RLS, SOB with exertion, ulcer, uses walker, vertigo
Allergies: Penicillins
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) and Influenza AB Antigens, POC: SARS CoV 2 DETECTED (8/21/2021)
CDC Split Type:

Write-up: 59-year-old female presented complaining of shortness of breath. Patient stated that she was recently in the hospital for urinary tract infection. She stated that the day prior to arrival she began having worsening shortness of breath and sputum production. She admitted to fever and chills. She normally wears 4 L nasal cannula at home and today was requiring 6LNC. Pt smokes 4 ppd and has not been wearing her oxygen per husband.


VAERS ID: 1742761 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Chest pain, Chills, Condition aggravated, Electrocardiogram, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: approx end of July, Pfizer #1, fever, headache body aches, chills, nausea X 3 days
Other Medications: Biotin, Isoniazid, Melatonin, Vitamin B6 , Rifampim
Current Illness:
Preexisting Conditions: Covid Jan 2021 Elevated LFT cephalosporin vs sepsis related; new TSH abnl June 2021 pancytopenia poss due to sepsis xanthogranulomatosis pyelonephritis with obstructing stones
Allergies: Ceftriaxone and Ethambutol
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: fever, headache, body aches, chills nausea, chest pain and anxiety X 1 week


VAERS ID: 1745090 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Chills, Computerised tomogram head normal, Extra dose administered, Feeling abnormal, Flatulence, Headache, Immunoglobulin therapy, Injection site pain, Night sweats, Platelet count decreased, Posture abnormal, Protrusion tongue, Retching, Syncope, Unresponsive to stimuli, Urinary incontinence, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eltrombopag Gabapentin Atorvastatin Celexa Vit D Calcium
Current Illness:
Preexisting Conditions: Multiple sclerosis ITP Aneurysm HLD Depression/Anxiety Neurogenic bladder
Allergies: codeine, morphine - emesis
Diagnostic Lab Data: Plt 13K
CDC Split Type:

Write-up: Patient developed headache, chills, nightsweats, and soreness at injection site, similar to previous COVID-19 Moderna vaccinations. Patient received vaccine around 1545, at approximately 0745 the next morning, the patient woke up, walked to the bathroom, urinated, walked to the sink to wash hands and called for her husband because something was wrong. Her husband found her collapsed over the sink, was able to ease her to the floor, she had a limp posture but was conscious initially. She then flopped her head back, face contorted, tongue protruding, unresponsive, started heaving, emesis of "mustard yellow" color coming out of her nose and mouth, urinary incontinence, and flatulence. She regained consciousness after a couple minutes and was not post-ictal. EMS arrived and she was transported to ED, initial BG was 149. Head CT wnl. Platelet count noted 13K (was 400K < 2 weeks prior). She received IVIG and steroids during her hospital admission. She had no recent viral illness, no changes to her environment, medications, and no new medical history.


VAERS ID: 1745525 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: NOT a misfill vaccine incident. Pt lied on consent form 8-21-21 & stated NEVER received covid vaccine. Rph Ran CAIR on 8-21-21 = no covid vaccine on report, so savon gave pt pfizer shot. Pt came in 9-28-21 for 2nd dose, ran CAIR again & it shows pt got moderna at another facility on 3-16-21. Pfizer dose 9-28-21 refused & pt did NOT get vaccine.


VAERS ID: 1746570 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN ? / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Chest pain, Heart rate increased, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: Allergies to grass and ragweed.
Allergies: N/A
Diagnostic Lab Data: None, I am fine. Don''t want anything fromvaers.
CDC Split Type:

