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From the 7/23/2021 release of VAERS data:

Found 506,830 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 46 out of 5,069

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VAERS ID: 1461780 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Nausea-Medium, Additional Details: Patients BP was 120/87 after the 15 minute period. Symptoms resolved after giving the patient water.


VAERS ID: 1461783 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypotension, Lethargy, Loss of consciousness, Nausea, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Abdominal Pain-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Severe, Systemic: Nausea-Severe, Systemic: Vomiting-Severe, Systemic: Weakness-Medium, Additional Details: Patient''s original BP was 91/57 and second reading was 92/72. She fainted for less than a minute and regained consciousness. She suffered from severe nausea/abdominal pain and vomited. Patient was given water and felt much better after throwing up. She also complained of feeling tired.


VAERS ID: 1461837 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: According to the documentation system, the patient received Moderna on 01/12/2021. The patient was administered Pfizer on 07/07/2021. The patient denies ever receiving the initial dose of Moderna.


VAERS ID: 1461847 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-31
Onset:2021-07-07
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis, Jugular vein thrombosis, Subarachnoid haemorrhage, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: dural venous sinus thrombosis involving the mid and posterior aspects of the superior asagittal sinus, extending into the transverse and sigmoid sinuses. The dural venous sinus thrombosis extends into the upper 1/3 of the jugular vein on the left and to the jugular bulb on the right. She also has subarachnoid hemorrhage in the left inferior temporal lobe and bilateral occipital lobes. The event that led to hospitalization and finding the thrombosis was a syncopal episode on 7/7/21


VAERS ID: 1461850 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient felt lightheaded after vaccine. Noted excessive sweating. Initial vitals BP: 90/60, HR: 49, Sp02: 97% R: 18. Second set of vital signs BP: 110/61, HR: 51, Sp02: 98%, R: 18 and T: 98.7. EMS was called when vitals did not improve and patient was transported to a local medical facility at 10:10am.


VAERS ID: 1461854 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cardio Care, Fish oil caps
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none, didn''t seek ER because I couldn''t remain unmoving for long without distress increasing. We are 1 hr from nearest hospital. I didn''t feel I would survive the trip to seek medical help.
CDC Split Type:

Write-up: woke up gasping for breath, difficulty breathing, chest constriction with pain, heart pressure, pulse pressure in shoulders, neck and top of head treated with Cardio Care and Aconitum Napellus 30 C every 1/2 hr to 1 hr depending on symptom expression and walking and staying up right caused improvement of symptoms. Laying down and lack of movement cause symptom worsening, difficulty in breathing and increasing chest & heart pressure


VAERS ID: 1461921 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-07
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: methimazole 5mg/day
Current Illness: No
Preexisting Conditions: hyperthyroidism start from 2.5 years ago
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient got her 2nd covid19 vaccine on July 2nd. starting from July 7th, after eating methimazole, she feel headache, nausea, want to vomit, but can''t spit it out. she is lack of energy. she take methimazole for more than 2 years, never has this symptom before. all abnormal happened 1 week after her 2nd covid19 vaccine. I am worried about her.


VAERS ID: 1461922 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Nausea, Pain, Pain in extremity, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Within a few hours arm was sore but into the evening swollen and warm to the touch. Experienced headaches,chills, sweats,nauseated and achy everywhere. These continued and stopped by the pharmacy to make sure everything was normal. Which the pharmacist said that it''s stronger than the first one and it was normal. It''s now Saturday, 7/9 and still not feeling great. Was told it could be a week.


VAERS ID: 1461924 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated protein C resistance test, Blood thyroid stimulating hormone, Full blood count, International normalised ratio, Laboratory test, Metabolic function test, Protein S, Prothrombin time, Retinal vascular disorder, Thyroxine, Visual impairment, Von Willebrand's factor antigen test
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec adapalene cream
Current Illness: Headaches and fatigue after first Pfizer COVID vaccine on 6/15/2021
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: PT, PTT, INR, CBC with differential, CMP, TSH, T4, von Willebrand factor, Factor V Leiden, Protein C quantitative, Protein C activity, Protein S quantitative, Protein S activity,
CDC Split Type:

Write-up: Spot in right eye vision would not go away, saw ophthalmologist and diagnosed with clot in retinal capillary.


VAERS ID: 1461940 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: Patient has rash on whole body that presented at about 8 pm 7/7/21


VAERS ID: 1461974 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: elevated troponin
CDC Split Type:

Write-up: Patient developed chest pain c/w myopericarditis, troponin elevated. transferred to tertiary care facility


VAERS ID: 1461987 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chest pain, Costochondritis, Cough, Dizziness, Dysgeusia, Ear pain, Eye pain, Fatigue, Headache, Lymphadenopathy, Nausea, Neck pain, Oropharyngeal pain, Pain in extremity, Palpitations, Parosmia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Vestibular disorders (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: See previous report
Other Medications: Metformin, ramipril, levothyroxine, duloxetine, eliquis, simvastatin
Current Illness: Had very bad reaction to 1st Pfizer vaccine; still had not recovered from some of that; in ER for dehydration 6/9
Preexisting Conditions: Fibromyalgia, back is screwed up
Allergies: Codeine, amatriptline, ativan, levofloxisin, etc
Diagnostic Lab Data: My dr doesn''t believe in reactions to meds or shots, so I didn''t bother, except finally texted him for what I could do about nausea & dizziness. Didn''t hear back right away so I took Pepto Bismol with old script of meclizine
CDC Split Type:

Write-up: Heart palpitations severe headache, eyeballs pounding, dizzy, temp 102, glands swollen, neck pain, ears hurt, cough, sore throat, pain in L & R arms, all over body aches & pains, nauseau, bad "paint" taste/smell (still ltd senses taste & smell from CoVid19 since 12/15/2020), tiredness/fatigue, chest pain (costochondritis)


VAERS ID: 1462004 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-03
Onset:2021-07-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Headache, Impaired driving ability
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Patient states he developed "seizure symptoms" four days after second dose of Moderna COVID vaccination. Patient described "seizure symptoms" as a headache and chest pain severe enough that he was not able to drive. He took an aspirin for his symptoms and symptoms were completely resolved in two hours. Similar episodes occurred Thursday, Friday, and Saturday. Writer advised patient to seek emergency medical care for symptoms on Saturday for further evaluation. Patient was resistant, and writer stressed importance of evaluation of chest pain. Unable to follow up further.


VAERS ID: 1462008 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-06-04
Onset:2021-07-07
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (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: hay fever
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bells Palsy started on 7/7/2021 Emergency room diagnosed on 7/8/2021


VAERS ID: 1462022 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Abdominal pain upper, Diarrhoea, Pyrexia, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: The first Covid vaccine I was having trouble breathing and a tight chest 5 days post-vaccination.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: The day I got the vaccine, I started getting severe diarrhea and it lasted for 4 days. I then got severe upper abdominal pain for 2 days where I could not stand up straight. My lower abdomen is now swollen and painful and my entire stomach aches every time I eat. I also had 101?F fever for 2 days following vaccination. I have lost 5 pounds since I got the vaccine.


