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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 461 out of 10,317

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VAERS ID: 1909713 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-22
Onset:2021-11-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acyclovir
Current Illness: herpes outbreak-HSV2
Preexisting Conditions: HSV 2
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen and painful lymphnode in right arm and right groin area-began on day two post vaccination and lasted four full days


VAERS ID: 1909727 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-11-24
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK LA / IM

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

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

Write-up: Labs were unremarkable except for positive COVID-19 test. Chest X-ray was negative for findings of COVID pneumonia, he did not have any hypoxia. Symptom onset date is unclear with positive SARS-CoV-2 testing on 11/24/2021. He had been in contact with known COVID-19 positive individual(s) prior to being hospitalized.


VAERS ID: 1909762 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-11-24
   Days after vaccination:279
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Malaise, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: evaluation and management of symptomatic COVID-19 infection with acute hypoxic respiratory failure. Symptom onset occurred on 11/24/21 with positive SARS-CoV-2 testing on 11/24/21. He had not been in contact with known COVID-19 positive individual(s) prior to being hospitalized.


VAERS ID: 1909768 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-11-24
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK LA / IM

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

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

Write-up: Labs were unremarkable except for positive COVID-19 test. Chest X-ray was negative for findings of COVID pneumonia, he did not have any hypoxia. Symptom onset date is unclear with positive SARS-CoV-2 testing on 11/24/2021. He had been in contact with known COVID-19 positive individual(s) prior to being hospitalized.


VAERS ID: 1909872 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-25
Onset:2021-11-24
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac stress test, Chest X-ray, Chest pain, Computerised tomogram thorax, Echocardiogram, Electrocardiogram, Fibrin D dimer, Pericarditis, Ultrasound scan
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: flonase 1 spray Both nartes, daily prn, alfuzosin 10mg q 24, Multivitamin 1xdaily
Current Illness: Unknown
Preexisting Conditions: Benign prostatic hyperplasia Frequent PVCs Kyphosis Nocturnal hypoxia Prediabetes
Allergies: NKA
Diagnostic Lab Data: 11/23/21- 11/24/21 CT chest, EKG, Chest Xray, NM stress test, 2D ECHO, DDimer 11/29/21-CT chest, EKG, Chest Xray Ultrasound, 2D ECHO
CDC Split Type:

Write-up: Patient presented 11/23/21, 1 month after booster shot, with chest pain, then again 11/29/21- found to be Pericarditis


VAERS ID: 1909879 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Administered the Pediatric dose when should have received over 12 dose


VAERS ID: 1909890 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Peds dose of pfizer given instead of 12+ dose


VAERS ID: 1909960 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Gait inability
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Headache and tired. 80 yrs old, Vac date 4/4/2021
Other Medications: Lovastatin, Gabapentin, Aspirin, Sleep-Aid, Vyzilta (eye drops), Rhopressa (eye drops), Vitamin C.
Current Illness: Osteoarthritis, glaucoma
Preexisting Conditions: Osteoarthritis, glaucoma
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe burning sensation in feet near toes, pain in knees, pain in hip, pain in shoulders. Could not walk. Symptoms were nearly gone one day later.


VAERS ID: 1909994 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Muscle twitching, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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 known
Preexisting Conditions: Behavioral tics - self limited and resolved. No diagnosed Tic Disorder
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle tremors in left arm and now in both arms - twitching intermittently when trying to hold still. Started after vaccine given. H/o motor tics in past but these resolved.


VAERS ID: 1910011 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure decreased, Chills, Headache, Impaired work ability, Influenza like illness, Oxygen saturation decreased, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad)

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

Write-up: resting heartrate was between 95 and 120 beats per minute with my blood pressure dropping to 90/50 with O2 saturation of 74%, along with flu like symptoms including fever of 102, chills, aches and a horrible headache. I experienced this for 2 days one of which I had to call in sick to work(Wednesday) off Thursday through Sunday.


VAERS ID: 1910461 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation, No adverse event, Syringe issue
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: Vanish point 1ml 1" syringe leaked upon pushing on plunger and vaccine liquid squirted onto the outside of recipient arm rather than being injected IM. Proper dose was re-administered with a new syringe. No adverse event occurred.


VAERS ID: 1912136 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-11-13
Onset:2021-11-24
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Rash, Rash papular, Rash pruritic
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: Following patients 2nd Moderna COVID-19 vaccine , he experienced a similar moving, itchy rash that lasted 3-4 days. Patient wa
Other Medications: Claritin
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented with an itchy rash on chest and shoulders about 2 weeks post vaccinations (booster dose). The skin at the rash appears raised. Rash has traveled access his body affecting his ankles, calves, neck, forearms, buttocks, shoulders and chest. The rash has not subsided to date. Antihistamines temporarily alleviate itching.


VAERS ID: 1912148 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Gait disturbance, Joint stiffness, Pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hytrin 5mg hs Zegerid 40/1100 bif Servant discus bid Flovent discus bid Prometrium 100 mg hs Evamist 2 sprays hs Miralax 17 g hs
Current Illness: None
Preexisting Conditions: Intrinsic asthma Interstitial cystitis Lichen planus Dry eye Ibs
Allergies: Sulfa ..penicillin. Donnatol..ditropan..iodine .keflex..donutamine Cinobac..clindamycin..bactrim..macrobid..macrofantin..Venetian violet...atropine..anticholenergics..antispadmodics..avelox..tobradex. Propriacaine..sulfites
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Widespread joint pain and stiffness. Presently Joint tenderness. Difficult walking..pain


VAERS ID: 1912365 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Conjunctivitis, Ear pain, Influenza like illness, Nasal congestion, Neck pain, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, Throat irritation, Tinnitus
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hearing impairment (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), Arthritis (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: Yes
Current Illness: No
Preexisting Conditions: CLL
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Mild Flu like symptoms, chest congestion, pink eye like symptoms, runny/congestion of the nose, sore/scratchy throat starting approximately 24-36 hours after running for 7days. Now neck pains then right ear ache/tinnitus


VAERS ID: 1912367 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 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? 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: 1912368 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 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? 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: 1912369 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 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? 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: 1912373 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 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? 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: 1912398 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 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? 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: 1912611 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-02
Onset:2021-11-24
   Days after vaccination:267
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1912620 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac imaging procedure abnormal, Chest pain, Echocardiogram normal, Ejection fraction, Ejection fraction normal, Electrocardiogram normal, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity
Allergies: NKDA
Diagnostic Lab Data: Elevated troponin (peak high sensitivity troponin T 349). Normal EKG and echocardiogram (normal EF). He had a cardiac MRI with small area of inflammation on delayed enhancement imaging, consistent with myocarditis. LVEF 71% on cardiac MRI.
CDC Split Type:

Write-up: Patient developed chest pain 11/24/21. On 11/27/21, he presented to Hospital and was noted to have elevated troponin levels. He was then transferred to hospital.


VAERS ID: 1912658 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 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? 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: 1912661 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 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? 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: 1912673 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 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? 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: 1912685 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-12
Onset:2021-11-24
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Pyrexia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PROLIA, CALCIUM, ASPIRIN
Current Illness:
Preexisting Conditions: FIBROMYALGIA
Allergies: BACTRIM
Diagnostic Lab Data: POSITIVE COIVD AFTER FULLY VACCINATED
CDC Split Type:

Write-up: COUGH, FEVER


VAERS ID: 1912692 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-11-24
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 RA / IM

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

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

Write-up: positive covid test


VAERS ID: 1912696 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 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? 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: 1912700 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-11-24
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 LA / IM

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

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

Write-up: positive covid test


VAERS ID: 1912703 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-11-24
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / IM

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

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

Write-up: positive covid test


VAERS ID: 1912718 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 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? 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: 1912723 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 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? 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: 1912728 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 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? 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: 1912755 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 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? 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: 1912760 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 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? 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: 1912791 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-01
Onset:2021-11-24
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dysuria, Headache, Lethargy, Pollakiuria, Urinary tract infection, Urine analysis
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: I was taking a multivitamin (occasionally), pre/probiotics (variety of powdered vegetables), B-Complex, Magnesium, Calcium, digestive enzymes and Zinc.
Current Illness: I was not experiencing any illness at the time.
Preexisting Conditions: I have skin cancer.
Allergies: I am allergic to ampicillin, meloxicam and latex (band-aid brand).
Diagnostic Lab Data: I had a urinalysis done. It was noted that I had a UTI.
CDC Split Type: vsafe

Write-up: After receiving my third dose, I felt a pinch of pain while urinating. I used to get those years ago (haven''t had a UTI for 3-4 years), but I went to urgent care and was told that I had a UTI. There was frequency of urination and a little bit of urine. I was given cipro. I also felt lethargic, anxious and had headaches. I am still experiencing a bit of pain even though I have completed my medication.