Write-up: I am fine as don''t know if the legal statement about going to jail is helping the public with vacine hesitancy, or to build back trust with the CDC, WHO, FDA, pharmaceutical companies, or the NIH, or their VARES all birds of the same feather. I am fine and don''t need your help. The vacine might have saved my life as I got Covid 19 really badly, even after getting the vaccine. I don''t need your help or the government''s help and I don''t need to go to your court or sue anybody. VARES, the FDA, NIH, WHO, pharmaceutical companies and CDC could make a lot of positive changes in the way they deal with people and the science and be more objective and neutral and maybe we wouldn''t have so many citizens that have lost trust and respect and developed vacine hesitancy. It is disheartening and disappointing. My heart started to beat numerous times and pulpatate several times in less than a second. I had chest pain. My heart would beat irradictly. I am better now. The vacine could have saved my life for all I know. The circle of vaers, FDA and big pharma has caused distrust and vacine hesitancy in the population. I figured it is a waste of time to fill this out. I don''t want anything from VARES, but figured you would want to know. Obviously, reading these statements throughout about imprisonment, none of these organizations want to know, unless it fits their narrative. I am fine now and even though I got the vacine and had heart pulpatations that were very rapid and then a couple weeks later cought Covid 19 really badly even though being vaccinated, perhaps the vacine saved my life? I am fine and need nothing from vaers and knew it was a waste of time to let you know the vacine messed up my heart for a couple weeks. My heart seems to be fine and I wish I never wasted my time with this report. My heart would beat numerous times in less than a second like muscle spasms....but in my heart. It has since went away, but I figured vaers might want to know, but it doesn''t fit into the vaers, FDA, pharmaceutical company circle and I should have known that. Good luck to you vaers. If vaers, FDA and the pharma industry all took a more honest approach and moved away from the same narrative then you''d have a lot less vacine hesitancy. My father heard of my heart problem after getting the vaccine and he choose not to get it. He is on life support now. Vaers, FDA, CDC, who, all have a long way to go and should change their approach and conflicts of interest if they really want to get the population vaccinated and regain trust.


VAERS ID: 1747876 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Feeling abnormal, Gait disturbance, Head discomfort, Paraesthesia, Peripheral swelling, Swelling, Swelling face, Throat tightness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: she was really dizzy; it was hard to walk around; off balance; Within a few minutes of getting it, she started to feel tight/started to feel off,/she felt her sandals were tighter; She did not have a breathing issue, but her throat started to feel tight; intense pressure in her head; the right side of her body, her face, her arm felt like swollen; the right side of her body, her face, her arm felt like swollen; the right side of her body, her face, her arm felt like swollen; felt tingly; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (Within a few minutes of getting it, she started to feel tight/started to feel off,/she felt her sandals were tighter), THROAT TIGHTNESS (She did not have a breathing issue, but her throat started to feel tight), HEAD DISCOMFORT (intense pressure in her head), SWELLING (the right side of her body, her face, her arm felt like swollen) and SWELLING FACE (the right side of her body, her face, her arm felt like swollen) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Fish allergy, Shellfish allergy and Peanut allergy. Concomitant products included ATENOLOL for Blood pressure abnormal. On 21-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Aug-2021, the patient experienced FEELING ABNORMAL (Within a few minutes of getting it, she started to feel tight/started to feel off,/she felt her sandals were tighter), THROAT TIGHTNESS (She did not have a breathing issue, but her throat started to feel tight), HEAD DISCOMFORT (intense pressure in her head), SWELLING (the right side of her body, her face, her arm felt like swollen), SWELLING FACE (the right side of her body, her face, her arm felt like swollen), PERIPHERAL SWELLING (the right side of her body, her face, her arm felt like swollen) and PARAESTHESIA (felt tingly). On 23-Aug-2021, the patient experienced BALANCE DISORDER (off balance). On 24-Aug-2021, the patient experienced DIZZINESS (she was really dizzy) and GAIT DISTURBANCE (it was hard to walk around). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Adverse event, at an unspecified dose and frequency and CETIRIZINE HYDROCHLORIDE (ZYRTEC [CETIRIZINE HYDROCHLORIDE]) for Adverse event, at an unspecified dose and frequency. On 21-Aug-2021, FEELING ABNORMAL (Within a few minutes of getting it, she started to feel tight/started to feel off,/she felt her sandals were tighter), THROAT TIGHTNESS (She did not have a breathing issue, but her throat started to feel tight) and HEAD DISCOMFORT (intense pressure in her head) had resolved. At the time of the report, SWELLING (the right side of her body, her face, her arm felt like swollen), SWELLING FACE (the right side of her body, her face, her arm felt like swollen), PERIPHERAL SWELLING (the right side of her body, her face, her arm felt like swollen), PARAESTHESIA (felt tingly), BALANCE DISORDER (off balance), DIZZINESS (she was really dizzy) and GAIT DISTURBANCE (it was hard to walk around) outcome was unknown. 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. The patient stated that she also has allergy for topical shampoo. It was reported that, She states that on day 2 after the shot when she woke up on 23-August-2021, she was just feeling not right and off balance, and on 24August2021, when she woke up in the morning, she rolled over to get out of bed, her balance was off, and it cleared up as the morning went by. When caller started feeling her throat kind of tight, she took Benadryl, and then again, a few hours later when she felt like her face was kind of puffy, swelling, she took some more Benadryl, and then took Zyrtec for about a week.


