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

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



Case Details (Reverse Sorted by Onset Date)

This is page 454 out of 8,010

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VAERS ID: 1625961 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Connecticut  
Vaccinated:0000-00-00
Onset:2021-08-20
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
SMQs:, Medication errors (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: USJNJFOC20210843178

Write-up: VIAL PUNCTURED ON 19-AUG-2021 AT 4:35 PM AND ADMINISTERED ON 20-AUG-2021 AT 2:30 PM; This spontaneous report received from a pharmacist concerned a 33 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: 21-SEP-2021) dose was not reported, administered on 20-AUG-2021 14:30 for prophylactic vaccination. No concomitant medications were reported. On 20-AUG-2021, the patient experienced vial punctured on 19-aug-2021 at 4:35 pm and administered on 20-aug-2021 at 2:30 pm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vial punctured on 19-aug-2021 at 4:35 pm and administered on 20-aug-2021 at 2:30 pm was not reported. This report was non-serious.


VAERS ID: 1625964 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-20
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210843291

Write-up: VACCINE WAS ADMINISTERED OUTSIDE OF 2 HR ROOM TEMPERATURE WINDOW; VACCINE WAS ADMINISTERED OUTSIDE OF 2 HR; This spontaneous report received from a physician concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown) dose was not reported, administered on 20-AUG-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 20-AUG-2021, the patient experienced vaccine was administered outside of 2 hr room temperature window. On 20-AUG-2021, the patient experienced vaccine was administered outside of 2 hr. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccine was administered outside of 2 hr room temperature window and vaccine was administered outside of 2 hr was not reported. This report was non-serious.


VAERS ID: 1625972 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-08-20
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210844071

Write-up: JOINT PAIN; FEVER; This spontaneous report received from a patient concerned a 39 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: UNKNOWN) dose was not reported, administered on 20-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 20-AUG-2021, the patient experienced joint pain. On 20-AUG-2021, the patient experienced fever. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from fever, and joint pain. This report was non-serious.


VAERS ID: 1627721 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient fainted within 15 minutes after receiving a covid vaccine. Patient laid on the floor and a minute clinic provider was with the patient until the emt arrived. Patient did not want to go with the emt to the hospital. Minute clinic provider stayed with patient until EMT arrived and was okay with patient going home as long as she got a ride. Her dad came to pick her up. Patient had not eatten prior to vaccination.


VAERS ID: 1627724 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-18
Onset:2021-08-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F47485 / 1 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Eye swelling
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: N/a
Preexisting Conditions: N-a
Allergies: N-a
Diagnostic Lab Data: No medical test was done.
CDC Split Type:

Write-up: 8/20/21 10pm I experience my eye getting swollen. I put some allergic eye drops. Symptoms didn?t change but increase. 8/23/21 : I went to urgent care. They prescribed antibodies.


VAERS ID: 1627726 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: patient feels his shoulder is swollen but not at injection site....could be from is pacemaker


VAERS ID: 1627727 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-13
Onset:2021-08-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Computerised tomogram, Dyspnoea, Electrocardiogram normal, SARS-CoV-2 test negative, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Approximately one hour prior took the following vitamins: Multi, D''Mannose, Vitamin D, Probiotic
Current Illness: NA
Preexisting Conditions: Breast cancer diagnosed 2017. Treatment completed same year.
Allergies: Sulfa
Diagnostic Lab Data: COVID 19 test: Negative EKG: Normal Chest x-Ray: Normal CT Scan: Pending
CDC Split Type:

Write-up: 7 days following injection, developed shortness of breath and chest pain. Unable to sleep for 2 nights waking up to "catch my breath".


VAERS ID: 1627732 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dysphagia, Eye swelling, Fatigue, Flushing, Headache, Hyperhidrosis, Lethargy, Mouth swelling, Pain, Pruritus, Pyrexia, Rash, Swelling face, Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Chills-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fever-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium


VAERS ID: 1627734 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Extra dose administered, Fatigue, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: on Cuvitru (immunoglobulin) for CVID
Current Illness: Common variable immunodeficiency
Preexisting Conditions: Common variable immunodeficiency
Allergies: sulfa antibiotics
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Patient spiked fever a few hours after receiving the 3rd dose, along with joint pain, body ache and fatigue. Symptoms were severe and she went to ER 2 days later and received IV fluids and pain medications. Fever lasted for 3 days. Her symptoms gradually resolved on day 4.


VAERS ID: 1627744 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Lymph Node Swelling-Medium, Additional Details: patient is experient under arm lymph node swelling and painful. Patient is under to resume normal activities after 3 days. He will follow up with MD after one more day of taken advil or motrin.


VAERS ID: 1627756 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-10
Onset:2021-08-20
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Atelectasis, Blood creatinine, Blood urea, COVID-19, Chest X-ray abnormal, Chills, Fatigue, Headache, Liver function test normal, Lung infiltration, Malaise, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anxiety Congenital liver disease Depression Hyperlipidemia Liver transplant Seizure disorder Traumatic brain injury Primary sclerosing cholangitis Insomnia OSA Epilepsy
Allergies: The patient denies any known medication allergies.
Diagnostic Lab Data: Positive for SARS-CoV-2 RNA by PCR Abnormal E Gene Ct cycles 15.1 Comment: Cycle threshold (Ct) values are not comparable between tests and may not be comparable between different lots of the same test. Currently there is no consensus as to whether or not particular Ct values correlate with a person being or not being infectious or risk level for disease severity. So, appropriate care should be taken with interpretation of Ct values. N2 Gene Ct cycles 16.7 Comment: Cycle threshold (Ct) values are not comparable between tests and may not be comparable between different lots of the same test. Currently there is no consensus as to whether or not particular Ct values correlate with a person being or not being infectious or risk level for disease severity. So, appropriate care should be taken with interpretation of Ct values. Resulting Agency MGHL Specimen Collected: 08/20/21 10:30 Last Resulted: 08/20/21 11:31
CDC Split Type:

Write-up: is a pleasant 66 y.o. male. Patient presents today with fever, chills, body aches, mild headache, fatigue. He has had no nausea, vomiting, diarrhea, reduced appetite, and reduced food/fluid intake. On examination, patient appears nontoxic, but does appear mildly ill. No tachycardia, stable blood pressure, normal oxygenation on room air. Lung sounds are clear, respiratory rate and effort is normal. Presentation highly suggestive of viral syndrome, likely COVID during the ongoing COVID pandemic. Patient is vaccinated, but is on immunosuppressants for liver disease so additional workup performed as above. This was reassuring, with exception of moderate acute kidney injury with elevated BUN and creatinine. Electrolytes stable. Liver function tests at baseline. COVID test was positive. Chest x ray reveals some mild changes suggestive of mild infiltrate versus atelectasis. Patient does not have purulent pedum production. Ambulation trial here with stable oxygenation on room air, and clinically appears well enough to be treated expectantly at home. Given AKI and medical history though, I did offer hospital observation for insurance of adequate hydration as well as repeat check of patient''s metabolic profile. He would prefer to have this treated at home, and is willing to follow up with primary care physician for repeat laboratory testing. At home, he will drink plenty of fluids, use Tylenol as needed, may have small doses of Ibuprofen a few times per day, and must follow up closely with primary care physician. He is comfortable with this outpatient plan of care. Return precautions discussed, questions solicited and answered.