VAERS ID: 1912796 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3303080 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood potassium decreased, Dizziness, Hypokalaemia, Metabolic function test, Nausea, Tachycardia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: CMP (potassium- 2.3) 11/30/2021.
CDC Split Type:

Write-up: Severe tachycardia (heart rate 190), lightheadedness and nausea. In just a few minutes arrived at ED: hypokalemia; received 40mEq oral potassium and 20mEq IV potassium.


VAERS ID: 1912802 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-14
Onset:2021-11-24
   Days after vaccination:283
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Diarrhoea, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantoprazole, Ozempic, Metformin, Levothyroxine, Atorvastatin, Venlafaxine, Cetirizine, Norco, Fentanyl Patch
Current Illness:
Preexisting Conditions: B 12 DEFICIENCY, HYPERTENSION, MORBID OBESITY, DM TYPE 2
Allergies: Codeine, Lotensin, Pollens, Vioxx, Penicillin
Diagnostic Lab Data: POSITIVE COVID AFTER FULLY VACCINATED.
CDC Split Type:

Write-up: COUGH, SORE THROAT, FEVER, CHILLS, AND DIARRHEA.


VAERS ID: 1912844 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-20
Onset:2021-11-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Inflammation, Pain
SMQs:, 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: Nothing taken at the time of vaccination per patient
Current Illness: No - per patient
Preexisting Conditions: Allergic rhinitis, obstructive sleep apnea, podagra
Allergies: Cats (animal dander)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Left/arm shoulder pain. Evaluated here in the physician office. Physician started him on Medrol Dose Pak 11/30/21 for inflammatory reaction. .and pain.


VAERS ID: 1912876 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 RA / IM

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

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

Write-up: Generalized itchy and painful rash


VAERS ID: 1912935 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Underdose
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: Patient came in for 2nd dose of Pfizer. However RN erroneously gave patient an empty, pre-prepped with air in syringe (no vaccine yet). No adverse effects noted to the reporter. Patient was then correctly given vaccine dose.


VAERS ID: 1913014 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 5618 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Condition aggravated, Cough, Nasal congestion, Oropharyngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetirzine 1mg/ml
Current Illness: Sore throat cough nasal congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore throat, nasal congestion cough fever chill


VAERS ID: 1913016 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypersensitivity, Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Allergic Reaction, Unspecified, Initial Encounter. Swelling of lips. Treatment Children''s Zyrtec in AM, Benadryl at night.


VAERS ID: 1913068 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. P100352680 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT RECEIVED BOTH VACCINES ON 11-23-2021 AT APPROXIMATELY 2:35PM. PATIENT STATES, THEY PASSED OUT TWICE FOR NO REASON AND WANTED THIS TO BE REPORTED.


VAERS ID: 1913140 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Chills, Extra dose administered, Fatigue, Feeling abnormal, Gait disturbance, Headache, Hyperhidrosis, Injection site pain, Injection site swelling, Muscle spasms, Muscle tightness, Thirst, Vaccination site movement impairment
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I almost fainted after receiving the Prevnar 13 vaccine.
Other Medications: Simvastatin 40/day, Allegra 180 mg/day, Flovent 110 2puffs morning and night, Multi-Vitamin, Vitamin C, Omega 3 fatty acids, Calcium Citrate, Magnesium Citrate, Vitamin D, Co-enzyme 110, PreserVision Areds 2, Glucosamine & Chondroitin S
Current Illness: Chronic Fatigue Syndrome and Fibromyalgia
Preexisting Conditions: Chronic Fatigue Syndrome and Fibromyalgia
Allergies: Garlic, Night Shade vegetables, fermented foods, fragrances, tree pollens
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within minutes of receiving the vaccine, I felt a heavy wave of exhaustion. I became sweaty and very thirsty. My brain felt un-focused. The pharmacist brought me a bottle of water. I drank it, and left about 15 minutes later with my husband. When I got home, I developed a headache that began with tight muscles at the top of my neck. The head-ache got worse and worse. All my muscles began to feel very tight -- spasm like. My brain could not focus well. My heart felt like it was struggling to make the next beat. I had chills. I woke up the next morning feeling even worse. My muscles were so tense. My heart felt effected, like it could barely make the next beat. My muscles didn''t seem to function well. Walking took extra effort. Using my hands and arms took extra effort. By now the swelling and pain in my arm at the injection site was huge. This was way worse than anything I experienced with the first two Pfizer shots. The head-ache and tight muscles lasted 3 days. By the second day, my arm was so swollen and painful, I couldn''t lift it. The swelling had a diameter of about 7 inches, and it was raised almost an inch at the center where the needle had gone in. I began to apply cold packs to the sore, swollen arm, and tried to massage it around the edges where it wasn''t too painful to touch. I continued to do cold packs a couple times a day, and to massage. By day 4 and 5, I could lift the arm, and began to work the muscle a little to see if it would help to reduce the swelling. It is one week today since the vaccine, and my arm is almost completely back to normal. There remains just a small amount of swelling, no pain.


VAERS ID: 1913172 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-12
Onset:2021-11-24
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypersensitivity, Paraesthesia, Pruritus, Rash, Skin burning sensation, Skin irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Blisovi fe 24
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None have been ran yet. I am going to the dermatologist today and can report on this eventually once I have the answers.
CDC Split Type:

Write-up: My symptoms first began as a tingling, itching, and pins and needles sensation in my hands. It later progressed to my feet and all other random areas of my body. The itching sensation I felt was spontaneous and random. It didn?t appear to be caused from something I was repeatedly touching. I noticed it most frequently on areas of my body where my clothing was touching, or after doing some thing with my hands. I did not begin to experience a rash from itching until Sunday, 11/27. The itching began to turn into a rash, that was consistent with the pattern of my scratches. The more I itched, the more irritated my skin would become. The rashes eventually were accompanied with hives. My symptoms have been manageable with Benadryl, however I need to keep repeatedly taking Benadryl every four hours to keep the itching, burning sensation in my skin from returning. After doing extensive research online to try and figure out what the cause of this could be, it appears to be an allergic reaction. This condition is called dermatographia urticaria, also known as skin writing disease. I am concerned this is a potential delayed side effect to the vaccine. My fianc� and I both experienced the same symptoms on the same day as each other. We haven?t been able to pinpoint the cause of what is causing this allergic reaction as we have not changed any of the products we have been using recently. We do not currently have any other known allergies. And we would like to know if this is a potential side effect of the Moderna booster that has been reported. We have lived with this spontaneous, chronic condition now for about a week.


VAERS ID: 1913191 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 5 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: Synthroid, 125 mcg, s.i.d. Magnesium oxide 1 gm, b.i.d.
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Client came to clinic to receive booster. He was screened by registration desk via system. Although there were several COVID vaccine listed for this patient, the registration staff only wrote down the first 2 Moderna doses, onto the form that goes to the vaccinator. The vaccinator reviewed the CDC screeing checklist as well as the information on any previous doses given to the vaccinator, and the patient did not inform the vaccinator that there were more that the 2 Moderna doses given. He was given a booster dose of Moderna. So in total, he had received the following: primary series of Moderna on 3/3/21 and 3/31/21, Janssen on 5/6/21, Janssen on 6/3/21, and then a Moderna booster dose on 11/24/2021. He did not have any adverse outcomes with this booster dose as of today which is 12/1/2021.


VAERS ID: 1913245 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-11-24
   Days after vaccination:256
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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


VAERS ID: 1913279 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-11-17
Onset:2021-11-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site nodule, Injection site pruritus, Skin discolouration
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Itchy knot at the injection site that started a week after receiving the vaccine. It lasted a few days and then went away, leaving discoloration on the skin.