VAERS ID: 1462102 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dermatitis acneiform, Pain, Pain in extremity, Pyrexia, Rash, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient developed an itchy rash on torso and upper body. They were red almost like pimples and very itchy. Also developed a fever of 102, and arm was throbbing. Father alternated Ibuprofen and Tylenol for the fever , and Benadryl for the itchy rash. Today she is doing much better but still has a itchy rash on the arm. She no longer has a fever and seems to be much better.


VAERS ID: 1462107 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-04
Onset:2021-07-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort
SMQs:

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

Write-up: Pt stopped by the pharmacy Saturday 7/10/21 and stated he develpoed "pressure" in his R ear - like it feels like water is in it. He saw his PCP and no sign of infection or congestion.


VAERS ID: 1462153 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-07-07
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular
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: None
Current Illness: None
Preexisting Conditions: Celiac
Allergies: Celiac
Diagnostic Lab Data:
CDC Split Type:

Write-up: My uterus feels like it?s massive, I started my period exactly 2 weeks after the beginning of my last period (very early), and I?m experiencing much heavier bleeding than normal.


VAERS ID: 1462180 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling hot, Headache, Injection site nodule, Injection site reaction, Injection site warmth, Migraine, Pain, Pain in extremity, Pruritus, Pyrexia, Rash, Rash erythematous, Trigeminal neuralgia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Demyelination (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Beta Blocker, Triptan, Pain Rx, Tylenol PM, Sodium Bicarbonate, Baby Aspirin, Stress B vitamins/multi vitamin, choline.
Current Illness:
Preexisting Conditions: Chronic Migraine, Trigeminal Neuralgia, Chronic kidney disease
Allergies: PCN, shellfish
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: First night fever/chills, body ache headache. Next day persistent migraine, then trigeminal neuralgia episode until day 4. Arm sore on first day, then golfball knot and hot red rash spread around site---hurts. Rash (small hives) on right side of face, under chin, and neck on right side very itchy and hot.


VAERS ID: 1463026 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-07-07
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210716802

Write-up: CHILLS THAT WERE SHAKING HEAD AND COLD AND TEETH CHATTERING IN HEAD; FEELING VERY WEAK; POSSIBLE FEVER; This spontaneous report received from a patient concerned a female 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: Unk) dose was not reported, administered on 07-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 07-JUL-2021, the subject experienced chills that were shaking head and cold and teeth chattering in head. On 07-JUL-2021, the subject experienced feeling very weak. On 07-JUL-2021, the subject experienced possible fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from chills that were shaking head and cold and teeth chattering in head, feeling very weak, and possible fever. This report was non-serious.


VAERS ID: 1463033 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-07
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210718545

Write-up: DIARRHEA/ STOOLS MOSTLY WATERY; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. The patient''s concurrent conditions included cancer. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 06-JUL-2021 for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 07-JUL-2021, the subject experienced diarrhea/ stools mostly watery. Treatment medications included: loperamide hydrochloride. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of diarrhea/ stools mostly watery was not reported. This report was non-serious.


VAERS ID: 1463072 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0108 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Fatigue, Feeling abnormal, Headache, Oropharyngeal pain, Pleurisy, Pyrexia, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (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: --Saysara - antibiotic for acne; 1x/day --Ceterizine PRN for allergies --Albuterol inhaler PRN for allergy-induced asthma symptoms
Current Illness: None known
Preexisting Conditions: Just allergy-induced asthma symptoms, but would not consider her to be "asthmatic". Very active child and goes many weeks at a time without using inhaler. She was 6 weeks premature; her lungs have been playing "catch-up " ever since.
Allergies: Sensitivity to wheat
Diagnostic Lab Data:
CDC Split Type:

Write-up: She began feeling badly the day after 2nd dose. Sore throat, runny nose, sneezing, headache, fatigue. Today is 4th day after 2nd dose and she feels pretty awful. Started running low fever and complaining of *chest pain* and *pain in back and shoulders* and pain upon *deep breaths*.


VAERS ID: 1463078 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-07
Onset:2021-07-07
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Hypersensitivity, Peripheral swelling, Swelling of eyelid, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: NO
Preexisting Conditions: NO
Allergies: KNA to medications. Patient is lactose and tolerant
Diagnostic Lab Data: blood work @ hospital
CDC Split Type:

Write-up: Patient had a very bad allergic reaction to her 2nd dose of vaccine of pfizer on 7/6/21 . her reaction occured on 7/7/21 she broke out in bubble hives as well as her feet fingers and eyelids swelling up. today marks 4 days. I did take her to her primary on 7/8/21 he prescribed her benadryl . the next day got worse , so I took her to the hospital on 7/9/21. doctor drew a blood sample to check her organs she said everything looked ok. So doctor said she was gonna report it and I was to do so as well. Symptons have not gone away and we are going on day 4 so doctor said it should be gone in 3 days. So if shes not bring her back into hospital. I am very worried, and am up through out the night settting my alarm every 2 hrs to make sure shes not flaring up.


VAERS ID: 1463397 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-30
Onset:2021-07-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Palpitations and increased pulse rate (40%) for days 7-11+ (still ongoing) post vaccine, mainly in the evening Diarrhea for days 7-11+ (still ongoing) post vaccine


VAERS ID: 1463507 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site paraesthesia, Injection site pruritus, Injection site swelling, Injection site vesicles, Pain, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Body Aches Generalized-Mild, Systemic: Chills-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Blistering at site of injection and down the arm-Medium, Systemic: Headache-Mild, Additional Details: Pt presented 5 days post immunization with blistering at and around injection site on right arm. Day 1 post injection stated she had fever, chills, body aches, headaches. Day 2 said she had tingling in injection arm, but didn''t see anything. Day 4 post injection she noticed blistering and redness at injection site and down her arm. Day 5, blistering still present and came into pharmacy to report


VAERS ID: 1463527 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Joint range of motion decreased
SMQs:, Arthritis (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: None
Current Illness: high cholesterol
Preexisting Conditions: high cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cannot raise arm for two days., it is ok on the third day and forward.