VAERS ID: 1747924 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Muscle tightness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pfizer, Inc. EUA 027034; Pfizer, Inc. EUA 027034; Pfizer, Inc. EUA 027034; Pfizer, Inc. EUA 027034
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Pain (I have had previous hx of pain over the years.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101084037

Write-up: I had severe joint pain the same day with tiredness that lasted over 24hrs. The following day I am having severe muscle pain, the joint pain decreased but the muscle pain seems to be targeting areas; I had severe joint pain the same day with tiredness that lasted over 24hrs. The following day I am having severe muscle pain, the joint pain decreased but the muscle pain seems to be targeting areas; I had severe joint pain the same day with tiredness that lasted over 24hrs. The following day I am having severe muscle pain, the joint pain decreased but the muscle pain seems to be targeting areas; I had severe joint pain the same day with tiredness that lasted over 24hrs. The following day I am having severe muscle pain, the joint pain decreased but the muscle pain seems to be targeting areas; This is a spontaneous report from a contactable other health care professional(patient). A 38-year-old non pregnant female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Batch/Lot Number: not reported, Expiry date: not reported), via an unspecified route of administration, administered in Left Arm on 21Aug2021 09:15 (at the age of 38 years old) as DOSE 2, SINGLE for covid-19 immunization. Historical vaccine included first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Batch/Lot Number: not reported, Expiry date: not reported) via unspecified route of administration on an unspecified date as dose 1, single for covid-19 immunization . The patient had not received any other vaccine within 4 weeks. Patient was not pregnant at time of vaccination. The patient was not diagnosed with COVID-19 prior to vaccination. The patient was not tested for COVID post vaccination. Medical history included HBP (high blood pressure) hypertension, pain. The patient have had previous history of pain over the years. Concomitant medication in 2 weeks included nifedipine, vitamin d, MULTIVITAMIN (ascorbic acid, biotin, calcium pantothenate, cyanocobalamin, folic acid, nicotinic acid, pyridoxine hydrochloride, riboflavin, thiamine hydrochloride, tocopheryl acetate) and elderberry taken for an unspecified indication, start and stop date were not reported. No known allergies was reported. On 21Aug2021 11:00,The patient experienced severe joint pain the same day with tiredness that lasted over 24hrs the following day having severe muscle pain, the joint pain decreased but the muscle pain seems to be targeting areas where the patient had previous history of pain over the years and it was tightening my muscles. The patient had not taken any pain medication to help with the symptoms. The patient did not received any treatment for the events. The outcome of the event arthralgia was recovering, fatigue was recovered on 22Aug2021 and the other events myalgia, muscle tightness were unknown. Follow up attempts are completed. No further information was expected.


VAERS ID: 1747967 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation, Lymphoedema, Off label use, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Retroperitoneal fibrosis (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Breast cancer (had a cancer diagnosis and I had breast cancer and I have gone through radiation.); Lymph node excision; Radiation therapy; Sentinel node biopsy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101164364