VAERS ID: 1913294 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-11-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase normal, Basophil count decreased, Basophil percentage decreased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bicarbonate normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood magnesium increased, Blood phosphorus normal, Blood potassium normal, Blood pressure decreased, Blood sodium normal, Blood urea increased, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Condition aggravated, Confusional state, Cough, Creatinine renal clearance decreased, Dehydration, Dementia, Diarrhoea, Differential white blood cell count, Dyspnoea, Encephalopathy, Eosinophil count decreased, Eosinophil percentage decreased, Fibrin D dimer increased, Full blood count, Glomerular filtration rate normal, Haematocrit decreased, Haemoglobin decreased, Hypercapnia, Hypoxia, Immature granulocyte percentage increased, Lung opacity, Lymphocyte count, Lymphocyte percentage, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume increased, Mental status changes, Metabolic encephalopathy, Metabolic function test, Metabolic function test abnormal, Monocyte count, Monocyte percentage, Neutrophil count, Neutrophil percentage increased, Nucleated red cells, Parkinson's disease, Platelet count decreased, Procalcitonin, Protein total normal, Red blood cell count decreased, Red cell distribution width normal, Schizoaffective disorder, Sleep apnoea syndrome, Speech disorder, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (narrow), Pseudomembranous colitis (broad), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg Oral Every 6 hours PRN, Max of 3,000 mg in 24 hours from all sources Calcium Carbonate-Vitamin D 500-200 MG-UNIT 1 tablet Oral Daily Carvedilol 6.25 mg Oral 2 times daily with meals Cholecalciferol 125 mcg Oral Every
Current Illness: none
Preexisting Conditions: Pre-Existing Active Problems Diagnosis Date Noted POA ? Cervical myelopathy 10/14/2021 Unknown ? Urinary incontinence 10/14/2021 Unknown ? Hypothyroid 10/14/2021 Unknown ? Schizoaffective disorder 10/14/2021 Unknown ? Dementia 10/14/2021 Unknown ? Acute embolism and thrombosis of left popliteal vein 10/08/2021 Unknown ? Obesity, morbid 10/08/2021 Unknown ? Platelets decreased 10/08/2021 Unknown ? Multiple falls 10/06/2021 Unknown ? Recurrent falls 10/06/2021 Unknown ? Diverticulosis Unknown ? Essential hypertension, benign 06/14/2013 Unknown ? Iron deficiency anemia 06/14/2013 Unknown ? Psychiatric disorder 06/14/2013
Allergies: NKA
Diagnostic Lab Data: Comprehensive Metabolic Panel (CMP) (Abnormal) Collected: 11/27/21 1103 Order Status: Completed Specimen: Blood, Venous Updated: 11/27/21 1141 Sodium Level 139 134 - 146 mmol/L Potassium Level 4.2 3.4 - 5.0 mmol/L Chloride 102 98 - 112 mmol/L HCO3 28 21 - 29 mmol/L Anion Gap 9 9 - 18 mmol/L Glucose Level 98 70 - 99 mg/dL Blood Urea Nitrogen 21 High 8 - 20 mg/dL Creatinine 0.63 0.50 - 1.10 mg/dL MDRD eGFR $g60 $g=60 mL/min/1. CG eCrCl 85 mL/min/1.73 m2 Calcium Level Total 8.0 Low 8.6 - 10.4 mg/dL Protein Total 6.5 6.0 - 8.0 g/dL Albumin Level 2.4 Low 3.5 - 5.0 g/dL Bilirubin Total 0.3 0.2 - 1.0 mg/dL Alkaline Phosphatase 47 35 - 104 IU/L Alanine Aminotransferase 14 10 - 40 IU/L Aspartate Aminotransferase 23 10 - 40 IU/L C Reactive Protein (CRP), Blood Level (Abnormal) Collected: 11/27/21 1103 Order Status: Completed Specimen: Blood, Venous Updated: 11/27/21 1141 C-Reactive Protein 39.0 High <=5.0 mg/L D-Dimer (Abnormal) Collected: 11/27/21 1103 Order Status: Completed Specimen: Blood, Venous Updated: 11/27/21 1136 D-Dimer Quant 1,690 High 0 - 500 ng/mL FEU Complete Blood Count w/Differential (Abnormal) Collected: 11/27/21 1103 Order Status: Completed Specimen: Blood, Venous Updated: 11/27/21 1120 White Blood Cell 4.87 4.00 - 10.80 x10*3/uL Red Blood Cell 3.90 Low 4.20 - 5.40 x10*6/uL Hemoglobin 11.9 Low 12.0 - 16.0 g/dL Hematocrit 36.8 Low 37.0 - 47.0 % Mean Cell Volume 94.4 80.0 - 100.0 fL Mean Cell Hemoglobin 30.5 27.0 - 33.0 pg Mean Cell Hemoglobin Concentration 32.3 32.0 - 37.0 g/dL Red Cell Diameter Width 13.4 11.0 - 16.0 % NRBC Absolute Count 0.00 0.00 - 0.01 x10*3/uL NRBC Automated 0.0 0.0 - 0.1 %WBC Platelet 73 Low 140 - 400 x10*3/uL Mean Platelet Volume 10.5 7.4 - 11 fL Neutrophil Automated 70.1 35.0 - 80.0 % Immature Granulocyte Automated 1.6 High 0.0 - 0.6 % Lymphocyte Automated 20.7 20.0 - 50.0 % Monocytes Automated 7.2 2.0 - 12.0 % Eosinophil Automated 0.0 0.0 - 6.0 % Basophil Automated 0.4 0.0 - 2.0 % Neutrophil Absolute Count 3.41 1.80 - 7.80 x10*3/uL Immature Granulocyte Absolute Count 0.08 High 0.00 - 0.05 x10*3/uL Lymphocyte Absolute Count 1.01 1.00 - 4.00 x10*3/uL Monocyte Absolute Count 0.35 0.00 - 0.90 x10*3/uL Eosinophil Absolute Count 0.00 0.00 - 0.50 x10*3/uL Basophil Absolute Count 0.02 0.00 - 0.20 x10*3/uL Magnesium, Blood Level [354976504] (Normal) Collected: 11/26/21 1407 Order Status: Completed Specimen: Blood, Venous Updated: 11/26/21 1511 Magnesium Level 2.2 1.6 - 2.5 mg/dL Phosphorus, Blood Level [354976505] (Normal) Collected: 11/26/21 1407 Order Status: Completed Specimen: Blood, Venous Updated: 11/26/21 1511 Phosphorus Level 3.2 2.5 - 4.5 mg/dL
CDC Split Type:

Write-up: Hospitalized (11.25.21 - 11.29.21); COVID-19 positive (11.24.21); Fully vaccinated PLUS Booster - moderna Discharge Summary DO (Physician) ? ? General Medicine BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider: DO Admission Date: 11/25/2021 Discharge Date: Nov 29, 2021 Active Hospital Problems Diagnosis Date Noted POA ? Pneumonia due to COVID-19 virus 11/25/2021 Unknown Resolved Hospital Problems Diagnosis Date Noted Date Resolved POA ? Acute respiratory failure with hypoxia 11/29/2021 11/29/2021 Unknown ? Diarrhea due to COVID-19 11/29/2021 11/29/2021 Unknown ? Acute metabolic encephalopathy 11/29/2021 11/29/2021 Unknown Pre-Existing Active Problems Diagnosis Date Noted POA ? Cervical myelopathy 10/14/2021 Unknown ? Urinary incontinence 10/14/2021 Unknown ? Hypothyroid 10/14/2021 Unknown ? Schizoaffective disorder 10/14/2021 Unknown ? Dementia 10/14/2021 Unknown ? Acute embolism and thrombosis of left popliteal vein 10/08/2021 Unknown ? Obesity, morbid 10/08/2021 Unknown ? Platelets decreased 10/08/2021 Unknown ? Multiple falls 10/06/2021 Unknown ? Recurrent falls 10/06/2021 Unknown ? Diverticulosis Unknown ? Essential hypertension, benign 06/14/2013 Unknown ? Iron deficiency anemia 06/14/2013 Unknown ? Psychiatric disorder 06/14/2013 Unknown Discharge Disposition: skilled nursing facility Active Issues Requiring Follow-up: Resolved acute hypoxic respiratory failure due to COVID pneumonia. Supportive and symptomatic treatment. Out of isolation on 12/1/21. Resolved acute diarrhea due to COVID. PRN imodium. Acute metabolic encephalopathy. Resolved. Due to COVID and dehydration. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient is a 69 year old female with a past medical history of HTN, schizoaffective disorder, dementia, hypothyroidism and recent diagnosis of cervical myelopathy who presented from her LTC facility. She was found to be COVID positive on 11/22 at her facility. She had cough and SOB. She was sent to the ED due to worsening symptoms. In the ED, she was hypoxic requiring 3L NC. She was given fluids for soft bps due to dehydration. Chest xray showed B/L opacities that were consistent with COVID pneumonia. She was given IV Decadron. She was transferred to hospital for COVID pneumonia. She was started on Decadron and Remdesivir. Her hypoxia resolved. She was noted to have encephalopathy on her chronic dementia, but this resolved. She developed diarrhea due to COVID. This resolved. She was transferred back to her facility on 11/29/21. CONSULTS / RECOMMENDATION: Consult Orders (From admission, onward) None INPATIENT PROCEDURES: Surgery and Procedures None Non-surgical Procedures (From admission, onward) None BP 144/84 | Pulse 56 | Temp 36.5 �C (Oral) | Resp 24 | Ht 1.727 m | Wt 130.6 kg | SpO2 96% | BMI 43.78 kg/m� Physical Exam Constitutional: General: She is not in acute distress. Appearance: She is obese. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Pulmonary: Effort: No respiratory distress. Breath sounds: Normal breath sounds. No wheezing or rales. Abdominal: General: There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: Right lower leg: No edema. Left lower leg: No edema. Skin: General: Skin is warm and dry. Neurological: Mental Status: She is alert. Cranial Nerves: No cranial nerve deficit. Comments: Oriented times 2 to person and place H&P:: CHIEF COMPLAINT: Pneumonia due to COVID-19 virus Assessment/Plan ASSESSMENT / PLAN: Pneumonia due to Covid 19 virus Acute Respiratory Failure with hypoxia Vaccinated Covid positive on 11/22, symptom onset ~ 11/20 CXR w/ hazy bilateral opacities Procal 0.08 Currently requiring 3L NC, wean as tolerated (baseline RA) Decadron and Remdesivir Daily covid labs Tele, pulse ox Prone PRN Acute Encephalopathy Dementia Suspected Parkinsons per recent admission Schizoaffective disorder Worsened mentation likely 2/2 to above. Unclear baseline She had mild hypercapnia at Hospital. Likely has undiagnosed OSA in setting obesity. Consider CPAP/BiPAP if increasing lethargy. Continue home psych meds Recently diagnosed Cervical Myelopathy Per D/C summary on 10/14, was deemed poor surgical candidate and was supposed to follow up w/ Orthospine in 2 weeks regarding further management. Unclear if she ever followed up. PT/OT HTN Continue home anithypertensives Hx of SIADH Stable Continue salt tabs ?Hx of chronic Diastolic CHF No Echo on file On 20 mg lasix daily, will continue Hypothyroidism Continue synthroid Hx of DVT No longer on anticoagulation DVT PPX - lovenox FULL CODE - Per prior admission. Patient does not have capacity to answer this question and unable to reach court appointed guardian over the phone Discussed with Dr. whose insight is reflected above Subjective HISTORY OF PRESENT ILLNESS: Patient is a 69 y.o. female with PMH of essential hypertension, schizoaffective disorder, dementia, hypothyroidism, and recent admission for recurrent falls thought to be secondary to cervical myopathy but a poor surgical candidate. There was also suspected component of UTI, LLE cellulitis, parkinsonism, and polypharmacy contributing. She has court appointed legal guardian and currently resides at nursing facility. Patient unable to reliably provide any history and unable to reach guardian over the phone. History is severely limited and obtained primarily through chart review. Patient was reportedly more confused than baseline and was found to be COVID positive at nursing facility on 11/22. She was reportedly having cough and shortness of breath. Patient denies shortness of breath, chest pain, fevers or chills at this time. In the emergency department she was hypoxic requiring 3 L nasal cannula. Blood pressure was initially soft for which she was given 1 L normal saline bolus. Laboratory workup was fairly unremarkable. Chest x-ray did show 80 bilateral opacities that could be consistent with COVID pneumonia. She was given IV Decadron and transferred to hospital for further management. Due to bed availability transfer was delayed for over 24 hours. Patient Active Problem List Diagnosis ? Diverticulosis ? Essential hypertension, benign ? Iron deficiency anemia ? Psychiatric disorder ? Multiple falls ? Recurrent falls ? Acute embolism and thrombosis of left popliteal vein (HCC) ? Acute hypoxemic respiratory failure (HCC) ? Obesity, morbid (HCC) ? Platelets decreased (HCC) ? Cervical myelopathy (HCC) ? Urinary incontinence ? Hypothyroid ? Schizoaffective disorder (HCC) ? Dementia (HCC) ? Pneumonia due to COVID-19 virus Past medical, surgical, family and social history reviewed Objective OBJECTIVE: BP 153/70 | Pulse 73 | Temp 36.5 �C (Oral) | Resp 24 | Ht 1.727 m | Wt 130.6 kg | SpO2 98% | BMI 43.78 kg/m� Physical Exam Vitals reviewed. Constitutional: General: She is not in acute distress. Appearance: Normal appearance. She is well-developed. She is obese. HENT: Head: Normocephalic and atraumatic. Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: Oropharynx is clear. Eyes: Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Neck: Vascular: No JVD. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds. No murmur heard. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: Normal breath sounds. No wheezing. Abdominal: General: Bowel sounds are normal. There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: General: No tenderness. Normal range of motion. Cervical back: Neck supple. Skin: General: Skin is warm and dry. Findings: No erythema. Neurological: General: No focal deficit present. Mental Status: She is alert. Comments: Patient is oriented to person, thinks she is at Hospital. She knows it is thanksgiving but is unable to give me the actual date. Does not know why she is here. Can follow simple commands and answer simple questions but answers are often inappropriate Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior is cooperative.


VAERS ID: 1913334 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-16
Onset:2021-11-24
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Intensive care, Pleural effusion, Renal impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

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

Write-up: Right-sided pleural effusion, PE and decreasing renal function resulting in ICU admission.


VAERS ID: 1913435 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-25
Onset:2021-11-24
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Blood test, Cholecystitis, Cholelithiasis, Computerised tomogram, Flank pain, Muscle spasms, Nephrolithiasis, Pain, Urine analysis
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Gallstone related 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: I WAS TAKING CELECOXIB 200MG, HYDROCHLORIDE THIAZIDE 25MG (HCT), TOROVASTATIN 20MG, TALAPURINOL 300MG, ASPRIN 81MG, PRILOSEC 200MG, ALPHABASE W/O IRON
Current Illness: NO
Preexisting Conditions: KIDNEY STONES, GALLSTONES, BACK PAIN, HIGH BP, HIGH CHOLESTEROL
Allergies: NO
Diagnostic Lab Data: ER did a CT scan, bloodwork, urine work. kidney stone and gallstone and inflamed gallbladder
CDC Split Type: vsafe

Write-up: Very severe pain in my right flank, my right back, right where my right kidney is. I believed it was my 3rd episode with kidney stones. for the next 30 hours i took ibuprofen for 3 days 36 hours. and the pain was getting more and more severe. i called my medical group and they advised me to go to the ER. I went to the ER and they did bloodwork, urine work and a CT scan. And discovered yes i had a kidney stone and gallstone and an inflamed gallbladder. they gave me pain meds and released me. on this las Monday i-- I SAW MY PCP''S PARTNER AS A FOLLOW UP AFTER MY ER VISIT DR. - he scheduled me for an ultrasound of my gallbladder. and right now the pain is somewhat diminished but they think i have gallstones . MY PCP IS DR- HE WOULD KNOW ALL MY BACKGROUND INFO I still have spams in my right back that comes and goes and are sporadic.


VAERS ID: 1913437 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-16
Onset:2021-11-24
   Days after vaccination:281
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: COVID 19 positive post full vaccination; mild URI symptoms


VAERS ID: 1913447 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-16
Onset:2021-11-24
   Days after vaccination:281
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: COVID-19 positive after full vaccination; URI symptoms, fatigue


VAERS ID: 1913513 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-11-24
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Urinary tract infection, Urine analysis abnormal
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pramipexole 1.5mg 1xday Alendronate Sodium tablets 70mg 1xweek
Current Illness: none
Preexisting Conditions: I don''t want to add them.
Allergies: none
Diagnostic Lab Data: Urinalyses- found UTI (11/26/2021)
CDC Split Type: vsafe

Write-up: I had extreme fatigue. I went to the doctor on 11/26/2021. They said I had an urinary track infection. I was prescribed antibiotics for nitrofurantoin 100mg 2xday for 7 days.


VAERS ID: 1913619 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Flushing, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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:
Preexisting Conditions: PMH: Lichen slerosus et atrophicus of the vulva, Underweight, non-recurrent unilateral inguinal hernia w/ out obstruction or gangrene
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had a syncopal event immediately post vaccination. Pt was taken to med bay. Vitals: 12:44 100/60, 85, 100% -- $g 12:46 98/62, 88 -- $g 12:48 103/70 VSS Pt flushed but color improved when placed in lying position with legs elevated. Pt stable upon release. No S/S of distress. No swelling of the lips or tongue. Gait strong and steady. mother instructed to call 911 if pt has s/s respiratory distress.