VAERS ID: 1627927 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-09
Onset:2021-08-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intermenstrual bleeding, Polymenorrhoea
SMQs:, Haemorrhage terms (excl laboratory terms) (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: irregular spotting and shortened menstrual cycle


VAERS ID: 1627942 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure decreased, Chest pain, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Blood pressure normally drops within 2 minutes after receiving any vaccine. This started around the age of 15.
Other Medications: Lexapro
Current Illness: None
Preexisting Conditions: None
Allergies: Gluten; dairy
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: His blood pressure dropped to 100/58 the first time I took it and 15 minutes later it went up to 108/58. He began to have really bad chest pain. He turned gray. All of this happened about 3 hours after he received the vaccine. I made him lay down and elevate his legs and I called the doctor''s office and they advised me someone would follow up. It took him 2 1/2 hours to recover. I was advised by the doctor''s office to monitor him and if he got worse to take him to the ER. He was back to normal after a few hours.


VAERS ID: 1627953 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-27
Onset:2021-08-20
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Oropharyngeal pain, Parosmia, Taste disorder
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: change in taste and smell, sore throat, cough


VAERS ID: 1627967 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Chills, Dizziness, Dyspnoea, Fatigue, Headache, Injection site discolouration, Injection site erythema, Injection site induration, Injection site pain, Myalgia, Neck pain, Pain in extremity, Taste disorder, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu vaccine - localized allergic reaction including: hives, redness and swelling to injection site, area warm to touch and painf
Other Medications: Wellbutrin XL 150mg Hydrochlorothiazide 25mg Protonix 40mg
Current Illness: none
Preexisting Conditions: Depression Peripheral edema GERD
Allergies: PCN, Amoxil, beef, pork, lamb, gelatin, latex, seafood, milk
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Dizziness, shortness of breath, metallic taste in mouth, shaking chills, severe neck pain, headache, extreme fatigue, muscle and joint pain. Ping-Pong size knot at injection site, purple/red and warm to touch, constant shocking pain to injection site and entire right arm.


VAERS ID: 1627977 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood test normal, Hyperhidrosis, Loss of consciousness, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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:
Other Medications: none
Current Illness: Hypertension
Preexisting Conditions: Hypertension
Allergies: Eggs, goat, lamb
Diagnostic Lab Data: BS 102 (2hours after a full breakfast)
CDC Split Type:

Write-up: My Blood sugar went down to a dangerous level. I was sweating and shaking I passed out one day after getting the vaccine. I had to drink lots of sweet juices then I felt better. (I do run low BS but never passed out or feel sick from it)


VAERS ID: 1627992 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: No known illnesses
Preexisting Conditions: No known chronic or long-standing health conditions
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Pfizer for the 1st, and 2nd doses. Her third immunocompromised dose was accidently given as Moderna. Patient waited her 15 minutes after vaccination with no issues reported, no signs, and no symptoms. Nothing reported after 24 hours of receiving the vaccine.


VAERS ID: 1628008 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Diarrhoea, Laboratory test
SMQs:, Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 50 mcg daily
Current Illness: No
Preexisting Conditions: Hashimotos
Allergies: No known allergies
Diagnostic Lab Data: ER- 8/24 tests pending
CDC Split Type:

Write-up: Diarrhea, lower back pain with no relief of pain with Tylenol and ibuprofen.


VAERS ID: 1628029 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-29
Onset:2021-08-20
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation irregular, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Started bleeding like it was my menstrual cycle around two weeks early as I had a period two days after I got the first shot and now am bleeding again. My periods have been normal up until this and this doesn''t seem like a normal period. I?m not bleeding a lot but it stops and then starts again.


VAERS ID: 1628033 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Erythema, Fatigue, Pain in extremity, Pyrexia, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nature''s Own Skin, Hair, and Nails vitamins; Multivitamin; Tylenol Arthritis; Immune Support
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: Codeine and Sulfa Drugs
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever, chills, extreme fatigue--Friday 8/20/21 Redness, hot to touch and swelling, soreness spreading across upper arm and toward elbow--8/21/21 Redness, hot to touch and swelling, soreness spreading across upper arm and toward elbow--8/22-23-24/21


VAERS ID: 1628040 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-08-20
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: sore throat


VAERS ID: 1628046 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Fatigue, Influenza like illness
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ELIQUIS 2X PLAVIX 1X
Current Illness: NONE
Preexisting Conditions: CAD/AFIB/SSS/SVS
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: FLU LIKE SYMPTOMS...EXTREME FATIGUE, CHILLS,SHORTNESS OF BREATH


VAERS ID: 1628060 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-18
Onset:2021-08-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Back pain, Blood test normal, Chest X-ray abnormal, Chest discomfort, Chills, Confusional state, Constipation, Cough, Diarrhoea, Headache, Hyperhidrosis, Injection site pain, Myalgia, Nasal dryness, Nausea, Pneumonia, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Sinusitis, Swelling, Viral test negative, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), 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: Zoloft; Abilify; Norvasc
Current Illness: Sinus infection after first dose
Preexisting Conditions: High blood pressure; anxiety; depression
Allergies: Amoxicillin; Phenergan
Diagnostic Lab Data: Chest x-ray pneumonia 8/23/2021. 15 panel viral panel negative 08/2021. Blood work normal 08/2021.
CDC Split Type: vsafe

Write-up: I got a sinus infection and was prescribed two antibiotics and two doses of steroids as well. They have been trying to figure out what is going on and yesterday, 8/23/2021, they finally figured out that I am on the verge of pneumonia. I had gone to on call three times and the DR two times and it has just been ongoing. The DR checked me for various viruses and they could not figure it out. My symptoms started with a headache and then of course the pain from the shot and the swelling, muscle aches and it varied through the month, what my symptoms were. There was chest tightness, cough, runny nose, congestion. My nose went from dry to runny, as I said it just varied from day to day. I also had vomiting and nausea. I also went from being constipated to having diarrhea. I had a fever and chills and was just like pouring sweat too. I want to say, confusion was there too, loss of memory a but if that makes sense. Also my lower back hurt really, really bad.


