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From the 1/14/2022 release of VAERS data:

Found 1,031,637 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

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VAERS ID: 1905979 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-11-25
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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: Breakthrough COVID 19 infection not requiring hospitalization


VAERS ID: 1906061 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol, Medroxyprogesterone, xanax, Spironalactone, Seroque
Current Illness: n/a
Preexisting Conditions: Bipolar Disorder
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash, nonspecific skin erruption beginning on right hip, spreading to lower back and abdomen. Symtpoms began one day after vaccination and have been spreading for 4 days. Patient prescribed Zyrtec and Prednisone.


VAERS ID: 1906069 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-02-18
Onset:2021-11-25
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Asthma, Atrial fibrillation, Basophil percentage, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood chloride increased, Blood creatinine normal, Blood glucose normal, Blood potassium decreased, Blood sodium increased, Blood urea decreased, COVID-19, Carbon dioxide normal, Chest X-ray normal, Condition aggravated, Cough, Dysphonia, Dyspnoea, Electrocardiogram, Electrocardiogram QT interval, Eosinophil percentage decreased, Glomerular filtration rate normal, Granulocyte percentage, Haematocrit normal, Haemoglobin normal, Hypoxia, Immature granulocyte count, Influenza A virus test negative, Influenza B virus test, Lymphocyte percentage, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Monocyte percentage increased, Nasal congestion, Oxygen saturation decreased, Platelet count normal, Protein total normal, Red blood cell count normal, Red cell distribution width normal, Respiratory syncytial virus test negative, SARS-CoV-2 test positive, Sinus rhythm, Tachycardia, Wheezing, White blood cell count normal
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol Dulera loratadine montelukast multivitamin tiotropium
Current Illness: Asthma exacerbation
Preexisting Conditions: Asthma GERD HTN osteoarthritis
Allergies: amoxicillin
Diagnostic Lab Data: 11/25/21 ER TODAY''S LABS: WBC (7.07) GRAN%, AUTO (58.1) LY%, AUTO (29.1) MO%, AUTO (10.5) EOS%, AUTO (0.8) BASO%, AUTO (0.8) IG% (0.7) RBC (4.38) HEMOGLOBIN (13.4) HEMATOCRIT (40.3) MCV (92.0) MCH (30.6) MCHC (33.3) RDW (13.6) PLATELET COUNT (332) MPV (8.8) _COVID-19 RT-PCR(CEPHEID) (SARS-CoV-2 POSITIVE) _FLU A RT-PCR (CEPHEID) (Flu A NEGATIVE) _FLU B RT-PCR (CEPHEID) (Flu B NEGATIVE) _RSV RT-PCR (CEPHEID) (RSV NEGATIVE) GLUCOSE (94) UREA NITROGEN (6) _CREATININE,SER/PLS(CKD-EPI) (0.6) _EST GFR(CKD-EPI) (109.31) SODIUM-BLOOD(SERUM) (146) POTASSIUM (3.4) CHLORIDE (107) CO2 (26.0) CALCIUM (8.4) PROTEIN,TOTAL (8.3) ALBUMIN (4.3) ALTV (37) AST (90) ALKALINE PHOSPHATASE (100) BILIRUBIN, TOTAL (0.3) IMAGING: CXR Impression: * No active cardiopulmonary disease. EKG: NSR 85 bpm, QTc 502, no ST elevations
CDC Split Type:

Write-up: Presented to ER on 11/25/21: 46F h/o severe persistent asthma, HTN here with wheezing and SOB that started this morning. pt reports she was in a substance use treatment program until 8 days ago. she came back and she thinks the cold weather prompted her asthma to act up. she ran out of her albuterol 2 days ago. has been coughing. no fever/chills. hoarse voice and nasal congestion. denies CP, leg swelling. denies any substance use since leaving treatment program. noted to be 81% on RA when EMS arrived. pt given 1 duoneb and was 93% on RA on arrival. ER COURSE: duoneb decadron 12mg mag 2g ___________________________________________________________ CLINICAL IMPRESSION/PLAN: 46F h/o severe persistent asthma here with wheezing, SOB and cough x2 days after running out of her meds. reported to be hypoxic to 81% on RA at home. sig improvement with duoneb and was 93% here on RA. mildly tachy, AF. still with sig wheezing but moving air well, no accessory mm use, speaking in full sentences. second duoneb, decadron, mag labs, CXR, covid swab reassess after second duoneb 1226pm reassessment after second neb- pt breathing comfortably. still with diffuse bilateral wheezes. SaO2 97% on RA but drops to low 90s at times and when sleeping to 88-89%. CXR clear will start 1hr cont albuterol neb given ongoing diffuse wheezes 1311 covid test positive patient well appearing, moving air well covid explains hypoxia despite good air movement and no accessory mm use start remdesivir will require admission to Hospital.


VAERS ID: 1906133 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Induration, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OCP- Slynd
Current Illness: previous NON covid upper respiratory infection approx 1 month prior.
Preexisting Conditions: NONE
Allergies: Amoxicillin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: gigantic wheel, hardness, itching, pain, extreme headache


VAERS ID: 1906161 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-23
Onset:2021-11-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hypoaesthesia, Paralysis, Swollen tongue, Tremor
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: basaglar, levothyroxine, metformin, zolpidem, atorvastatin, jardiance,
Current Illness: unknown
Preexisting Conditions: diabetes, hypothyroidism, insomnia, high cholesterol
Allergies: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient woke up on 11/25/2021 at 5 am to use the bathroom, started feeling numbness in the legs once walking down the stairs and then felt total paralysis which led her to fall down the stairs. She stated that she was shaking and her tongue swelled. This lasted until 12pm that day so 7 hours total and then the feelings subsided and now the patient is feeling perfectly fine with resolution of all symptoms. She has not seen MD yet but will be notifying the MD at her appointment.


VAERS ID: 1906446 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Blood test, Chest pain, Computerised tomogram normal, Dyspnoea, Electrocardiogram normal, Fibrin D dimer increased, Pain, Pain in extremity, Painful respiration, Pericarditis
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500 mg 2x day, cymbalta 120mg, trazodone 100mg, tradjenta 5mg, klonipin .5mg, incassa (birth control) 1 pill per day progesterone only.
Current Illness: None
Preexisting Conditions: diabetes
Allergies: None
Diagnostic Lab Data: 11/26 - tons of blood work at ER, d-dimmer, several ekg''s, chest xray, ct scan with and without contrast. all negative except for the d-dimmer number was 660. 11/29 - Follow up with cardiologist who diagnosed pericarditis most likely due to covid vaccine.
CDC Split Type:

Write-up: 24 hours after receiving vaccine, I began getting severe chest pain and shortness of breath. At 48 hours post vaccine, I called my PCP who advised me to go the the ER. I had pain in my arm (where the shot was given) and pain in my chest on the left side. It radiated to my back. It hurt to take a breath in. At the ER, I was put on the EKG machine, blood word done, chest xray. My d-dimmer was 660. That was the only number that was not within normal limits. They did a CT scan with and without contrast of my chest to look for a possible blood clot. Nothing was found. I was sent home with Naproxen and told to follow up with a cardiologist 3-5 days after. I went to the cardiologist 4 days after the ER, he diagnosed pericarditis most likely due to the covid booster vaccine.


VAERS ID: 1906919 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pruritus, Injection site rash, Myalgia, Rash erythematous
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxin 75 MCG tab once daily, Estradiol 0.025 MG patch once weekly, Progestrone 200 MG tab once daily, Alendronte 70 MG tab once weekly, vitamin D3 2000 UI tab once daily, fish oil 1200 mg once daily, Calcium Citrate 400 MG tab once
Current Illness: N/A
Preexisting Conditions: Hypothyroid
Allergies: Iodine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Three inch diameter red rash around the injection site, severe itching in the same area lasting three and a half days going to mild symptoms on days 4 and 5. Headache, fatigue, muscle aches lasting three days then only injection site symptoms and mild headache controlled with Tylenol and Aveno hydrocortisone cream 1% applied 3 times daily on day 4 and 5 post vaccine. Rash around injection site minimal in appearance on day 5 itching minimized with Aveno hydrocortisone cream 1% applied 3 times daily.


VAERS ID: 1906926 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H22QB / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Injection site erythema, Injection site pruritus, Injection site swelling, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingrix (2 months prior)
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: No
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever (wasn''t sure of the temp number), itching and redness at the injection site, swelling. Patient used hydrocortisone and alcohol for the bruised area


VAERS ID: 1907165 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-17
Onset:2021-11-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

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

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

Write-up: Severe hives, itchiness and swelling all over the body.


VAERS ID: 1908555 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-20
Onset:2021-11-25
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, Chills, Cough, Fatigue, Malaise, Myalgia, Psychiatric symptom, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Bipolar1 disorder Anemia Marijuana abuse
Allergies:
Diagnostic Lab Data: 11/25/21 Covid +
CDC Split Type:

Write-up: He was admitted due to psychiatric issues. He reports feeling ill for 2-3 days prior to admission, with myalgias, fever, chills, mild cough, fatigue, generally improving. He denies nausea, vomiting, diarrhea.SARS Coronavirus-2 infection: symptom onset around 11/23, with mild and improving symptoms. Chest X-ray was negative. Per history, vaccinated with recent booster dose.. Covid-19 positive. Denies N/V, fever, HA, dizziness, CP, SOB, DOB, abdominal pain, changes in bowel (diarrhea/constipation) or bladder habits.


VAERS ID: 1909013 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-15
Onset:2021-11-25
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On day 5 of Spontaneous outbreaks of hives in all different areas of my body. They resolve on their own or with aid of benedryl only to show up in a different area shortly after. Have never experienced this before. Unsure if related to booster or not. Did not experience on first two doses of the vaccine. Wanted to file in case there are other reports.


VAERS ID: 1909166 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-09
Onset:2021-11-25
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 RA / 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: 1909179 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-06
Onset:2021-11-25
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive 11/29/2021
CDC Split Type:

Write-up: COVID vaccine breakthrough case


VAERS ID: 1909243 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-11-25
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID + 11/25/21
CDC Split Type:

Write-up: breakthrough case


VAERS ID: 1909308 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-05
Onset:2021-11-25
   Days after vaccination:293
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, insulin aspart, insulin glargine, levothyroxine, rosuvastatin, sertraline
Current Illness:
Preexisting Conditions:
Allergies: Atorvastatin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted as inpatient on 11/25/21 due to acute respiratory disease due to COVID-19 virus. Patient was tested for COVID-19 and was positive on 11/24/21.


VAERS ID: 1909314 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-11-25
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK RA / IM

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

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


VAERS ID: 1909330 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-29
Onset:2021-11-25
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Loss of personal independence in daily activities, Mobility decreased
SMQs:, Dementia (broad), Parkinson-like events (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Tacrolimus, Cefdinir, Ciprofloxacin (Bulk), Cycloserine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to Hospital admitted as observation on 11/24/21 due to impaired mobility and ADLs


VAERS ID: 1909333 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-15
Onset:2021-11-25
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 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: 1909353 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-18
Onset:2021-11-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F22A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Dizziness, Headache, Illness, Pain, Vertigo, X-ray normal
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Tinnitus / hearing loss (long standing). No other issues or vestibular issues.
Allergies: Cat allergies
Diagnostic Lab Data: 11/26 visits to Urgent Care and then follow up for EKGs and blood tests at Hospital
CDC Split Type:

Write-up: Nov 18 received Moderna booster shot. Approximately 16 hours after receiving vaccine had dizziness, body aches and what seemed to be typical side effects that subsided in a day or two. After 1 week the dizziness/vertigo feeling came back. Additionally my blood pressure spiked, I was sick and had a severe headache sending me to the ER. Blood work and Xrays came back normal. Blood pressure returned to normal within a day. However, since 1 week following the shot, the dizziness, vertigo, almost seasick type feeling has not subsided and continues from the time I wake up until I go to sleep at night. This has never happened to me before in my life and I am concerned.


VAERS ID: 1909385 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-09
Onset:2021-11-25
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, Blood lactate dehydrogenase, Blood lactic acid, Blood thyroid stimulating hormone, C-reactive protein abnormal, COVID-19, Chest X-ray, Cough, Decreased appetite, Dyspnoea, Electrocardiogram, Eye discharge, Fatigue, Fibrin D dimer, Full blood count, Hypoxia, Inappropriate schedule of product administration, Inflammation, Metabolic function test, Procalcitonin, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Scan with contrast, Serum ferritin, Troponin
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 650mg prn for fever/pain Almacone Oral Suspension prn for upset GI Bisacodyl 10mg rectal prn for constipation Carbamide peroxide otic 5 drops BID in effected ears Docusate 100mg TID for constipation Ibuprofen 600mg TID for pai
Current Illness: 3/5/2021 - Leg swelling and sore throat.
Preexisting Conditions: Allergic conjunctivitis, Epilepsy, profound mental retardation, mixed hyperlipidemia, hypothyroidism, carnitine deficiency, impaired fasting glucose.
Allergies: Amoxicillin, Augmentin, Carbamazepine, penicillin, tegretol, and tricyclic antidepressants - reactions not listed.
Diagnostic Lab Data: 11/30/2021: Valporic Acid level; troponin, cbc, lactic acid, TSH, CMP, Ddimer, ferritin, lactate dehydrogenase, procalcitonin, C reactive protein inflammation CT Angiography Chest with contrast, chest xray, ekg
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated. No booster Cough, runny nose, anorexia, fevers, shortness of breath, dyspnea, congestion, fatigue, hypoxic, eye drainage.


