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From the 11/19/2021 release of VAERS data:

Found 894,019 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 465 out of 8,941

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VAERS ID: 1735993 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH I / 1 LA / SYR

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

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

Write-up: Diarrhea.


VAERS ID: 1736010 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #0.3 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprezole, stool softner, zertec
Current Illness: None
Preexisting Conditions: CAD, dysthemia, also have a pace maker
Allergies: Dog and cat dander, arborvitae
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Headache, nausea, chills, muscle aches and tiredness. Treating it with naproxen, 22o mg tid


VAERS ID: 1736016 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LA / IM

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

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

Write-up: Headache, fever, soreness at injection site, fatigue beginning at 0100. Managed with rest, fluids, and ibuprofen.


VAERS ID: 1736055 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, General physical condition abnormal, General physical health deterioration, Hyporesponsive to stimuli, Neurological symptom, Pallor, Throat irritation, Tremor, Unresponsive to stimuli, Visual brightness, Visual impairment
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pfizer 0.3 mL covid-19 (NDC 59267-1000-01 lot 301358A exp 11/21) was administered to the patient. About 5 minutes after administrating the shot, the patient complained of vision changes, seeing a bright light, burning throat, weakness, shortness of breathe. When I talked to the patient he had a delay in response compared to before the shot was administered, I had the EPI pen ready as the patient was declining in condition, I decided to give 10ml of Benadryl after calling 911, I took the patients blood pressure and did not note hypotension. The fire department arrived and took patients vitals everything looked ok, but the patient did not look okay, the gentleman from the fire department agreed the patient did not look good, patient looked pale, and not responding. Patient developed shaking in his right hand. The fire department asked the wife if she wanted to drive him, or should they call EMS. Wife requested an ambulance. Patient was taken by ambulance to destination chosen by EMS. Patients wife showed up after I closed the pharmacy and informed me the patient went to medical center and emergency room doctor sent her back to the pharmacy to get aspirin 81mg per patients wife emergency room doctor said patient had a neurological even after the vaccine, I talked to patients wife about the aspirin dose and formulation patients wife was a very nice lady as well as patient.


VAERS ID: 1736138 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-18
Onset:2021-09-26
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tested covid positive despite being fully vaccinated.


VAERS ID: 1736151 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-19
Onset:2021-09-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, 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: Prenatal vitamin, sunflower let chin, fish oil, iron
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, swelling, itching. Did not occur until 7 days post injection


VAERS ID: 1736152 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Headache, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: None
CDC Split Type:

Write-up: Major anxiety attack (only 1 x in past history 2001 when given procardia after birth) Anxiety attack lasted 4 hours. Headache all day , sore arm (hot swollen ).


VAERS ID: 1736160 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (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: Zyrtec 10mg daily Multi vitamin daily Zofran PRN Imitrex 50mg PRN Hydroxyzine 50mg PRN
Current Illness: None
Preexisting Conditions: Migraines PTSD Anxiety Ehler?s Danlos Hyper mobility Joint Syndrome Conversion Syndrome Pseudoseizures
Allergies: Keflex-hives Amoxicillin-hives PCN-hives Lisinopril-tachycardia and decreased BP Zosinamide-manic, left eye closure, dry mouth, irritability, anger Shrimp-hives Dialaudid -anaphylaxis Vancomycin-anaphylaxis Propranolol-muscle pain, urine retention Cymbalta-auditory/visual hallucinations Paxil- SI Topimax- non-epileptic seizures Pollen, trees, grass- per allergist Tape/Bandages
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Tachycardia started approximately 30 minutes after receiving dose. Seizures began approximately 6 hours after receiving dose


VAERS ID: 1736161 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301408A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Injection site pain, Myalgia, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: Amlodipine Atorvastatin Metformin Lisinopril/hctz
Current Illness: None
Preexisting Conditions: Diabetes Htn
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tachycardia Fatigue Chills Muscle aches Joint pain Site pain


VAERS ID: 1736457 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1736468 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Systemic: Headache-Severe, Systemic: Nausea-Severe, Systemic: Vomiting-Severe, Additional Details: advised pt mom to get tylenol and emetrol. if problems persist, recommended to go to urgent care


VAERS ID: 1736480 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-21
Onset:2021-09-26
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Irritability, Menstruation delayed, Muscle spasms
SMQs:, Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Fertility disorders (broad), Hypoglycaemia (broad)

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

Write-up: Period/cycle came 5 days after the second dose. Cramping started within 48 hours of the shot along with irritability.


VAERS ID: 1736484 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 2 RA / IM

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

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

Write-up: Site: Swelling at Injection Site-Severe, Additional Details: arm very swollen - entire length arm. no other side effects.


VAERS ID: 1736487 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Ear discomfort, Fatigue, Flushing, Hyperhidrosis, Hypoaesthesia, Lethargy, Malaise, Pallor, Paraesthesia, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Pt recieved flu then covid vaccine, said she didnt feel good and fainted. LOC for 6 seconds, woke up with nausea. Pt given juice and water and ice pack. Pt felt better after 15 minutes. Pt reported N/V, tinginling in fingers, flushing of face, loss of color to face, and ears felt on fire.