VAERS ID: 1463604 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Back pain, Blood test, Computerised tomogram, Feeling abnormal, Hypoaesthesia, Nausea, Pain in extremity, Urine analysis, Vomiting, Weight decreased
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Naproxen, tomatoes
Diagnostic Lab Data: Blood, urine, CAT scan, IV, multiple meds
CDC Split Type:

Write-up: Twelve hours after vaccine, he developed severely sore arm, shoulders and down back. This was followed by severe vomiting, to which he lost two pounds in 4 hours. Arriving at the ER at 5:45 AM, he had horrible stomach pain, (we could see his stomach move), nausea, vomiting. His hands, arms and face became fuzzy then numb. He was given multiple medications to ease symptoms, along with IV. He had tests of blood, urine and a CAT scan. This was followed by morphine. Discharge around noon on 7-8-21


VAERS ID: 1463619 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Eye pruritus, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: none
Preexisting Conditions: seasonal allergies, used albuterol MDI in childhood for asthma/wheezing - hasn''t needed it in "years"
Allergies: egg, milk, wheat, shrimp (detected on allergy testing), episode with lip swelling after eating nuts in the past. Environmental (seasonal) allergy symptoms
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received vaccine at approx 9am and around 2:15 pm she started developing itchy eyes, swelling of eyelids L$gR, redness of cheeks. No shortness of breath, no difficulty swallowing, no hoarseness of voice.


VAERS ID: 1463636 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Hypoaesthesia, Neck pain, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad)

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

Write-up: Tingle and numb left hand, leg, head, back side of the neck. Pain in the neck. ?Heavy? chest


VAERS ID: 1463646 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Prenatal Slow Fe Zyrtec
Current Illness: NA
Preexisting Conditions: High blood pressure
Allergies: Penicillin Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches lasting three days, ibuprofen taken every 6 hours Sore throat Low grade fever on second night


VAERS ID: 1463705 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: 2nd pfizer vaccine dose was given to pt on 07-06-2021. We found out on 07-09-2021 that vaccine expiration date was outside the recommended 31 day window. We tried to reached out to pt on 07/10 & 07/11 but we were unable to talk to reach.


VAERS ID: 1463728 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: 2nd dose pfizer vaccine was given to patient on 07/07/202. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window. We reached out to pt on 07/10/21. Patient will return to the pharmacy on 07/15/21 to get the 2nd dose again.


VAERS ID: 1463735 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: 2nd dose pfizer vaccine was given to patient on 07/07/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window. We reached out to pt on 07/15/21 to get the 2nd dose again.


VAERS ID: 1463739 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: 2nd dose pfizer vaccine was given to patient on 07/07/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window. We reached out to pt on 07/15/21 to discuss incident but we were unable to talk to pt.


VAERS ID: 1463740 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

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

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

Write-up: 1st dose of pfizer vaccine was given to patient on 07/07/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window. We reached out to pt on 07/15/21 to get the 2nd dose again. She will return to pharmacy on 07/12 to take the 1st dose again.


VAERS ID: 1463742 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: 1st dose pfizer vaccine was given to patient on 07/07/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window. We reached out to pt on 07/10/21 to get the 1st dose again. Patient will return to the pharmacy to repeat dose on 07/12/21.


VAERS ID: 1463888 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-07-07
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use; Penicillin allergy (The patient had Penicillin unknown reaction, happened when patient was very young.); Smoker
Preexisting Conditions: Comments: The patient had history of drug abuse or illicit drug use. The patient had no medical history.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210718942

Write-up: FEELING ITCHY ALL OVER BODY; INJECTED ARM WAS SORE; This spontaneous report received from a patient concerned a 57 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included penicillin allergy, smoker, and alcohol user, and other pre-existing medical conditions included the patient had history of drug abuse or illicit drug use. The patient had no medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A expiry: UNKNOWN) dose was not reported, administered on 07-JUL-2021 11:00 for prophylactic vaccination. No concomitant medications were reported. On 07-JUL-2021, the subject experienced injected arm was sore. On 08-JUL-2021, the subject experienced feeling itchy all over body. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from feeling itchy all over body, and the outcome of injected arm was sore was not reported. This report was non-serious.


VAERS ID: 1463982 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Decreased appetite, Malaise, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: nausea lack of appetite fever comes and goes coughing muscle aches "not feeling well"


VAERS ID: 1464014 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: No known medications upon review of chart.
Current Illness: No known illnesses.
Preexisting Conditions: No chronic medical problems per review of chart.
Allergies: No known allergies.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: About five minutes after receiving the vaccine in his left arm, the patient developed redness itchiness and rash at the site of the vaccine. No systemic symptoms. Received an ice pack to the area. Pt was monitored in clinic for 30 minutes, during which time symptoms had fully resolved.


VAERS ID: 1464051 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-29
Onset:2021-07-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash erythematous, Rash papular, Rash pruritic, Skin warm
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: Prenatal vitamin
Current Illness: UTI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Circular, raised, red, warm, itchy rash appeared after 8 days (about 1.5 inches in diameter). The rash continues to spread. It is now about 7 inches across. It''s upraised and red around the outside edge with a very irregular border. It''s very itchy with slight bumps throughout the rash.


VAERS ID: 1464064 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Decreased appetite, Fatigue, Impaired work ability, Influenza like illness, Migraine, Myalgia, Oropharyngeal pain, Pyrexia, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan/HCTZ, Pantoprazole, Pulmicort Flex inhaler, Montelukast, Rosuvastatin
Current Illness: none
Preexisting Conditions: Sleep apnea, High BP, High Cholesterol, gerd. minor asthma
Allergies: Eggs
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Developed a migraine about an hour after shot. Started feeling very tired and my throat was feeling sore. Muscle soreness started and is still present 5 days later. Next day after shot had some bad flu like symptoms; intermittent shivers and feverish. Could not get out of bed and I was so tired, yet could not get good sleep. Muscle aches and migraine headaches. Second day still was extremely tired with migraine and muscle aches with a slight stomach ache. Lost my appetite going on 5 days post shot. Took days off of work because of side effects


VAERS ID: 1464114 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Decreased appetite, Diarrhoea, Dysgeusia, Fatigue, Nausea, Paraesthesia oral, Rash, Swelling face, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Taste and smell disorders (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (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: None
Current Illness: None
Preexisting Conditions: History of hypothyroidism and history of allergic reactions with unknown etiology.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client states that she started having symptoms on Wednesday morning (07-07-21). These symptoms included weakness and fatigue, decrease in appetite, and a metallic taste in her mouth. She states on Friday (07-09-21) she had nausea, vomiting, diarrhea, severe abdominal pain. facial swelling, hives around her mouth, tightness in her tongue, and had developed a rash from head to toe. She states that she used Benadryl prior to going to the Emergency Room. She states that she was treated in the ER with oral steroids and pepcid and was discharged home on a steroid pack.