VAERS ID: 1628072 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Blister, Feeling hot, Headache, Herpes zoster, Hyperhidrosis, Musculoskeletal pain, Nausea, Rash, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Lisinopril Armour Thyroid Vit B-C complex
Current Illness: None
Preexisting Conditions: Graves - Thyroid disease
Allergies: None
Diagnostic Lab Data: None -
CDC Split Type:

Write-up: Approx 3:30 am Friday morning 8/20, day after injection, woke up with a headache, sweating profusely, continued through the day. Started getting nauseated, never vomited. Late Friday afternoon into Saturday, felt hot especially face and head but no fever. Still had headaches and slight nausea. Saturday night through the night, headache & nausea continued, entire body "hot" but still no fever. Then started developing pain between my shoulders, upper & lower back pain, lower back pain the worse. Sunday morning around 10am, low back pain worse and moved into right buttocks. By noon, right buttocks extremely painful and noticed rash with blisters. Shingles! I''ve had two episodes of shingles in my life, both times previously left buttocks, but none in at least two years. Called my doctor''s office yesterday morning, told them what had happened, and he called in a prescription for Valacyclovir HCL, 1 gram tablet, 3x a day for next 5 days. This was my 2nd vaccine. No problem with the first, 4/16/21. Waited, was not going to take a 2nd because my younger sister who is a cancer patient had a bad reaction, also reported. Still have a slight headache. Still have slight nausea. Shingles pain this morning is 7-8 out of 10.


VAERS ID: 1628078 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Hyperhidrosis, Restlessness, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Dizziness, severe headache, vomiting. restless, fainting 5-10 mins, and sweating constantly. Healthcare provider stated patient is having a reaction to vaccination and could las up to 4 days- 2 weeks.


VAERS ID: 1628091 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 - / IM

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

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

Write-up: Patient came for second shot, we realized after shot was given that patient was a few days early on his second dose. First dose given 7/29 second dose given 8/20. No physical adverse effects to date. Patient will be notified and procedures will be verified for possible changes to prevent duplicate occurence.


VAERS ID: 1628109 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-12
Onset:2021-08-20
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: FULLY VACCINATED, ADMITTED TO HOSPITAL 8/20/2021 POSITIVE COVID-19


VAERS ID: 1628117 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-25
Onset:2021-08-20
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 Sofia antigen test with a positive result.
CDC Split Type:

Write-up: Patient received the Moderna vaccine on 1/28/21 and 2/25/21, so was fully vaccinated when they tested positive for COVID-19 on 8/20/21.


VAERS ID: 1628126 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-08
Onset:2021-08-20
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 Sofia antigen test with a positive result.
CDC Split Type:

Write-up: Patient received the Pfizer COVID-19 vaccine on 3/18/21 and 4/8/21, so was fully vaccinated when they tested positive for COVID-19 on 8/20/21.


VAERS ID: 1628144 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-01
Onset:2021-08-20
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 PCR test with a positive result.
CDC Split Type:

Write-up: Patient received the Pfizer COVID-19 vaccine on 1/12/21 and 2/1/21, so was fully vaccinated when they tested positive on 8/20/21.


VAERS ID: 1628154 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-02-25
Onset:2021-08-20
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 AR / IM

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

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


VAERS ID: 1628164 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-18
Onset:2021-08-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeding disorder, Limb mass, Mobility decreased, Pain in extremity, Restless legs syndrome
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: cosentyx shots, glipizide, htz, losartan, metformin
Current Illness: no
Preexisting Conditions: arthritis, autoimmune disease
Allergies: codeine, bacterium
Diagnostic Lab Data:
CDC Split Type:

Write-up: not able to get out the bed she was having restless leg syndrome she couldn''t even walk, she had bad pain on the right side of her leg and notice a mass on the inner part of her leg which was painful. she went to urgent care. the pain has been getting worse.


VAERS ID: 1628176 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-06
Onset:2021-08-20
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Dizziness, Erythema, Gait disturbance, Loss of consciousness, Mobility decreased, Rash macular
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin on an occasional basis
Current Illness: Allergies
Preexisting Conditions: Kidney stones, border line asthma, high bp with pregnancy, foot edema that started with pregnancy
Allergies: peanuts, soy, coconut, black pepper, strawberries, tomatos, onion; possible anesthesia meds (they never know exactly which ones)
Diagnostic Lab Data:
CDC Split Type:

Write-up: On Friday (8/20/2021) morning, I noticed red blotch marks on my upper clavicle near my neck. Wasn''t burning or anything. Just there and very splotchy. Thought I''d keep an eye on it. On Saturday (8/21/2021) late afternoon, I came back from my ill mother''s house after doing some refrig clean out. As soon as I got home, I felt pain in my lower back immediately. Kind of pulsing throbbing pain... almost to the point that it could cut right through you. Thought maybe it was because of the work at my mom''s or the office work I do causing back problems. Decided to rest it as best I can. On Sunday (8/22/2021), I could barely get out of bed because of the pain in the morning. I rested most of the day. It was very difficult to get in and out of bed and walk around. Hurt very badly. I did try heat in the shower, an ice pack, and linement. On Monday (8/23/2021), still having trouble getting out of bed and walking around. I had to lift my legs up to get into the car which I never have to do. I had trouble at work and getting into the office building. I rested when I got home. Very difficult to get into and out of bed. Hurt badly. When I went to try to take a shower and get the warm heat on my back, I found I had more trouble getting out of bed. Nearly fell on the floor. I managed to struggle to get to the floor. I couldn''t straighten up. Then I got dizzy and blacked out. I fell back onto the bed. Was out for about an hour. I struggled to get back up. I managed to get into the shower and get my teeth brushed, but still was hurting badly. I notice new pain on the right hip area. Still hurting today.


VAERS ID: 1628180 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: 2nd dose administered eight days early outside of the 4 day grace period by 4 days. No Adverse Events noted.


VAERS ID: 1628196 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 2 LA / IM

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

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

Write-up: Patient arrived and reported no previous vaccination. Requested J&J which was administered. Upon entry in System it was noted that patient received one dose of Moderna on 02/16/2021.


VAERS ID: 1628201 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / UNK - / IM

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

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

Write-up: The patient received their vaccine on Thursday Aug 19th. She stated that 24 hours after the vaccine she has had daily headaches and had developed mouth cores.