Write-up: got the Pfizer booster; got the Pfizer booster; Lymphedema; Swelling; This is a spontaneous report from a non-contactable physician (patient). A patient of unspecified age and gender received bnt162b2 (BNT162B2), dose 3 via an unspecified route of administration, administered in arm on 21Aug2021 (Batch/Lot number was not reported) as DOSE 3 (BOOSTER), SINGLE for covid-19 immunisation. Medical history included breast cancer (had a cancer diagnosis and had breast cancer and had gone through radiation), radiation/radiation therapy, surgery/one node that had been taken out and got a sentinel node, just one node biopsy for the ''surveillance notes'' on the same arm. The patient''s concomitant medications were not reported. Reportedly, the patient got the Pfizer booster on 21Aug2021 because the patient had a cancer diagnosis and had breast cancer and had gone through radiation. The patient was about to start a ARIMIDEX for oral chemotherapy and that''s why the patient got the booster. So, after the patient got the injection, in 2021, the patient got swelling and then lymphedema which the patient didn''t get before, even after surgery and after radiation therapy. The patient asked was that vaccine still effective because lymphedema lasted (the patient got the injection on 21Aug2021 and it was still, the swelling was just starting to go down, a little bit) and after speaking with the surgeon there was a question for the patient that the patient had, the patient did not have axillary node complete dissection, just had one node that had been taken out with no lymphedema noted after surgery (further clarification unknown). So, the patient especially being a physician, asked was the vaccine still effective when the patient got all that swelling. The patient had got a sentinel node, just one node biopsy for the ''surveillance notes'' on the same arm and that was where the patient got the injection (further clarification unknown). So, the patient was trying to get advice. Outcome for swelling was recovering; lymphedema was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1749338 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-19
Onset:2021-08-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Influenza like illness, Malaise, Muscular weakness, Musculoskeletal stiffness, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12; D3
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Felt sick with flu-like symptoms for 2 days. Slight fever. Body stiffness. Spent most of time in bed. Weakness in legs.


VAERS ID: 1749342 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F158448 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea, Full blood count, Metabolic function test, Tachycardia, Troponin
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Asthma
Allergies: Vitamin D Prenatal vitamins
Diagnostic Lab Data: 9/29/21 CBC trop BNP chest X-ray BMP
CDC Split Type:

Write-up: Tachycardia short of breath


VAERS ID: 1753285 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alopecia, Pain, Presyncope, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vit c, d and B12, zinc and omega 3
Current Illness: none
Preexisting Conditions: none
Allergies: PCN and erythromycin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Rash on chest, 2 near syncopal episodes alond with fever and bodyaches all occured about 24 hours after vacinnation. one week later hair stated falling out. employee com[plains of daily fever and continued hair loss. as of 10-1-2021


VAERS ID: 1753899 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-08
Onset:2021-08-21
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO196 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Biopsy, Herpes gestationis, Rash, Rash vesicular, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Presidnisone
Current Illness: Had a bleed on the pituitary gland in June 2021; gave birth July 28 2021
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Biopsy
CDC Split Type:

Write-up: 13 days after my first dose I broke out in a blistering rash on my arms and legs with severe swelling. My dermatologist diagnosed me with Pemphigoid Gestationis via a biopsy- despite it being rare and usually occurring in 2nd/3rd trimester, while I was 3 weeks postpartum. Could it be related to getting the vaccine postpartum while on a low dosage of prednisone? I?d been told by my endocrinologist it was tempered enough for me to get the vaccine. I was also told by my neurologist and endocrinologist the PG rash was unrelated to the bleed on my pituitary gland. I didn?t have PG with my other two pregnancies. The only new factor was my increased age and the vaccine.


VAERS ID: 1753909 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-19
Onset:2021-08-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dehydration, Diarrhoea, Disorientation, Influenza like illness, Injection site pain, Joint swelling, Muscular weakness, Productive cough, Respiratory tract congestion, Sneezing, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (narrow)

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

Write-up: Patient reports symptoms of diarrhea, vomiting, flu like reaction, muscle weakness, muscle site pain, dehydration, joint swelling, congestion, coughing, sneezing, sputum production, and disorientation. Patient required two separate visits to Urgent Care and a follow up to with is general physician for these symptoms.


VAERS ID: 1754031 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Cardiac flutter, Chest discomfort, Dizziness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypertension (narrow), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad)

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

Write-up: Reports fluttering in chest, chest pressure, lightheaded, dizziness, increased blood pressure increasing throughout day. On 8/21/2021, the day after receiving vaccine, reported symptoms continued through the weekend, client reports the symptoms felt intense at times, reports symptoms did get better on 8/24/21, client did go to her doctor, and doctor offered an ekg and holter monitor which client refused at this time.


VAERS ID: 1754202 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-09
Onset:2021-08-21
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was admitted to local Hospital 08/26/21 with blood clots in each lung.