VAERS ID: 1909420 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-08
Onset:2021-11-25
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE LISTED
Preexisting Conditions: OBESITY
Allergies: NONE
Diagnostic Lab Data: COVID-19 NAAT
CDC Split Type:

Write-up: BREAKTHROUGH COVID 19 INFECTION. MILD SX OF URI CONTINUE. RECEIVED REGEN-COV TODAY 11/30/21


VAERS ID: 1909467 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-06
Onset:2021-11-25
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Fatigue, Headache, Influenza, Pain, Respiratory tract congestion, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot, I had flu like symptoms after getting the vaccine.
Other Medications: Synthroid; Metformin; Zonisamide; Vitamin D; Iron
Current Illness:
Preexisting Conditions: Migraines; Thyroid Disease
Allergies: Penicillin; Bactrim; Avelox; Sulfa drugs
Diagnostic Lab Data: Covid-19 Positive.
CDC Split Type: vsafe

Write-up: I started to get a splitting headache and my nose started running out of nowhere. For a couple of days before that I felt really sore and I did not think it was anything. I had chills that evening. The next day I had complete exhaustion and I had no sense of taste or smell. It has been five days and I still can''t taste or smell. It feels like I have a bad flu. I feel really tired and achy and as the day goes on I feel more congested. I did a rapid test at home and it was positive. On the third day I had a PCR test and it was positive.


VAERS ID: 1909653 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-16
Onset:2021-11-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Eye swelling, Joint swelling, Rash, Rash pruritic, Sensitive skin
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Symptoms: Migrating rash over whole body including palms of hands. Itchy. Swelling of wrists, eyes. Skin sensitive to touch. Treatment: Prednisone 20 mg twice daily by mouth for five days, coupled with Benadryl Allergy 25mg per tablet (50 mg taken with each dose) twice daily (morning and evening - Total 100 mg per day.


VAERS ID: 1909680 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Pain, Pain in extremity, Paraesthesia, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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: Viome blend supplements, pre and pro biotic, prenatal, Zoloft
Current Illness: Slight cold earlier that month.
Preexisting Conditions: Depression, anxiety, infertility
Allergies: Crab, dogs
Diagnostic Lab Data: None. I don''t have a primary care doctor in the area yet so haven''t been able to make an appointment. If this goes on another day I will be calling any doctor in the area to get some help.
CDC Split Type:

Write-up: Pain in left arm that has now continued almost a week. Pain has gotten to the point that I feel like I''m constantly losing circulation in my arm with the pins and needles feeling. I get this feeling almost immediately when anything touches my upper arm or shoulder. It''s keeping me from sleeping. I had to move to a recliner to get enough weight off of my arm to not feel pain. Even laying on my back with my arm touching the bed or on my back with my arm above my head, on my back with my arm on my stomach/chest, or on my right side with my arm laying on top of the rest of me causes too much pressure and I get pain, pins and needles. This was not an issue prior to receiving the flu and Pfizer vaccines.


VAERS ID: 1909699 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Influenza like illness, Metabolic function test, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (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: aspirin 81 mg oral tablet, delayed release (enteric coated) [take 1 tablet (81 mg) by oral route once daily] carvediloL 12.5 mg oral tablet [take 1 tablet (12.5 mg) by oral route 2 times per day with food] Centrum Silver 0.4-300-250 mg-mcg-
Current Illness: NOne
Preexisting Conditions: Encounter for general adult medical examination without abnormal findings Hypothyroidism, unspecified Hyperlipidemia, unspecified Other specified depressive episodes Heart failure, unspecified Gastro-esophageal reflux disease without esophagitis Peripheral vascular disease, unspecified Anxiety disorder, unspecified Wedge compression fracture of third lumbar vertebra, subsequent encounter for fracture with routine healing
Allergies: Sulfa (Sulfonamide Antibiotics): ropinirole: pravastatin: erythromycin base:
Diagnostic Lab Data: BMP pending
CDC Split Type:

Write-up: FLu like symptoms; loss of appetite loss of 15 lbs


VAERS ID: 1909729 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-23
Onset:2021-11-25
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19, Chest X-ray abnormal, Dizziness, Dyspnoea, Electrocardiogram abnormal, Pneumonia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: HTN, former smoker, history of cerebral aneurysm
Allergies: unknown
Diagnostic Lab Data: Oxygen saturation 65% at residence on 11/25/21. EKG showed Atrial Fib. PCR test positive for SARS-CoV-2. CXR showed pneumonia.
CDC Split Type:

Write-up: BREAKTHROUGH INFECTION: vaccinated 2/23/21 and 3/23/21 with Moderna. Went to ER via ambulance 11/25/21 with c/o dizziness x 1 week and shortness of breath. Was admitted to hospital that day.


VAERS ID: 1909736 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-23
Onset:2021-11-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever, 57, April 2021, Pfizer 2nd dose
Other Medications: 81 mg low-dose aspirin daily
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain and swelling under right arm at lymph node upon waking. Lasted 48 hours.


VAERS ID: 1909742 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-11-25
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hypoxia, Mechanical ventilation, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: emergency department at an outside hospital on November 24. She was found to be hypoxic and to be positive for SARS-CoV-2. She was started on nasal cannula oxygen with improvement in her hypoxia. She was started on remdesivir and dexamethasone. Respiratory status declined further and she required initiation of noninvasive ventilation and high-flow nasal cannula oxygen.


VAERS ID: 1909746 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-09
Onset:2021-11-25
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Decreased appetite, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Patient seen and examined this evening upon arrival to the hospital medicine service. Patient in semi recumbent position on simple face mask at 4 liters/minute. Patient states onset of symptoms was during the holiday and has continually gotten worse. Patient reports chills, shortness of breath and decreased appetite. Denies chest pain, abdominal pain, nausea, vomiting, headache, dizziness, diarrhea, fevers and chills.


VAERS ID: 1909750 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-11-25
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Productive cough
SMQs:, Infective pneumonia (broad)

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

Write-up: productive cough and fatigue that began 3 days prior. Upon arrival, she was hemodynamically stable and saturating well on room air. /Health authority who confirmed that she was not an appropriate candidate for monoclonal antibody infusion


VAERS ID: 1909758 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-11-25
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Constipation, Fatigue, Hypertension, Proctalgia
SMQs:, Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: rectal cancer s/p chemotherapy and radiation presenting with rectal pain and constipation. On arrival, patient is mildly hypertensive but otherwise vitals are stable. On exam, patient appears fatigued. Immunocompromised Consulted ID regarding patient''s immunocompromised state and new Covid diagnosis. They have recommended providing monoclonial antibodies, which have been ordered.


VAERS ID: 1909760 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-11-25
   Days after vaccination:274
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cerebral infarction, Intensive care
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: admitted to the neurological ICU with R MCA territory infarct and was found to have COVID pneumonia


VAERS ID: 1909766 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-11-25
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / UNK LA / IM

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

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

Write-up: 45 year old male with history of sleep apnea, COVID positive past few days with worsening SOB over past few days. Pt with O2 sats mid 80''s on RA. CTA no PE. Pt requiring 4L O2, and no beds available locally.


VAERS ID: 1909771 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-21
Onset:2021-11-25
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Dyspnoea, Dyspnoea exertional, Fatigue, Feeling abnormal, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: presents to ED complaining of shortness of breath, general weakness and fatigue, cough and sore throat for past 3 days. Pt had a positive at home covid test on 11/25/21. He was feeling OK then but has steadily been feeling worse. Today he is losing his breath with any activity. He has occasional cough, which has been dry but is hacking when it occurs


VAERS ID: 1909809 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-17
Onset:2021-11-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 21102114 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram head, Headache, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Probiotic Vitamin D3 Vitamin C
Current Illness: Chest inflammation
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Got a ct scan on brain 11/27/2021 everything came back normal
CDC Split Type:

Write-up: Pain in legs and Severe headache. Started 11/25/21 headache improved but persisted the next day. Leg pain was still present.


VAERS ID: 1909842 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-10
Onset:2021-11-25
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, C-reactive protein increased, Lymphadenitis, Magnetic resonance imaging abnormal, Nausea, Pain, Pyrexia, Red blood cell sedimentation rate normal
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zofran as needed, claritin as needed, ibuprofen as needed, culturelle kid''s probiotic daily, Augmentin 480mg PO BID x 7 days (10/9/21-10/15/21)
Current Illness: Runny nose (possible viral illness)
Preexisting Conditions: Pyloric stenosis, s/p dilation pyloric dilation in 2015
Allergies: NKDA, none
Diagnostic Lab Data: MRI showed mesenteric adenitis; ESR13/CRP37 (increased to 116 on 11/27).
CDC Split Type:

Write-up: Worsening severe sharp constant LLQ abdominal pain radiating to the RLQ and nausea. Hurts when she eats and with activity and nothing makes it better. Also presented with fever to 102.3 F. Thought to be possible appendicitis, but appendix not removed.


VAERS ID: 1909911 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Chills, Headache, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singular; Lexapro; Cyclobenzaprine
Current Illness: N/A
Preexisting Conditions: Chronic Back Pain
Allergies: Penicillin; Vicodin; Percocet; Amoxicillin
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: I have had fever, vomiting, nausea, chills, muscle aches, and headache. I have also had some abdominal pain. I had a virtual visit with my doctor today 11/30/21. My doctor advised to me take some Tylenol and he prescribed me some nausea medicine and told me to stay hydrated.


VAERS ID: 1909939 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-09
Onset:2021-11-25
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Inflammatory marker increased, Kawasaki's disease, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vasculitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Patient started to develop fevers associated with elevated inflammatory markers and with Kawasaki disease


VAERS ID: 1910031 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Discomfort, Fatigue, Headache, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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:
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Slight pain, swelling and itching at injection site. Experienced fatigue, joint pain, and headache that caused some discomfort for approximately 24 hours after the injection. All side effects responded to regular strength Tylenol.


VAERS ID: 1910043 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Loss of consciousness, Muscular weakness, Palpitations, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: After 2nd Pfizer shot, fainted approximately 18 hours later
Other Medications: Benadryl
Current Illness: None
Preexisting Conditions: None
Allergies: rondamycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cold Sweat and racing heart followed by momentary loss of consciousness which was then followed with total loss of muscle control for 3.5 hours while laying immobilzed on bathroom floor. Could only turn head which resulted in vomiting.


VAERS ID: 1910056 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1. Albuterol 0.083% Inh Soln 2.5 mg/3 ml: 2.5 mg inhalation every 8 hours 2. ClonazePAM: 2 mg g.t. Current Illness: Active Problems R56.9 - Seizures J96.10 - Chronic respiratory failure Z93.1 - Gastrointestinal tube present Z43.0 - Tracheostomy care Z93.0 - Tracheostomy dependent
Preexisting Conditions: Chronic Problems G40.309 - Progressive myoclonic epilepsy, Lafora
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient started having clinical seizures above her neurological baseline


VAERS ID: 1910841 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-10
Onset:2021-11-25
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Drug hypersensitivity, Extra dose administered, Feeling abnormal, Impaired work ability, Rash, Rash pruritic, Skin warm, Urticaria, Vulvovaginal pain, Vulvovaginal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Hypersensitivity (narrow), Medication errors (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: VANCOMYCIN, iv injection, 54 yo, hospital. Staph infection on face.
Other Medications: Vyvanse, multi vitamins b12 ,powder vit c, omega 3
Current Illness: None
Preexisting Conditions: ADD, high cholesterol, psoriasis in total remission.
Allergies: VANCOMYCIN (had red man syndrome at hospital, 8 years ago) I get rashes with asprian, orange juice. Allergic to many over the counter meds.
Diagnostic Lab Data: Benedryl..not much help. Zertex made me sick. predisone hopefully will kick in. I am too welted up and miserable to work.
CDC Split Type:

Write-up: J and J vacinne. 2nd shot = the booster. 2 weeks after, I developed a horrid reaction to Monistat. Never had issues with allergies. My vagina swelled up to size of an orange,painful swollen, red. Rash inner things up abdomen. Then 5 days later , a ucteria rash, . With welts, all over my back,neck, arms,legs. ITCHY,painful, hot. THIS IS THE SAME REACTION I HAD WITH VANCOMYCIN. red man syndrome. I bought benedryl with minor helping of itching. Zertec dud not work. I went to my Dr. 5 days after rash kept spreading. She put me on prednisone today. I''ll see if this works. I did not want to go to ER, because of all the covid cases in the hospitals. The rash is horrible, spots allover my body. I am itchy and miserable. My skin was beautiful before this disease invaded my tissue. Due to vivid vacinne.