VAERS ID: 1628202 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-01-25
Onset:2021-08-20
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 AR / IM

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

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


VAERS ID: 1628253 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Dysstasia, Feeding disorder, Influenza like illness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Propecia multivit zinc, D, magnesium
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever, chills, weakness, flu like symptoms, unable to stand up. Unable to do much of anything, unable to eat. This lasted about 3 days. We think he''s ok now. Hopefully. He had to get this for work.


VAERS ID: 1628262 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blepharospasm
SMQs:, Dystonia (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: allergic reaction to influenza vaccine preservative (large painful, itchy rash)
Other Medications: losartan 75 daily, lansoprazole 30 mg daily, fluoxetine 20mg daily, magnesium citrate 250 daily, zinc 50mg daily, Vitamin B2 once daily
Current Illness: none
Preexisting Conditions: asthma, hypertension, depression
Allergies: amoxicillin, ace inhibitors, Levaquin,
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Eye twitching that is not going away. It has been 4 days since I received vaccine.


VAERS ID: 1628291 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 LA / IM

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

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

Write-up: Patient suffered syncopal event 10 minutes after vaccination; EMS called; Refused transport. Patient is a nurse and post 13 hour shift at hospital. Spouse picked her up after episode. VS Stable. She was ashen and clammy initially but AOx4 after "smelling salts" utilized.


VAERS ID: 1628309 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-01
Onset:2021-08-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Hypoaesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: Sertraline, omeprazole, metoprolol, multivitamin
Current Illness: None
Preexisting Conditions: Esophageal dysmotility, asthma, GERD, anxiety
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: New numbness to the tip of the tongue on the left side only, starting 8/23/21


VAERS ID: 1628315 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Full blood count, Metabolic function test, Paraesthesia, Vitamin B12
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Vitamin C, Excedrin, vitamin D3, vitamin B12, hydroxyzine, lactobacillus, lisinopril, hydrocodone chlorothiazide
Current Illness:
Preexisting Conditions: Hypertension, gallstones, obesity, abnormal Pap smear
Allergies: Latex
Diagnostic Lab Data: CBC, TSH, vitamin B12, CMP
CDC Split Type:

Write-up: Paresthesia left lateral foot


VAERS ID: 1628358 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-08
Onset:2021-08-20
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test negative
SMQs:, 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: Humira Methotrexate, lisinopril, Peroxicam
Current Illness: Rheumatoid arthritis hypertension
Preexisting Conditions: same
Allergies: none
Diagnostic Lab Data: Anti SARS COV2 spike protein IgG NON REACTIVE INDEX 0.06
CDC Split Type:

Write-up: Immune level checked on 2/2/21 and was immune.( 1.38) Immunity rechecked on 8 / 20 and was found to be non-immune (.06)


VAERS ID: 1628388 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / IM

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

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

Write-up: No adverse reactions.


VAERS ID: 1628393 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Heavy menstrual bleeding, Pain in extremity, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Started period first time since February. Heavy bleeding and headache everyday since. Had a fever on 2nd day of shot ranging from 99.3-99.8. Also, had a sore arm.


VAERS ID: 1628403 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / IM

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

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

Write-up: none


VAERS ID: 1628437 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-02
Onset:2021-08-20
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blepharospasm, Eye movement disorder, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu shot made me break out in Hives, turn red and I was itchy.
Other Medications: adderall, venlaflaxine, omperazole, i dont remeber th name but its a medicine to helo me sleep.
Current Illness: none
Preexisting Conditions: PTSD, night terrors, high cholesterol, pre-diabetes, investing current liver issues because of my labs for months. sleep apnea, vertigo
Allergies: wheat, gluten chicken, eggs, turkey, banana, pineapple, eggs, cows milk, bakers yeast, brewers yeast, oats, rye, barley, bran, mushroom, bell peppers, squash, black tea, coffee, garlic, ginger, sesame , oregano
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: My left eye twitches open and closes on its own, changes focus on its own, sometimes my eyes cross and uncross too. almost like a tick. But almost like a Robot too, my left eye wandered to a dog and lady walking past my house and I was trying to watch tv. I felt as if someone else was controlling my eye remotely.


VAERS ID: 1628442 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-08-20
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Decreased appetite, Malaise
SMQs:, Anaphylactic reaction (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: Unknown
Preexisting Conditions: Hypertension, diabetes
Allergies: Cipro, codeine, Macrodantin, sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Malaise, decreased appetite, cough, hospitalization.


VAERS ID: 1628443 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

Write-up: Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Additional Details: patient received vaccine with mother - no issue at first but according to RPh, they returned and she had hives all over her hands. no sequelae known to have occur since as of today 8/24/21


VAERS ID: 1628444 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Appendicectomy, Appendicitis, Computerised tomogram abdomen abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None at all
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CAT scan with inflamed appendex showing appendicitis. Appendex was removed in appendectomy.
CDC Split Type:

Write-up: I got severe abdominal pain which turned out to be appendicitis. I''ve never had any pain or symptoms before it. Pain started the next day after getting vaccine. Appendex was inflamed. Happened rapidly and with no prior pain before taking the vaccine.


VAERS ID: 1628451 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 AR / IM

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

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

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Joint Pain-Medium, Systemic: Lymph Node Swelling-Medium


VAERS ID: 1628485 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Vaccine Pfizer, 2nd dose, R arm, lot # EW0171. Patient looked unstable walking, reported feeling dizzy. They laid her down on a cot. Vitals: 1515: HR 71, BP 102/62, resp 14, O2 100% room air; 1520 - HR 77, BP 98/60, resp 12, O2 100% room air; 1525: HR 77, bp 100/64; resp 14, 100% room air; 1530: HR 73, bp 98/66, resp 14, O2 98% room air. After last vitals she reported feeling much better,


VAERS ID: 1628492 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest pain, Costochondritis, Electrocardiogram, Inflammation, Musculoskeletal disorder, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 1st mederna vaccination for covid 19. Massive migrane.
Other Medications: Amitriptyline
Current Illness:
Preexisting Conditions: Chronic kidney diseases. Bladder disease
Allergies: Penicillins. Shellfish
Diagnostic Lab Data: Xray. Blood work. Ekg.
CDC Split Type:

Write-up: Costochrondritis. inflammation of cartilage in chest. Skeletal muscular issue. Stabbing pain in chest and pressure started Friday the day of my 2nd dose of mederna.


VAERS ID: 1628528 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-29
Onset:2021-08-20
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site scar
SMQs:

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

Write-up: On return to the clinic for second dose, a small scar area is noted below injection site on L arm. Appears to be from scratching at previous site however it is lower than injection site. Mother reports no adverse affects of 1st dose. Skin is well healed where evidence of scratching/scar is noted. 2nd dose administered, site marked for mother to monitor. Mother will monitor.