VAERS ID: 1757243 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Feeling abnormal, Heart rate increased, Hypertension, Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: None, my doctor would not accept it was an adverse reaction. Would not accept my complaints.
CDC Split Type:

Write-up: As soon as I got the injection I felt my chest and throat tighten up, I was lightheaded and felt like I couldn''t breathe. My BP was checked and at about 153/99 which is VERY high for me. My usual is about 100/80. I laid down and tried to relax and then I started feeling my arms and legs get tingly. I was not hyperventilating. After an hour I decided to try to drive home even though I just did not feel right. I had to pull over because I felt my heart rate going up and stopped and had fire fighters help me out. My husband drove me home and I really started feeling the tingling in my legs and still felt like I could not breathe. I emailed my doctor who blew it off as a panic attack. To this day I still have that feeling at random times.


VAERS ID: 1757268 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-17
Onset:2021-08-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Agitation, Blood creatinine increased, Blood lactic acid, Brain oedema, Chest X-ray normal, Delirium, Dyskinesia, Electroencephalogram abnormal, Endotracheal intubation, Feeling abnormal, Hypertension, Hypertensive emergency, Hypertensive encephalopathy, Intensive care, Magnetic resonance imaging head abnormal, Memory impairment, Mental status changes, Metabolic acidosis, Posterior reversible encephalopathy syndrome, Pyrexia, Seizure, Swallow study, Unresponsive to stimuli, Urine analysis abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: buprenorphine/naloxone, clonidine, metformin, gabapentin, victoza, hydroxyzine, nifedipine, trazodone, cyclobenzaprine, labatolol, tylenol
Current Illness: Reported runny nose/cough on 8/17/21 by telehealth visit, COVID test was recommended.
Preexisting Conditions: substance use disorder - no relapses in years, hypertension, type 2 diabetes with neuropathy, hyperlipidemia, vitamin D deficiency, generalized anxiety, PTSD, sleep apnea, tobacco use, back pain
Allergies: no known allergies
Diagnostic Lab Data: See item 18 for hospital related labs and imaging reported.
CDC Split Type:

Write-up: I saw patient for a telehealth visit on 8/17/21 she had runny nose/cough and I recommended she get a COVID test which she endorsed planning to get at Pharmacy later that day. It''s not entirely clear what happened in the interim as her memory from this point is not clear and she made no contact with our clinic in the interim but she then presented to the ED for altered mental status on 8/28. Per hospital records, hospital course was as follows: "44-year-old female with a history of hypertension, OUD on Suboxone, Anxiety, non-insulin-dependent type 2 diabetes, macular degeneration, OSA and neuropathy who presented to the ED for altered mental status. Initially, patient was severely altered and agitated making history difficult. Per her husband she had had an episode of staring followed by unresponsiveness and thrashing about. When EMS arrived for her she was very agitated and delirious. Required benzos, Versed and ketamine in order to sedate her. On arrival to the ED she was severely hypertensive with SBP greater than 200. Admission was requested due to concern of altered mental status in relation to this high blood pressure. Immediately on arrival to the floor she subsequently went on to have 2 seizures, one witnessed, and a significant post ictal state and subsequent agitation that required multiple doses of Ativan and eventually intubation for airway protection. She was subsequently transferred to the ICU. Neurology was consulted who felt that her seizures were likely secondary to hypertensive encephalopathy. She underwent an EEG that showed diffuse slowing consistent with encephalopathy but no seizures at that time. She also had an MRI that did show edema in the posterior aspect. With all of this information together and her current presentation she was diagnosed with posterior reversible encephalopathy syndrome secondary to hypertensive emergency. After about 24 to 48 hours she was able to adequately follow commands and was extubated on 8/31. Patient had strict parameters for blood pressure control for systolic less than 140 which were initially managed with as needed''s. She was eventually started on nicardipine drip. Other resultant abnormalities secondary to her seizures include acute renal failure with a peak creatinine of 3 (urine studies consistent with ATN) and metabolic acidosis secondary to lactic acid buildup. These both quickly improved over the next 2 days with bicarb and IVF. During this time she also had a fever to 100.7 (unrelated to recent seizure) which raise suspicion for aspiration. She is empirically started on Unasyn. Over the next couple days she had clear chest x-rays and no further fevers so antibiotics were stopped. Despite being extubated she continued to have significant agitation so was maintained on a Precedex drip and a PICC was placed for her nicardipine GTT. Finally on 9/2 her mental status had improved and she was able to be weaned off Precedex, passed a swallow study. Transition to oral antihypertensives was begun. She was started on amlodipine 10 mg, lisinopril 10 mg, HCTZ 12.5 mg and carvedilol 3.125 mg BID. Over the next 24 hours her blood pressure slowly began to normalize and nicardipine drip was turned off on 9/3. She was subsequently transferred out of the ICU. BPs largely stabilized on following regimen: Amlodipine 10 mg, lisinopril 20 mg nightly, HCTZ 25 mg, carvedilol 12.5 twice daily. Neurology signed off, recommended she continue taking Vimpat 100 mg twice daily. Her blood pressure goal is SBP less than 140. Neurology will follow up with her outpatient in 3 months, will determine need for continued antiseizure medication at that time. She was advised to not drive until seizure-free for 6 months. She was discharged home in stable condition on 9/6/2021. She will follow up with her PCP on 9/14/2021 to recheck blood pressures, adjust medications as needed, repeat BMP. " Hospital recommendations to PCP included: "If able to verify timing of Covid vaccination in relation to seizure, consider if needs to be reported to the VAERS. Patient was unclear of exact timing, did obtain second Covid vaccination at Pharmacy somewhere between 2 to 10 days prior to hospitalization" Per discussion with patient on 9/14/21, she believes she received vaccination (COVID19 Moderna #2) shortly before symptoms started, I confirmed with Pharmacy staff she got vaccine 8/17, not known if she had a COVID19 test before she got the vaccine. nor was patient remember if she had a COVID test (as had been recommended on 8/17 at televisit due to her symptoms) She thinks she got fogginess mentally within a few days and that she then likely was not taking her routine medications in the time leading up to her presentation to the ED on 8/28 (11 days after vaccination but symptoms starting sooner).