VAERS ID: 1736490 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-26
Onset:2021-09-26
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

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

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1736494 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever of 103 degrees for roughly 3 hours followed by fever lowering to 100 degrees for roughly 16 hours with severe headache, nausea, and vomiting. Strong soreness in joints from shivering with fever.


VAERS ID: 1736658 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-17
Onset:2021-09-26
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1736667 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Unknown  
Location: Florida  
Vaccinated:1972-12-28
Onset:2021-09-26
   Days after vaccination:17804
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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? 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: lip swelling


VAERS ID: 1736672 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chills, Diarrhoea, Faeces discoloured, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol 3 with codeine ? synthroid ? metoprolol? chlorathalidone ?lorazepam ? protonix tabs amiodipine ? magnesium oxide?potassium
Current Illness: Ademna in legs
Preexisting Conditions: Mitral valve disorder?hypothyroidism?overactive bladder osteoarthritis
Allergies: Demerol ? beef?grass?pollen?grass & trees ? macrobid ? milk ? mold
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Back ache- nausea-diarrhea (black)-sweats-chills


VAERS ID: 1736703 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Zyrtec
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, Microdantin, Macrobid
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Broke out in hives one day following 2nd injection of Moderna. Hives started on neck and chest and continue to move upwards towards my right and left side of neck, and down the right side of my arm (side the injection was given).


VAERS ID: 1736720 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-09-26
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had COVID vaccine on 3/12/21(Janssen), and is hospitalized now (admitted 9/26/21) with acute hypoxic rerspiratory failure secondary to COVID pneumonia (expected D/C is not for 3 or 4 more days)


VAERS ID: 1736759 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Maternal exposure during pregnancy, Premature labour, Urine analysis normal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, famotidine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Normal urinalysis, fetal heart rate monitoring and tocometer
CDC Split Type:

Write-up: I am 32 weeks pregnant with my second pregnancy (first ended in miscarriage at 7 weeks). I started feeling contractions in the date specified. These became more frequent over the course of two hours. I called the nurse triage line and was told to present to the hospital where I was observed overnight and given medication to stop them. My cervix was unchanged so I was able to get sent home with nifedipine for any continued contractions.


VAERS ID: 1736814 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-30
Onset:2021-09-26
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest discomfort, Dyspnoea, Echocardiogram normal, Electrocardiogram, Myocarditis, Syncope, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Citalopram and levothyroxine
Current Illness:
Preexisting Conditions: Anxiety, hypothyroidism
Allergies: latex, sulfonamide antibiotics
Diagnostic Lab Data: Hospital admission 9/26 through 9/27 EKG, troponin testing (elevated), echocardiogram (normal), cardiac catheterization (no obstructive CAD)
CDC Split Type:

Write-up: Patient reports feeling short of breath since receiving COVID vaccine in March. In September had a syncopal episode and had some chest discomfort, was hospitalized and diagnosed with myopericarditis. Patient feels this is related to her COVID vaccine. Resolved within 24 hours with pericarditis therapy.


VAERS ID: 1736815 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-23
Onset:2021-09-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood fibrinogen decreased, Exposure during pregnancy, Foetal death, Foetal heart rate abnormal, Foetal hypokinesia, International normalised ratio abnormal, Prothrombin level abnormal, Ultrasound antenatal screen abnormal
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (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: Gestational diabetes
Allergies: Penicillin
Diagnostic Lab Data: Coagulation panel showed critically low fibrinogen, abnormal findings for PT and INR. Pt transferred to higher level of care for treatment of possible disseminated intravascular coagulation.
CDC Split Type:

Write-up: Pt came to hospital for decreased fetal movement. Ultrasound verified no cardiac activity in fetus, diagnosed intrauterine fetal demise at 34 weeks, 2 days gestation. Pt reported she had received her second covid vaccine on 9/23/21, after it was mandated for her job. She reported last feeling baby move on 9/25/21.


VAERS ID: 1736829 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-12
Onset:2021-09-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: Red rash all over body. Took Benadryl


VAERS ID: 1736855 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dysphagia, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Nasacort
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Aspirin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Severe Nausea, Vomitting, and diarrhea that lasted for approximately 5 hours. Could not keep water down.


VAERS ID: 1736857 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia
SMQs:, 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: None
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Joint Pain in wrist


VAERS ID: 1736858 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 RA / IM

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

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

Write-up: Patient was supposed to be receiving a flu shot but Pfizer Covid-19 was inadvertently grabbed and given to patient Patient is currently on way for treatment


VAERS ID: 1736868 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Hyperhidrosis, Malaise, Thirst, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none reported by patient
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Just a few minutes after receiving his vaccine, the patient said he was not feeling good at all. He was sitting down for his 15 minute observation as required, but appeared to be sweating profusely and said he felt very tired all of sudden. He said he was extremely thirsty and also reported he had not eaten anything yet today. He was given water. He vomited a little. Paramedics were called to examine him and found him to be ok. He reported feeling "much better" after about 45 minutes after receiving his vaccine.