VAERS ID: 1912129 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-30
Onset:2021-11-25
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, Rash, Scratch, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: arthritic pain increase since Pfizer mRNA vaccine before this incident
Other Medications: cannabis vaporized, tulsi (holy basil) tea, purple morning glory flower
Current Illness:
Preexisting Conditions: debilitating chronic pain levels up from moderate chronic pain levels prior to Pfizer mRNA vaccine
Allergies: only known allergy is tree pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 2021-11-25 took a hike and got a little bit scratched by some grasses. Not much tree pollen around, which I know I have been allergic to in the past, and a fair amount of flower pollen. Started developing worrying-looking viral-shaped redness about the scratches and some itchiness. On 2021-11-27 took another hike and this time got a bit scratched by some trees instead. Once again, did not appear to be much tree pollen, and didn''t seem to be much pollen at all around on most of the hike. I started developing the worst, itchiest hives ever. My skin has rash from wrist , 2-3 inches past where I got scratched, clustered around my scratches and around a tattoo from the previous Friday before the first scratch, inside the elbow, and further up the biceps clustered again around the light scratches. I also got a few stomach scratches that look similarly worrying, viral. I note that I have never had hives before unless counting Chicken Pox as a very small child. This mRNA Pfizer vaccine seems to be sending my immune system into turbo mode!


VAERS ID: 1912836 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-17
Onset:2021-11-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / SYR

Administered by: Private       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: tetanus vaccine around 2004
Other Medications: Lipitor, baby aspirin, Metoprolol, Lisinopril, Glucosamine condroitin.
Current Illness: none
Preexisting Conditions: high cholesterol and high blood pressure
Allergies: Only allergic reactions -- 1) tetanus shot -- about 17 years ago; 2) prednizone shot (caused incessant hiccups for 72 hours). None other.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: A week after the Moderna Booster, I had a full body rash from my neck to my waist. After a day, it started to spread down my legs as well to my knees.


VAERS ID: 1912934 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-22
Onset:2021-11-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Swollen lymph node under arm of injection. lasted a week


VAERS ID: 1913020 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-22
Onset:2021-11-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

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

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

Write-up: Beginning a few days after vaccination, patient experienced swelling of lymph node behind/under ear, specifically on the side of the body (left) that he received his vaccine. It became about "the size of an almond" and has been this way for approximately 7 days. Patient reported no pain, fever, or any other lymph node swelling or symptoms


VAERS ID: 1913060 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FIC5618 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Anticipatory anxiety, Chills, Decreased appetite, Headache, Lethargy, Malaise, Nasopharyngitis, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Within 24 hours, patient developed a 104 degree fever, severe lethargy, nausea and stomach pain, headache, chills, and decreased appetite. His fever was maintained with Ibuprofen and alleviated within 48 hours. However, he still complains of feeling generally sick with a headache and severe cold symptoms one week later. He had no prior health conditions and has never contracted COVID-19. However, he now has anxiety about receiving the scheduled second dose since he has never been more sick from any actual illness in his life.


VAERS ID: 1913258 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-23
Onset:2021-11-25
   Days after vaccination:275
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/30/21 SARS/COV-2 Postive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1913368 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-28
Onset:2021-11-25
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Calculus urinary, Computerised tomogram abdomen abnormal, Influenza like illness, Nephrolithiasis, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Shingles and flu shot same day and sick for 3-4 days with flu symptoms and fever 2020
Other Medications: TUMS; vitamin 2; vit D3; vit B12
Current Illness: No
Preexisting Conditions: Bronchiectasis
Allergies: LEVAQUIN
Diagnostic Lab Data: Cat scan, 5 by 7mm kidney stone in ureter
CDC Split Type: vsafe

Write-up: When I first got the shot Oct 28, within 10-12 hours I started with a fever, flu like symptoms in bed for 3 days until Tuesday. Then on Nov 25th I started having abdominal pain and it was an 8/10 so I went to the emergency room. They did a cat scan and said I had a 5 by 7mm stone stuck in my ureter. I had pain and vomiting with it and it is still in me.


VAERS ID: 1913883 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acne, Bone pain, Chills, Cough, Diarrhoea, Headache, Lid sulcus deepened, Mobility decreased, Pain, Photophobia, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Periorbital and eyelid disorders (narrow), Osteonecrosis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: *Synthroid 88mg *Women''s Vitamin *Vitamin D3 *Vitamin Calcium, Magnesium with Zinc
Current Illness: *Hashimotos *Possible Kidney Problems, Blood in Urine
Preexisting Conditions: *Hashimotos
Allergies: *The entire CILLIAN family *All CHOLESTROL Medications *Compozine "mixed" Sulfur *Some generic Levothyroxine like (Amneal)
Diagnostic Lab Data: *None, BUT a stool test due, per seperate reason... However I"couldn''t" get it completely yet, still healing
CDC Split Type:

Write-up: *BAD Chills & Fever *BAD Bone Aches *BAD Piercing Pain *BAD Diarrhea, that smelled like MEDICAL WASTE & a INFECTED fish *Throwing-up foam *Had a hard time getting up to use the bathroom *Achy Head *Sunken & Light Sensitive Eyes *Next day a couple of painful pimples emerged on my face *A week later, and I still have a bad cough


VAERS ID: 1914214 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-26
Onset:2021-11-25
   Days after vaccination:303
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Inappropriate schedule of product administration, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: not known
Preexisting Conditions: not known
Allergies: not known
Diagnostic Lab Data: PCR + on 11/29 for Covid
CDC Split Type:

Write-up: Client vaccinated with Moderna vaccines for Covid on 1/26 and 2/26/2021. Symptoms started 11/25 - chills, fever x 2 days, sore throat. PCR + on 11/29. Had not received booster dose.


VAERS ID: 1914252 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 8030 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Contusion, Dyspnoea, Fibrin D dimer increased, Flank pain, Influenza like illness, Myalgia, Pain, Pulmonary thrombosis, Pyrexia, Ultrasound scan normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), 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? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin 10mg Calcium Vitamins C& D Florestar
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: D-Dimer and CAT scan confirmed 4 blood clots in right lung and 1 blood clot in left lung. No clots were found in lower extremities bilateral during ultrasound.
CDC Split Type:

Write-up: 11/24/21 the day after the shot I had a persistent fever of 103 F not made better with tylenol; pcp notified and no remedy prescribed. Bruise on left arm size of a 50 cent coin. Flu like symptoms continued until Sunday 11/28/21. On 11/29/21 Acute pain on right flank/ ribs began but due to a history of slipped disk I thought this pain was muscular. On 11/30/21 at 9am I flew to visit family and by 10pm I became unable to breathe so I went to Emergency Room. MD and RN suggested my experience was a vaccine reaction.


VAERS ID: 1914365 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-23
Onset:2021-11-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Breast tenderness, Burning sensation, Lymphadenopathy, Pain
SMQs:, Peripheral neuropathy (broad), Lipodystrophy (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: Euthyrox, One a day vitamin, vitamins C, D, zinc
Current Illness: None
Preexisting Conditions: Low Thyroid
Allergies: Dairy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph gland under right arm 4 days. Shooting burning pain in left breast every night for about 30 seconds. This started 11/27/2021. This is still happening. Breast tenderness throughout the day also.


VAERS ID: 1915849 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-07
Onset:2021-11-25
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Hypoxia, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Leukocytosis, Lung opacity, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (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), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 78 y/M with h/o CKD-3, COPD, PVD s/p R BKA, CAD s/p PCI, HFrEF (LVEF 40%), Afib
Allergies:
Diagnostic Lab Data: 12/01/2021 COVID-19, Flu A & Flu B Panel by PCR, Covid Detected 12/01/21 Chest Xray "Asymmetric reticular densities, right greater than left which may reflect atypical/viral pneumonitis, including potentially Covid pneumonia."
CDC Split Type:

Write-up: 12/01/21 ID note: "Multifocal pneumonia due to COVID-19 virus with hypoxia; Fever on admission to 102.7, now afebrile, was on 2 LPM NC, now weaned down to 1 LPM; Onset cough on 11/25; FLU a/b negative; Covid + PCR on 12/1; Cxray 12/1: Asymmetric reticular densities, right greater than left which may reflect atypical/viral pneumonitis, including potentially Covid pneumonia. Acute leukocytosis, trending down. S/p azithromycin x1 11/30. PMH: DM type 2, HTN, COPD, PVD s/p R BKA, subdural hematoma s/p mechanical fall, CAD s/p PCI, HFrEF (LVEF 40%), atrial fib on apixaban, CKD stage 3, depression. COVID vaccinations- was at nursing home, no records in I-CARE noted. Continue dexamethasone day, continue remdesevir day 1/5, continue anticoagulation".


VAERS ID: 1916327 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-18
Onset:2021-11-25
   Days after vaccination:311
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Mechanical ventilation, SARS-CoV-2 test
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen ammonium lactate 5% lotion carvedilol 6.25 mg BID divalproex 125 mg capsule hydrochlorothiazide insulin glargine loperamide silver sulfadiazine trazodone
Current Illness: none
Preexisting Conditions: Alzheimer''s disease with late onset Type 2 diabetes mellitus with hyperglycemia Peripheral vascular disease, unspecified Neoplastic (malignant) related fatigue Other disorders of plasma-protein metabolism, not elsewhere classified Essential (primary) hypertension Localized edema
Allergies: none
Diagnostic Lab Data: COVID-19 PCR 11/26/21
CDC Split Type:

Write-up: Hospitalization with COVID pneumonia requiring respiratory support with mechanical ventilation


VAERS ID: 1916500 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-23
Onset:2021-11-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Headache, Mouth ulceration, Myalgia, Vulval ulceration
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 10mg
Current Illness: None
Preexisting Conditions: None
Allergies: Immitrex
Diagnostic Lab Data: Blood work drawn.
CDC Split Type:

Write-up: Muscle pain and aches, mouth ulcers, vulva ulcers, extreme stomach pain. Headache.


VAERS ID: 1916520 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-24
Onset:2021-11-25
   Days after vaccination:274
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / SYR

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

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

Write-up: Blood clots in lungs


VAERS ID: 1916583 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-21
Onset:2021-11-25
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Decreased appetite, Diarrhoea, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, hypertension, obesity, HLD, and CHF. Patient diagnosed with colon cancer and is currently receiving chemotherapy treatment. Last session was done 10 days ago.
Allergies: No known allergies
Diagnostic Lab Data: 12/1/2021 COVID-19 (NAA) Testing, resulted positive
CDC Split Type:

Write-up: Patient presented to the ED for evaluation of generalized weakness, reduced appetite, diarrhea, and shortness of breath that began one week ago. Also reports dry cough.


VAERS ID: 1916776 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-01
Onset:2021-11-25
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hypoxia, Inappropriate schedule of product administration, Influenza like illness, Mental status changes, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Pt received Pfizer vaccines on 05/01/2021 and 05/25/2021. Pt presented to the ED on 11/25/2021 with complaints of AMS, flu-like symptoms, and hypoxia. Pt was found to be COVID positive and requiring supplemental oxygen.


VAERS ID: 1917001 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064H21A / 1 - / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Chills, Laboratory test, Nausea
SMQs:, Acute pancreatitis (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrocortisone 15mg; Levothyroxine 125mcg
Current Illness: No
Preexisting Conditions: Adrenal hyperplasia; Hashimoto''s hypothyroidism
Allergies: No
Diagnostic Lab Data: Pending.
CDC Split Type:

Write-up: Nausea, chills and ongoing chest pain.


VAERS ID: 1917038 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-11-25
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / UNK - / -

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

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

Write-up: Covid positive..family contact


VAERS ID: 1917079 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-27
Onset:2021-11-25
   Days after vaccination:302
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / UNK - / -

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

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

Write-up: Covid positive household contact


VAERS ID: 1917161 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M21B / 3 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pain, Respiratory tract congestion, 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? Yes
Hospitalized? No
Previous Vaccinations: meningitis
Other Medications: Zyrtec, Flonase nasal spray
Current Illness: cold around the beginning of number
Preexisting Conditions: Allergies
Allergies: peanuts, nuts
Diagnostic Lab Data: took at home covid test and it was positive -on 11/30/2021
CDC Split Type: vsafe

Write-up: felt achy on the 25th, also felt achy on the 26, also experienced congestion on the 27th


VAERS ID: 1917279 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Fatigue, Gastrointestinal pain, Headache, Illness, Injection site erythema, Injection site swelling, Malaise, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pneumovax.
Other Medications: Synthroid, Cytomel; Multivitamin, Fibercon, ButyrEn
Current Illness:
Preexisting Conditions: Atypical non-Hashimoto''s autoimmune thyroiditis; COVID-19
Allergies: Pneumovax; Tessalon
Diagnostic Lab Data:
CDC Split Type:

Write-up: Autoimmune patient with highly sensitive immune reaction and severe COVID-19 survivor having illness and malaise following all 3 rounds of the Pfizer-BioNTech vaccine. No immediate reaction, but debilitating illness for 1-3 weeks afterward with illness ramping for several days starting ~12 hours after injection, then very slowly tapering off over the course of weeks. Symptoms include debilitating gut pain, diarrhea, headaches, debilitating muscle aches, joint pain, swelling at the injection site, pain and soreness of the injected arm, redness as the injection site, debilitating fatigue. No adverse reaction requiring emergency care and no immediate reaction in the first 4 hours following injection. The patient''s physician noted that autoimmune patients of this type should ideally receive a reduced dosage for boosters of this vaccine to still gain benefit but suffer less debilitating illness, however, no such option has been cleared at this time. The full-dose booster and subsequent illness was judged to be less dangerous than risking re-infection of COVID-19, but the wear on the patient if multiple boosters per year are required over the course of years is a significant concern. Allowing autoimmune patients to receive an adjusted dosage of the adult formulation or a standard child''s dose of the child formulation for an adult autoimmune patient would go a long way towards addressing this concern so that future boosters could be recommended without hesitation.