VAERS ID: 1757591 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Joint pain started the following day after second dose of vaccine. Most noticeable in elbow joints, and knees. Still having fairly consistent joint pain in knees and elbows. I have a very physical job and have always been very fit and active and never experienced joint pain like this. Other joints become painful with strenuous use when that same kind of use never caused joint pain before. This very distinctly started the day after my second vaccine. Other reactions if relevant were a mild fever which also occurred after the first dose. And became sick with a sinus infection immediately following the second dose which resolved in about 12 days.


VAERS ID: 1759625 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea exertional, Fatigue, Headache, Injection site nodule, Injection site pain, Injection site pruritus, Injection site reaction, Injection site warmth, Myalgia, Pain, Respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: All flu vaccines ever received.
Other Medications: Novolog, Toujeo, April, spironolactone, losartan, rosuvastatin, Xyzal, Tylenol, Advil
Current Illness: None
Preexisting Conditions: Type I Diabetes, hypertension, hypercholesterolemia, PCOS, environmental allergies
Allergies: Sulfa, ACE Inhibitors
Diagnostic Lab Data:
CDC Split Type:

Write-up: Congestion and headache started within an hour. Over the next 6 hours severe exhaustion, body aches (muscular pain), shortness of breath upon exertion, chest pressure and heaviness, migraines, fever, chills, cough and runny nose all started and progressed for 2 days. I didn''t leave the bed for 3 days. Symptoms lasted 7 full days, and I''m still having trouble being short of breath. Severe injection site reaction causing a 3" diameter reaction site-fever, itching, pain, and a 1.5" diameter knot that lasted 3 weeks.


VAERS ID: 1761571 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Back pain, Dizziness, Feeling abnormal, Headache, Hypoaesthesia, Laboratory test, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Did routine labs September 9th. I have my doctors appointment to review the results today. 10/5/21.
CDC Split Type:

Write-up: The next day I had a headache and back ache and sore arm. The next couple days I had a sore arm. Five days post vaccine I woke up with numb/tingling legs. The following days the numbness and tingling was moving through my body, feet all the way to stomach, arm and neck and moved up into the back of my head. I began experiencing extreme dizziness for about a week. The dizziness subsided. However, I had horrible brain fog and weakness. The numbness went away in my stomach and neck. But it has moved to the top of my head and forehead and lower legs. It is constant. A numb/tingling scalp, forehead and lower legs has not stopped and it has been 7 weeks post the vaccine injection.