VAERS ID: 1736883 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-17
Onset:2021-09-26
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Pneumonia to both lungs


VAERS ID: 1736913 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-03
Onset:2021-09-26
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chest pain, Cough, Dyspnoea, Flank pain, Micturition urgency, Oxygen saturation decreased, Productive cough, Pyrexia, Sputum discoloured, Urinary incontinence, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

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

Write-up: per ED note: 58-year-old male presents emergency room with complaints of cough and shortness of breath that has had over the past 3 days. Cough is productive of yellow phlegm. Patient states he has had previous episodes of pneumonia. Patient is normally on home O2 of 3 L and was found to be a 9% on his home O2 of 3 L. Patient states he developed a fever today. Patient admits to central chest pain with coughing. Patient states he has occasional wheezing. No abdominal pain nausea vomiting or diarrhea. Patient does complain of bilateral lumbar back pain and right side pain. This is also been present over the past 3 days. Patient admits to having urinary urgency to the point that he cannot make it to the bathroom in time before he urinates on himself.


VAERS ID: 1736920 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-09-26
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Hiccups, Nausea, Pyrexia, Skin ulcer, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Per ED note: The patient is a 55-year-old male with past medical history of diabetes mellitus and end-stage renal disease on hemodialysis who presents to emergency department for complaint of nausea, vomiting, and hiccups. The patient states that he has been having hiccups intermittently for the last week and over the last 2 to 3 days he has had vomiting. He also admits that he has been having chills that have been going on for the last several days. He denies any shortness of breath, chest pain, or abdominal discomfort. The patient was febrile upon arrival in the emergency department with a temperature of 102.2 ?F. He states that he is fully vaccinated for COVID-19. He is currently being treated for a left foot ulceration and follows with the wound clinic.


VAERS ID: 1736926 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-28
Onset:2021-09-26
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, Exposure to SARS-CoV-2, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban (Eliquis) 5 mg Tablet Directions: 1 tablet oral twice a day (Active) cholecalciferol (vitamin D3) 50 mcg (2,000 unit) Tablet Directions: 1 tablet oral daily (Active) digoxin 125 mcg (0.125 mg) Tablet Directions: 1 tablet oral
Current Illness:
Preexisting Conditions: Diabetes, HTN, Hypothyroidism; Dementia;Atrial fibrillation, suspect chronic, s/p PPM, Anxiety. Smoking Status Unknown if ever smoked
Allergies: Latex, erythromycin
Diagnostic Lab Data: SARS-CoV-2 Antigen (+) on 9/26/2021
CDC Split Type:

Write-up: This is an 86 year old female, , with past medical history significant for Atrial fibrillation, s/p PPM, Hypertension, Hypothyroidism, DM type 2, non-insulin dependent, Dementia, Anxiety, who initially presented to the Emergency Room this AM for monclonal antibodies post exposure. The patient is a resident where there is currently a covid outbreak. She received her MABs and was transported back to the facility. On arrival to the facility, the patient vomited and 02 sats were 76% on room air therefor she was sent back. A CXR was negative for an infiltrate and showed possible Cardiomegaly.


VAERS ID: 1736939 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Pain, Product administered at inappropriate site
SMQs:, Drug abuse and dependence (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Yesterday 09/26/2021 I received my second moderna dose but instead of on the deltoid muscle I received a bit higher specifically my shoulder. The pain feels 10 times planful than the first shot so I believe it was placed Incorrectly.


VAERS ID: 1737027 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular 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: unknown
Current Illness: none known
Preexisting Conditions: none known
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: The mother of the patient called and reported that patient had the chills and body shakes that have lasted all night long and she is feeling weak and feels like she is going to pass out when ever she tries to get out of bed. The mother doesn''t believe that she ate or drink anything since getting the shot. I recommended that she seek medical care immediately.


VAERS ID: 1737056 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8831 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Pain
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: invokana 100 mg , losartan 50mg, cresto dextral 2mg, xaltro
Current Illness: no
Preexisting Conditions: diabetic
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Total body pain for over 24 hours . Chills and headache, no fever


VAERS ID: 1737061 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Wellbutrin, Lexapro, Buspirone
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Menstrual cycle started two days prior to regularly expected start date, significantly heavier, increased blood clots. Headaches intensified


VAERS ID: 1737123 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-18
Onset:2021-09-26
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Lymphadenopathy, Pain
SMQs:, Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 3/09/2021 - Typical second dose side effects.
Other Medications: Metformin, Lamictal,tegretol, cymbalta, vyvanse, trazidone, buspar, 2 statens
Current Illness: None
Preexisting Conditions: Epilepsy, Narcolepsy, High Blood Pressure, High lipids, fibromyalgia, PCOS/Metabolic syndrome, pre diabetes
Allergies: Walnuts, PCN, sulfa, Xyrem, adhesive tape
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Woke up 9/26/21 - Same typical reactions as second shot but more more severe. Higher temperatures, severe body pain, etc. **That night, I started to feel massive swelling in my underarm lymph node/breast area on the same arm has my shot. Pain has reduced but swelling still present.**


VAERS ID: 1737125 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-09-26
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1737155 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injury associated with device, Product dose omission in error
SMQs:, Extravasation events (injections, infusions and implants) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Additional Details: PATIENT IS GIVEN EMPTY SYRINGE BEFORE SHE WAS GIVEN 0.3 ML OF PFIZER COVID 19 VACCINE. WHEN THE INCIDENT TOOK PLACE, I INFORMED HER THAT THE SYRINGE WAS EMPTY AND I HAD TO RE-STICK HER AGAIN WITH VACCINE. MOM CALLED AN HOUR LATER AND WANTED A REPORT DONE.