VAERS ID: 1464207 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-04-09
Onset:2021-07-07
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Pain, 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: Amlodipine
Current Illness: None
Preexisting Conditions: HTN, Alcohol dependence, Depression, Asthma, Allergic rhinitis, Smoker
Allergies: None
Diagnostic Lab Data: 07/07/21: Positive SARS-COV-2 RNA
CDC Split Type:

Write-up: 07/07/21: Body aches


VAERS ID: 1464239 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-07-07
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Pharmacy       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: no
Current Illness: no
Preexisting Conditions: GERD
Allergies: no
Diagnostic Lab Data: at home positive rapid antigen positive PCR positive
CDC Split Type:

Write-up: became symptomatic 07/07/2021, at home test positive, rapid antigen positive, PCR positive


VAERS ID: 1464284 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

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

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


VAERS ID: 1464293 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Limb injury, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Arthritis (broad)

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

Write-up: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1464316 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Cardiac flutter, Chest X-ray normal, Chest pain, Electrocardiogram normal, Fatigue, SARS-CoV-2 test negative
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Arthritis (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: PCN
Diagnostic Lab Data: Seen on 7/12/2021: Ekg and CXR reported as normal. Rapid covid testing was reported as negative
CDC Split Type:

Write-up: Chest pains starting 3-4 hours after vaccine Intermittent Heart fluttering. Fatigue and joint pains. Joint pains and fatigue have improved but CP and fluttering marginally less


VAERS ID: 1464378 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-05
Onset:2021-07-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Electrocardiogram, Laboratory test, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG done 7/9/21- abnormal. CXR and lab work ordered stat- not yet completed
CDC Split Type:

Write-up: Tachycardia and abnormal ekg


VAERS ID: 1464380 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-28
Onset:2021-07-07
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Pyrexia, SARS-CoV-2 test positive, Upper respiratory tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: GLIPIZIDE, BULK, MISC lisinopriL (ZESTRIL) 20 mg tablet metFORMIN 500 mg/5 mL solution pioglitazone HCl (ACTOS ORAL)
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: Contains critical data COVID-19: Positive Infection Onset 7/7/2021 SARS-CoV-2 (related to COVID-19) Specimen information: Swab / Nares Added: 7/7/2021 by POCT COVID-19 PCR (Collected 07/07/21) Onset date: 7/7/2021 Resolve Add: Rule-Out COVID-19 and Respiratory Viruses Add: Rule-Out SARS-CoV-2 (related to COVID-19) Add: Probable COVID-19 New Results - Lab Updated Procedure 07/07/21 1201 POCT COVID-19 PCR Collected: 07/07/21 1153 | Final result | Specimen: Swab POC COVID-19 PCR DetectedAbnormal Point of Care COVID-19 PCR Testing Method Lot Expiration Date 10/7/21
CDC Split Type:

Write-up: URI AND FEVER


VAERS ID: 1464385 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, Injection site pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrocodone 3/325mg-10mg 1 tab. (Norco)
Current Illness: Hyperlipidemia, HTN, GERD, Type 2 Diabetes, Sinusitis, SVT
Preexisting Conditions: Hyperlipidemia, HTN, GERD, Type 2 Diabetes, Sinusitis, SVT
Allergies: Amoxicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: vaccine was given to patient after it had expired after twelve hours after vial was punctured. (vaccine was expired for 10 hours) vial was punctured on 7/6/2021 at 11am, Vaccine was given to patient on 7/7/21 at 8:30 am side effects from vaccine soreness and swelling on L arm, 7/9/2021 Checked patient she stated she is starting to feel better from her arm.


VAERS ID: 1464401 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-30
Onset:2021-07-07
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aortic arteriosclerosis, Arterial tortuosity syndrome, Atrioventricular block first degree, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood magnesium normal, Blood potassium decreased, Blood sodium normal, Blood urea increased, COVID-19, Carbon dioxide decreased, Chest X-ray abnormal, Chest pain, Coagulation test, Electrocardiogram QT interval, Electrocardiogram ST-T change, Electrocardiogram T wave abnormal, Eosinophil percentage increased, Full blood count, Haematocrit normal, Haemoglobin normal, Hiatus hernia, Lung hyperinflation, Lymphocyte percentage, Monocyte percentage increased, Neutrophil percentage, Osteoarthritis, Platelet count normal, QRS axis, SARS-CoV-2 test positive, Sinus rhythm, Spinal osteoarthritis, Troponin I increased, White blood cell count normal
SMQs:, Acute renal failure (broad), Asthma/bronchospasm (broad), Myocardial infarction (narrow), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Congenital, familial and genetic disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 mg tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 80 mg tablet blood sugar diagnostic (ONETOUCH ULTRA BLUE TEST STRIP) strip clopidogreL (PLAVIX) 75 mg tablet cyanocobalamin 1,000 mcg tablet denosumab (PROLIA) 60
Current Illness:
Preexisting Conditions: Nervous Chest pressure Migraine headache Hypermetropia Chest pain Circulatory NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC) Hypertension, essential Peripheral vascular disease (CMS/HCC) Genitourinary Stage 2 chronic kidney disease Carcinoma of vulva (CMS/HCC) Musculoskeletal Arthritis Endocrine/Metabolic Mixed hyperlipidemia Type 2 diabetes mellitus (CMS/HCC) Other Carcinoma of upper-outer quadrant of female breast, left (CMS/HCC)
Allergies: NKA
Diagnostic Lab Data: SARS-CoV-2 (related to COVID-19) Specimen information: Swab / Nasopharynx Added: 7/8/2021 by COVID-19 (SARS CoV-2,RNA Molecular Amplification) (Collected 07/08/21) Onset date: 7/8/2021 Resolve Add: Rule-Out COVID-19 and Respiratory Viruses Add: Rule-Out SARS-CoV-2 (related to COVID-19) Add: Probable COVID-19 New Results - Lab Updated Procedure 07/08/21 0436 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 07/08/21 0225 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical 07/08/21 0436 COVID-19 PCR Collected: 07/08/21 0225 | Final result | Specimen: Swab from Nasopharynx LABORATORY: CBC: Results from last 7 days Lab Units 07/08/21 0521 07/07/21 2205 WBC AUTO K/mcL 5.5 5.7 HEMOGLOBIN g/dL 11.1* 12.4 HEMATOCRIT % 33.3* 37.3 PLATELETS K/mcL 191 189 NEUTROS PCT AUTO % -- 60 LYMPHS PCT AUTO % -- 25 MONOS PCT AUTO % -- 9 EOS PCT AUTO % -- 5 CHEMISTRY: Results from last 7 days Lab Units 07/08/21 0521 07/07/21 2205 SODIUM mmol/L 140 138 POTASSIUM mmol/L 3.4* 3.6 CHLORIDE mmol/L 106 103 CO2 mmol/L 26 21 BUN mg/dL 22 28* CREATININE mg/dL 0.75 0.90 CALCIUM mg/dL 9.2 9.5 Results from last 7 days Lab Units 07/08/21 0521 MAGNESIUM mg/dL 2.0 COAGULATION: OTHER TESTS: 0 Lab Value Date/Time TROPONINI <0.03 07/08/2021 0521 TROPONINI <0.03 07/08/2021 0143 TROPONINI <0.03 07/07/2021 2205 TROPONINI 0.04 (H) 09/22/2018 0212 TROPONINI 0.04 (H) 09/21/2018 2300 TROPONINI 0.04 (H) 09/21/2018 1951 IMAGING: ECG 12-lead: HOSPITAL or TEST FACILITY Once Chest pain Result Date: 7/8/2021 Test Date: 2021-07-07 Pat Name: Department: YH ED Patient ID: 000033840 Room: T248 Gender: Female Technician: DOB: Requested By: 51694 Order Number: 3288472815 Reading MD: Measurements Intervals Axis Rate: 86 P: 53 PR: 250 QRS: 14 QRSD: 90 T: 10 QT: 377 QTc: 453 Interpretive Statements Sinus rhythm with first degree AV block Nonspecific ST & T-wave abnormality Electronically Signed On 7-8-2021 9:43:54 EDT by X-ray chest 2 views Result Date: 7/8/2021 XR CHEST 2 VW IMPRESSION: 1. Moderate to large hiatal hernia reidentified. 2. No acute cardiopulmonary process. 3. See below report. 4. Stable hyperexpansion changes of the lungs. END OF IMPRESSION: INDICATION: Chest pain. TECHNIQUE: Frontal and lateral projections of the chest are acquired. COMPARISON: Chest radiograph dated September 21, 2018. FINDINGS: Moderate to large hiatal hernia is noted. Some thoracic aortic tortuosity and atherosclerotic calcifications are noted. Some multilevel degenerative changes of the thoracic spine are noted. Hyperexpansion changes of the lungs are stable. No consolidation, effusion or pneumothorax is identified. Degenerative changes of severe degree are noted in the left shoulder. Rotator cuff fixation anchors are noted in the right humeral head region. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 7/7/2021 - 7/9/2021 (2 days) Last attending ? Treatment team Chest pain Principal problem Primary Admission Diagnosis Medical Problems Hospital Problems POA * (Principal) Chest pain Unknown Hypertension, essential Yes Mixed hyperlipidemia Yes Stage 2 chronic kidney disease Yes Type 2 diabetes mellitus (CMS/HCC) Yes Disposition: Home CODE STATUS (LOI): Full Code _ Active Issues Requiring Follow-up Chest pain: Unclear etiology patient should have a stress test done after discharge would wait a couple weeks to verify the patient is not developing Covid as the accuracy of the test may be degraded if patient has Covid infection. May be reflux related so we will start patient on on Protonix for the next 30 days can likely stop it after that time period. Patient understands to try Maalox or Mylanta She has an episode of pain like this and should return to the emergency department if she has not undergone stress testing if she has recurrence of the pain. Test Results Pending at Discharge Outpatient Follow-Up Future Appointments Date Time Provider Department Center 10/11/2021 1:20 PM DO FIFTH IM Hospital Course HPI: Chest pain Hospital Course: Patient is a 92-year-old female with 2 episodes of chest pain lasting about 15 minutes each over the past couple weeks. Patient had negative troponins. Patient had prior Covid vaccine. Patient underwent Covid swab as does everybody admitted to this hospital which returned positive. Likely incidental finding. Patient did not have any additional episodes of chest pain unclear is what the underlying etiology is. Would wait for at least 2 weeks to verify that patient is not developing Covid and should undergo stress test after such time is completed. Please follow-up with your outpatient provider to arrange this testing. Patient''s been advised to return to the emergency room or seek medical attention if she becomes symptomatic with the Covid including runny nose cough. I do not believe patient to be contagious though I explained to her do not know that with certainty.