VAERS ID: 1913638 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Extra dose administered, Fatigue, Pain in extremity, Product preparation issue
SMQs:, Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: Lesion of plantar nerve, predislocation syndrome of metatarsophalangeal joint, Hyperlipidemia, colon polyps, malignant neoplasm of female breast,
Allergies: non listed
Diagnostic Lab Data: We had patient stay in clinic for 45 minutes and see a medical provider in clinic for immediate symptom or side effect check. Patient was given information to contact the clinic for any SX. 11/30/2021 patient contacted clinic triage RN to tell us her symptoms of "...sore/discomfort in her arm, tired/lack of energy, and a few chills" has resolved over the weekend. she stated she was feeling well and would contact the clinic if anything changed.
CDC Split Type:

Write-up: Patient was given 0.3 ml of undiluted Pfizer COVID-19 vaccine for an appointment for her Booster dose. 1st dose 3/27/21 2nd dose 4/24/21


VAERS ID: 1913643 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Product administration 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: Pt accidently given 0.3mL of air instead of vaccine. Full pediatric dose given after. Pt stable and released from the vaccination site.


VAERS ID: 1913668 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-31
Onset:2021-11-24
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Eye pruritus
SMQs:, Anaphylactic reaction (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: ?Omega 3 1200 MG Capsule 1 capsule Orally Once a day ?Metamucil 48.57 % Powder as directed Orally ?Aspirin 81 MG Tablet Chewable 1 tablet Orally Once a day ?Estradiol 1 MG Tablet 1 tablet Orally 3 times a week ?Vitamin D3 1000
Current Illness: none
Preexisting Conditions: Graves'' disease . Hypothyroidism. Restless leg syndrome. Endometriosis. Menopause. Hypercholesterolemia. Depression. Gastritis. Vitamin D deficiency by labs at Rheumatolgists. Osteoporosis-hip fracture without trauma 8/13, On alendronate. consider drug holiday 8/18. Polymyalgia rheumatica- Iron deficiency. Echo-mild/mod TR 1/18.
Allergies: SULFA DRUGS: Allergy Diflucan: Allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: nonproductive cough resolved, itchy eyes. starting 11/24/21


VAERS ID: 1913669 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: After 2nd COVID vaccine dose (Pfizer/BioNtech, received in March 2021, 51 years of age at time of vaccination).
Other Medications: atorvastatin, losartan, diltiazem, pantoprazole, Vitamin D, Vitamin B12
Current Illness: None.
Preexisting Conditions: myocardial infarction (2015)
Allergies: Allergic to bee-sting.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Body ache (resolved in 24 hours), headache (resolved in 24 hours), mild fever (resolved in 24 hours).


VAERS ID: 1913705 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: None
Current Illness:
Preexisting Conditions: NO Significant PMH
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately post vaccination pt had dizziness and a syncopal event. Pt reported buzzing in his ears. Vitals: 15:20 (supine) 127/59, 68, 12, 100% -- $g 15:30 (sitting) 112/55, 78, 12, 100% Pt given water and s/s resolved. Advised pt to request next vaccination in the supine position. Pt stable and released from the vaccination site.


VAERS ID: 1913720 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Oropharyngeal pain, Respiratory tract congestion, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: 11/25/2021 COVID home test; neg. 11/26 Strep test; neg.
CDC Split Type: vsafe

Write-up: 11/23 vaccination administered; 11/24 onset of sore throat. Ongoing symptoms next few days. 11/26 Friday night it got worse, took her to urgent care. No temp. Cough. Congestion. Symptoms lasted every day since. Rinse with salt water to help, gargle. Cough medicine, over the counter. She missed school 11/30/2021. Lingering but not worse.


VAERS ID: 1913755 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: anastrozole 1 mg tablet AndroGel 20.25 mg/1.25 gram (1.62 %) transdermal gel pump Centrum Silver chlorhexidine gluconate 0.12 % mouthwash chromium 200 mcg capsule Take by oral route. Cinnamon Contour Next Test Strips USE 10 STRIPS EVERY DAY
Current Illness:
Preexisting Conditions: PMH: Type 2 Diabetes Mellitus without Complication Diabetic Peripheral Neuropathy Pure Hypercholesterolemia Smoker Obstructive Sleep Apnea of Adult Retinopathy Due to Diabetes Mellitus
Allergies: Allergies: PCN (chest pain/tightness 10yrs ago)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4mins post vaccination pt reported that w/ previous Pfizer vaccinations he had elevated BP lasting ~30mins. Pt was otherwise asymptomatic. Vitals: 16:19 173/84, 94, 20, 99% -- $g 16:22 172/91, 93, 20, 100% -- $g 16:25 154/78 -- $g 16:29 152/67, 90, 20, 100% -- $g 16:38 171/68 -- $g 16:50 143/64, 94, 20, 100% Pt released at 16:50 in stable condition. Pt walked to exit w/ slow steady gait.


VAERS ID: 1913802 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-11-16
Onset:2021-11-24
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Dizziness, Fatigue, Haematochezia, Headache, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lantus; Solostar; atorvastatin; lisinopril; pioglitazone; Januvia; aspirin
Current Illness: None
Preexisting Conditions: Diabetes; vertigo; knee surgery
Allergies: None
Diagnostic Lab Data: Cat scan
CDC Split Type: vsafe

Write-up: Headache on the 24th, blood in his stools 11/27/2021, dizziness, vomiting, fatigue, sore arms .


VAERS ID: 1913825 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Interchange of vaccine products
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medications: Apri 0.15-0.03mg tab PO daily Venlafaxine 75mg PO daily
Current Illness:
Preexisting Conditions: PMH: CHRONIC LOW BACK PAIN 05/14/2021 CERVICAL HIGH RISK HPV TEST POSITIVE 02/05/2021 GENERALIZED ANXIETY DISORDER 11/15/2017 FHX OF BREAST CANCER 08/29/2013 FHX OF DM 07/13/2012 MAJOR DEPRESSIVE DISORDER, RECURRENT EPISODE 10/19/2011
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt previously received Janssen COVID vaccine 5mins post vaccination pt reported dizziness. Vitals: 119/74, 82, 18 Pt stable and released from the vaccination site.


VAERS ID: 1914243 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Cough, Erythema, Hypertension, Muscle tightness, Myocarditis, Pain, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C Vitamin D B12 Zinc Multi Vitamin Zyertec
Current Illness: None
Preexisting Conditions: Fatty liver disease
Allergies: Gluten ,lactose, latex
Diagnostic Lab Data: 11/26/2021 11/28/2021
CDC Split Type:

Write-up: Swollen arm,redness,painful,severe itching.7�5 spread.tightness in neck and shoulders. Chest tightness, high blood pressure. Coughing.Diagnosed with myocarditis given steriod pack,itch pill,nausea meds,and two inhalers. It''s been 7 days and symptoms of chest tightening is still there and coughing.


VAERS ID: 1914375 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-12
Onset:2021-11-24
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

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

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

Write-up: 12 days after receiving the Moderna booster shot. Rashes started appearing through the top part of body. The rashes would come and go and would not stay on area. Two days after, rashes started to appear on lower parts as well. Rashes have seem to become bigger but they come and go.


VAERS ID: 1915961 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy (known allergies: Penicillin.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101670247

Write-up: This is a spontaneous report from a contactable consumer, the patient. A 57-year-old non-pregnant female patient received the third (booster) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FG3527) via an unspecified route of administration in the left arm on 24Nov2021 at 14:15 (at the age of 57-years-old) as a single dose for COVID-19 immunisation. Medical history included penicillin allergy. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within 4 weeks prior to the COVID-19 vaccine. Concomitant medications were not reported. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: ER8735) via an unspecified route of administration on 20Apr2021 (at the age of 56-years-old) and the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0173) via an unspecified route of administration in the left arm on 11May2021 (at the age of 56-years-old); both as single dose for COVID-19 immunisation. On 24Nov2021, the patient experienced severe fever each day since shot, chills, headaches, body aches and fatigue that prevented everyday activities. The events did not result in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. It was unknown whether any therapeutic measures were taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events severe fever each day since shot, chills, headaches, body aches and fatigue that prevented everyday activities were unknown at the time of this report.


VAERS ID: 1915962 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Immunisation, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (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: OMEPRAZOLE; SIMVASTATIN; LEVOTHYROXINE.
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101671152

Write-up: This is a spontaneous report from a contactable consumer, the patient. A 52-year-old non-pregnant female patient received the third (booster) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: 30145BA) via an unspecified route of administration in the left arm on 24Nov2021 at 09:45 (at the age of 52-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history. The patient had no known allergies. Concomitant medications included omeprazole (MANUFACTURER UNKNOWN), simvastatin (MANUFACTURER UNKNOWN) and levothyroxine (MANUFACTURER UNKNOWN); all for unspecified indications from unknown dates and unknown if ongoing. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: ER873) via an unspecified route of administration in the left arm on 04Apr2021 at 13:45 (at the age of 52-years-old) and the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0167) via an unspecified route of administration in the left arm on 29Apr2021 at 14:15 (at the age of 52-years-old) as a single dose for COVID-19 immunisation. On 25Nov2021 at 06:00, the patient experienced swollen and pain in the left armpit, close to the left breast. The events did not result in doctor or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events swollen and pain in the left armpit, close to the left breast was not resolved at the time of the report.