VAERS ID: 1737171 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injury associated with device, Product dose omission in error
SMQs:, Extravasation events (injections, infusions and implants) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Additional Details: PATIENT WAS STICK WITH AN EMPTY SYRINGE BEFORE SHE WAS GIVEN 0.3 ML PFIZER COVID19 VACCINE. WHEN THE INCIDENT TOOK PLACE, I INFORMED HER THAT I STICKED WITH AN EMPTY SYRINGE AND I HAD TO RE-STICK HER WITH PFIZER COVID19 VACCINE. MOM CALLED AN HOUR LATER AND WANTED ME TO REPORT THE INCIDENT.


VAERS ID: 1737182 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-09-26
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

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

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

Write-up: 9/26/21 patient presented to the ED hypoxic about 5 days after onset of URI symptoms, tested positive for covid-19 and was admitted to the hospital, currently hospitalized with covid-19 pneumonia


VAERS ID: 1737187 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-11
Onset:2021-09-26
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1737188 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-09-26
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Nasal congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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: ESTRADIOL. LEVOTHYROXINE, LORATADINE, PROGESTERONE, NASOCORT, OMEPRAZOLE, PRO AIR, TRAZODONE, TOPRAMATE
Current Illness: UPPER RESPIRATORY SYMPTOMS
Preexisting Conditions: HYPOTHYROIDISM, MIGRAINE, HEARTBURN, SLEEP DISTURBANCE, HIGH CHOLESTEROL
Allergies: AMOXICILLIN, CODEINE
Diagnostic Lab Data: SARS COVID-19 NASAL SWAB 9/27/21: POSITIVE
CDC Split Type:

Write-up: 9/26/21: RUNNY AND STUFFY NOSE, COUGH, HEADACHE


VAERS ID: 1737191 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1737194 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-09-26
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1737196 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Lymph node pain, Lymphadenopathy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: N/a
CDC Split Type:

Write-up: Currently 15 weeks pregnant Swollen area and lymph node right above right clavicle...very tender to touch


VAERS ID: 1737242 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Confusional state, Feeling cold, Headache, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), 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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: confusion, shivering/freezing feeling, high heart rate, headache


VAERS ID: 1737249 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-31
Onset:2021-09-26
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UK
Current Illness: UK
Preexisting Conditions: UK
Allergies: UK
Diagnostic Lab Data: 9/27/21 tested positive using Binax Now antigen test.
CDC Split Type:

Write-up: Positive for Covid with symptoms: chills, slight cough, and sore throat.


VAERS ID: 1737280 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-11
Onset:2021-09-26
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Patient developed breakthrough COVID-19 requiring hospitalization.


VAERS ID: 1737292 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-22
Onset:2021-09-26
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Patient developed breakthrough COVID-19 requiring hospitalization.


VAERS ID: 1737296 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

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

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

Write-up: Pt wife reported that pt fainted while driving home. Wife reported no serious injury to patient but was concerned what to do following. Pt was doing ok at time of reporting per wife. Advised to monitor heart rate/blood pressure, vision changes or headaches. advised following up with MD as soon as possible.


VAERS ID: 1737304 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain, Arthralgia, Asthenia, Chills, Fatigue, Feeling abnormal, Myalgia, Nausea, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Klonopin
Current Illness: Scleroderma, interstitial lung disease, Raynaud?s Syndrome, white matter disease
Preexisting Conditions: Scleroderma, interstitial lung disease, Raynaud?s Syndrome, white matter disease
Allergies: Z-Pak
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever, chills, body aches, joint pain, muscle pain, nausea, upset stomach, abdominal cramps, brain fog, fatigue, weakness


VAERS ID: 1737306 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Sudden rapid heart beat and continued increased heart rate 100 to 120


VAERS ID: 1737328 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
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: PT. INCORRECTLY GIVEN PFIZER AS HER 2ND COVID SHOT INSTEAD OF MODERNA, TO MATCH HER 1ST SHOT...NO ADVERSE REACTION.


VAERS ID: 1737373 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Ibuprofen 800
Current Illness:
Preexisting Conditions: pre-diabetic
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash All over body . Low grade fever . Dizzy spells .


VAERS ID: 1737391 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Product administered to patient of inappropriate age
SMQs:, Anticholinergic syndrome (broad), Vestibular 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had received injection on 9/25/2021. He was taken to the ER by his father for the complainant of dizziness and lightheadedness.