VAERS ID: 1464416 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / IM

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

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

Write-up: Moderna vaccine vials (Lot#:002C21A, expiration 10/14/21) were removed from freezer and delivered from larger healthcare facility within enterprise to our facility with a fridge expiration date of 6/24/21. The fridge expiration date was written on the bag that the vials came in, but not directly on the vials. On 7/7/21, pharmacist grabbed a vial from the pharmacy fridge without looking at the expiration date on the bag and drew up 3 vials. The nurse then took the labeled 3 doses (labeled with manufacturer expiration and time of expiration from puncture of the vial time) and administered to 3 separate patients that day. Pharmacy caught adverse event on 7/9/21 when reporting doses given. Notified Moderna safety team on 7/12/21 who recommended to report to report to VAERS but not to administer additional dose as no studies done on patients receiving more than 2 doses. No further follow-up recommended. No adverse reactions noted.


VAERS ID: 1464418 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / IM

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

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

Write-up: Moderna vaccine vials (Lot#:002C21A, expiration 10/14/21) were removed from freezer and delivered from larger healthcare facility within enterprise to our facility with a fridge expiration date of 6/24/21. The fridge expiration date was written on the bag that the vials came in, but not directly on the vials. On 7/7/21, pharmacist grabbed a vial from the pharmacy fridge without looking at the expiration date on the bag and drew up 3 vials. The nurse then took the labeled 3 doses (labeled with manufacturer expiration and time of expiration from puncture of the vial time) and administered to 3 separate patients that day. Pharmacy caught adverse event on 7/9/21 when reporting doses given. Notified Moderna safety team on 7/12/21 who recommended to report to report to VAERS but not to administer additional dose as no studies done on patients receiving more than 2 doses. No further follow-up recommended. No adverse reactions noted.


VAERS ID: 1464419 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Pain in extremity, Pyrexia, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 said she had an immediate headache and later had pain in shoulder area, fever, blurred vision, elevated heart rate, and pain in feet. She treated with acetaminophen and diphenhydramine.


VAERS ID: 1464426 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / IM

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

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

Write-up: Moderna vaccine vials (Lot#:002C21A, expiration 10/14/21) were removed from freezer and delivered from larger healthcare facility within enterprise to our facility with a fridge expiration date of 6/24/21. The fridge expiration date was written on the bag that the vials came in, but not directly on the vials. On 7/7/21, pharmacist grabbed a vial from the pharmacy fridge without looking at the expiration date on the bag and drew up 3 vials. The nurse then took the labeled 3 doses (labeled with manufacturer expiration and time of expiration from puncture of the vial time) and administered to 3 separate patients that day. Pharmacy caught adverse event on 7/9/21 when reporting doses given. Notified Moderna safety team on 7/12/21 who recommended to report to report to VAERS but not to administer additional dose as no studies done on patients receiving more than 2 doses. No further follow-up recommended. No adverse reactions noted.