VAERS ID: 1917773 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-04
Onset:2021-11-25
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Cough, Decreased appetite, Dyspnoea, Fatigue, Hypoxia, Lung infiltration, Lung opacity, Pain, Pain in extremity, Peripheral swelling, Pyrexia, Respiratory distress, SARS-CoV-2 test positive, Ultrasound Doppler normal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet guaiFENesin (MUCINEX) 600 MG 12 hr tablet metFORMIN (GLUCOPHAGE) 1000 MG tablet methylPREDNISolone 4 MG TBPK SITagliptin (JANUVIA) 100 MG tablet
Current Illness: 11.25.21 - Emergency department - SOB - diagnosed with pneumonia due to COVID and hypoxia - DC''d 11.26.21 - Emergency department - Respiratory distress due to COVID; active hypoxia - transferred / admitted
Preexisting Conditions: Type 2 diabetes mellitus Obesity
Allergies: Demerol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (11.26.21); COVID-19 positive (11.25.21); fully vaccinated Admission Date: 11/26/2021 Discharge Date: 11/30/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus HOSPITAL COURSE: Patient is a 48 y.o. male who presents to hospital with shortness of breath. Patient is fully vaccinated against COVID and began having symptoms approximately 1 week ago. Initial symptoms were fatigue generalized aches and fever. He subsequently developed a cough decreased appetite and worsening shortness of breath. He lost smell and taste, days ago. Because of worsening shortness of breath he was seen in the emergency department yesterday. He was found to have a chest x-ray consistent with COVID pneumonia and positive COVID test. He was requiring 6 L of oxygen and admission was recommended but there were no available inpatient beds. The patient did not wish to board in the emergency department overnight and was discharged home on 6 L of oxygen. He did receive a dose of dexamethasone while in the emergency department yesterday. Overnight his shortness of breath worsened and he developed hypoxemia with oxygen saturations into the mid 80s. After several hours he eventually returned to the emergency department where CT scan showed diffuse bilateral ground-glass infiltrates but no PE. Due to his worsening hypoxemia he was referred to the hospital for further evaluation care and transferred to bigger hospital for further inpatient care. 11.31.21: Progress: improving Outcome Summary: Patient ready for discharge this afternoon. He has been able to maintain his oxygen sats above 90% on room air. Discharge instructions were provided and he will be leaving via private vehicle with family. Pneumonia due to COVID-19 virus Assessment & Plan Patient with symptoms for approximately one week (11/19) Seen in ED 11/25 for diagnosis, found to by hypoxic Fully vaccinated Worsening hypoxia on admission, CT with diffuse infiltrates negative for PE Dexamethasone 4/10 Remdesivir 3/5 Vacillating between 5 and 6 L of supplemental oxygen. He had some swelling and pain in the bilateral lower extremities. I dosed with Lasix 40 mg once and got bilateral lower extremity Dopplers which were negative for DVT.


VAERS ID: 1919605 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-01
Onset:2021-11-25
   Days after vaccination:269
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: a lump on the right side of her neck around the clavicle area that was half the size of a tennis ball, her doctor said said that a lymph node possibly became swollen; This spontaneous case was reported by a consumer and describes the occurrence of LYMPHADENOPATHY (a lump on the right side of her neck around the clavicle area that was half the size of a tennis ball, her doctor said said that a lymph node possibly became swollen) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 067F21A, 012A21A and 028A21A) for COVID-19 vaccination. No Medical History information was reported. On 01-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 28-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 24-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 25-Nov-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced LYMPHADENOPATHY (a lump on the right side of her neck around the clavicle area that was half the size of a tennis ball, her doctor said said that a lymph node possibly became swollen). At the time of the report, LYMPHADENOPATHY (a lump on the right side of her neck around the clavicle area that was half the size of a tennis ball, her doctor said said that a lymph node possibly became swollen) was resolving. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. It was reported that, on 27-Nov-2021, a lymph node possibly became swollen. It had been subsided, but still feel it and see it. It was about a 1/4 the size of a tennis ball. No concomitant and treatment medications were reported.


VAERS ID: 1919851 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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.MOD20213

Write-up: Today I felt dragging; running a fever of 100,tonight I have a temp on f 99; chills; This spontaneous case was reported by a nurse and describes the occurrence of FEELING ABNORMAL (Today I felt dragging), PYREXIA (running a fever of 100,tonight I have a temp on f 99) and CHILLS (chills) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 24-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Nov-2021, the patient experienced PYREXIA (running a fever of 100,tonight I have a temp on f 99) and CHILLS (chills). On 26-Nov-2021, the patient experienced FEELING ABNORMAL (Today I felt dragging). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) for Fever and Chills, at a dose of 1 dosage form. At the time of the report, FEELING ABNORMAL (Today I felt dragging) and CHILLS (chills) outcome was unknown and PYREXIA (running a fever of 100,tonight I have a temp on f 99) was resolving. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medication information was not provided by the reporter.


VAERS ID: 1919889 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: bumps all over body-Medium, Additional Details: patient says he got bumps all over body, slight itch


VAERS ID: 1920365 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O12F21A / N/A RA / 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: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tinittus Ringing in my ears


VAERS ID: 1920692 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-23
Onset:2021-11-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH2028 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Libido decreased, Peripheral swelling, Rash, Renal pain, Semen volume decreased, Vaccination site scar
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Fertility disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: Sea food
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash, swellness on arm, headaches, pain in kidney area, low libido, low production of semen, scarring on the arm where vaccine was injected.


VAERS ID: 1920707 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-23
Onset:2021-11-25
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B12A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Acute respiratory failure, Adult failure to thrive, Auscultation, C-reactive protein, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cognitive disorder, Confusional state, Cough, Decreased appetite, Disorientation, Dyspnoea, Fatigue, Fibrin D dimer, Full blood count, Hyperkalaemia, Hypophagia, Hypoxia, Metabolic function test abnormal, Pneumonia, Pneumonia bacterial, Renal failure, SARS-CoV-2 test positive, Sputum discoloured, Stubbornness, Treatment noncompliance
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), 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? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler azithromycin (ZITHROMAX) 250 MG tablet cyproheptadine 4 MG tablet escitalopram (LEXAPRO) 5 MG tablet esomeprazole (NEXIUM) 20 MG delayed release capsule F
Current Illness: 10.22.21: PROCEDURE PERFORMED: ANTERIOR RESECTION OF CERVICAL FOUR/FIVE OSTEOPHYTE 11.23.21: Primary Care office appointment - cough and abdominal pain reported; Chest X-Ray done: Possible developing mild patchy infiltrate or atelectasis in the right upper lung zone. A follow-up chest x-ray can be obtained for further study. 11.25.21: ED visit - This is a 83 y.o. male who presents today for failure to thrive, cough and hypoxia. He is currently being treated for bacterial pneumonia without improvement. On presentation he does appear dry on exam. His lungs are clear to auscultation bilaterally. He is hypoxic down to 87% on room air. He is COVID positive. Checks x-ray is consistent with COVID pneumonitis. He will require admission for hypoxia.
Preexisting Conditions: Calcified granuloma of lung Neck fracture COPD (chronic obstructive pulmonary disease) GERD (gastroesophageal reflux disease) CAD (coronary artery disease) Cardiomyopathy Cervical osteophyte Vitamin D deficiency Carotid artery disease Hyperglycemia Neurogenic dysphagia Incisional hernia without mention of obstruction or gangrene Petechial rash Normocytic anemia Monoclonal gammopathy Chronic cough Normochromic anemia Thrombocytopenia Varicose veins of both lower extremities Ulcerative esophagitis Oropharyngeal dysphagia Memory disturbance Cervical spondylosis Essential hypertension B12 deficiency Nonischemic cardiomyopathy Cigarette nicotine dependence in remission
Allergies: Amoxicillin-pot ClavulanateHives, Rash AugmentinSkin Rashes/Hives, Hives, Rash PenicillinsRash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (11.25.21 - still currently admitted); COVID-19 positive (11.25.21); fully vaccinated HISTORY OF PRESENT ILLNESS: Paitent is a 83 y.o. male with a history of CKD 3, GERD and major depressive disorder who presents today with shortness of breath, anorexia and extreme fatigue. His niece reported that the patient has cognitive deficits and has been stubborn and won?t answer anyone?s questions including his PCP and family members. Patient did acknowledge having a cough that occasionally produced yellow sputum and feeling very fatigued with no appetite. He was diagnosed with right upper pneumonia, hyperkalemia and renal insufficiency by his PCP on 11/23/2021 and started on Azithromycin but has refused to take his antibiotics. Reportedly he has not been eating or drinking very much since then. Due to these circumstances his niece brought him to Emergency Department for evaluation. On presentation he does appear dry on exam. Patient was found hypoxic at 87% on room air on presentation. He required 6 L of oxygen to maintain sats above 90%. Comprehensive metabolic panel demonstrated renal insufficiency which was improved from previous but still above his baseline. Previous hyperkalemia had resolved. COVID-19 positive. Chest x-ray was consistent with COVID pneumonitis, previously right upper lobe pneumonia was not demonstrated. He was given 1L of IV fluids and 6mg IV Decadron. Given his hypoxia and failure to thrive he was transported via EMS to Hospital for further care and management of pneumonia due to COVID-19. Pneumonia due to COVID-19 virus Assessment & Plan Patient with a reported 3-5 days of cough, shortness of breath, anorexia and fatigue. Diagnosed with RUL pneumonia on 11/23/2021 by PCP and was prescribed Azithromycin. Patient refused to take antibiotic. COVID 19 positive Chest x-ray was consistent with COVID pneumonitis, previously right upper lobe pneumonia was not demonstrated. Admitted for supportive care and monitoring. On 6 L 02 to maintain sats above 90% Plan: - Supportive care - Decadron 6 mg daily (1/10) - remdesivir - Albuterol HFA q4h sch - monitor on tele and continuous pulse oximetry - ICS, Acapella, Mucinex - daily CBC, CMP, CRP, D-dimer - wean off oxygen as able. DVT prophylaxis: Lovenox 40 mg sq daily Progress Note from 12.2.21: Disorientation Assessment & Plan Patient is not alert to place, time, or situation. He has not been since admission. (niece and nephew) whom he lives with say they were concerned about memory and were going to have him worked up for dementia prior to Covid illness. They have noticed confusion and faltering memory for over 2 years. The ACE assessment was completed and the patient is definitely incapable of making medical decisions. Psych evaluation has occurred. Per previous discussion with family, patient''s wishes at this point would be to discharge home with hospice. Plan hospice meeting in am. Acute respiratory failure with hypoxia Assessment & Plan Currently on room air - 1L see COVID plan of care Monitor on continuous pulse oximetry Pneumonia due to COVID-19 virus Assessment & Plan Symptom onset around 11/21, Covid positive 11/25, shortness of breath, anorexia and fatigue. Patient currently requiring room air to 2 L nasal cannula. COVID stable. Patient continues to have decreased oral intake see failure to thrive plan of care. Plan: - Supportive care - Decadron 6 mg daily (9/10) - remdesivir 5/5 - completed 11/30 - Albuterol HFA q4h sch - monitor on tele and continuous pulse oximetry - ICS, Acapella, Mucinex - wean off oxygen as able, Patient currently on 1L will do walk saturation to determine if home oxygen is needed.


VAERS ID: 1920921 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-19
Onset:2021-11-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site reaction, Injection site urticaria, Muscle twitching, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dyskinesia (broad), Dystonia (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: magnesium tablets vitamin d vitamin c gaba
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: on the 5th day post Moderna vaccine I developed muscle twitching on my right arm (injection site) for a whole day. The following day, I developed hives around the injection site and my back for 3 days.