VAERS ID: 1737403 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

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

Write-up: vertigo, dizziness and nausea since 9/26/2021


VAERS ID: 1737418 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA166078 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Gastrointestinal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole Tablet Delayed Release 20 MG Give 1 tablet by mouth two times a day for Upper GI BLeed Pharmacy On Hold 9/26/2021 17:00 9/26/2021 Tums Tablet Chewable 500 MG (Calcium Carbonate Antacid) Give 2 tablet by mouth every 6 hours as
Current Illness: none
Preexisting Conditions: MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES NTA (1 pts) Medical Management 4/28/2020 Primary Present on Admission 4/29/2020 view U07.1 COVID-19 Pulmonary 12/8/2020 Diagnosis During Stay 12/8/2020 view E78.5 HYPERLIPIDEMIA, UNSPECIFIED Medical Management 6/8/2020 Diagnosis 6/8/2020 view N40.1 BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS N/A, not an acceptable Primary Diagnosis 4/29/2020 Diagnosis Present on Admission 4/29/2020 view F10.10 ALCOHOL ABUSE, UNCOMPLICATED Medical Management 4/28/2020 Diagnosis Present on Admission 4/29/2020 view G47.39 OTHER SLEEP APNEA Medical Management 4/28/2020 Diagnosis Present on Admission 4/29/2020 view F41.9 ANXIETY DISORDER, UNSPECIFIED Medical Management 4/28/2020 Diagnosis Present on Admission 4/29/2020 view Z87.440 PERSONAL HISTORY OF URINARY (TRACT) INFECTIONS N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis Present on Admission 4/29/2020 view E03.9 HYPOTHYROIDISM, UNSPECIFIED Medical Management 4/28/2020 Diagnosis Present on Admission 4/29/2020 view M10.00 IDIOPATHIC GOUT, UNSPECIFIED SITE N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis Present on Admission 4/29/2020 view I48.20 CHRONIC ATRIAL FIBRILLATION, UNSPECIFIED Cardiovascular and Coagulations 4/28/2020 Diagnosis Present on Admission 5/5/2020 view I10 ESSENTIAL (PRIMARY) HYPERTENSION N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis 4/28/2020 view E87.1 HYPO-OSMOLALITY AND HYPONATREMIA Medical Management 4/28/2020 Diagnosis 4/28/2020 view G89.29 OTHER CHRONIC PAIN N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis 4/28/2020 view E11.22 TYPE 2 DIABETES MELLITUS WITH DIABETIC CHRONIC KIDNEY DISEASE NTA (2 pts) Medical Management 4/28/2020 Diagnosis 4/28/2020 view I87.2 VENOUS INSUFFICIENCY (CHRONIC) (PERIPHERAL) Medical Management 4/28/2020 Diagnosis 4/28/2020 view I50.1 LEFT VENTRICULAR FAILURE, UNSPECIFIED Cardiovascular and Coagulations 4/28/2020 Diagnosis 4/28/2020 view R01.1 CARDIAC MURMUR, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis 4/28/2020 view R33.9 RETENTION OF URINE, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis 4/28/2020 view G47.00 INSOMNIA, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis 4/28/2020 view I48.0 PAROXYSMAL ATRIAL FIBRILLATION Cardiovascular and Coagulations 4/28/2020 Diagnosis Present on Admission 4/29/2020 view I50.32 T CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE Cardiovascular and Coagulations 4/28/2020 Diagnosis Present on Admission 4/29/2020 view M25.562 T PAIN IN LEFT KNEE N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis Present on Admission 4/29/2020 view M25.561 T PAIN IN RIGHT KNEE N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis Present on Admission 4/29/2020 view R53.82 T CHRONIC FATIGUE, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis Present on Admission 5/5/2020 view F33.1 T MAJOR DEPRESSIVE DISORDER, RECURRENT, MODERATE Medical Management 4/28/2020 Diagnosis 4/28/2020 view J44.9 T CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED NTA (2 pts) Pulmonary 4/28/2020 Diagnosis Present on Admission 4/28/2020 view R53.1 T WEAKNESS N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis 4/28/2020 view F33.2 T MAJOR DEPRESSIVE DISORDER, RECURRENT SEVERE WITHOUT PSYCHOTIC FEATURES Medical Management 4/28/2020 Diagnosis 4/28/2020 view R26.89 OTHER ABNORMALITIES OF GAIT AND MOBILITY N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis Present on Admission 8/4/2020 view M62.59 MUSCLE WASTING AND ATROPHY, NOT ELSEWHERE CLASSIFIED, MULTIPLE SITES Non-Surgical Orthopedic/Musculoskeletal 4/28/2020 Diagnosis Present on Admission 8/4/2020 view R41.841 T COGNITIVE COMMUNICATION DEFICIT N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis Present on Admission 11/4/2020 view M17.0 BILATERAL PRIMARY OSTEOARTHRITIS OF KNEE Non-Surgical Orthopedic/Musculoskeletal 4/28/2020 Diagnosis Admitting Dx 4/28/2020 view R26.2 T DIFFICULTY IN WALKING, NOT ELSEWHERE CLASSIFIED N/A, not an acceptable Primary Diagnosis 4/28/2020 Diagnosis
Allergies: lithium
Diagnostic Lab Data:
CDC Split Type:

Write-up: GI BLEED


VAERS ID: 1737494 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Tinnitis, called patient today and it did subside after a couple of hours, she still has intense pressure. Advised pt to check with her physician.