VAERS ID: 1464431 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-31
Onset:2021-07-07
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL5262 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: Updated Procedure 07/08/21 1517 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 07/08/21 1009 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical 07/08/21 1517 COVID-19 PCR Collected: 07/08/21 1009 | Final result | Specimen: Swab from Nasopharynx
CDC Split Type:

Write-up: UNKNOWN - Suspected COVID-19 virus infection


VAERS ID: 1464560 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Headache, Interchange of vaccine products, Malaise
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), 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:

Write-up: This is an administration error report. This client received the J&J vaccine on 03/29/2021 through his place of work from us at the health department. We went back out to this clients place of employment for a vaccine clinic on 07/07/21 and the place of work sent out a text reminding people who signed up for the vaccine clinic and this client responded to the employers text saying "I think I will get Moderna today." The clients employer or the health department did not catch that the client had J&J vaccine on 03/29/2021 until after we gave the Moderna vaccine first dose on 07/07/2021. This error was caught after administering the first dose of Moderna. Client was having symptoms of headache, dizziness and just not feeling well.


VAERS ID: 1464667 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Electrocardiogram ST segment elevation, Sinus rhythm, Troponin I increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Melatonin 5mg, Depakote ER 500mg, guanfacine 1mg, olanzapine 7.5mg
Current Illness: None
Preexisting Conditions: Mental health concerns
Allergies: NKDA
Diagnostic Lab Data: 7/9/21 Troponin I level: 2338.87, EKG: Sinus rhythm, ST elevation, prob normal variant, anterior leads CXR: normal
CDC Split Type:

Write-up: Chest pain for two days after 2nd vaccination. Chest pain resolved with ibuprofen.


VAERS ID: 1464677 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WAG3859 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Blood calcium normal, Blood magnesium normal, Blood phosphorus normal, Chest pain, Chills, Dyspnoea, Echocardiogram normal, Electrocardiogram ST segment elevation, Electrocardiogram repolarisation abnormality, Full blood count abnormal, Influenza like illness, Intensive care, Leukocytosis, Metabolic function test normal, Myocarditis, Nausea, Oropharyngeal pain, Pain in extremity, Pyrexia, Troponin increased, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (narrow), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Whey Protein
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: PT is a 17 y/o previously healthy boy who presented with 3 days of moderate-severe, substernal chest pain, dyspnea, and nausea 2 days after receiving the 2nd dose of the Pfizer COVID-19 vaccine found to have elevated troponins at 3.36 and ST elevation, probably early repolarization on EKG consistent with perimyocarditis. 7/11 Cardiac ECHO showed "Normal biventricular systolic function. No pericardial effusion." He was initially admitted to the PICU. His initial CBC showed a mild leukocytosis with normal BMP, Ca, Mg, and Phos. Troponins were trended q8h and were downtrending (1.59 <- 2.91 <- 3.36) at the time of discharge. - He remained asymptomatic and hemodynamically stable throughout his entire admission and his physical exam at the time of discharge was significant for "Regular rate and rhythm; normal S1/S2. No murmurs, rubs, or gallops. Capillary refill <2 seconds. 2+ Radial pulses. No tibial edema present."
CDC Split Type:

Write-up: PT is a 17 y/o previously healthy boy who presents with 3 days of moderate-severe, substernal chest pain, dyspnea, and nausea 2 days after receiving the 2nd dose of the Pfizer COVID-19 vaccine. On Tuesday (7/6), PT received the second Pfizer COVID-19 vaccine. The following day (Wednesday 7/7) PT had "flu-like symptoms" with chills, subjective fever, and a sore arm that resolved by Thursday (7/8). He was back to his baseline state of health on Thursday (7/8) and felt fine that whole day. On Friday afternoon (7/9) when he was at work washing dishes where he had some physical exertion he began to notice at 16:30-17:00 that he developed substernal, sharp, 7/10 chest pain that did not radiate, improve/worsen with deep breaths, sitting up, laying down or with movement of his upper extremities. It worsened towards the end of the night and peaked at 8/10 by 22:00-23:00 that same evening. His sister picked him up from work per his regular routine and he went home and took a shower which improved the pain to a 5-6/10 when he went to sleep. He woke up at 3 AM on Saturday (7/10) AM and had one episode of NBNB emesis associated with the chest pain. When he woke up later that morning he felt improved until 10-12 AM he developed mild chest pain again which he took Tums for. He also tried Motrin which did not help his pain at all. On the morning of admission (7/11), he woke up at 6-7 AM with upper right back pain, dyspnea, and nausea along with the persistent chest pain which prompted him to present to MFSH. He does endorse mild sore throat but denies any fevers, recent sick contacts, known COVID-19 exposure or previous history of COVID-19. There is a family history of cardiac disease including a fatal MI in his father. His mother''s family also has a history of heart disease and both sides have a history of high cholesterol. He did add Whey Protein recently to his diet to for muscle building, but he DENIES any drug, alcohol, tobacco, vaping, marijuana, THC use. He does not play any sports regularly. He also denies any recent bug/tick bites or rashes.


VAERS ID: 1464740 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-30
Onset:2021-07-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Guillain-Barre syndrome, Headache, Pyrexia, Rhinorrhoea
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: migraine relief med, 2 allergy pills, inhaler, breathing treatments for preexisting conditions, tylenol occas.
Current Illness: denies any in that time span
Preexisting Conditions: s) if I get sick usually respiratory problems; migraines
Allergies: Benzolyne
Diagnostic Lab Data: none so far
CDC Split Type:

Write-up: 1 week after vaccine symptoms began of fever, runny nose, headache, and diarrhea; currently diarrhea persists and runny nose, and worried about Guillian Barre syndrome, very tired. Trying to stay hydrated, went over 20 times (diarrhea today). Saw Dr on 7/9/21 and called for another appt. today and they instructed her to call here. Encouraged her to get in and see Dr again asap for ongoing diarrhea symptom.


VAERS ID: 1464766 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / UNK LA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: diclofenac, pristiq
Current Illness: none
Preexisting Conditions: depression/anxiety
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: no adverse reaction; just given (mistakenly) to an individual that was not 18 at time of vaccine


VAERS ID: 1464781 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dysgeusia, Sensation of foreign body, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: LAYTEX NEOMYCIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was very worried before she even received her dose as she has a serious Latex allergy. She even brought her own epipen and boxes of latex free gloves for staff to use. After waiting 30 minutes, pt waved down a medical assistant who was walking by and informed him she started to taste metal in her mouth and felt a lump in her throat that wasn''t there previously. Patient was very calm and alert. I took her vitals which were normal. As time went on and we were reviewing pt''s medical history (maybe 5 min), pt said her tongue started to feel like it was swelling and she started to feel very slightly dizzy. I told her we should probably call medical service so they can evaluate her further and see if she needs epi. She agreed. Medical service was called they examined pt, and afterward, decided to schedule her downstairs where they wheeled pt down in a wheelchair. She was able to walk and sit in the wheelchair under her own power. She was assessed and observed. No intervention was required.


VAERS ID: 1465097 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patient was vaccinated without meeting the age requirement of 12 years old due to language barrier.


VAERS ID: 1465134 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:
CDC Split Type:

Write-up: Patient was vaccinated before reaching age of eligibility (12) due to language barrier.


