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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 477 out of 8,941

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VAERS ID: 1737437 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 301308A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash macular
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium, vitamin D+K
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 24 hours after receiving my Covid booster shot, I started to get large red itchy blotches on my left back starting near the back of the armpit area to the top of my tailbone. The next day I also noticed both my wrists had the same red itchy blotches. I took some over the counter antihistamine and used topical hydrocortisone cream. On day three, the red blotches and itchy skin appear to be clearing up.


VAERS ID: 1737439 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-04
Onset:2021-09-25
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction, COVID-19, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hospitalization being treated for anaphylaxis and covid screening positive.


VAERS ID: 1737446 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Ear pain, Headache, Nausea, Peripheral swelling
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: 1st COVID vaccine she became real sick
Other Medications: fetanell, docsozoane,
Current Illness: cancer
Preexisting Conditions: cancer
Allergies: aspirin, penicillin, morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Her arm became swollen, her head hurts so bad til it is making her ear hurt, nausea and feel weak.


VAERS ID: 1737462 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-21
Onset:2021-09-25
   Days after vaccination:4
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: Catheterisation cardiac, Echocardiogram, Myocarditis, Stress cardiomyopathy, Troponin
SMQs:, Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Acute myocarditis vs stress induced cardiomyopathy 3 days after 3rd dose (booster dose) of Pfizer vaccine.


VAERS ID: 1737468 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial paralysis, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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: No
Current Illness: None
Preexisting Conditions: None
Allergies: Feathers
Diagnostic Lab Data:
CDC Split Type:

Write-up: Facial drooping/slight numbness on left side of face.


VAERS ID: 1737469 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-29
Onset:2021-09-25
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Exposure to SARS-CoV-2
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization chest pain and dyspnea known exposure.


VAERS ID: 1737472 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 E0155BA / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: 09/26/2021 went to the ER and was given abnormal results... had blood work done and has to have chest exam
CDC Split Type:

Write-up: Patient reported that she started having tightness in her chest and shortness of breath the next day after getting the vaccine...


VAERS ID: 1737473 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient received the vacation (2nd dose) around 8:40am on a Friday. By Saturday 4am, patient was throwing up and wife called EMS who diagnosed "non-epileptic seizures". On Sunday he still had some tingling sensation. I received the call from patient on Monday morning and patient was doing find. He had spoke to his PCP also.


VAERS ID: 1737491 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 301358A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Reporting that a 15 year old individual received both a Moderna and a Pfizer COVID-19 vaccine. This individual received Pfizer on 8/31/2021 and Moderna on 9/25/2021.


VAERS ID: 1737500 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-09
Onset:2021-09-25
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atelectasis, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Fibrin D dimer, Lung opacity, Pleural effusion, Pulmonary embolism
SMQs:, Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, acyclovir, aspirin, atorvastatin, calcium-vitamin D, gabapentin, metoprolol, mycophenolate, omeprazole, prednisone, tacrolimus
Current Illness: None
Preexisting Conditions: Hyperlipidemia, hypertension, CAD, Raynaud''s disease, sleep apnea, esophageal reflux, constipation, history of kidney transplant, history of prostate cancer, ED, arthritis, osteopenia, varicose veins, thrombocytosis, s/p splenectomy
Allergies: NKA
Diagnostic Lab Data: 9/26/21: D-dimer: 1100 Chest xray: new opacity left lower lobe CT angiogram: Small-moderate number of proximal subsegmental acute pulmonary emboli to the left lower lobe with some distal consolidative atelectasis and trace left effusion.
CDC Split Type:

Write-up: Pulmonary emboli 9/26/21


VAERS ID: 1737516 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-01
Onset:2021-09-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Public       Purchased by: ?
Symptoms: Chills, Extra dose administered, Migraine, 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: Zoloft, Claritin, vitamin B and C
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bad migraines, fever, chills for the 72 hours after.


VAERS ID: 1737523 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 301358A / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Palpitations, Sleep disorder
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Every night since getting the vaccine I have not been able to sleep I am woken up to what feels like my heart racing I have taken my pulse during these moments and have had a pulse over 100 at resting, I have not seeked medical treatment yet due to looking on the internet and finding that this is said to have happened to other people. But if it continues I will be seeking a doctor to see what the recommendation would be.