VAERS ID: 1737498 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-21
Onset:2021-09-26
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest pain, Cough, Dyspnoea, Pyrexia, SARS-CoV-2 test positive, Troponin increased, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: aspirin (aspirin) 81 mg, EC Tablet, PO, Daily atenolol (atenolol) 50 mg, TAB, PO, Daily docusate (docusate sodium) 100 mg, CAP, PO, Q12H (Every 12 hours) gabapentin (gabapentin) 300 mg, CAP, PO, TID levothyroxine (levothyroxine) 50 mcg
Current Illness:
Preexisting Conditions: DM HTN
Allergies: NKA
Diagnostic Lab Data: 9/26/21 PCR COVID 19 test positive
CDC Split Type:

Write-up: Patient tested positive for COVID 9/26/2021, chest pain, shortness of breath, cough and fever x1 week. Troponin elevated (58)


VAERS ID: 1737512 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Lymphadenopathy, Musculoskeletal stiffness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever,chills,muscle aches and stiffness,dizziness over the course of 23 hours so far,also a little swelling of glands in neck,but effects waning.Took Tylenol to break fever about 8 hours in,only 500 mg because Tylenol upsets my stomach.Will return to work within 48 hrs of dose.


VAERS ID: 1737524 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-03
Onset:2021-09-26
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization weakness and GI distress.


VAERS ID: 1737534 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: diarrhea, vomiting, diffuse urticaria


VAERS ID: 1737544 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Headache, Lymphadenopathy, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Junel Fe 1/20, Aleve, Ibuprofen
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fever, chills, muscle pain, back pain, swollen lymph nodes


VAERS ID: 1737578 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-15
Onset:2021-09-26
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site nodule, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec .Tylenol, biotin, calcium ,centrum silver. Iron Omega
Current Illness:
Preexisting Conditions:
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site knot from march 15th still painful and red hot and swollen down to elbow


VAERS ID: 1737608 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-17
Onset:2021-09-26
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

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

Write-up: Patien''s son called pharmacy saying his mom had stroke on 9/26/2021, 9 days after she received her 2nd Pfizer dose on 9/17/2021


VAERS ID: 1737630 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013089 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood potassium decreased, Electrocardiogram QT prolonged, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Torsade de pointes, shock-associated conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Hypokalaemia (narrow)

Life Threatening? Yes
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: Lqts gene mutation kcnh2
Allergies: None
Diagnostic Lab Data: Potassium 3.1, QTc 628
CDC Split Type:

Write-up: Loss of consciousness, probable cardiac syncope, prolonged QT to 628, last known prior QT in March of 2021 was 467.


VAERS ID: 1737779 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Chest pain, shortness of breath, and itchiness. Took one Benadryl tablet and symptoms did not return thereafter.


VAERS ID: 1738054 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-19
Onset:2021-09-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Influenza like illness, Injection site reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 60 mg Birth control pill
Current Illness:
Preexisting Conditions: Narcolepsy with cataplexy
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Delayed Injection site reaction. It?s become swollen, red and hot and it?s extremely big and growing. I also came down with flu like symptoms a week after and my breastfed baby is having them as well.


VAERS ID: 1738066 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site rash, Injection site swelling, Injection site warmth, Rash papular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 70 mg, levothyroxine 88 much, Zyrtec 10 mg bid, singular 10 mg, beyaz, valacyclovir, Flexeril 10 my, tizanidine, percocet
Current Illness: N/a
Preexisting Conditions: Hashimoto''s, ADHD, Raynaud''s, environmental allergies, cervicalgia, cervical spondylosis
Allergies: Bentyl, Nickel
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2-3 inch erythematous, swollen/raised rash at injection site. Skin warm in affected area. 2 day after eruption slightly larger and pruritic


VAERS ID: 1738251 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Fever, chills, severe body aches and pains and headache. All not relieved with over the counter medications.


VAERS ID: 1738515 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Decreased appetite, Dizziness, Fatigue, Injection site erythema, Injection site swelling, Musculoskeletal stiffness, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Injections slightly sore several hours after injection. Arm sore/stiff 7 hours after injection. 3"x4" area around injection site swollen/warm by 10AM day following injection. Arm very sore/stiff. Tire/slightly dizzy day following injection. Diminished apatite day following injection. 4"x5" area around injection site swollen/warm by 6pm day following injection. Arm sore/stiff. Body temp increase 1.5 degrees by 8pm day following injection. 5"x7" area around injection site swollen/warm 9am 2 days after injection. Slight reddening of area around injection site, very sore. Diminished apatite continues 2 days following injection. 400mg ibuprofen before bed 2nd day after injection. No change 3rd day after injection. Injection site still swollen/warm/sore and slightly reddened. Occasionally dizzy when walking/turning head, diminished apatite.


VAERS ID: 1738626 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-19
Onset:2021-09-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Itching (assumed it was a mosquito bite) was not a mosquito bite. Next morning itching persisted. Area had begun to swell, looks like a bump. By noon, area was still itchy and had turn a pinkish red color, bump is still visible into the evening.