VAERS ID: 1628542 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2020-12-28
Onset:2021-08-20
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol HFA (VENTOLIN HFA) 90 mcg/actuation inhaler hydroCHLOROthiazide (HYDRODIURIL) 25 mg tablet (Expired) loratadine (CLARITIN) 10 mg tablet melatonin 10 mg montelukast (SINGULAIR) 10 mg tablet (Expired) WIXELA INHUB 250-50 mcg/do
Current Illness:
Preexisting Conditions: Problem List 13 items Respiratory Allergic rhinitis Persistent asthma without complication Circulatory Essential hypertension Frequent PVCs Palpitation Endocrine/Metabolic Subclinical hyperthyroidism Other Overweight(278.02) Insomnia Preventative health care
Allergies: CodeineRash, Nausea and Vomiting
Diagnostic Lab Data: Updated Procedure 08/22/21 1647 POCT COVID-19 PCR Collected: 08/22/21 1645 | Final result | Specimen: Swab from Nares POC COVID-19 PCR DetectedAbnormal Lot # 1000270419 Point of Care COVID-19 PCR Testing Method Cepheid Lot Expiration Date 06/12/2022
CDC Split Type:

Write-up: nasal congestion, loss of taste and smell, Exposure to COVID-19 virus


VAERS ID: 1628546 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-21
Onset:2021-08-20
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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: zinc 50 mg; omeprazole 20 mg; magnesium 250 mg; vitamin D 4000 IU
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: amoxicillin
Diagnostic Lab Data: PCR nasopharyngeal swab
CDC Split Type:

Write-up: Patient contracted Covid


VAERS ID: 1628553 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash macular
SMQs:, 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: Unknown
Current Illness: No known illnesses
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Within 5 minutes of getting vaccine, patient developed red splotches from shoulder to elbow. Splotches went away in 30 minutes after taking oral diphenhydramine.


VAERS ID: 1628561 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wixela inhub, Clindamycin, Pradaxa, Imbruvica, Spiriva Respimat, Flonase, Bumex, Pepcid, Diltiazem, Lipitor, Prilosec Flecainide, Vitamin b-12, Mucinex
Current Illness:
Preexisting Conditions: Autoimmune hemolytic anemia (unspecified), Diastolic heart failure stage C unspecified acuity, Chronic lymphoid leukemia, Chronic hypoxemic respiratory failure, Asthma overlap syndrome (Asthma w/COPD), Hyperlipidemia, Adult OSA, Atrial flutter paroxysmal, Atrial fibrillation paroxysmal, Right exudative age related macular degeneration w/active choroidal neovascularization, GERD, Thrombocytopenia unspecified, Atherosclerosis of aorta, Solitary pulmonary nodule, Long term warfarin oral anticoagulant therapy, Microscopic hematuria, Obesity, Osteoarthritis of bilateral knees, Nonalcoholic fatty liver, Peripheral venous insufficiency, Male hypogonadism, Osteoarthritis of bilateral feet, Right facial muscle weakness, Osteoarthritis of right shoulder, Anemia due to blood loss
Allergies: Cipro, Penicillin Class, Sulfa, Mobic
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Used 0.8 instead of 1.8 diluent when mixing up


VAERS ID: 1628580 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Injection site discomfort, Injection site erythema, Injection site pain, Injection site rash, Lymph node pain, Lymphadenopathy
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily multivitamin, Vitamin E, fish oil, protein powder
Current Illness: None
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On 8/20 I woke up with a red, oval rash directly around my injection site on my left arm. It increased in size the following day and became uncomfortable to the touch. I tried treating with OTC allergy medicine (Benadryl and Zyrtex) but it didn''t go away. It was mildly painful to the touch for several days. The rash finally went away 8/22. On 8/21 my left armpit''s lymph node because enlarged and uncomfortable to the touch. It is still there today as I report. Also on 8/21 I was unusually dizzy and fatigued.


VAERS ID: 1628588 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site erythema, Injection site pain, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Novalog Insulin
Current Illness: None
Preexisting Conditions: Type 1 diabetes
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Fever of 103.5 that wouldn?t come down with Tylenol . This lasted about 24 hours. Continued elevated temperature for another 24 hours after that (99.7). Pain, swelling and redness at injection site for 5 days. Today is day 5 and the pain is minimal now but was moderate to severe for 3-4 days. Extreme fatigue for the first 24-36 hours starting the following day after vaccination. Moderate to severe headache for about 3 days following vaccination.


VAERS ID: 1628603 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Imbruvica, Zoloft, Lisinopril, Revie, Neurontin, Vitamin B-1, Diprolene, Prilosec, Nizoral, Protopic, Kenalog
Current Illness: None
Preexisting Conditions: Chronic lymphoid leukemia, HTN, Vascular malformation unspecified, Generalized anxiety disorder, Moderate cannabis use disorder, Chronic sinusitis, osteoarthritis of left knee, patellofemoral syndrome, Grief reaction, Current left knee medial meniscus tear, Instability of joint, Colon polyp, Neck pain, Thoracic spine pain, lymphocytosis, Pulmonary nodule, Insomnia, Restless leg syndrome, Chronic daily headache, Severe alcohol use disorder, Iron deficiency anemia
Allergies: Ciprofloxacin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Used 0.8 cc instead of 1.8cc diluent when mixing up


VAERS ID: 1628622 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-09-17
Onset:2021-08-20
   Days after vaccination:337
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Ear discomfort, Feeling abnormal, Impaired work ability, Musculoskeletal stiffness, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dept/Mgr: Transplant Resolution of Symptoms: symptomatic Covid-19 Vaccine Yes/No: Yes Date of last dose: 01/12/21 Notes: EE became symptomatic on 08/20/21: plugged ears ? called PCP because she thought she had an ear infection, but wasn?t offered an in-person apt (only telehealth) so she waited over the weekend to see if ear symptoms would resolve. Reports that the next day, 8/21, EE felt ?off? + stiff neck + congestion/runny nose). Called out sick on 08/22. Covid swabbed on 08/23 with positive results. EE articipated; wants antibody testing at Facility (told EE that once she is cleared from Facility she can go to Facility). Facility orders were placed. VAERS & Agency (#52031) to follow. EE instructed to quarantine, notify manager and to keep Facility informed on health status/ Facility clearance for advice on RTW.


VAERS ID: 1628646 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Epilepsy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Use of emergency medication to stop seizures over the course of the day of injection and following 3 days.
CDC Split Type:

Write-up: Seizures started 3 hours after receiving the first dose of Pfizer injection, body temperature was 99 degrees. This continued for the next 3 days.