VAERS ID: 1915973 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Immunisation, Pain in extremity, Peripheral swelling, Pyrexia, Temperature regulation disorder, Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy (other_medications_in_two weeks: allergy pills); Blood pressure abnormal (other_medications_in_two weeks: blood pressure meds); Mitral valve prolapse (Mitro-valve prolapse); Sulfonamide allergy (Known allergies: Sulfa.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101677147

Write-up: This is a spontaneous report from a contactable consumer, the patient. A 54-year-old non-pregnant female patient received third (booster) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 24Nov2021 at 13:30 (at the age of 54-year-old) as a single dose for COVID-19 immunisation. Medical history included mitro-valve prolapse, blood pressure, sulfa allergy and unspecified allergy. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID-19 vaccine. Concomitant medications received within two weeks of vaccination included vitamins (unspecified) for unknown indication, unspecified blood pressure medications and allergy pills; all from unknown date and unknown if ongoing. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 31Mar2021 at 15:00 (at the age of 53-year-old) and the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 22Apr2021 at 15:00 (at the age of 53-year-old); both as single dose for COVID-19 immunisation. The patient experienced arm swollen and painful within minutes on 24Nov2021 at 13:45. The patient experienced fever, chills, inability of body to regulate temperature through 26Nov2021 (reported as Friday) evening. On 27Nov2021, (reported as Saturday), injection site and surrounding area was swollen, red and extremely itchy. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events fever, chills, inability of body to regulate temperature was resolved on 26Nov2021, while that of the events arm swollen and painful within minutes, injection site and surrounding area was swollen, red and extremely itchy was not resolved at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1915974 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Immunisation, Pain in extremity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: Other medical history: none; Known allergies: none.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101677154

Write-up: This is a spontaneous report from a contactable other healthcare professional, the patient. A 46-year-old non-pregnant female patient received the third dose (booster) of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FH8028) via intramuscular route of administration in the left arm on 24Nov2021 at 12:00 (at the age of 46-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history and no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient did not receive any concomitant medications. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EH9899) via intramuscular route of administration in the left arm on 05Jan2021 at 12:00 (at the age of 45-years-old) and also received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EL3248) via intramuscular route of administration in the left arm on 26Jan2021 at 12:00 (at the age of 45-years-old); both as a single dose for COVID-19 immunisation. On 24Nov2021 at 12:15, the patient experienced left arm pit pain and swelling. The patient could not raise arm without pain and could not sleep on it. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events left arm pit pain and swelling and can''t raise arm without pain. can''t sleep on it was not resolved at the time of this report.


VAERS ID: 1916077 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213021A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Influenza like illness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever of 103 started at 0100 on 11/24/2021 with headache and flue like symptoms. Symptoms continued until approx 12:00 pm on 11/24/2021. Fatigue and flue like symptoms continued throughout 11/24/2021. Other than fatigue, symptoms resolved as of 11/25/2021. All symptoms resolved as of 11/26/2021


VAERS ID: 1916080 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-17
Onset:2021-11-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03721A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D, Krill Oil, Vitamin C, hydrocortisone
Current Illness: None
Preexisting Conditions: Wolff-Parkinson-White Syndrome, psoriasis
Allergies: None
Diagnostic Lab Data: CT scan on 11/24 that showed inflamed/suggestion of appendicitis.
CDC Split Type:

Write-up: 2A on 11/24, severe pain started in abdomen. Wasn''t able to sleep much more and pain continually got worse. Visited doctor and was recommended to ER. Admitted into ER and CT scan later on 11/24 showed acute appendicitis. Had surgery around 8p on 11/24 to remove appendix. Recovery going well.


VAERS ID: 1916393 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-17
Onset:2021-11-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, Cardiac flutter, Cardioversion, Chest X-ray, Echocardiogram
SMQs:, Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Guillain-Barre syndrome (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity
Allergies: Norco
Diagnostic Lab Data: Echo Cardiogram, Chest X-Ray
CDC Split Type:

Write-up: Woke up at 3:30 AM 6.5 days after the 3rd Pfizer vaccine with my first ever occurrence of what was diagnosed as Paroxysmal Atrial Fibrillation. Symptoms were feeling of fluttering in the chest and mild weakness. Was given Cardizem IV and converted to normal sinus rhythm in the ER. Was admitted inpatient for observation and tests.


VAERS ID: 1916434 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 RA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Confusional state, Disorientation, Dyskinesia, Laboratory test, Magnetic resonance imaging, Nerve conduction studies
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Partial paralysis due to two strokes
Preexisting Conditions: Two strokes
Allergies: Bactrim, macrobyd, codine
Diagnostic Lab Data: After the first shot in January 2021, she was taken by ambulance to a Medical Center for a three day stay. As documented in the VAERS reports for that event, she had a multitude of tests completed. Including MRI, cat scan, nerve tests.
CDC Split Type:

Write-up: Same as following the first two shots. Approximately 10 hours after the shot, patient was mentally confused and disorientated. She was not able to control her leg movement to perform a simple transfer from one chair to her wheelchair. Just as before after the first and second shot, she was much more alert and able to control her legs after about fours waiting time.


VAERS ID: 1916435 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dysgeusia, Fatigue, Headache, Joint stiffness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Eosinophilic pneumonia (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fevers after 10 hours of getting shot and lasting up to 27 hours after getting shot with them getting up to 102.3 and 102.8. Joint stiffness and severe muscle aches. Headache for 2 days. Metal taste when eating for 1 full day after getting shot. Severe fatigue for 3 days.


VAERS ID: 1916552 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-10
Onset:2021-11-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Pain in extremity
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), 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: Multivitamins for people 50 plus and Vitamin D3 tablet.
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Penicillin and Amoxicillin, Spinach , Perfume.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swelling in both ankels and severe pain in bottom left foot in the middle.


VAERS ID: 1916559 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: Adderall XR, Duloxetine, Omeprazole 20mg, Flonase, Vitamin B Complex, Multivitamin
Current Illness: Migraine, received Moderna booster at the same time.
Preexisting Conditions: Migraine, ADHD, LPR
Allergies: Intolerance to visible egg in food. Allergic rash bacitracin.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The flu vaccine gave me bruises on my right arm. There''s still significant bruising 8 days after receiving the vaccine.


VAERS ID: 1916660 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Fatigue, Headache, Hypersensitivity, Malaise, Pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: bumex, aspirin, synthroid, cymbalta, lipitor, atenolol,
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, hypothyroidism
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient reported waking on 11/24/2021 approximately 0800 with severe fatigue/malaise, headache, body aches. Pt spouse later entered and stated pt appeared to be having allergic reaction. Pt spouse noticed welps on skin and generalized redness across face and chest. Pt took Benadryl 50mg PO and symptoms resolved. Pt states that on 11/25/2021, he felt better with minimal fatigue remaining.


VAERS ID: 1916686 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-19
Onset:2021-11-24
   Days after vaccination:309
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Obesity
Allergies: Latex, Penicillins, Sulfa Antibiotics
Diagnostic Lab Data: SARS-COV-2 by NAA detected SARS on 11/24/21
CDC Split Type:

Write-up: Pt received Moderna Vaccines on 01/19/2021 and 02/16/2021. Pt came to the ED on 11/24/21 with complaints of AMS and hypoxia. Pt required supplemental oxygen and was found to be COVID positive.


VAERS ID: 1916707 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-11-24
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Exposure to SARS-CoV-2, Hypoxia, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Pt received Pfizer vaccines on 03/01/21 and 03/22/21. Pt presented to the ED on 11/24/21 with complaints of SOB and hypoxia after being exposed to a spouse with COVID. Pt was found to be COVID positive on 11/24/21. Pt required BiPAP.


VAERS ID: 1916766 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-11-10
Onset:2021-11-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKOWN / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mobic, Omeprazole
Current Illness: enlarged lymphnode.
Preexisting Conditions: Amputated fifth digit, Trochlear Dysplasia. GERD
Allergies: nkda, nka
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Two weeks after the vaccine, a itchy rash would start to circulate around my body. It would come and go, and show up in different spots regularly. We initially thought the reaction was due to a dose of Doxycycline that I took one week prior, but a coworker was having the exact same issue one week later. I decided to report when that same coworker saw a dermatologist that said they have been seeing an increase in patients who have received their third dose get rashes all over the skin. It seems to be subsided with prescribed Hydroxyzine and Cetirizine.