VAERS ID: 1739743 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypotension, Injection site reaction, Lip swelling, Nausea, Pharyngeal swelling, Pruritus, Rash erythematous, Swollen tongue, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax
Current Illness: NO
Preexisting Conditions: MCAS
Allergies: Flu Vaccine, All antibiotics, Almost all processed foods, etc.
Diagnostic Lab Data: 0
CDC Split Type:

Write-up: Swollen lips, tongue and throat. Very large red rash where injected. Itching and hives. Trouble breathing. Low blood pressure.Dizzy. Nauseaus.


VAERS ID: 1740555 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-01
Onset:2021-09-26
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/26 SARS/COV-2, NAAT positive
CDC Split Type:

Write-up: Breakthrough COVID-19


VAERS ID: 1740621 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dyspepsia, Dysphagia, Gait disturbance, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg ec tablet Coenzyme Q10 200 mg capsule Fish oil, oral, 1200 mg Glucosamine Chondroitin, oral, 1500 mg Multivitamin tablet Pravastatin 40 mg tablet Vitamin C 1000 mg taglet
Current Illness: NA
Preexisting Conditions: Bladder cancer survivor Two heart stents
Allergies: Codeine (causes hives) Morphine (causes severe hallucinations)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1215AM, 9/26/2021, moderate heartburn/indigestion, difficulty swallowing hot/cold beverages 1215AM 9/26/2021, moderate to severe joint pain in both knees and both hips, unable to sleep Treated with Tylenol 300PM, 9/26/2021, adverse symptoms began to subside 1030PM, 9/26/2021, severe joint pain in both knees and both hips, difficulty sleeping, difficulty walking Treated with Tylenol 400PM, 9/27/2021, adverse symptoms began to subside 830PM, 9/27/2021, normal sleep pattern


VAERS ID: 1740623 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-26
Onset:2021-09-26
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/27 COVID positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1740625 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Migraine, Mobility decreased, Pain, Pain in extremity, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal Vitamin D Zyrtec Omega 3 Calcium Magnesium
Current Illness: None
Preexisting Conditions: Depression and anxiety
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extremely sore arm 2 hours after injection. Progressively getting worse. To the point I can?t even lift arm. Body aches and severe migraine at about 5pm. Heart palpitations that entire evening. Chills intermittent. Still experiencing symptoms almost 48 hours later.


VAERS ID: 1740627 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-04-01
Onset:2021-09-26
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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

Write-up: 7 months pregnant at time of second dose and had normal pregnancy and delivery, with healthy 9lb 3oz and 21in baby at time of birth. Exclusively breastfed baby until 9/26/2021 when he died suddenly and unexpectedly. Cause of death has not been determined but in autopsy they did not find any indication of clotting or other issues; we are waiting on pathology and toxicology results.


VAERS ID: 1740628 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-23
Onset:2021-09-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 2588 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Menstrual disorder, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Prescription Levothyroxine 1x daily for hypothyroid
Current Illness: None
Preexisting Conditions: Hashimoto?s hypothyroid
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Menstrual cramps and vaginal bleeding as if on period, but not due for period. Prior to vaccine, period was extremely regular so this is abnormal.


VAERS ID: 1740809 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Lymphadenopathy, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 104 fever, violent chills, severe headache, nausea, diarrhea, body ache, sore arm 9/26 and 9/27 and swollen axillary lymph node on 9/28.


VAERS ID: 1740815 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Employee calling to report a reaction after receiving a COVID-19 vaccine. Vaccine Name - Pfizer Vaccine Date - ? 9/25/2021 Is this your first or second dose- 3rd Booster Date of symptom onset - ? 9/26/2021 Symptoms - ? Headache, body aches, chills fever (101.0, and 100.6) Last day of work and shift - ? NA Home remedies- Employee stated she took Tylenol for the fever Any improvement- The Tylenol seemed to be helping the fever Recommendation- Advised employee to continue taking Tylenol as needed for fever per pack instructions. Employee voiced understanding Employee of information ? Yes Employee voiced any concerns ? No Employee?s questions answered to employee?s satisfaction -Yes


VAERS ID: 1740825 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Injection site erythema, Injection site swelling, Lymphadenopathy, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: EE received Booster Vaccine on 9/25/2021, at TCH Vaccine event in PFW, sides effects were swollen lymph nodes, redness and swollen at injection site, has taken Tylenol/ibuprofen and cols compress to help with pain. Advise to rest and drink fluids


VAERS ID: 1740835 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-24
Onset:2021-09-26
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 RA / IM

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

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1740837 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-26
Onset:2021-09-26
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1740841 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-09-26
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1740846 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-03
Onset:2021-09-26
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1740867 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Extra dose administered, Injection site erythema, Injection site swelling, Lymphadenopathy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: EE received Covid 19 Booster (Dose #3) of Pfizer on 09/25/2021 at facility. She reported swollen lymph nodes and swollen redness of arm at the injection site, body aches, chills, a fever of 102 no others stated. She was advised to take Tylenol or ibuprofen with a cold compress to help alleviate pain and assist with fever drink fluids and rest. Adhere to the illness in the work place at facility for work return.