VAERS ID: 1761702 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017EZ1A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac monitoring abnormal, Condition aggravated, Ventricular extrasystoles
SMQs:, Ventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Hypokalaemia (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: Atorvastatin 10 ml, one a day Daily multi-vitamin Baby aspirin, one a day
Current Illness: none
Preexisting Conditions: Premature ventricular contractions (PVC''s)
Allergies: none
Diagnostic Lab Data: 9/3/2021 ? Echocardiogram, and 12-lead ECG, office visit, and placing of the 7-day monitor to check PVC percentages. Note: The echocardiogram was done post ablation procedure, but not before the vaccine was administered, so there is no post ablation/pre-vaccine baseline to reference. 9/13/2021 ? Cardiac MRI test administered to compare against pre-ablation baseline to assess for any additional scar tissue. 10/4-2021 ? Office visit to discuss test results and re-do the 12-lead ECG. 7-day monitor revealed PVC?s at a rate of approximately 9%, so 4.5 times the rate pre-vaccination, and other test revealed these are new PVC?s originating from a different area, not a return of the previous PVC?s. Dr. wants to check for heart inflammation (myocarditis) and has ordered a heart PET scan, date to be determined, before proceeding further, but is at this point is of the opinion that another ablation procedure may be necessary if the PVC?s persist. Proceeding with caution but says there is no immediate danger of catastrophic heart failure and I can continue with my workout routines and outdoor physical activities. Note: Dr. has not dismissed the correlation between the vaccine and the PVC rate reversal, and in fact has another PVC patient with similar issues post vaccine, though the other patient received the Pfizer injection. I told him I intentionally skipped the due date the 2nd shot for now, he did not object or advise that I should get the 2nd shot, at least for now.
CDC Split Type:

Write-up: See # 12 above. The PVC condition had been monitored for several years, but over time had grown in frequency (approximately 25%) and echocardiogram history began to show a diminished percentage of lower chamber output. After consultation with Dr. a decision was made to do a heart ablation procedure to attempt to significantly reduce the PVC frequency. The procedure was successfully performed on June 30, 2021. A few weeks after the procedure a 7-day monitor was worn to measure the post procedure PVC results. At the follow up visit on August 16, 2021, the test results revealed the PVC?s had been reduced to less than 2% in frequency, and it was assumed that the heart function percentage likely had increased as well, so to confirm this result a follow up echocardiogram was put on the schedule for September 9th. At that time I was encouraged by Dr. to go ahead and get the covid-19 vaccine. The covid vaccine (Moderna) was taken on Friday afternoon (8/20) and by Saturday morning (8/21) I noticed the PVC?s had returned at a much higher rate. I assumed this would probably diminish after a few days and did not even monitor it for about a week or so. Self-monitoring the PVC rate varied but averaged about 12-13%. When it persisted I contacted the Doctors office and they advised me to come in earlier for the echocardiogram, a 12-lead ECG, and an office visit. To date, the symptoms have not diminished and PVC rate has been monitored and remains above 9%.


VAERS ID: 1761959 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWD184 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Laboratory test, Posture abnormal
SMQs:, Dystonia (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: Flu Vaccination
Other Medications: Aspirin 81mg (once daily) Omeprazole 20mg (once daily) Vitamin D3 PreserVision Cinnamon 2250mg (twice daily) Pravastatin 20mg (once daily) Norvax 5mg (once daily) Metformin 1000mg (once daily) Tradjenta 5mg (once daily) Jardiance 10mg (onc
Current Illness: None
Preexisting Conditions: Massive Stroke High Blood Pressure High Cholesterol
Allergies: Flu vaccine
Diagnostic Lab Data: Various Test Ran
CDC Split Type:

Write-up: Hand closed up into a fist and it is difficult to reopen.