VAERS ID: 1465136 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-05
Onset:2021-07-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cardiac monitoring, Electrocardiogram, Palpitations, X-ray
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Junel, prenatal vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin, Percocet
Diagnostic Lab Data: I went to the emergency room on July 12, they ran and EKG, x ray, blood work, and gave me a heart monitor to wear for the next 2 days. I am to follow up with a cardiologist.
CDC Split Type:

Write-up: Heart palpitations started on July 7, 2021 and have persisted since. I went to the emergency room after visiting my primary care doctor?s office. I left with a heart monitor.


VAERS ID: 1465391 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

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

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

Write-up: Patient received Janssen vaccine. Patient did not disclose during screening and completion of consent form that Moderna COVID-19 vaccine had previously been received. During immunization record entry in ALERT, Immunization database, it was revealed that patient had previously received 2 doses of Moderna. - 04/21/2021 Moderna Lot: 047B21A - 06/04/2021 Moderna Lot: 034C21A Provider on Duty (POD) r contacted patient 24 hours post vaccination for follow-up. Patient reported feeling well with no side affects. Patient disclosed rationale for receiving 3rd COVID-19 vaccination as fear of the Delta variant of the COVID-19 virus, lifting of the mandate on mask wearing, and wanting maximum protection against COVID-19 infection.


VAERS ID: 1465673 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-07
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Pain in extremity, Pyrexia
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210719140

Write-up: ARM PAIN; HUGE HEADACHE; MINI FEVER; This spontaneous report received from a patient . The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 07-JUL-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 07-JUL-2021, the subject experienced arm pain. On 07-JUL-2021, the subject experienced huge headache. On 07-JUL-2021, the subject experienced mini fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from arm pain, huge headache, and mini fever. This report was non-serious.


VAERS ID: 1466241 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-07
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2076A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Fall, Head injury, Headache, Hyperventilation, Hypotension, Joint injury, Laboratory test, Limb injury, Nodule, Speech disorder, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210707; Test Name: Blood pressure; Result Unstructured Data: Decreased; Test Date: 20210707; Test Name: Laboratory test; Result Unstructured Data: not reported
CDC Split Type: USJNJFOC20210718537

Write-up: SYNCOPE/COLLAPSED; FELL DOWN; TREMBLING; HYPERVENTILATED; BLOOD PRESSURE WAS VERY DOWN; COULD NOT TALK; HIT HEAD; HIT HAND; HIT ELBOW; BUMP ON HEAD, ELBOW, AND HAND; HEADACHE; This spontaneous report received from a patient concerned a 61 year old Hispanic or Latino female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 2076A21A, and expiry: unknown) dose was not reported, frequency 1 total, administered on 07-JUL-2021 for prophylactic vaccination on left arm. No concomitant medications were reported. On 07-JUL-2021, after receiving vaccine, the patient felt dizzy and could not talk. The patient fell down and hit her head, hand, and elbow. Paramedics were called to help the patient and she was taken to emergency room (ER). The patient was informed that her blood pressure was very down, she was hyperventilated and was trembling. On the same day, the patient felt fine and experienced headache after going home and noted bump on her head, hand, and elbow because of the fall. The patient was diagnosed with syncope/collapsed. Laboratory data included: Blood pressure (NR: not provided) Decreased, and Laboratory test (NR: not provided) not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from syncope/collapsed, trembling, hyperventilated, blood pressure was very down, and could not talk, and the outcome of fell down, hit head, hit hand, hit elbow, headache and bump on head, elbow, and hand was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0:- 20210718537- covid-19 vaccine ad26.cov2.s-syncope/collapsed. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1466242 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-07-07
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210707; Test Name: PCR; Result Unstructured Data: Covid 19 positive
CDC Split Type: USJNJFOC20210718595

Write-up: CONFIRMED CLINICAL VACCINATION FAILURE; CONFIRMED COVID-19 INFECTION; This spontaneous report received from a patient concerned a 62 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, and expiry: unknown) dose was not reported, 1 total administered on 27-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 07-JUL-2021, the patient had confirmed covid-19 infection. On an unspecified date, the patient had confirmed clinical vaccination failure. Laboratory data (dates unspecified) included: PCR (Polymerase Chain Reaction) (Result: Covid 19 positive). The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from confirmed covid-19 infection, and the outcome of confirmed clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0-20210718595-covid-19 vaccine ad26.cov2.s-Confirmed Clinical Vaccination Failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.


VAERS ID: 1466465 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrocortisone Ointment Elecon Ointment
Current Illness: None
Preexisting Conditions: Seasonal and food allergies. Mild mitral valve regurgitation and mild peripheral pulmonic stenosis.
Allergies: Codeine
Diagnostic Lab Data: Neurological assessment by urgent care doctor.
CDC Split Type:

Write-up: Left hand pain, tingling and numbness for last 5 days following injection. After injection left arm was painful from injection site to hand. Arm pain resolved 2 full days later, but hand pain remains.


VAERS ID: 1466500 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-04-06
Onset:2021-07-07
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms
SMQs:, Dystonia (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: Insulin, Lisinopril
Current Illness: Arrhythmia, M?ni?re''s disease
Preexisting Conditions: Diabetes, High Blood Pressure
Allergies: Poison Ivy, Poison Sumac, Peanuts, Sulfa Drugs,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe muscle spasms in the lower extremities lasting at least 3 to 5 minutes.


VAERS ID: 1466569 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 20MG, Spironlactone 25MG, Vitamins D, C, Zink
Current Illness: none
Preexisting Conditions: low level high blood pressure (117/80)
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling (size of a large grape), inflammation, soreness of the Supraclavicular lymph nodes on the left side of neck.


VAERS ID: 1466643 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / UNK LA / IM

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

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

Write-up: silver dollar size whelp at point of injection raised about 1/16 of an inch with bright redness throughout whelp. Physician ordered antibiotics (unknown) to cover risk of cellulitis.


VAERS ID: 1466679 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Maternal exposure during pregnancy, Product administered to patient of inappropriate age
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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: Aspirin- low 81mg ( 1 tab by mouth daily) Prenatal plus 27 - 1mg ( Prenatal vit-Fe-Fumarate-Fa) 1 tab by mouth daily
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pregnant pt with a due date of 10/26/21, came to clinic for an ob ck, wanting Moderna vaccine, pt will be tuning 18 yrs old in less than 7 days of her visit, Provider aware, vaccine approved to give, pt tolerated vaccine well, no problems with vaccine. Pt has Hx of elevated antibody titers in pregnancy, per PCI no complications from this, is at an increase risk for preeclampsia, pt taking low dose aspirin per PCI, no other complications or health concerns with pt


VAERS ID: 1466719 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-24
Onset:2021-07-07
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Gait inability, Headache, Musculoskeletal stiffness, Pain, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient said that he experienced extreme dizziness. When he stood up he had a headache and could not walk. Patient stated that his hand locked up and it was painful to move. He went to bed and when he woke up he was fine. Patient stated that this happened 44 days after taking the vaccination. Patient stated that he started this was a one time occurrence and that it happened around 8pm.