VAERS ID: 1628650 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed an itchy, burning rash on the front of his shoulders on both sides, but it was reportedly worse on his right side.


VAERS ID: 1628652 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-16
Onset:2021-08-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Headache, Neck pain, Pain, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: shingles
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none- seen MD that isntructed her it was like due to vaccine
CDC Split Type:

Write-up: severe head, neck, and shoulder pain. and fever. Reports could not sleep or move due to pain.


VAERS ID: 1628658 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-14
Onset:2021-08-20
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088021A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling, Lymphadenopathy, Pain, Tremor, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Ortho Cyclen
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Examined by my PCP on Tuesday August 24 at 11:15 am
CDC Split Type:

Write-up: I had a very sore arm at the injection site which I knew was to be expected that began the day after the vaccine on Sunday, August 15. On Wednesday August 18th I noted my axillary lymph nodes were swollen. I felt achey, tired, shakey and with a slight headache on Thursday and Friday, the 19th and 20th. Late afternoon on the 20th , my arm began to itch and I noticed a red, raised urticarial rash around the injection site measuring 5.5 x 3 inches. I took OTC Zyrtec and the hives resolved however the raised, erythematous rash persisted. It was not painful but continued to itch. On Tuesday morning approximately 5:00 am I awoke with urticaria around my eyes, lower forehead, nasal bridge and behind my ears. I did not have any breathing problems or swallowing difficulty.


VAERS ID: 1628660 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-02
Onset:2021-08-20
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event
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: Ensure original (gluten-free) suspension Verapamil hcl 120 mg tablet, extended release Zoloft 25 mg tablet Ibuprofen 600 mg tablet Acidophilus 1 billion u tab Daily multivitamin tab Trazodone 50 mg tab Zofran 4 mg tab Latanoprost 0.005
Current Illness: Adult failure to thrive Malignant neoplasm of oropharynx Dysphagia, oropharyngeal phase Age-related physical debility Muscle weakness (generalized) Difficulty in walking, not elsewhere classified Resident?s on hospice care
Preexisting Conditions: Hemiplegia and hemiparesis following cerebral infarction affecting unspecified side Nonrheumatic aortic (valve) stenosis Cerebral infarction, unspecified Anxiety disorder, unspecified Major depressive disorder Syncope and collapse Other hyperlipidemia Limitation of activities due to disability Abdominal aortic aneurysm, without rupture Heart failure, unspecified History of urinary tract infection/resolved Nonrheumatic aortic (valve) stenosis Other partial intestinal obstruction Unspecified severe protein-calorie malnutrition Hypertension
Allergies: Morphine
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: No Adverse Event noted. Resident''s on hospice care


VAERS ID: 1628664 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-13
Onset:2021-08-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Headache, Vertigo
SMQs:, Guillain-Barre 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroid, multi vitamin, vitamin D, vitamin C
Current Illness: no
Preexisting Conditions: hypothyroid
Allergies: latex bactrium
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vertigo off and on for 2 days followed by weakness and fatigue followed by severe headache and fatigue over 5 day period


VAERS ID: 1628684 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Electrocardiogram abnormal, Immediate post-injection reaction, Syncope, Ventricular extrasystoles
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Hypokalaemia (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: Vitamin D, 50,000 once a week, Iron 45mg, Vitamin C 500mg, Calcium 600mg
Current Illness: N/A
Preexisting Conditions: Anemia, (Gastric bypass, 2005)
Allergies: PCN
Diagnostic Lab Data: Vital signs, Random blood sugar; 101, EKG (NSR) PVC noted.
CDC Split Type:

Write-up: She immediately experienced a syncopal episode, lasted less than a minute. (ammonia capsule popped open and under nose), VS low-normal. After syncopal episode, she developed sensation of palpitation, which also improved. EKG performed, showed NSR, PVC noted. She denied any CP or SOB. She was cleared for discharged home, advised to monitor symptoms. Instructed to go to ED should she develop any worsening of palpitations, or develop CP/SOB, advised to f/u as scheduled with PCP.


VAERS ID: 1628690 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

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

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

Write-up: Patient and legal guardian (Father- ) came in for second dose of COVID vaccine. Upon arrival, was checked to see vaccination history. First dose was found under file with DOB of . First and second dose consent forms showed DOB of . Both patient and father were asked if the consent forms had the correct DOB and both attested yes. After explanation of the concern, father said it must be an input error in . The pediatrician''s name () was called however they were closed. After another verbal attestation, the second dose was administered on 8/20/2021. The pediatrician was called on 8/24/2021 and confirmed DOB is and therefore patient was 11 years of age at time of COVID vaccinations.


VAERS ID: 1628701 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: Shortly after receiving the vaccine the patient fainted and bumped head on the floor.


VAERS ID: 1628703 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-29
Onset:2021-08-20
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain natriuretic peptide normal, C-reactive protein increased, Chest pain, Echocardiogram normal, Electrocardiogram ST segment depression, Electrocardiogram ST segment elevation, Fatigue, Headache, Pain, Pyrexia, Troponin I increased, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillins, lactose intolerance
Diagnostic Lab Data: Troponin 1 High Sensitivity: 8/22: 1523 ng/L, 8/23: 3452-- $g2205-- $g799-- $g1037-- $g937. B-type natriuretic peptide: 8/23/21: 59 C-reactive protein on 8/23/21: 5.1 mg/dL ECHO on 8/23/21 was normal EKG on 8/23/21: ST elevation, junctional ST depression
CDC Split Type:

Write-up: One day after second dose, patient developed fatigue, headache and body aches. Two days after 2nd vaccine dose, patient had persistent symptoms, but developed fever to 106 and chest pain. ER evaluation showed abnormal EKG (ST elevation) and elevated troponin to 1523 ng/L. he was admitted for observation, had a normal ECHO and trended troponins. His troponin peaked at 3452, and continued to decrease. he did not require any intervention.