VAERS ID: 1920989 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-04
Onset:2021-11-25
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Laboratory test abnormal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, CHF, A fib, SDH, CKD3
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB, cough, abnormal labs


VAERS ID: 1921067 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-02
Onset:2021-11-25
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, Atrial flutter, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Cardiomegaly, Cerebral atrophy, Cervical spinal stenosis, Chest X-ray abnormal, Computerised tomogram head abnormal, Computerised tomogram spine, Dental caries, Echocardiogram abnormal, Ejection fraction decreased, Emphysema, Fall, Hypoxia, Intervertebral disc degeneration, Intervertebral disc protrusion, Left ventricular enlargement, Lung opacity, Mucosal hypertrophy, Periodontal disease, Respiratory tract congestion, SARS-CoV-2 test positive, Scan with contrast, Ventricular hypokinesia, Vertebral foraminal stenosis, Vertebral osteophyte
SMQs:, Cardiac failure (narrow), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Gingival disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet Acetaminophen-Caffeine (EXCEDRIN TENSION HEADACHE) 500-65 MG TABS apixaban (ELIQUIS) 5 MG tablet aspirin 81 MG enteric coated tablet atorvastatin (LIPITOR) 40 MG tablet budesonide/formoterol (SYMBICORT)
Current Illness: 2/26/21- urinary retention 2/26/21-Spinal stenosis of lumbar region, unspecified whether neurogenic claudication present
Preexisting Conditions: ? Arthritis hip ? Blood disease Pt with polycythemia ? Bradykinesia ? CAD (coronary artery disease) May 2012 Stent placement. ? Colon polyps ? COPD (chronic obstructive pulmonary disease) ? Diabetes type 2, uncontrolled ? Essential hypertension, benign ? Hyperlipidemia ? Infectious viral hepatitis Hepatitis A when in military ? Kidney disease nephritis age 10 ? Mixed hyperlipidemia due to type 2 diabetes mellitus 5/18/2015 ? Muscle disorder RLS-no meds ? Myocardial infarction 2012 had stent placed ? OSA on CPAP ? PLMD (periodic limb movement disorder) ? PVD (peripheral vascular disease) ? Sleep apnea ? Snores ? Urinary tract infection
Allergies: No Known Allergies
Diagnostic Lab Data: CV Echo Limited with Contrast [354952966] Collected: 11/26/21 1206 Order Status: Completed Updated: 11/26/21 1333 Narrative: Address: (PRIVACY) Phone: (PRIVACY) LIMITED ECHOCARDIOGRAPHY REPORT Name: (PRIVACY) Study Date: 11/26/2021 MRN: (PRIVACY) Patient Location: (PRIVACY) DOB: (PRIVACY) Patient Class: Outpatient Gender: Male Ordering Physician: (PRIVACY) Age: 73 yrs Height: 178 cm Performed By: RDCS Weight: 105 kg Resting HR: 60 BSA: 2.2 m2 Resting BP: 126/70 mmHg Reason For Study: Atrial fibrillation/flutter (AF), ., CHF findings on CXR, hypoxia History/Symptoms: Covid-19, Coronary artery disease, COPD, Former smoker, Obsutrictive sleep apnea, Peripheral artery disease, Diabetes Mellitus Electronically signed by: MD on 11/26/2021 01:33 PM Interpretation Summary The technical quality of the exam was limited due to suboptimal acoustic windows. Due to limited acoustic windows, Definity was administered. The global left ventricular ejection fraction is 38%. There is mild to moderate global hypokinesis of the left ventricle. The right ventricle is normal size. Right ventricular function cannot be assessed due to poor image quality. No pericardial effusion. There is no comparison study available. STUDY PERFORMED/QUALITY: A two-dimensional transthoracic echocardiogram with color flow and spectral flow Doppler was performed in limited views only. The technical quality of the exam was limited due to suboptimal acoustic windows. Due to limited acoustic windows, Definity was administered. Location: Portable. LEFT VENTRICLE: By volumetric assessment, the LV appears mildly enlarged. The left ventricular ejection fraction is 38%. The LV ejection fraction was determined utilizing Simpson''s Biplane method. There is mild to moderate global hypokinesis of the left ventricle. RIGHT VENTRICLE: The right ventricle is normal size. Right ventricular function cannot be assessed due to poor image quality. PERICARDIUM/PLEURAL: No pericardial effusion. INFERIOR VENA CAVA: The inferior vena cava was not visualized during the exam. Left Ventricle Mitral Valve EF(MOD-Avg): 38 % MV E/A: 0.65 EDV(MOD-sp4): 168.7 ml MV dec time: 0.28 sec ESV(MOD-sp4): 95.6 ml MV E max vel: 0.53 m/sec SV(MOD-Avg): 68.5 ml MV A max vel: 0.81 m/sec EDV(MOD-sp2): 191.7 ml MVA(P1/2t): 2.6 cm2 ESV(MOD-sp2): 127.7 ml MV P1/2t: 83.4 msec MV dec slope: 1.82 m/sec2 Med Peak E'' Vel: 0.05 m/sec Lat Peak E'' Vel: 0.03 m/sec E/e'' avg: 11.7 ______________________________________________________________________________ Tricuspid Valve Great Vessels RAP systole: 3.0 mmHg IVC diam: 1.7 cm ______________________________________________________________________________ Doppler Measurements & Calculations MV P1/2t max vel: 0.52 m/sec Reference Table: Normal Mild ModerateSevere Men LVEF $g 52% 41-51% 30-40% <30% Women LVEF $g 54% 41-53% 30-40% <30% Men LVIDd 4.2-5.8 5.9-6.3 6.4-6.8 $g6.8 Women LVIDd 3.8-5.2 5.3-5.6 5.7-6.1 $g6.1 LA Volume (ml/m^2) < 34 35-41 42-48 $g48 ______________________________________________________________________________ Electronically signed by: MD on 11/26/2021 01:33 PM All sources of data reside in the Cardiology EJECTION FRACTION ECHO [354952968] Collected: 11/26/21 1206 Order Status: Completed Updated: 11/26/21 1333 EJECTION FRACTION ECHO 38 % DR CHEST 2 VIEWS FRONTAL AND LATERAL [354935377] Resulted: 11/25/21 0904 Order Status: Completed Updated: 11/25/21 0906 Narrative: EXAMINATION: Frontal and Lateral View Chest EXAM DATE: 11/25/2021 8:33 AM TECHNIQUE: Frontal and lateral views INDICATION: fall. COMPARISON: None ENCOUNTER: Not applicable _________________________ FINDINGS: Mild cardiomegaly and central vascular engorgement. Hazy interstitial opacity could reflect early interstitial edema versus bibasilar infiltrates. No effusion. No pneumothorax. Bony structures are unremarkable to extent of view. _________________________ Impression: Mild cardiomegaly, congestion, and hazy bibasilar opacities possibly reflecting early interstitial edema versus bibasilar infiltrates. CT HEAD WITHOUT IV CONTRAST [354935375] Resulted: 11/25/21 0839 Order Status: Completed Updated: 11/25/21 0841 Narrative: EXAMINATION: CT Head without Contrast EXAM DATE: 11/25/2021 8:22 AM TECHNIQUE: Multiple axial noncontrast images of the brain were obtained and reformatted according to the standard protocol. QPP DOCUMENTATION: At least one of the following dose reduction techniques was utilized: Iterative reconstruction, and/or Automatic Exposure Control, and/or mA/kV adjustment based on body size. INDICATION: Head trauma, mod-severe, fall COMPARISON: There are no priors uploaded into this patient''s jacket at the time of dictation HAND DOMINANCE: Right ENCOUNTER: Not applicable ____________________ FINDINGS: Intracranial hemorrhage: None. Infarct/Vascular: No CT evidence of acute infarct. There is minimal periventricular and subcortical white matter hypodensity, nonspecific though usually seen in the setting of slight chronic microvascular ischemic disease. Intracranial Mass: No evidence of intracranial mass. CSF Spaces: Minimal prominence of the ventricles and CSF spaces likely due to minimal global atrophy. Calvarium and Scalp: Unremarkable. Paranasal Sinuses and Orbits: There is mild diffuse = is thickening throughout the maxillofacial sinuses with postsurgical changes seen along the medial maxilla bilaterally. Extensive periodontal disease is present with innumerable dental caries and scattered areas of ventral cortical breakthrough along the visible mandibular teeth. Orbits are unremarkable. ____________________ Impression: 1. No acute intracranial abnormality. Incidental findings are discussed above. CT SPINE CERVICAL WITHOUT CONTRAST [354935376] Resulted: 11/25/21 0839 Order Status: Completed Updated: 11/25/21 0841 Narrative: EXAMINATION: CT Cervical Spine without Contrast EXAM DATE: 11/25/2021 8:22 AM TECHNIQUE: Routine Protocol thin section noncontrast axial cervical spine CT was performed with coronal and sagittal multiplanar reformatted images. QPP DOCUMENTATION: At least one of the following dose reduction techniques was utilized: Iterative reconstruction, and/or Automatic Exposure Control, and/or mA/kV adjustment based on body size. INDICATION: Neck trauma (Age $g= 65y), fall COMPARISON: None ENCOUNTER: Not applicable ____________________ FINDINGS: Alignment: Anatomic. Vertebrae: No fracture/dislocation. Intervertebral Discs: Multilevel degenerative disc changes with prominent posterior disc osteophyte seen at C5-C6 and C6-C7 with associated probable superimposed central protrusion at C5-C6 and mild spinal canal narrowing at both of these levels. Examination is not optimized for assessment of the cord/canal contents. Additional note of moderate right bony neural foraminal canal narrowing at C5-C6 and mild left bony neuroforaminal canal narrowing at C6-C7. Paraspinal Tissues: There is no prevertebral hematoma. Lung Apices: Mild emphysema. ____________________ Impression: 1. No fracture/dislocation. 2. Degenerative changes of the cervical spine, greatest at C5-C6 and C6-C7 where there is mild spinal canal and bony neuroforaminal canal narrowing, discussed above. Specimen: Swabbed Collection from Nasopharynx Updated: 11/25/21 0855 COVID-19 PCR Detected
CDC Split Type:

Write-up: Patient discharged after (3) days inpatient admission. Patient is a 73-year-old man with a past medical history significant for coronary artery disease status post PCI, paroxysmal atrial relation Eliquis, parkinsonism along with cognitive impairment who presented with weakness and mechanical fall. He was found to be hypoxic requiring 2 L. patient tested positive for COVID-19 pneumonia. He was started oral dexamethasone. Given the unclear etiology of fall, echocardiogram performed which showed LVEF 38% and moderate global hypokinesis. Cardiology is consulted recommended starting Entresto. Patient was initially on IV Lasix and was transition to oral Lasix 20 mg at discharge. Cardiology recommending patient following with mitral cardiologist to evaluate for possible stress testing given that etiology for cardiomyopathy was unclear. Patient was evaluated by PT and OT recommended home with home health. Patient was evaluated by pulmonary rehab who recommended patient be discharged on 2 L by nasal cannula supplemental oxygen at all times. Patient is discharged home in medically stable condition.


VAERS ID: 1921100 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram head, Magnetic resonance imaging head, Magnetic resonance imaging neck, Nausea, Vertigo, Vestibular neuronitis, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: atorvastatin (LIPITOR) 10 MG tablet take 1 tablet by mouth once daily 90 tablet 3 ? blood sugar diagnostic Strp Use as directed to check blood sugar twice daily for diabetes E11.65 100 strip 11 ? blood-glucose meter,continuous (Dexcom G4 Re
Current Illness: none
Preexisting Conditions: Diabetes, obesity, dilated cardiomyopathy
Allergies: NKDA
Diagnostic Lab Data: blood work done at hospital 11/25/21 blood work, CT brain, MRI and MRI of the head and neck done 11/28/21 at hospital, also seen by neurology and neurosurgery
CDC Split Type:

Write-up: developed severe vertigo and N/V within 24 hours, seen at ED x 2 and diagnosed with vestibular neuritis - symptoms severe for 4-5 days and now slowly improving


VAERS ID: 1921158 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-18
Onset:2021-11-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 2 LA / IM

Administered by: Unknown       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: High pitched sound in right ear. Intermittent.


VAERS ID: 1921679 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-11
Onset:2021-11-25
   Days after vaccination:287
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram, Dyspnoea, Malaise, Nausea, 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), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Naproxen
Current Illness:
Preexisting Conditions: History of asthma, obesity, history of UTI, hearing loss, osteoarthritis, history of urinary incontinence, history of C-section, history of bilateral intraocular lens implant, history of allergic rhinitis.
Allergies: Tylenol
Diagnostic Lab Data: who has been fully vaccinated against COVID-19, but has not gotten the booster shot as yet. She started to feel sick since last Saturday and was not feeling well. She was having some nausea and vomiting. However, lately she has become more short of breath and was using the albuterol inhaler, which she used p.r.n. more frequently. Therefore, was brought to the emergency room where she was diagnosed with COVID-19 infection and she was found to be saturating only 89% on room air. On 3 L, she is saturating 95% on room air. Three attempts were made to get an ABG on her and the patient''s family is refusing anymore attempts at ABG. Patient denies any chest pain. No headache. No abdominal pain. We are awaiting a CT of the chest without contrast on her. No antibiotic at this point of time. She has been started on Decadron and remdesivir. We are going to add vitamin D and vitamin C and Mucinex on her as well. Based on the CT scan results, she was started on ceftriaxone. On RA on 12/1/21 and discharged
CDC Split Type:

Write-up: Presented to ER on 11/25/21


VAERS ID: 1921691 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-01
Onset:2021-11-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lethargy, Lymphadenopathy, Myalgia, Night sweats, Pain in extremity, Pruritus, Sleep disorder, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Night sweats, lethargy, sore arm, severe itching with what appeared to be hives over 2-3 day period unable to sleep due to itching, muscle aches, enlarged lymp node in left lower neck. Other than night sweat and sore arm the other symptoms were delayed 2-5 days after booster.