VAERS ID: 1916822 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-05
Onset:2021-11-24
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Pt received Moderna Vaccines on 04/05/21 and 05/03/21. Pt presented to the ED on 11/24/21 with complaints of SOB and fatigue. Pt was found to be COVID positive. Pt required supplemental oxygen.


VAERS ID: 1916829 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-22
Onset:2021-11-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Urinary tract infection
SMQs:

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: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: UTI


VAERS ID: 1916858 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site inflammation, Injection site pain, Injection site pruritus, Injection site swelling, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Swelling and pain at injection site and down arm for 4 days. Raised reddened area that is slightly itchy at injecion site. Looks like inflammed bee sting


VAERS ID: 1916984 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-11-24
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anticoagulant therapy, Arteriosclerosis coronary artery, Asthenia, Brain natriuretic peptide increased, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray normal, Chronic left ventricular failure, Chronic obstructive pulmonary disease, Cough, Depression, Diarrhoea, Drug use disorder, Dyslipidaemia, Emphysema, Essential hypertension, Fatigue, Fibrin D dimer, Hyperglycaemia, Insulin-requiring type 2 diabetes mellitus, Rheumatoid arthritis, SARS-CoV-2 test positive, Sleep apnoea syndrome
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Drug abuse and dependence (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Depression (excl suicide and self injury) (narrow), Other ischaemic heart disease (narrow), Lipodystrophy (broad), Hypersensitivity (broad), Arthritis (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Accu-Chek Aviva Plus Blood Glucose Monitor Accu-Chek Aviva Plus Test Strips Accu-Chek Softclix Lancets acetaminophen (TYLENOL) 500 MG tablet albuterol (PROVENTIL, VENTOLIN, PROAIR) 108 (90 Base) MCG/ACT inhaler atorvastatin (LIPITOR) 40 MG
Current Illness:
Preexisting Conditions:
Allergies: Lisinopril Vasotec
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 11/29/2021-still admitted currently; COVID-19 positive 11/24/21; fully vaccinated ASSESSMENT Principal Problem: Pneumonia due to COVID-19 virus Active Problems: Emphysema OSA (obstructive sleep apnea) Type 2 diabetes mellitus with hyperglycemia, with long-term current use of insulin Dyslipidemia Essential hypertension Depression with anxiety History of ITP Rheumatoid arthritis Acute respiratory failure with hypoxia Chronic, continuous use of opioids Coronary artery disease involving native coronary artery of native heart without angina pectoris Chronic diastolic heart failure PLAN Cont O2 support, wean as able; currently on 2L Day of illness: 5 Cont Decadron x 10 days total Remdesivir - multiple high risk factors Cont other supportive measures CXR - no significant infiltrates Still at high risk of worsening as she reaches day 7 to 10 of illness 12/2/2021 note: Acute hypoxic respiratory failure-secondary to Covid infection vs COPD Sx start 11/24/21: weakness, fatigue, diarrhea, cough Covid + 11/24/21 CRP: 15 D-dimer: 950 BNP 370 CXR: no acute abnormalities Will cont remdesivir and decadron Lovenox for DVT ppx Will continue supplemental oxygen to maintain SaO2$g90% Cont mucinex and tessalon pearls The patient is on 1 L NC Dispo: Will monitor respiratory status. Improvement in kidney function. PT/OT. Likely dc home in 2-3 days.


VAERS ID: 1917032 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Laboratory test, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: Mental Illness
Allergies: None
Diagnostic Lab Data: 12/30/2021 ... all tests normal
CDC Split Type:

Write-up: Dizzy, Nausea, Headache


VAERS ID: 1917040 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-17
Onset:2021-11-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Injection site infection, Injection site scab, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient described pain and soreness in upper arm one week after receiving injection as well as fever and chills. Used Neosporin on area. Doctor visit 11/23/2021: Injection site has small scab. Noticed infection without any surrounding erythema. Mildly tender to palpation. Rest of arm exam unremarkable with good range of motion.


VAERS ID: 1917054 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-18
Onset:2021-11-24
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Covid positive household contact


VAERS ID: 1917084 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-19
Onset:2021-11-24
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK - / -

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

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

Write-up: COVID-19 positive; contact unknown.


VAERS ID: 1917103 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-13
Onset:2021-11-24
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / 3 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Have not gotten care as it seems to maybe be getting better. However, if it gets worse or not 100% I will likely seek medical care.
CDC Split Type:

Write-up: This was my booster shot for Moderna. I did not experience the following symptoms for my first two doses. I began itching on my stomach the evening reported. This itching progressed and became intense on the palms of my hands and my feet for the next several days. On 11/28/21 I noticed that when I itched my torso or neck, white/red welts/hives appeared where I itched. This has continued. The itching on my hands and feet as gotten better but has not completely gone away. I have not changed anything, to my knowledge that would have brought on this type of reaction; no change in diet, clothes, detergents, etc. I have also found that my skin feel sensitive to clothing that I have previous worn and has never caused me discomfort. Hot showers also irritate my skin and aggravate the itching.


VAERS ID: 1918851 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-01
Onset:2021-11-24
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

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

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

Write-up: I continue to have readness 4x4 inch in armpit; swelling in armpit; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by an other health care professional and describes the occurrence of ERYTHEMA (i continue to have readness 4x4 inch in armpit) and SWELLING (swelling in armpit) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In November 2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Nov-2021, the patient experienced ERYTHEMA (i continue to have readness 4x4 inch in armpit) and SWELLING (swelling in armpit). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) in November 2021 for Adverse event, at an unspecified dose and frequency. At the time of the report, ERYTHEMA (i continue to have readness 4x4 inch in armpit) and SWELLING (swelling in armpit) had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported.


VAERS ID: 1918867 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site induration, Vaccination site pain, Vaccination site swelling
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: LEVOTHYROXINE; LISINOPRIL; FLONASE ALLERGY RELIEF; VITAMINS NOS
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Mastectomy (Patient had a mastectomy in the left side in the past.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Developed a hardness the size of half a dollar, it is red and sore; Pain, tenderness and swelling in the arm of the injection, the right on/Developed a hardness the size of half a dollar, it is red and sore; Pain, tenderness and swelling in the arm of the injection, the right one; Developed a hardness the size of half a dollar, it is red and sore; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE INDURATION (Developed a hardness the size of half a dollar, it is red and sore), VACCINATION SITE PAIN (Pain, tenderness and swelling in the arm of the injection, the right on/Developed a hardness the size of half a dollar, it is red and sore), VACCINATION SITE SWELLING (Pain, tenderness and swelling in the arm of the injection, the right one) and VACCINATION SITE ERYTHEMA (Developed a hardness the size of half a dollar, it is red and sore) in an 85-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 051F21A) for COVID-19 vaccination. The patient''s past medical history included Mastectomy (Patient had a mastectomy in the left side in the past.). Concomitant products included LEVOTHYROXINE, LISINOPRIL, FLUTICASONE PROPIONATE (FLONASE ALLERGY RELIEF) and VITAMINS NOS for an unknown indication. On 23-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Nov-2021, the patient experienced VACCINATION SITE INDURATION (Developed a hardness the size of half a dollar, it is red and sore), VACCINATION SITE PAIN (Pain, tenderness and swelling in the arm of the injection, the right on/Developed a hardness the size of half a dollar, it is red and sore), VACCINATION SITE SWELLING (Pain, tenderness and swelling in the arm of the injection, the right one) and VACCINATION SITE ERYTHEMA (Developed a hardness the size of half a dollar, it is red and sore). At the time of the report, VACCINATION SITE INDURATION (Developed a hardness the size of half a dollar, it is red and sore), VACCINATION SITE PAIN (Pain, tenderness and swelling in the arm of the injection, the right on/Developed a hardness the size of half a dollar, it is red and sore), VACCINATION SITE SWELLING (Pain, tenderness and swelling in the arm of the injection, the right one) and VACCINATION SITE ERYTHEMA (Developed a hardness the size of half a dollar, it is red and sore) outcome was unknown. No treatment medication were reported. This case was linked to MOD-2021-396109, MOD-2021-396130 (Patient Link).