VAERS ID: 1628742 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-11
Onset:2021-08-20
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Headache, Nasal congestion, Oropharyngeal pain, Pain, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin (LIPITOR) 40 mg tablet flash glucose sensor (FREESTYLE LIBRE 14 DAY SENSOR) insulin aspart U-100 (NovoLOG Flexpen U-100 Insulin) 100 unit/mL (3 mL) insulin pen insulin glargine,hum.rec.anlog (BASAGLAR KWIKPEN U-100 INSULIN)
Current Illness:
Preexisting Conditions: Nervous Cannabis dependence, in remission Circulatory Coronary arteriosclerosis Essential hypertension Digestive Obesity Genitourinary Polycystic ovarian syndrome Endocrine/Metabolic Type 2 diabetes mellitus Hyperlipidemia Other Bipolar 1 disorder Tobacco user
Allergies: LisinoprilCoughing
Diagnostic Lab Data: 08/23/21 2300 COVID-19 (SARS CoV-2 RNA, RT-PCR) Collected: 08/20/21 0000 | Final result | Specimen: Swab from Nasopharynx COVID-19 POSITIVEAbnormal
CDC Split Type:

Write-up: Dx Headache ? Vomiting ? Nasal Congestion ? Chills ? Generalized Body Aches ? Sore Throat


VAERS ID: 1628769 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-08-20
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Differential white blood cell count, Full blood count, Hyperkalaemia, Metabolic function test, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Peripheral neuropathy (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), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC with diff, BMP,
CDC Split Type:

Write-up: Hyperkalemia, AKI, weakness of lower extremities


VAERS ID: 1628803 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-10
Onset:2021-08-20
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK - / -

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

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

Write-up: Positive COVID unknown contact mild symptoms


VAERS ID: 1628879 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Deep vein thrombosis, Fibrin D dimer increased, Lymphadenopathy, Ultrasound Doppler abnormal
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Esgic 50/325/40, gabapentin, levothyroxine, mesalamine, sertraline, sucralfate, lansoprazole
Current Illness:
Preexisting Conditions: anxiety, PTSD, possibility that the patient is a Factor V Leiden carrier or antithrombin III mutation carrier. I do not have lab report detailing her hypercoagulable disorder. She reported no prior history of venous thromboembolism prior to this month.
Allergies: Biaxin, cephalosporins, clarithyromycin, codeine, hydrocodone, iodinated contrast media, latex, levofloxacin, metronidazole, nalbuphine, oxycodone, povidone-iodione, propoyphene, rizatriptan, sumatriptan, statins, sulfa
Diagnostic Lab Data: elevated d-dimer on Hospital ER visit 8-22-21. Evaluated in Hospital ER - ultrasound demonstrated right upper extremity DVT and axillary lymphadenopathy.
CDC Split Type:

Write-up: Right upper extremity DVT.


VAERS ID: 1629089 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product dose omission issue
SMQs:, Medication errors (broad)

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

Write-up: The RN picked up an empty syringe and administered to the patient before realizing there was no vaccine in the syringe. The patient was subsequently vaccinated correctly after the error was discovered (within a short time). The patient did not experience and adverse reaction to the vaccine once received.


VAERS ID: 1629095 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-01
Onset:2021-08-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN0183 / 3 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Headache, Injection site pain, Skin warm
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Injection site soreness; 51; 23MAR21; injection; Pfizer EP7534
Other Medications: Ruxolitinib 45mg Pantoprazole 40mg Vitamin E 200 Metoprolol 50mg Aspirin 81mg Desvenlafaxine 100mg
Current Illness: No other short term illnesses
Preexisting Conditions: Polycythemia Vera Aortic Aneurysm
Allergies: No allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Slight headache Body felt extremely hot but no fever Tiredness Injection area soreness


VAERS ID: 1629099 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: pt did not have any known reactions or outcomes.


VAERS ID: 1629105 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event
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: no
Current Illness: no
Preexisting Conditions: No
Allergies: NKA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt did not have any known reactions or outcomes.


VAERS ID: 1629278 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin disorder, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient states that the next day after her vaccine, she started to notice her skin on her hands was different. She thought it was simply dry skin and began to use lotion, but it did not help. Later, she realized it was not dry skin when it began to peel off between her fingers and along her torso.


VAERS ID: 1629304 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-18
Onset:2021-08-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Fatigue, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: STATED SYMPTOMS STARTE ON THE FRIDAY THE 20TH AT 11PM, HAD SWOLLEN THROAT, CHEST PAIN, LIGHT HEADED, FATIGUE, DIZINESS.


VAERS ID: 1629305 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Fatigue, Headache, Hyperhidrosis, Hypoaesthesia, Myalgia, Pain, Paraesthesia, Pharyngeal swelling, Tunnel vision
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (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: Whooping cough and flu shot
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Levaquin cortisone reacted to whooping cough and flu shot nut allergy latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm and leg numb and tingled, tunnel vision, disoriented, swelling of throat dizzy, headache, fatigue, sweats, body aches, muscle aches Took benadryl, ibuprofen and Tylenol


VAERS ID: 1629321 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-08-20
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Tested positive


VAERS ID: 1629520 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-05
Onset:2021-08-20
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Migraine, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Server migraine, lost of appetite, nausea, vomiting, and muscle pain and aches


VAERS ID: 1629728 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 immunisation, Extra dose administered
SMQs:, Medication errors (narrow), COVID-19 (narrow)

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

Write-up: Client received a Moderna 06/2/2021. Reported hadn''t had a dose prior but when submitting to the database the first dose of Moderna was reported.


VAERS ID: 1629732 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FO8448 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chapped lips, Feeling cold, Pyrexia, Vaginal ulceration, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, vomiting, stomach aches, lipschitz, vaginal ulcer


VAERS ID: 1629869 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Head discomfort, Migraine, Nausea, Uterine pain, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt states that she gets very sick when she gets a flu shot
Other Medications: N/A
Current Illness: Migraines
Preexisting Conditions: N/A
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states that she started to have head pressure 1 hour after receiving the vaccine. The headache/ migraine has been continual since then and has cause Nausea and vomiting. The vomiting has led her to have severe abdominal/ uterine pain that too has been consistent for the past 4 days. Patient has tried Zofran without any relief and also has utilized her migraine meds ( OTC Excedrin and Caffeine pills) that have not made any impact on her pain. I have suggested seeing her PCP, patient states that she does not have one at the moment. I advised her to see a clinician to validate the abdominal and headaches that she has been having the last few days. I also advised her to try some meclizine for the nausea and NSAIDS for the migraine.


VAERS ID: 1629874 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: lips swelling, urticaria, wheezing


VAERS ID: 1631062 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Oklahoma  
Vaccinated:0000-00-00
Onset:2021-08-20
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, Off label use
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210842952

Write-up: PUNCTURED VIAL ADMINISTERED AFTER HALF AN HOUR OF EXPIRATION; OFF LABEL USE; This spontaneous report received from a health care professional concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A expiry: 21-SEP-2021) dose was not reported, administered on 20-AUG-2021 for prevention of covid19. No concomitant medications were reported. On 20-AUG-2021, the patient experienced punctured vial administered after half an hour of expiration. On 20-AUG-2021, the patient experienced off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the punctured vial administered after half an hour of expiration and off label use was not reported. This report was non-serious.