VAERS ID: 1922531 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-04
Onset:2021-11-25
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 32030BD / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Herpes zoster, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Opportunistic infections (broad)

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

Write-up: Herpes Zoster outbreak, unusually severe. Sharp pains in the chest. As of the date of this report, some pain still at the injection site in the arm.


VAERS ID: 1922904 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-10-27
Onset:2021-11-25
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Insomnia, Mobility decreased, Near death experience
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: had a stroke; I almost died; can�t sleep; can�t even move; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (had a stroke) and NEAR DEATH EXPERIENCE (I almost died) in a 69-year-old patient of an unknown gender 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 27-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Nov-2021, the patient experienced CEREBROVASCULAR ACCIDENT (had a stroke) (seriousness criteria medically significant and life threatening), NEAR DEATH EXPERIENCE (I almost died) (seriousness criterion medically significant), INSOMNIA (can�t sleep) and MOBILITY DECREASED (can�t even move). At the time of the report, CEREBROVASCULAR ACCIDENT (had a stroke), NEAR DEATH EXPERIENCE (I almost died), INSOMNIA (can�t sleep) and MOBILITY DECREASED (can�t even move) outcome was unknown. Concomitant medications details were not reported by the reporter.Treatment details was not reported by the reporter. On 27-Oct-2021, patient received the booster dose and last night had a stroke, could not sleep and could not even move. Patient almost died. Company Comment : This case concerns a 69-year-old, patient of unknown gender with no relevant medical history, who experienced the unexpected events of Cerebrovascular accident, Near death experience, Insomnia, and Mobility decreased. The events occurred approximately 29 days after a dose of mRNA-1273 Vaccine which resulted in a Life threatening situation. The rechallenge was unknown since no information about the events of an earlier dose was disclosed. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Sender''s Comments: This case concerns a 69-year-old, patient of unknown gender with no relevant medical history, who experienced the unexpected events of Cerebrovascular accident, Near death experience, Insomnia, and Mobility decreased. The events occurred approximately 29 days after a dose of mRNA-1273 Vaccine which resulted in a Life threatening situation. The rechallenge was unknown since no information about the events of an earlier dose was disclosed. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.


VAERS ID: 1923171 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-23
Onset:2021-11-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Feeling abnormal, Headache, Respiratory tract congestion, SARS-CoV-2 test negative
SMQs:, Taste and smell disorders (narrow), Dementia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: Egg intolerance that has NOT affected vaccines before
Diagnostic Lab Data: I got two covid19 tests to see if I actually had the virus - both came back negative and that is why I am reporting.
CDC Split Type:

Write-up: After receiving my booster vaccine, I started to have all of the symptoms of COVID 19 - congestion throughout my chest to my head, a slamming headache, brain fog, and notable, loss of taste!


VAERS ID: 1923228 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-21
Onset:2021-11-25
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abnormal weight gain, Activated partial thromboplastin time shortened, Acute respiratory distress syndrome, Acute respiratory failure, Adenovirus test, Alanine aminotransferase increased, Albumin globulin ratio, Aspartate aminotransferase increased, Asthma, Autoimmune thyroiditis, Basophil percentage decreased, Blood albumin normal, Blood alkaline phosphatase normal, Blood bicarbonate, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine, Blood creatinine normal, Blood gases, Blood glucose normal, Blood lactic acid, Blood methaemoglobin, Blood pH decreased, Blood potassium normal, Blood sodium normal, Blood test, Blood urea normal, Bronchitis, Carbon dioxide normal, Carboxyhaemoglobin, Cardiac failure, Chest X-ray normal, Chest pain, Chlamydia test negative, Computerised tomogram, Dyspnoea, Dyspnoea exertional, Electrocardiogram abnormal, Enterovirus infection, Enterovirus test negative, Eosinophil count normal, Eosinophil percentage, Exposure to SARS-CoV-2, Glomerular filtration rate, Haematocrit normal, Haemoglobin normal, Headache, Human metapneumovirus test, Human rhinovirus test, Hyperhidrosis, Hypertensive heart disease, Immature granulocyte count, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, International normalised ratio normal, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin increased, Mean cell volume increased, Mean platelet volume normal, Monocyte count, Monocyte percentage, Mycoplasma test negative, Nasopharyngitis, Neutrophil count, Neutrophil percentage increased, Oropharyngeal pain, Oxygen saturation, PCO2, PO2, Platelet count normal, Procalcitonin, Prohormone brain natriuretic peptide increased, Protein total normal, Pyrexia, Red blood cell count decreased, Red blood cell nucleated morphology, Red cell distribution width, Respiratory syncytial virus test negative, SARS-CoV-2 test negative, Throat irritation, Troponin T normal, White blood cell count normal
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Furosemide, Levothyroxine
Current Illness: No other illness at the time.
Preexisting Conditions: In remission for stage 2A Cholangiocarcinoma. Remission started in Aug 2020.
Allergies: None
Diagnostic Lab Data: tHCT 38.2 % 36 54 Reference Range 36 - 54 % View Details Comments: Critical results Results read back and confirmed. tHGB 12.5 g/dL 12 16 Reference Range 12 - 16 g/dL View Details Comments: Critical results Results read back and confirmed. View Details Comments: Critical results Results read back and confirmed. Analysis Type Blood Gas View Details Comments: Critical results Results read back and confirmed. Sample Site Not Specified View Details Comments: Critical results Results read back and confirmed. Fetal Hemoglobin 46 % 15 25 Reference Range 15 - 25 % View Details Comments: Critical results Results read back and confirmed. HhB 10 View Details Comments: Critical results Results read back and confirmed. BE 2.1 mmol/L View Details Comments: Critical results Results read back and confirmed. Mode Nasal Cannnula View Details Comments: Critical results Results read back and confirmed. %Sat 90 % 90 100 Reference Range 90 - 100 % View Details Comments: Value above reference range Critical results Results read back and confirmed. Sample Type Venous View Details Comments: Critical results Results read back and confirmed. Allen Test Not Applicable View Details Comments: Critical results Results read back and confirmed. Oxyhemoglobin 87.1 % 90 100 Reference Range 90 - 100 % View Details Comments: Value above reference range Critical results Results read back and confirmed. Methemoglobin 0.7 % 0 3 Reference Range 0 - 3 % View Details Comments: Critical results Results read back and confirmed. Carboxyhemoglobin 2 % 0 5 Reference Range 0 - 5 % View Details Comments: Critical results Results read back and confirmed. pO2 61.4 mmHg View Details Comments: Value above reference range Critical results Results read back and confirmed pH 7.416 View Details Comments: Critical results Results read back and confirmed. pCO2 42 mmHg View Details Comments: Critical results Results read back and confirmed. HCO3 26.9 mmol/L View Details Comments: Critical results Results read back and confirmed. Lactic Acid Lvl 1.5 mmol/L 0.5 2.2 Reference Range 0.5 - 2.2 mmol/L GFR (CKD-EPI) 96 mL/min/1.73 m2 View Details Comments: GFR calculated based on CKD-EPI Creatinine Equation (2009). Age(years) Average GFR 20-29 116 mL/min/1.73 m^2 30-39 107 mL/min/1.73 m^2 40-49 99 mL/min/1.73 m^2 50-59 93 mL/min/1.73 m^2 60-69 85 mL/min/1.73 m^2 70+ 75 mL/min/1.73 m^2 Acceptable GFR =$g60 mL/min/1.73 m^2 Chronic Kidney Disease <60 mL/min/1.73 m^2 Kidney Failure <15 mL/min/1.73 m^2 Immature Granulocytes Abs 0.01 x10''3/microL 0 0.86 Reference Range 0 - 0.86 x10''3/microL Immature Granulocytes % 0.2 % 0 8 Reference Range 0 - 8 % Procalcitonin 0.16 ng/mL 0 0.5 Reference Range 0 - 0.5 ng/mL View Details Comments: Interpretive Reference Ranges: Systemic bacterial infection/sepsis: <0.5 ng/mL: Low risk for severe sepsis $g=0.5 and <2.0 ng/mL: Moderate risk for severe sepsis. Monitor patient both clinically and by reassessing PCT within 6-24 hours. $g=2.0 and <10.0 ng/mL: High risk for severe sepsis. $g=10.0 ng/mL: High likelihood of severe sepsis. Lower Respiratory Tract Infections: <0.1 ng/mL: Absence of bacterial infection. Use of antibiotics strongly discouraged. $g=0.1 and <0.25 ng/mL: Bacterial infection unlikely. The use of antibiotics is discouraged. $g=0.25 and <0.5 ng/mL: Bacterial infection is possible. Recommended to initiate antimicrobial therapy. $g=0.5 ng/mL: Suggests the presence of bacterial infection. Antibiotic treatment strongly recommended. Est CrCl (CG) 134.6 mL/min View Details Comments: Estimated Creatinine Clearance calculated based on Cockcroft-Gault formula using: Height 170 Weight 148.3 Estimated Creatinine Clearance Cockcroft Gault is utilized by the Pharmacy to assist in determining medication dosage based on kidney function. Multiple factors determine normal ranges, please contact the Pharmacy with questions. Globulin 2 Basophil Absolute 0.01 x10''3/microL 0 0.05 Reference Range 0 - 0.05 x10''3/microL Eos Absolute 0.11 x10''3/microL 0 0.45 Reference Range 0 - 0.45 x10''3/microL Mono Absolute 0.49 x10''3/microL 0 1 Reference Range 0 - 1 x10''3/microL Lymph Absolute 0.52 x10''3/microL 1 3 Reference Range 1 - 3 x10''3/microL Neutro Absolute 5.31 x10''3/microL 0.9 4.5 Reference Range 0.9 - 4.5 x10''3/microL Glucose 122 mg/dL 70 100 Reference Range 70 - 100 mg/dL Abs NRBCs 0 x10''3/microL 0 0.01 Reference Range 0 - 0.01 x10''3/microL HCG,Serum,Qual Negative Reference Range Negative View Details Comments: Certain conditions such as thromboplastic disease, certain neoplasms, heterophile antibodies, and weight loss supplements may cause false positive results. If a qualitative interpretation is inconsistent with the clinical evidence, results should be confirmed by an alternative method such as serum B-HCG. Troponin T 0.01 ng/mL 0 0.03 Reference Range 0 - 0.03 ng/mL View Details Comments: Normal: <0.03 ng/mL. Critical Value: 0.10 ng/mL and above. NRBC 0 % 0 0.2 Reference Range 0 - 0.2 % pro-BNP 138 pg/mL 0 900 Reference Range 0 - 900 pg/mL Albumin/Globulin Ratio 2 g/dL WBC 6.45 x10''3/microL 4.8 10.8 Reference Range 4.8 - 10.8 x10''3/microL Total Protein 6.4 g/dL 6.4 8.2 Reference Range 6.4 - 8.2 g/dL Sodium 137 mmol/L 133 143 Reference Range 133 - 143 mmol/L RDW 13.8 % 11 14.5 Reference Range 11 - 14.5 % RBC 3.82 x10''6/microL 4.2 5.4 Reference Range 4.2 - 5.4 x10''6/microL PTT 27 second 23 36 Reference Range 23 - 36 second View Details Comments: Therapeutic Range: 71 - 110 seconds PT 13.5 second 11.9 14.9 Reference Range 11.9 - 14.9 second Potassium 4.4 mmol/L 3.6 5.2 Reference Range 3.6 - 5.2 mmol/L Platelet 169 x10''3/microL 150 400 Reference Range 150 - 400 x10''3/microL Neutrophils 82.2 % 36 66 Reference Range 36 - 66 % MPV 9.6 fL 8 13 Reference Range 8 - 13 fL Monocytes % 7.6 % 0 12 Reference Range 0 - 12 % MCV 97.6 fL 80 98 Reference Range 80 - 98 fL MCHC 32.4 g/dL 32 36 Reference Range 32 - 36 g/dL MCH 31.7 pg 27 31 Reference Range 27 - 31 pg Lymphs 8.1 % 24 44 Reference Range 24 - 44 % INR 1.01 ratio 0.87 1.14 Reference Range 0.87 - 1.14 ratio View Details Comments: Therapeutic Range: 1.5 - 3.5 Hgb 12.1 g/dL 12 16 Reference Range 12 - 16 g/dL Hct 37.3 % 36 48 Reference Range 36 - 48 % Eosinophil % 1.7 % 0 4 Reference Range 0 - 4 % Creatinine 0.7 mg/dL 0.6 1.3 Reference Range 0.6 - 1.3 mg/dL CO2 24 mmol/L 21 32 Reference Range 21 - 32 mmol/L Chloride 102 mmol/L 98 112 Reference Range 98 - 112 mmol/L Calcium 9.8 mg/dL 8.8 10.5 Reference Range 8.8 - 10.5 mg/dL BUN 14 mg/dL 7 18 Reference Range 7 - 18 mg/dL Bili Total 0.4 mg/dL 0 1 Reference Range 0 - 1 mg/dL Basophil % 0.2 % 0 2 Reference Range 0 - 2 % AST 40 Units/L 7 37 Reference Range 7 - 37 Units/L ALT(SGPT) 61 Units/L 20 65 Reference Range 20 - 65 Units/L Alk Phos 115 Units/L 30 136 Reference Range 30 - 136 Units/L Albumin Level 4 g/dL 3.1 4.7 Reference Range 3.1 - 4.7 g/dL AGAP 11 5 15 Reference Range 5 - 15 Pregnant? Unknown Congregate Care Resident? No ICU Patient? No Hospitalized? No Date of Onset COVID19 Symptoms 11/29/2021 Symptomatic for COVID19? Yes Employed in Healthcare? Unknown First COVID19 Test? No Coronavirus, COVID-19 PCR Test Negative View Details Comments: The GenMark SARS-CoV-2 test is only for the detection of SARS-CoV-2 RNA under the Food and Drug Administration''s Emergency Use Authorization. Positive results are indicative of active infection with SARS-CoV-2; clinical correlation with patient history and other diagnostic information is necessary to determine patient infection status. Positive results do not rule out bacterial infection or co-infection with other viruses. Negative results do not preclude SARS-CoV-2 infection and should not be used as the sole basis for treatment or other patient management decisions. Negative results must be combined with clinical observations, patient history, and epidemiological information. RSV B PCR Not Detected Reference Range Not Detected RSV A PCR Not Detected Reference Range Not Detected Coronavirus PCR (not COVID-19) Not Detected Reference Range Not Detected Mycoplasma pneumoniae PCR Not Detected Reference Range Not Detected Chlamydia pneumoniae PCR Not Detected Reference Range Not Detected Parainfluenza 4 PCR Not Detected Reference Range Not Detected Parainfluenza 3 PCR Not Detected Reference Range Not Detected Parainfluenza 2 PCR Not Detected Reference Range Not Detected Parainfluenza 1 PCR Not Detected Reference Range Not Detected Influenza A H3 PCR Not Detected Reference Range Not Detected Influenza A H1 PCR Not Detected Reference Range Not Detected Influenza A H1 2009 PCR Not Detected Reference Range Not Detected Rhino_Enterovirus PCR Detected Reference Range Not Detected Metapneumo PCR Not Detected Reference Range Not Detected Adenovirus PCR Not Detected Reference Range Not Detected Influenza B PCR Not Detected Reference Range Not Detected Influenza A PCR Not Detected Reference Range Not Detected Encounter(s) Date(s): 11/29/21 - 11/30/21 Encounter Diagnosis Dyspnea (Discharge Diagnosis) - 11/29/21 Acute bronchitis (Discharge Diagnosis) - 11/29/21 Enteroviral infection (Discharge Diagnosis) - 11/29/21 Acute hypoxemic respiratory failure (Discharge Diagnosis) - 11/29/21 Acute respiratory failure with hypoxia (Final) - Acute bronchitis, unspecified (Final) - Enterovirus infection, unspecified (Final) - Abnormal weight gain (Final) - Other chest pain (Final) - Unspecified asthma, uncomplicated (Final) - Heart failure, unspecified (Final) - Hypertensive heart disease with heart failure (Final) - Autoimmune thyroiditis (Final) - Personal history of antineoplastic chemotherapy (Final) - Contact with and (suspected) exposure to COVID-19 (Final) - Personal history of malignant neoplasm of other digestive organs (Final) - Discharge Disposition: Home - 01
CDC Split Type:

Write-up: I had been having breathing troubles since mid March, but since I am being evaulated every three months for recurrence of cancer, did not think too much about it. The shortness of breath has gradually gotten worse with even mild exertion . On November 25, I began to feel the symptoms of a common cold; sore and scratchy throat, fever, headache, sweats, labored breathing (worse than usual). By Nov 28, I felt like I might have had breakthrough COVID, so I submitted a PCR at pharmacy. That night, symptoms worsened, so I went to Urgent Care. A chest X-Ray and swab for pneumonia were taken, and both were negative. I was sent home with no medications and told to return if worse. On Nov. 29, I felt considerable worse, to the point that I called 911 for fear I would pass out driving. I could not catch my breath and my oxygen sats on my home oximeter were in the mid 80''s. An EKG was obtained and I heard the paramedi state it was suspicious. I was taken to the hospital, and had a CT, bloodwork, breathing treatment and oxygen administered. I was sent home with Steroids, and a diagnosis of rhino enterovirus. The discharge summary states that I was in acute respiratory distress.


VAERS ID: 1923250 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-12
Onset:2021-11-25
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

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

Write-up: Itchy red hives that come and go all over body (especially hands and arms).


VAERS ID: 1923412 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Headache, Herpes zoster, Malaise, Musculoskeletal stiffness, Oropharyngeal pain, Pain of skin, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Anastrozole, Atenolol, Atorvastatin, Buspirone, Cabergoline, HCG, Lisinopril, Melatonin, Omeprazole, Ropinirole, Tadalafil, Tesosterone
Current Illness: None
Preexisting Conditions: High blood pressure, high cholesterol, low testosterone, restless leg, anxiety
Allergies: None
Diagnostic Lab Data: Strep throat and COVID-19 tests. Both negative.
CDC Split Type:

Write-up: Got shot at 3 pm on 11/24/2021. Had sore throat, stiff neck, headache and sore areas of scalp by 8 am next morning. Travelled for work on 11/29/2021 and saw Urgent Care in another city. Prescriped Lidocane for the sore throat. Returned home on 12/1 still not feeling well. Developed clear sores on scalp on 12/2. Developed shooting headaches and diarrhea on morning of 12/4. Diagnosed with Shingles at 4:00 pm on 12/4.


VAERS ID: 1923546 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-23
Onset:2021-11-25
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arrhythmia, Cardiac monitoring, Chest pain, Electrocardiogram abnormal, Palpitations, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (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: Claritin, TUMS, Refresh
Current Illness:
Preexisting Conditions: GERD, dry eyes
Allergies:
Diagnostic Lab Data: ECG on 11/26 showed arrhythmia, so did heart monitor worn 11/27-12/1.
CDC Split Type:

Write-up: Syncope, Chest pain and palpitations on subsequent days. Currently undergoing tests.


VAERS ID: 1923583 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-21
Onset:2021-11-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blister, Extra dose administered, Herpes zoster, Pruritus, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Medication errors (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B Complex Vitamin C Omega 3 Magnesium Melatonin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On 4th day after the booster shot, a small bump appears on the arm inner elbow. on the next morning five more rash appeared. Small clustered rashes appeared on the wrist with blisters came with extreme itch. Symptoms appears similar of the Shingles, on 6th day (on 11/30), I went to see doctor and the doctor prescribed me the medication for Singles


VAERS ID: 1923625 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-23
Onset:2021-11-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Hypoaesthesia, Movement disorder
SMQs:, Peripheral neuropathy (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Opportunistic infections (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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE, ROSUVASTATIN, DOXAZOSIN
Current Illness: NONE
Preexisting Conditions: LYMPHOMA
Allergies: NONE
Diagnostic Lab Data: Shingles virus attacked the nerve system on right leg.
CDC Split Type:

Write-up: I strongly believe the C-19 booster shot triggered the shingles virus attacked my right leg because I had two shingles vaccine shots three year ago. I lose feeling on my right leg and cannot maneuver my right foot.


VAERS ID: 1923682 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-23
Onset:2021-11-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Centrum Silver, Meloxicam, Calcium Citrate/D3 combo pill
Current Illness: Prostate Cancer found this past summer
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache that comes and goes almost daily...I''m not one who typically has headaches (for years)


VAERS ID: 1925313 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-24
Onset:2021-11-25
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Exposure to SARS-CoV-2
SMQs:, Anaphylactic reaction (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Lisinopril 20 MG Tablet 1 tablet Orally Once a day ?Atenolol 50 MG Tablet 1 tablet Orally Once a day
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: Sulfa Antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: lasting non-productive cough-has not changed since symptoms started in the evening of 11/25/21, exposure-wife positive for covid,


VAERS ID: 1925619 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-11
Onset:2021-11-25
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaemia, Blood test, Fatigue, Influenza virus test negative, Malaise, Pyrexia, SARS-CoV-2 test negative, Viral infection, White blood cell count decreased
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin; clonazepam
Current Illness: None
Preexisting Conditions: None
Allergies: Honey bees
Diagnostic Lab Data: COVID-19 test - negative; Influenza test - negative; Blood work - depressed WBC, anemia
CDC Split Type: vsafe

Write-up: I was feeling very tired and unusually exhausted, fatigued, etc. 11/25 & 11/26 I was feeling feverish around 99 degrees. Normal was 97 for me. I was feeling unwell like that for a few days. So I went to the doctor one week later. I got tested for COVID and the flu and they both came back negative. But there was a viral infection because of my depressed white blood cell count. I also had anemia which I''ve never had before. I''m supposed to take a multivitamin every day and then follow up to see if that improves.


VAERS ID: 1927761 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-16
Onset:2021-11-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Contusion, Rash erythematous, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: red hive like rash that has begun to spread,The rash is most severe on the knees and behind the knees,; accompanied by swelling; are bruise like lesions on the back of her knee; This spontaneous case was reported by a consumer and describes the occurrence of RASH ERYTHEMATOUS (red hive like rash that has begun to spread,The rash is most severe on the knees and behind the knees,), SWELLING (accompanied by swelling) and CONTUSION (are bruise like lesions on the back of her knee) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 16-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 50 microgram. On 25-Nov-2021, the patient experienced RASH ERYTHEMATOUS (red hive like rash that has begun to spread,The rash is most severe on the knees and behind the knees,), SWELLING (accompanied by swelling) and CONTUSION (are bruise like lesions on the back of her knee). At the time of the report, RASH ERYTHEMATOUS (red hive like rash that has begun to spread,The rash is most severe on the knees and behind the knees,), SWELLING (accompanied by swelling) and CONTUSION (are bruise like lesions on the back of her knee) outcome was unknown. No concomitant and treatment drugs were reported. It was reported that his wife received her Moderna booster dose (50mcg) on Tuesday 16-Nov-2021. On 25-Nov-2021, she began to develop a red hive like rash that had begun to spread rapidly across the body and was accompanied by swelling. Reporter met with an allergist and they did not attribute the rashes to the vaccine so he thought this could be dropped. This case was linked to MOD-2021-399702 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 02-Dec-2021: Follow up received contains significant information updated in inarrative supplement


VAERS ID: 1927872 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-01-22
Onset:2021-11-25
   Days after vaccination:307
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dry eye, Eye pain
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Corneal disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PREDNISONE; VIGAMOX; METOPROLOL; ATORVASTATIN; AMLODIPINE; OMEPRAZOLE
Current Illness: Blind right eye; Uveitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: dryness in both eyes; pain in right eye; This spontaneous case was reported by a consumer and describes the occurrence of DRY EYE (dryness in both eyes) and EYE PAIN (pain in right eye) in a 73-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 018F21A, 032L20A and 026L20A) for COVID-19 vaccination. Concurrent medical conditions included Uveitis and Blind right eye. Concomitant products included PREDNISONE, MOXIFLOXACIN HYDROCHLORIDE (VIGAMOX), METOPROLOL, ATORVASTATIN, AMLODIPINE and OMEPRAZOLE for an unknown indication. On 22-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 25-Nov-2021, the patient experienced DRY EYE (dryness in both eyes) and EYE PAIN (pain in right eye). The patient was treated with PREDNISOLONE ongoing since an unknown date at an unspecified dose and frequency and CARMELLOSE SODIUM (REFRESH [CARMELLOSE SODIUM]) ongoing since an unknown date for Adverse event, at an unspecified dose and frequency. At the time of the report, DRY EYE (dryness in both eyes) had not resolved and EYE PAIN (pain in right eye) was resolving. Pain in the right eye had reduced down to around 30%.