VAERS ID: 1740920 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-11
Onset:2021-09-26
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 - / -

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

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

Write-up: shortness of breath w/increased oxygen requirements and positive covid test 09/27/2021


VAERS ID: 1741033 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bradycardia, Chest pain, Dyspnoea, Heart rate decreased, Hyperhidrosis, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Severe hypotension, bradycardia, chest pain, diaphoresis, shortness of air,. I awoke from sleeping because I could not breathe. I am a RN and my husband is a nurse practitioner. I was very symptomatic with chest pain, SOA, diaphoretic. My husband could not feel a radial pulse but was able to auscultate my heart beat with a stethoscope. My blood pressure was only reading 55/46 and my heart rate was 44. I felt as if I was dying. Over the next hour before calling an ambulance, my blood pressure began to come up. The symptoms started to improve and dissipate so we did not call an ambulance but fear if I did not wake up I would have died due to the hypotension. I?m assuming that this would be considered a syncopal episode.


VAERS ID: 1741141 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Body temperature increased, Erythema, Myalgia, Pain in extremity, Peripheral swelling, Pruritus, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin, lovastatin, vitamin D, multi vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, sulfa, erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm then 24 hours later muscle and joint pains lasting 7 hours with 1.5 degree temperature above normal. Then a day later, the same reaction, lasting 8 hours. Arm is red, puffy, and warm and itches.


VAERS ID: 1741222 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / UNK RA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, vitamin C, Biotin, iron supplement, Lisinopril, low-dose aspirin, zinc supplement, simvastatin, omeprazole, Tylenol
Current Illness: Sciatic nerve damage
Preexisting Conditions: Skin cancer, heart stent
Allergies: Bacitracin, neomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intermittent body aches and fatigue throughout the day that lasted about an hour. Tylenol taken to mitigate aches.


VAERS ID: 1741291 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

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

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

Write-up: Patient got the Pfizer vaccine on 9/24/21 and starts to have numbness and tingling on right face on 9/26/21. Patient is advised to call her doctor.


VAERS ID: 1741303 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Feeling abnormal, Feeling hot, Head discomfort, Headache, Impaired work ability, Migraine, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No all supplementation and exercise discontinued 48 hours prior.
Current Illness: No
Preexisting Conditions: N/A
Allergies: No.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 hours after shot, fatigue set in and a warm feeling in head. About 1 a.m. that night, now Sunday morning I was awoken with a massive migraine. Felt heavy pressure in head, thought I had a blood clot in paranoia. Ate 4 Tylenol to soothe the massive throbbing headache (one I have never had in my life before, comparable to the worst hangover you could ever have x10). I was well hydrated drinking water and Gatorade through the night. If the Tylenol did not subside the pressure in my brain I would have gone to the Emergency Room that night, that is how severe and unworldy it was for me. Sunday awoke at 10 to see my daughter for my weekly visit. About 1 hour in I call it short and proceed to go home and rest as I had felt extremely exhausted and a massive mental fog over my mind. I hydrated again that a.m. with pedialyte and water. Slept close to 20 hours on Sunday. Monday I woke up feeling a bit off mentally, still with persistent body aches, joints I don''t normally ever feel aches in were sore but i took it slow and did not really complete anything that day, called out of work to try to fully recuperate. Tuesday, I wake up feeling no brain fog not really fatigued mentally atleast. I walk into work notice a bit of physical exhaustion from ordinary walk into work, felt warm in a.m. My lunch break began now I had to ascend 4 flights of steps in parking garage which I normally do with ease, except this time I was winded like I did a mild workout. As I''m driving in my car with a.c on I notice I still feel warm, I go home and take my temperature to discover it was at 101.1 f.. I subsequently called out of work for rest of day, took Tylenol and temperature slowly subsiding. Note: I am a 31 year old male (life time of exercise through sports/military/hobby, I currently exercise 4 to 5 times a week. Run on average 4 to 5 miles a week with 30 min weight training. I have no underlying health conditions. Days before vaccine I was feeling healthy as can be, as of right now muscle aches and mild fever persists close to 72 hours post second dose vaccine .


VAERS ID: 1741364 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-10
Onset:2021-09-26
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atelectasis, Atrial fibrillation, COVID-19, Chest X-ray abnormal, Chest pain, Condition aggravated, Dizziness, SARS-CoV-2 test positive
SMQs:, Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: multivitamin, fish oil, omeprazole, diltiazem ER coated beads capsule
Current Illness:
Preexisting Conditions: atrial fibrillation, GERD
Allergies: penicillins
Diagnostic Lab Data: 9/28 Chest X-ray: stable mild bibasilar atelectasis
CDC Split Type:

Write-up: Two days prior to ED presentation, the patient felt chest pain while working in his garden. He also felt lightheaded and dizzy. Patient was seen at urgent care and told he was in A-fib and tested positive for COVID-19. Today, patient presented to ED in A-fib with RVR with heart rate in the 150s. Patient will be admitted for management of A-fib with enoxaparin and diltiazem.


VAERS ID: 1741389 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 AR / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1741393 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 AR / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1741408 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-26
Onset:2021-09-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 AR / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1741436 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dehydration, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: covid vaccine pfizer dose 2
Other Medications: levothyroxine. montelukast. ajovy. allegra
Current Illness: none
Preexisting Conditions: hypothyroidism migraine
Allergies: sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: skin rash and swelling, dehydration worsening over 2 days, neck, arms, legs. Alleviate by benadryl


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