VAERS ID: 1631073 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-08-20
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MRNA 1273
Current Illness: Immunocompromised
Preexisting Conditions: Comments: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210843271

Write-up: JANSSEN COVID-19 VACCINE WAS ADMINISTERED TO THE PATIENT AS A BOOSTER DOSE, IN ERROR.; This spontaneous report received from a pharmacist concerned a 58 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: immunocompromised, and other pre-existing medical conditions included: The patient had no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 203A21A, expiry: 21-SEP-2021) dose was not reported, administered on 20-AUG-2021 12:45 for prophylactic vaccination. Concomitant medications included mrna 1273 for prophylactic vaccination. On 20-AUG-2021, the patient experienced janssen covid-19 vaccine was administered to the patient as a booster dose, in error. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of janssen covid-19 vaccine was administered to the patient as a booster dose, in error. was not reported. This report was non-serious.


VAERS ID: 1631075 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-08-20
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Dyspnoea, Headache, Hypopnoea, SARS-CoV-2 test, Sinus congestion, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210843312

Write-up: SHORTNESS OF BREATH (SOB); SHALLOW BREATHING; SOME COUGHING; SINUS CONGESTION; WHEEZING; MASSIVE HEADACHE; This spontaneous report received from a patient concerned a 56 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808980, and expiry: UNKNOWN) dose was not reported, administered on 17-JUN-2021 for prophylactic vaccination. Non-company suspect drugs included: interferon beta-1a (injection, route of admin, and batch number were not reported) dose and frequency were not reported from 19-AUG-2021 for drug used for unknown indication. No concomitant medications were reported. On 20-AUG-2021, the patient experienced shortness of breath (sob). On 20-AUG-2021, the patient experienced shallow breathing. On 20-AUG-2021, the patient experienced some coughing. On 20-AUG-2021, the patient experienced sinus congestion. On 20-AUG-2021, the patient experienced wheezing. On 20-AUG-2021, the patient experienced massive headache. Laboratory data (dates unspecified) included: COVID-19 virus test (NR: not provided) Negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from shortness of breath (sob), shallow breathing, massive headache, some coughing, sinus congestion, and wheezing. This report was non-serious.


VAERS ID: 1631087 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-20
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Pain, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210846228

Write-up: ARM IS JUST A BIT SORE; BODY WAS SORE; CHILLS; EXHAUSTED; AWFUL HEADACHE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 20-AUG-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 20-AUG-2021, the patient experienced chills. On 20-AUG-2021, the patient experienced exhausted. On 20-AUG-2021, the patient experienced awful headache. Treatment medications included: paracetamol. On 21-AUG-2021, the patient experienced body was sore. On 22-AUG-2021, the patient experienced arm is just a bit sore. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from body was sore, had not recovered from awful headache, and arm is just a bit sore, and the outcome of exhausted and chills was not reported. This report was non-serious.


VAERS ID: 1631092 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-08-20
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Chest pain, Chills, Dyspnoea, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no known drug allergies, no history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210846344

Write-up: SHARP CHEST PAIN; COULD NOT CATCH BREATH (HARD TIME TAKING A DEEP BREATH); EXTREME BACK PAIN; BAD CHILLS THAT WONT GO AWAY (FEELING OF FREEZING COLD); FEVER; HEADACHE; This spontaneous report received from a patient concerned a 19 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: non-alcohol user, and non-smoker, and other pre-existing medical conditions included: The patient had no known drug allergies, no history of drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A and expiry: UNKNOWN) dose was not reported, administered on 20-AUG-2021 11:00 for prophylactic vaccination. No concomitant medications were reported. On 20-AUG-2021, the patient experienced sharp chest pain. On 20-AUG-2021, the patient experienced could not catch breath (hard time taking a deep breath). On 20-AUG-2021, the patient experienced extreme back pain. On 20-AUG-2021, the patient experienced bad chills that wont go away (feeling of freezing cold). On 20-AUG-2021, the patient experienced fever. On 20-AUG-2021, the patient experienced headache. Treatment medications (dates unspecified) included: ibuprofen, acetylsalicylic acid, and paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from could not catch breath (hard time taking a deep breath), extreme back pain, bad chills that wont go away (feeling of freezing cold), fever, and headache on 21-AUG-2021, and had not recovered from sharp chest pain. This report was non-serious.


VAERS ID: 1631942 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Dysphagia, Headache, Pain in extremity, Rhinorrhoea
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Was fine after my injection however next morning I got the normal side effects like sore arm runny nose and headache. However the headache has lasted five consecutive days, I find it hard to swallow and get hot and cold sweats. I don?t believe I was told symptoms could last more than 2 days and I?m in pain constantly


VAERS ID: 1631950 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 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: Allergic: Itch (specify: facial area, extremeties)-Mild, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Additional Details: patient recieved vaccine on Friday 08/20, patients mother called on Tuesday 08/24, stating her son had a rash on torso that started on monday 08/21, no other symptoms present. patients mother gave him diphenhydramine and cortisone cream. relation to covid vaccine cannot be ruled out.


VAERS ID: 1632003 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Fatigue, Lethargy, Loss of consciousness, Musculoskeletal stiffness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: unconscious and not responding and stiffed up-Severe


VAERS ID: 1632030 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-09
Onset:2021-08-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Fatigue, Nasal congestion, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Taste and smell disorders (narrow), Immune-mediated/autoimmune disorders (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: Outpatient Medications famotidine (PEPCID) 20 mg tablet fluticasone (FLONASE) 50 mcg/actuation nasal spray LORATADINE (CLARITIN LIQUI-GEL ORAL) Clinic-Administered Medications levonorgestrel (MIRENA) IUD 52 mg
Current Illness:
Preexisting Conditions: Nervous Acute foot pain, right Acute right ankle pain Respiratory Allergic rhinitis Digestive Obesity Genitourinary Bartholin''s gland abscess Musculoskeletal Sprain of ligaments of lumbar spine, subsequent encounter Other General medical exam Low grade squamous intraepithelial lesion (LGSIL) on Papanicolaou smear of cervix
Allergies: DoxycyclinePalpitations PenicillinsHives / Urticaria, Swelling
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: Fatigue New loss of taste or smell Congestion or running nose


VAERS ID: 1632196 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Received undiluted dose of Pfizer, no adverse reactions, no additional treatment


VAERS ID: 1632205 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-20
Onset:2021-08-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Received undiluted dose of Pfizer, no adverse reactions, no additional treatment


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