VAERS ID: 1927885 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New York  
Vaccinated:2020-12-29
Onset:2021-11-25
   Days after vaccination:331
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bedridden, Loss of personal independence in daily activities, Photosensitivity reaction, Pruritus, Rash, Rash macular, Scratch, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Dementia (broad), Accidents and injuries (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: scratching while talking; No longer sit in the sun; Can''t swim; when patient scratches skin breaks and red blotchy skin shows; A 3 days rash/severe rash lasted only 3 days/patient scratches skin breaks; states being all thanksgiving day in bed; itching worst than ever had before, constantly itching; woke up in the middle of the night; This spontaneous case was reported by a patient and describes the occurrence of SCRATCH (scratching while talking), PRURITUS (itching worst than ever had before, constantly itching), SLEEP DISORDER (woke up in the middle of the night), PHOTOSENSITIVITY REACTION (No longer sit in the sun) and LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (Can''t swim) in a 75-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 045J21A, 039K20A and 029K20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 29-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Jan-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 24-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 25-Nov-2021, the patient experienced PRURITUS (itching worst than ever had before, constantly itching), SLEEP DISORDER (woke up in the middle of the night), BEDRIDDEN (states being all thanksgiving day in bed) and RASH (A 3 days rash/severe rash lasted only 3 days/patient scratches skin breaks). On an unknown date, the patient experienced SCRATCH (scratching while talking), PHOTOSENSITIVITY REACTION (No longer sit in the sun), LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (Can''t swim) and RASH MACULAR (when patient scratches skin breaks and red blotchy skin shows). On 27-Nov-2021, RASH (A 3 days rash/severe rash lasted only 3 days/patient scratches skin breaks) had resolved. At the time of the report, SCRATCH (scratching while talking) and PRURITUS (itching worst than ever had before, constantly itching) had not resolved and SLEEP DISORDER (woke up in the middle of the night), PHOTOSENSITIVITY REACTION (No longer sit in the sun), LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (Can''t swim), BEDRIDDEN (states being all thanksgiving day in bed) and RASH MACULAR (when patient scratches skin breaks and red blotchy skin shows) outcome was unknown. No concomitant medication were reported. Patient mentioned taking some antihistamines to calm the symptoms Patient stated having similar reaction after the second dose but with the booster dose was a thousand times worst Patient stated that, after the booster dose, the very next day woke up in the middle of the night with an itching worst than ever had before, rash. Patient mentioned nothing calmed down the itching not even cold patches. Patient stated being in bed all thanksgiving day. . severe rash lasted only 3 days. But it was constantly itching and when patient scratched skin broke and red blotchy skin showed. Patient stated of getting biopsy on Monday. Dermatologist recommended the patient to stay out the sun, patient was in and can''t swim or no longer sit in the sun, Patient mentioned of having scratching even while talking to the call center. This case was linked to MOD-2021-404304 (Patient Link).


VAERS ID: 1928078 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-25
Onset:2021-11-25
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: METOPROLOL SUCCINATE; ENALAPRIL; HYDROCHLOROTHIAZIDE; REPATHA; RITUXAN
Current Illness: Autoimmune disorder; Cholesterol (Diagnosed with before 2007); Coronary artery disease (Caller has 10 coronary artery stems); Hypertension; Interstitial lung disease (Diagnosed with after coronary artery disease, clarifies was diagnosed with after 2007 or after 2008.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: CT Scan; Result Unstructured Data: Test Result:nothing in the lung; Comments: there was nothing in the lung and the caller''s eart was not affected; Test Date: 2021; Test Name: CT Scan; Result Unstructured Data: Test Result:heart was not effected; Test Date: 20211125; Test Name: COVID; Test Result: Positive
CDC Split Type: USPFIZER INC202101699473

Write-up: Booster dose: Came down with and was diagnosed with Covid, 25Nov2021; Booster dose: Came down with and was diagnosed with Covid, 25Nov2021; This is a spontaneous report received from contactable reporter (Consumer or other non HCP) from product quality group. The reporter is the patient. A 73-year-old female patient received bnt162b2 (BNT162B2), administration date 05Feb2021 (morning or afternoon) (Batch/Lot number: unknown) as dose 1, single, administration date 07Mar2021 (toward dinner time, hard to get appointment originally) (Batch/Lot number: unknown) as dose 2, single and administered in arm left, administration date 25Oct2021 (morning) (Lot number: FF2593) as dose 3 (booster), single for covid-19 immunization. Relevant medical history included: "Cholesterol" (ongoing), notes: Diagnosed with before 2007; "Hypertension", start date: 2007 (ongoing); "Coronary artery disease", start date: 2007 (ongoing), notes: Caller has 10 coronary artery stems; "Interstitial lung disease" (ongoing), notes: Diagnosed with after coronary artery disease, clarifies was diagnosed with after 2007 or after 2008.; "Autoimmune disease", start date: May2021 (ongoing). Concomitant medication(s) included: METOPROLOL SUCCINATE taken for hypertension (ongoing); ENALAPRIL taken for hypertension (ongoing); HYDROCHLOROTHIAZIDE (ongoing); REPATHA taken for blood cholesterol (ongoing); RITUXAN taken for autoimmune disorder, start date: May2021 (ongoing). The following information was reported: DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant) all with onset 25Nov2021, outcome "unknown" and all described as "Booster dose: Came down with and was diagnosed with Covid, 25Nov2021". The event "booster dose: came down with and was diagnosed with covid, 25nov2021" was evaluated at the emergency room visit. The patient underwent the following laboratory tests and procedures: computerised tomogram: (2021) nothing in the lung, notes: there was nothing in the lung and the caller''s heart was not affected; (2021) heart was not effected; sars-cov-2 test: (25Nov2021) positive. Additional information: First dose: EL3302 or EZ3302, caller is not sure if second digit is an L or a Z: Route administration: one of arms, not sure if left or right arm, second dose: EZ9264 or EL9264, caller is not sure if second digit is an L or a Z: Route administration: opposite arm from first dose, caller unsure which arm received first dose. Metoprolol succinate: Began taking standard Metoprolol before Metoprolol succinate and began Metoprolol Succinate within the last two years. Enalapril: Medicines have changed since 2000 and caller can''t say when she began taking Enalapril. Hydrochlorothiazide: Indication: Water pill. Rituxan: The caller received two Rituxan treatments in the end of MAY2021, beginning of JUN2021 for autoimmune disease. A week after receiving booster dose vaccine, wasn''t feeling well but wasn''t sick. The caller was okay after the booster dose. The caller did not realize she was sick until the Wednesday before. At first the caller thought it was a cold but realized when cooking was happening in caller''s house that she could not smell. The caller was running a low grade fever, lots of aches and pains and developed a flu type of thing. A culture was performed in the emergency room by a nurse and the culture was positive. The caller has not been around anybody who tested positive for Covid. The patient took Tylenol, 500mg. The caller usually takes Tylenol on a regular basis and the caller reports takin Tylenol before receiving Pfizer Covid Vaccines and after receiving the Pfizer Covid Vaccines. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 1928690 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-11-22
Onset:2021-11-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Cough, Dyspnoea exertional, Headache, Heart rate increased, Pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Acid Reflux
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I''ve not sought medical attention for this, for fear that the cure could be even more adverse than the vaccine. I am not a medical expert but because my fiance has asthma, I have a pretty good understanding of what asthma is or does to the body. I at this point suspect I will never again be able to run like I once had due to this damedable vaccine that the government forced on it''s citizens. I WAS FINE BEFORE, AND NOW I MAY NEVER RETURN TO NORMAL.
CDC Split Type:

Write-up: Aside from the initial headache/achiness that I was told initially would accompany the vaccination, what has evolved since is much more concerning/grievous. Three (3) days after receiving the Janssen Johnson & Johnson Vaccine, I tried to participate in a community 5k. Being I have competed in multiple marathons, a 5K is a relatively simple task. At 1 mile I had to quit/withdraw because I was having something akin to an asthma attack and an extremely accelerated heart rate. I returned to my vehicle where I waited for my heart to return to a normal rate, but then began what can only be described as a coughing fit that lasted for close to 30 mins. Through that day and into the next, any physical exertion resulted in shortness of breath and accelerated heart rate. Example; walking up a flight of stairs. Or bending over to pick something up. Four (4) days after getting vaccinated I was walking down a ramp at a sporting event stadium, and again had something like an asthma attack, accompanied this time with significant chest pain under the right pectoral. To date, 15 days later I cannot exert any physical effort, even something as simple as carrying in a small bag of groceries into my home without my heart accelerating and running out of breath, the way I would be formerly when sprinting to the finish of a long training run.


VAERS ID: 1929148 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-22
Onset:2021-11-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cycle threshold 28.7 on 11/27/21
CDC Split Type:

Write-up: Hospitalization due to COVID-19 Reported per Moderna COVID-19 Vaccine


VAERS ID: 1929187 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-29
Onset:2021-11-25
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Apnoea, COVID-19, COVID-19 pneumonia, Intensive care, Positive airway pressure therapy, SARS-CoV-2 test positive, Sleep apnoea syndrome
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), 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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler ascorbic acid (VITAMIN C) 1000 MG tablet benzonatate (TESSALON) 100 MG capsule dexamethasone (DECADRON) 2 MG tablet
Current Illness:
Preexisting Conditions: Obstructive apnea Morbid obesity with body mass index (BMI) of 60.0 to 69.9 in adult (HCC) Controlled type 2 diabetes mellitus without complication, without long-term current use of insulin (HCC)
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 11/25/2021; COVID-19 positive 11/25/2021; fully vaccinated BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider: FNP Admission Date: 11/25/2021 Discharge Date: Nov 29, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxia (HCC) [J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] HOSPITAL COURSE: Very pleasant 20 y/o WM single community dwelling patient was admitted on 11/25 for acute respiratory failure with hypoxia secondary to bilateral COVID 19 pneumonia. He had the J&J vaccine in April 2021. He received supplemental oxygen and was compliant with prone positioning when instructed. When supine he had signfiicant apnea and needed CPAP for adequate oxygenation. His BMI is 63. He received Remdesivir and Decadron, as well as MDI''s and supportive medications. He was monitored in CCU until 11/28 due to his large size and potential for decompensation. Fortunately, he continued to improve daily. On 11/29, he required RA oxygen. A home oxygen evaluation confirmed the same. He was deemed medically stable for discharge. He needs a sleep study for his OSA. He needs a follow up CMP to re-evaluate the AST, ALT s/p Remdesivir. He should follow up with his PCP in a week after admission. He may return to work in 1 week as well.


VAERS ID: 1929207 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-16
Onset:2021-11-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site rash, Injection site reaction, Pain, Rash pruritic, Tenderness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth Control: Tri-Sprintec
Current Illness: Had a respiratory/sinus infection 3 weeks prior to the first dose. Was tested for COVID-19, test yielded a negative result.
Preexisting Conditions: None known.
Allergies: No known allergies.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Typical sore arm post-injection at the site for a day or two, all symptoms resolved. Approximately 8 days later a large red rash appeared in a large circular pattern below the injection site, in an egg shaped distribution. The rash was itchy, sore, and sensitive to touch. The rash resolved without treatment after approximately 5 days.


VAERS ID: 1929503 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anal incontinence, Delirium, Dysstasia, Gait disturbance, Speech disorder, Urinary incontinence, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trulicity, glimeride, budesonide, levothyroxine, dicyclomine, bupropion, potassium cl, Influenza Flu (seasonal) Afluria Quadrivalent
Current Illness: CHF, DIABETES, ATRIAL FIBRILLATION AS
Preexisting Conditions: AS ABOVE
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Delirium, mumbled speech,inability to stand or walk inability to eat,vomiting, loss of bowel and bladder control


VAERS ID: 1929579 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-22
Onset:2021-11-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Burning sensation, Diarrhoea, Dry skin, Frequent bowel movements, Hypersensitivity, Pain, Peripheral swelling, Pruritus, Rash, Skin tightness, Urticaria, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Women''s multivitamin, Fish Oil, Triflex, Calcium supplement, Vitamin D supplement, Hair Nails & Skin supplement.
Current Illness: I had a cold a month prior to the vaccination date.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I got the allergic reaction again on 12/04/2021 and I didn?t know what I ate that night so I took Zirtec again. It cleared up a little the next morning but as soon as I ate a boiled egg for breakfast, the rashes came back again all over my body from head to toes. It gave me an itching, aching, dryness, and burning sensation and also I felt tight between my breasts and felt floating on my stomach (feel like stomachache). I had to go to the restroom 4-5 times after each meal, the body acted like I had a diarrhea so I had to rush to immediate care that night on exit 14 of N400 to see the doctor on 12/05/2021. There, they gave me a Benadryl shot and Steroid shot because of my severe allergic reaction, it cleared body and my neck up with the shots. He also prescribed me Steroid pills to take. On 12/06/2021, my allergic reaction acted up again. I came to see a Nurse Practitioner at my Family doctor?s office to clarify the medication that was prescribed from the P.A.at immediate care and see what they could help me with the rashes because I was in a worse situation at that time. The rashes/hives were on all over my face, my neck, my body, legs, arms, you name it (it was all over my body). The Nurse Practitioner wanted to give me another Steroid shot but it was too soon because I just got 1 the previous night so she told me to take 1-20mg Pepcid AC 30 minutes before breakfast or dinner and take the steroid pills directed by the P.A. and 10mg Zirtec twice a day for 8 days. As soon as I took a Pepcid AC on the night of 12/06, I throw up the whole thing. Up til now (12/07/2021), the rashes/hives on my body, my face and my neck had cleared up but my legs and my arms. My hands feel swollen, itching, burning and tightness from the hives. I feel the same thing on the sides and the bottom of my feet.
CDC Split Type:

Write-up: I didn?t have any allergic reaction on the first 2 doses of Covid vaccines but the 3rd dose. I got the first allergic reaction on 11/25/2021. I had rashes/hives on my stomach area, my legs, my arms, and some on my butt. I took Benadryl for a day but it didn?t clear it up so I called pharmacy where I got the 3rd Covid vaccine, they told me to take Zirtec. I took Zirtec and it cleared the rashes off after 2-3 days.


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