VAERS ID: 1762495 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-04-30
Onset:2021-08-21
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT NOTED / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT NOTED / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, COVID-19, COVID-19 pneumonia, Chills, Computerised tomogram thorax, Cough, Dyspnoea, Fear, Lung infiltration, Pleuritic pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: furosemide (LASIX) 20 MG Tab omeprazole (PRILOSEC) 40 MG delayed-release capsule simvastatin (ZOCOR) 20 MG Tab albuterol 108 (90 Base) MCG/ACT Aero Soln inhalation aerosol
Current Illness: Dyslipidemia Tobacco use disorder Alcohol use disorder Anxiety . Environmental and seasonal allergies CAD (coronary artery disease) Nocturnal oxygen desaturation - NEEDS FORMAL SLEEP STUDY OUTPT JULY 2018 Colon wall thickening - needs colonoscopy or if normal colonoscopy w/in 10 years FU CT Overview CT abdomen/pelvis July 2018 - Short segment of wall thickening involving the sigmoid colon. This area had a similar appearance in April 2018. Needs correlation with colonoscopy report or follow up CT in 3-6 months. Colon wall thickening Acute left-sided low back pain with left-sided sciatica Stenosis of cervical spine with myelopathy Right groin pain Benign lymphomatous tumor Gastroesophageal reflux disease without esophagitis Psoas muscle abscess PTSD (post-traumatic stress disorder) Overview IMO load March 2020 Attention to colostomy Abnormal weight loss Generalized abdominal pain Incisional hernia, without obstruction or gangrene Primary insomnia Strep throat Abdominal aortic aneurysm (AAA) Hyponatremia Acute respiratory failure with hypoxia Iron deficiency anemia due to chronic blood loss Abnormal chest CT Other chest pain Hemolytic anemia Elevated troponin Mediastinal mass Splenomegaly Positive hepatitis C antibody test Abdominal wall abscess
Preexisting Conditions: see above
Allergies: Meloxicam, tape
Diagnostic Lab Data:
CDC Split Type:

Write-up: Coughing, shortness of breath and fever HISTORY OF PRESENT ILLNESS: Patient is a 64 y.o. male with past medical history of recent hospitalization at renown Medical Center for autoimmune Coombs positive anemia, hypertension, remote alcohol abuse, inflammatory mass of the esophagus that has been biopsied multiple times does not appear to be malignant, and history of leaking thoracic aneurysm with stenting, who presents to the Emergency Department with chief complaint of as mentioned above. The patient said he was convalescing from his recent hospitalization and had been taking prednisone 80 mg daily as directed when he was discharged and was well until yesterday. He began to develop a cough and some shortness of breath. He has pleuritic type pain when he coughs. He also had chills and fevers. He denies nausea vomiting diarrhea and said his appetite remains good. ER evaluation revealed Covid positive. CT angiogram showed no pulmonary embolism but infiltrate consistent with Covid pneumonia. Patient is being admitted for further evaluation. He did receive his vaccination Review of system: all systems are reviewed and otherwise negative besides what was mentioned in the history of present illness. Patient admits he is very anxious and has been through a lot medically and his new diagnosis of Covid frightens him.


VAERS ID: 1764550 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-08-21
Onset:2021-08-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Exposure during pregnancy, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Mornings: 65 mg Iron supplement, prenatal vitamin, 81mg low dose aspirin, and 25 mg chlorthalidone.
Current Illness: None
Preexisting Conditions: Asthma and environmental allergies- neither caused issues
Allergies: Penicillin, latex
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: At time of first dose I was 19 weeks pregnant. I began getting a headache about 30 minutes after vaccination. I remained hydrated with water and Gatorade. Headaches would go from mild to causing dizziness and nausea- they NEVER went away between shots. Tylenol lessened them, but did not remove. At time of second dose I was 23 weeks pregnant. Approximately 2 weeks after shot and headaches are beginning to fade to 3-5 days a week instead of daily. The intensity is also not as severe. Blood pressure was monitored between injections by OBGYN and Perinatal centers for routine appointments- no noticeable increase. Pregnancy due date 1/15/2022.


VAERS ID: 1764579 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-12
Onset:2021-08-21
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Tested Positive for Covid


VAERS ID: 1764587 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-08-21
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Tested Positive for Covid


VAERS ID: 1764670 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-25
Onset:2021-08-21
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Tested Positive for Covid


VAERS ID: 1764791 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-21
   Days after vaccination:2
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: Facial paralysis, Facial spasm
SMQs:, Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: one sided paralysis and uncontrollable facial movement.


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