VAERS ID: 1918875 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-15
Onset:2021-11-24
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site pruritus, Vaccination site rash
SMQs:, Hypersensitivity (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: Blood pressure abnormal; Function kidney decreased
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: rash itches, uncomfortable; got a rash on his arm; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (rash itches, uncomfortable) and VACCINATION SITE RASH (got a rash on his arm) in an 80-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Function kidney decreased and Blood pressure abnormal. On 15-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 24-Nov-2021, the patient experienced VACCINATION SITE PRURITUS (rash itches, uncomfortable) and VACCINATION SITE RASH (got a rash on his arm). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Rash, at an unspecified dose and frequency. At the time of the report, VACCINATION SITE PRURITUS (rash itches, uncomfortable) and VACCINATION SITE RASH (got a rash on his arm) outcome was unknown. Reporter reported that patient had low kidney function and she was concerned taking Benadryl. Furthermore she mentioned that patient was on lot of medication and they were blood pressure related, but she did not specify which ones. Reporter states that doctor did not think the rash was from the vaccine. This case was linked to MOD-2021-397536 (Patient Link).


VAERS ID: 1918887 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-01
Onset:2021-11-24
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Discomfort, Insomnia, Pain in extremity, Papule, 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: Blood disorder; Heart disorder (Heart problem).
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of DISCOMFORT (uncomfortable), INSOMNIA (cant sleep), PAPULE (a little bump on her arm, not red nor inflamed), PAIN IN EXTREMITY (Pain on left arm) and PRURITUS (but 3 days ago terrible itchy) in an 84-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 013F21A, 038A21A and 014M20A) for COVID-19 vaccination. Concurrent medical conditions included Blood disorder and Heart disorder (Heart problem).On 01-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form.On 30-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form.On 22-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 24-Nov-2021, the patient experienced DISCOMFORT (uncomfortable), INSOMNIA (cant sleep), PAPULE (a little bump on her arm, not red nor inflamed), PAIN IN EXTREMITY (Pain on left arm) and PRURITUS (but 3 days ago terrible itchy). At the time of the report, DISCOMFORT (uncomfortable), INSOMNIA (cant sleep), PAPULE (a little bump on her arm, not red nor inflamed), PAIN IN EXTREMITY (Pain on left arm) and PRURITUS (but 3 days ago terrible itchy) outcome was unknown. Patient did not taken any medications yet.Patient is on NSAID Reported as Concomitant medication. 3 days ago patient had all the events.


VAERS ID: 1918899 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-03
Onset:2021-11-24
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Pain in extremity, Vision blurred, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BISOPROLOL FUMARATE; CLONAZEPAM
Current Illness: Anxiety (She had it all her life.); Heartbeats premature; Stress (She had it all her life.)
Preexisting Conditions: Medical History/Concurrent Conditions: Eye laser surgery (Laser surgery on her right eye a few hours before she got the booster dose.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: My arm was sore; I had dizziness late that evening; I had vision changes; My right eye was blurry; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (My arm was sore), DIZZINESS (I had dizziness late that evening), VISUAL IMPAIRMENT (I had vision changes) and VISION BLURRED (My right eye was blurry) in an 83-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 031H21A, 011A21A and 037A21B) for COVID-19 vaccination. The patient''s past medical history included Eye laser surgery (Laser surgery on her right eye a few hours before she got the booster dose.) in November 2021. Concurrent medical conditions included Heartbeats premature, Anxiety (She had it all her life.) and Stress (She had it all her life.). Concomitant products included BISOPROLOL FUMARATE and CLONAZEPAM for an unknown indication. On 03-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 31-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 24-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 24-Nov-2021, the patient experienced PAIN IN EXTREMITY (My arm was sore), DIZZINESS (I had dizziness late that evening), VISUAL IMPAIRMENT (I had vision changes) and VISION BLURRED (My right eye was blurry). The patient was treated with MECLIZINE [MECLOZINE] on 27-Nov-2021 for Dizziness, at a dose of 12.5 milligram. At the time of the report, PAIN IN EXTREMITY (My arm was sore), DIZZINESS (I had dizziness late that evening) and VISUAL IMPAIRMENT (I had vision changes) outcome was unknown and VISION BLURRED (My right eye was blurry) was resolving. On 24 Nov 2021 patient drove her self after vaccine administration. On 25 Nov 2021 patient had blurred vision and on 29 Nov 2021 she had the same blurred vision but it was better than the previous nights. Patient got lightheaded all the time with bisoprolol and had been taking this medicine for past 3 years. This case was linked to MOD-2021-400034, MOD-2021-400041 (Patient Link).


VAERS ID: 1919303 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-17
Onset:2021-11-24
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (sore arm from the first two doses.) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 031L20A) for COVID-19 vaccination. No Medical History information was reported. On 17-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Nov-2021, the patient experienced PAIN IN EXTREMITY (sore arm from the first two doses.). At the time of the report, PAIN IN EXTREMITY (sore arm from the first two doses.) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. No treatment information was provided. This case was linked to MOD-2021-400075, MOD-2021-400094 (Patient Link).


VAERS ID: 1919324 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-20
Onset:2021-11-24
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032E211A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Electric shock sensation, Feeling abnormal, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: weird sensation,feeling like funny; left lower leg started like having an electric shock; numbness on the back of the neck, near the ear; This spontaneous case was reported by a consumer and describes the occurrence of ELECTRIC SHOCK SENSATION (left lower leg started like having an electric shock), HYPOAESTHESIA (numbness on the back of the neck, near the ear) and FEELING ABNORMAL (weird sensation,feeling like funny) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 013F21A, 011C211A and 032E211A) for COVID-19 vaccination. Concurrent medical conditions included Back disorder NOS. On 20-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 22-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 24-Nov-2021, the patient experienced ELECTRIC SHOCK SENSATION (left lower leg started like having an electric shock) and HYPOAESTHESIA (numbness on the back of the neck, near the ear). On an unknown date, the patient experienced FEELING ABNORMAL (weird sensation,feeling like funny). At the time of the report, ELECTRIC SHOCK SENSATION (left lower leg started like having an electric shock), HYPOAESTHESIA (numbness on the back of the neck, near the ear) and FEELING ABNORMAL (weird sensation,feeling like funny) outcome was unknown. Concomitant medications include Medication for thyroid and depression. No treatment information was provided. The patient is in her 60s.


VAERS ID: 1919342 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Nervousness
SMQs:, Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: very nervous/nerve-wracking; Patient received moderna booster dose after receiving two doses of pfizer; This spontaneous case was reported by a consumer and describes the occurrence of NERVOUSNESS (very nervous/nerve-wracking) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Patient received moderna booster dose after receiving two doses of pfizer) in a 51-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Previously administered products included for Product used for unknown indication: Pfizer (Lot Number ER8727 and Lot Number EW0162) from 26-Mar-2021 to 12-Apr-2021. Past adverse reactions to the above products included No adverse event with Pfizer. On 24-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Nov-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Patient received moderna booster dose after receiving two doses of pfizer). On an unknown date, the patient experienced NERVOUSNESS (very nervous/nerve-wracking). On 24-Nov-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Patient received moderna booster dose after receiving two doses of pfizer) had resolved. At the time of the report, NERVOUSNESS (very nervous/nerve-wracking) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient thinking that he should not have to a gotten a full dose. No concomitant medication was provided by the reporter. No treatment information was provided by the reporter.


VAERS ID: 1919346 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-24
Onset:2021-11-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Nasal congestion, Rhinorrhoea
SMQs:

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

Write-up: Runny nose; stuffed up nose; Headache; This spontaneous case was reported by a consumer and describes the occurrence of RHINORRHOEA (Runny nose), NASAL CONGESTION (stuffed up nose) and HEADACHE (Headache) in a 76-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027H21B) for COVID-19 vaccination. No Medical History information was reported. On 24-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 24-Nov-2021, the patient experienced RHINORRHOEA (Runny nose), NASAL CONGESTION (stuffed up nose) and HEADACHE (Headache). At the time of the report, RHINORRHOEA (Runny nose), NASAL CONGESTION (stuffed up nose) and HEADACHE (Headache) outcome was unknown. Concomitant medication was not provided. Treatment information was not provided.


VAERS ID: 1919348 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-23
Onset:2021-11-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Eosinophilic pneumonia (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: USMODERNATX, INC.MOD20213

Write-up: everything hurts; Feels like shit today; his muscles hurt; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (everything hurts), FEELING ABNORMAL (Feels like shit today) and MYALGIA (his muscles hurt) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 23-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Nov-2021, the patient experienced PAIN (everything hurts), FEELING ABNORMAL (Feels like shit today) and MYALGIA (his muscles hurt). At the time of the report, PAIN (everything hurts), FEELING ABNORMAL (Feels like shit today) and MYALGIA (his muscles hurt) outcome was unknown. No concomitant medications were reported No treatment information was provided


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