VAERS ID: 1466746 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

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

Write-up: The Janssen vaccine was given to the patient. Patient previously received 1 dose of the Pfizer vaccine on April 23rd, 2021. On follow-up with patient, no adverse reactions were noted from the Janssen vaccine.


VAERS ID: 1466828 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Deafness unilateral, Sudden hearing loss
SMQs:, Hearing impairment (narrow)

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

Write-up: sudden loss of hearing in left ear (same side of injection site)


VAERS ID: 1466857 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-20
Onset:2021-07-07
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1686 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: COVID-19 test
CDC Split Type:

Write-up: Tested positive for COVID-19 on 7/10/2021, had symptom onset on 7/7/2021. Was exposed to positive COVID-19 family members on 7/2/2021.


VAERS ID: 1466882 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Hypersensitivity, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient had vaccine Tuesday 7/6 around 6pm. Rash present on arm, neck and face Wednesday night. Patient visited emergency room Friday 7/9 because rash was still present. Emergency room diagnosis was Hypersensitivity Reaction. Was prescribed Benadryl 50mg and Prednisone 50mg.


VAERS ID: 1466893 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-07-05
Onset:2021-07-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO217 / 1 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Induration, Rash erythematous, Rash pruritic, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Allergy to Celexa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red spot with hard lump under surface slightly swollen started itching on 7-12-2021


VAERS ID: 1466895 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-06-24
Onset:2021-07-07
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anticoagulant therapy, Confusional state, Dysarthria, Facial paralysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diagnosed in medical record noted 6/17/2021 HEMIPLEGIA AND HEMIPARESIS FOLLOWING CEREBRAL INFARCTION AFFECTING LEFT NON-DOMINANT SIDE.. Also noted in nurses notes patient admitted with a history of CVA..
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: new onset of R-sided facial drooping, slurred speech, and confusion. VS: 98.7, 120 (apical), 22, 90/68, pulse ox 85% on room air. She was medicated with routine ASA and PRN Clonazepam. Pulse ox improved to 90%. . New orders received to send to ER via 911 for eval.


VAERS ID: 1466909 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Medium


VAERS ID: 1466982 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 UN / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1466995 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1467008 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1467091 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C / 2 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1467116 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling hot, Lethargy, Loss of consciousness, Pallor, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: No.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: The patient, 13 y/o female, presented to clinic for the second dose at approximately 9:00 AM on 7/7/2021. The patient denied contraindications to vaccination and reported that she experienced no adverse effects with the first dose of vaccine that was administered 3-weeks prior. The vaccine was administered by the public heath nurse to the patients left deltoid and the patient tolerated the injection well. After vaccination, the patient returned to the waiting area to sit with her mother for the 15 minute observation period. Approximately 5-10 minutes later, the patient''s mother called for help and reported, along with front desk staff, the the patient started convulsing for a few seconds and then lost consciousness. At this point, front desk staff contacted EMS and I arrived at the side of the patient. The patient was pale and lethargic. She had no visible swelling or difficulty breathing. She reported feeling extremely hot and appeared to struggle to stay conscious. The patient responded accurately when asked her name and date of birth. The patient was given water and placed in the supine position. EMS arrived and transported the patient to a local hospital for evaluation. The patient''s father was contacted on 7/8/2021 and he reported that the patient spent a number of hours in the hospital and that medical staff did not believe that she had a seizure and that the most likely etiology of her symptoms was vasovagal syncope. He reported that the patient was starting to feel better and was resting in bed. He was instructed to contact the health department with any questions/concerns and to report any additional side effects.


VAERS ID: 1467227 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, Peripheral coldness
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Omega 3 Fish Oil Women''s multivitamin Vitamin C 500mg
Current Illness: Stomach issues
Preexisting Conditions:
Allergies: Yellowjackets Honey Bee
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: Numbing and tingling feeling in left hand My hand felt very cold Pins and needles feeling in my left hand for 90 minutes


VAERS ID: 1467289 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue
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:
Current Illness:
Preexisting Conditions:
Allergies: Do have allergies to food, animals, environmental
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme exhaustion tiredness


VAERS ID: 1467323 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Skin burning sensation
SMQs:, Severe cutaneous adverse reactions (broad), Peripheral neuropathy (broad), Hypersensitivity (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: blister and burned skin in the arm


VAERS ID: 1467529 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Dyspnoea, Oxygen saturation decreased
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (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: Lorazepam, Hydroxyzine
Current Illness: UNK
Preexisting Conditions: UNK
Allergies: UNK
Diagnostic Lab Data: none
CDC Split Type:

Write-up: NA from Rehab called RN (on her cell phone) on 7/9/21 to report this patient had an AE 1.5 hours after receiving her Pfizer COVIC vaccine. Patient had SOB and increased anxiety. Her 02 sats dropped in to the 80s. Her MD was alerted and he ordered O2 at 2 liters, benedryl and constant O2 monitoring. Pt was given her usual Lorazapam and Hydroxazine for anxiety and appeared increasingly anxious. Pt. was monitored continuously until symptoms subsided on 7/10/21. She was then back to baseline. RN followed up with facility and reported this AE on the website.


VAERS ID: 1468219 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: 2nd dose pfizer vaccine was given to patient on 07/07/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468355 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

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

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

Write-up: 2nd dose pfizer vaccine was given to patient on 07/06/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468359 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: 2nd dose pfizer vaccine was given to patient on 07/07/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468362 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: 2nd dose pfizer vaccine was given to patient on 07/07/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468368 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: 1st dose pfizer vaccine was given to patient on 07/06/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468377 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: 1st dose pfizer vaccine was given to patient on 07/07/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468379 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 - / IM

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

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

Write-up: 1st dose pfizer vaccine was given to patient on 07/07/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468974 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paralysis, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

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

Write-up: blurred vision, paralysis all over body. Time of occurrence was about 12:30 am 7/13/21. No treatment has been given since vaccine. Has had cuts in ligament on ankle (work related injury) the day before covid shot.


VAERS ID: 1469650 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-07-07
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210725210

Write-up: QUARTER SIZE LUMP AT INJECTION SITE; SWELLING AT INJECTION SITE (ABOUT A DIAMETER OF BASEBALL); This spontaneous report received from a patient concerned a 64 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821286 expiry: 06-SEP-2021) dose was not reported, administered on 06-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 07-JUL-2021, the subject experienced quarter size lump at injection site. On 07-JUL-2021, the subject experienced swelling at injection site (about a diameter of baseball). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from swelling at injection site (about a diameter if baseball) on JUL-2021, and was recovering from quarter size lump at injection site. This report was non-serious.


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