VAERS ID: 1737563 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-20
Onset:2021-09-25
   Days after vaccination:248
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: Asymptomatic COVID-19, Exposure during pregnancy, Gestational hypertension, Induced labour
SMQs:, Hypertension (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), COVID-19 (narrow)

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

Write-up: Hospitalized for induction of labor asymptomatic COVID 19 . Gestational hypertension, EDD 9/23/2021, Birth 9/26/2021, 40w3d gestational age, wt 3.63 kg.


VAERS ID: 1737582 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-01
Onset:2021-09-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Cough, Diarrhoea, Dizziness, Fatigue, Nasal congestion
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Cold chills, stuffy nose, cough dizziness, tiredness, diarrhea,


VAERS ID: 1737584 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear infection, Fatigue, Headache, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oral Lamisil 250mg once daily
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Saturday morning was incredibly fatigued, running 100 degree fever, constant headache. Ibuprofen helped but only marginally. As of Monday sept 27 fever has not receded without administering 600mg ibuprofen every 4 hrs. Throat is incredibly sore and beginning of ear infection in right ear. I was totally healthy before the shot.


VAERS ID: 1737587 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Deafness unilateral, Dizziness, Hypoaesthesia, Malaise, Musculoskeletal stiffness, Nausea, Pain, Paraesthesia, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantoprazole 40mg, Letrozole 2.5mg
Current Illness: Acid refux
Preexisting Conditions: Breast Cancer
Allergies: Flomax, Taxol, Anastrozole , Alcohol,
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Five minutes after the vaccine I had a numbness from my arm that received the vaccine ( right arm ) , numbness traveled up to my brain, def in right ear ( still no hearing ) , stiff neck, stomach nausea , body aches, chills, fever, tingling in my right hand, weak and dizzy. Still having these issues currently and gets worse at night. Been taking Tylenol every four hours. I called doctor to inform her and never called back as of yet. I didn''t go to my primary Dr. because I was hoping these adverse effects would go away. It'' now two days after the vaccine and still feeling very sick.


VAERS ID: 1737640 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 EW0173 / 3 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Fear, Malaise, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingrix-2nd; age:68; 04/20/''21. All the bad symptoms began ~ 6 hours $g jab: deep chills, headache; could only fall into bed sh
Other Medications: No.
Current Illness: No.
Preexisting Conditions: Small, transient psoriasis patches on one hand, opposite elbow & left outer ankle bone; clear now.
Allergies: Had a CNS-type reaction to penicillin, age: 17 Reactions to sulfa drugs & amocycilin (spelling, sorry, can''t leave page): Hives as a young adult. Food allergies: kiwi & other foods
Diagnostic Lab Data: No. Stayed home & rested & did hours of deep, slow breathing to try to calm my system. Recommended to report this.
CDC Split Type:

Write-up: Was fine until about 6.5 hours after the ''jab,'' when I started to feel unwell, general malaise & noticed my heart was pounding heavily; was scared & rested quietly but did not go to sleep -- too scared. It was late night; I live alone, did not want to drive to an urgent care facility somewhere ... felt mostly better after noon yesterday. Today, feel like I have been ''through something'' but progressively better & more ''like myself.'' Nothing I ate or did would have brought on heart & bp pounding like that. No reaction like that after Covid vaxes 1&2. Told I should report this.


VAERS ID: 1737816 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 RA / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphonia, Arthralgia, Chest pain, Chills, Confusional state, Cough, Diarrhoea, Disorientation, Fatigue, Food craving, Hair disorder, Hyperphagia, Musculoskeletal pain, Oropharyngeal pain, Pain in extremity, Pain in jaw, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Osteonecrosis (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: September 24, I recieved the shot at 11:30am, by 1:30pm, I craved sweets, and eating more than usual. By 3:40pm I was fatigued and with slight confusion. Later that night, I was disoriented. The morning of 9/25, top of my heads hair follicals were sensitive, jaw, left elbow, right wrist, left toes are in pain, and a sharp pain down the righ knee. The evening of 9/25, a soar throat developed, a runny nose, lost of voice, chills and pains on the left shoulder blade. The morning of 9/26, I developed diahrea in the morning which continued at the time of this writing. The eventing of 9/26, I developed a dry cough when I lay down flat however, it stops when I sit up. I have chest pains as a result of the coughs.


VAERS ID: 1737821 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 FE3592 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Chest pain, Chills, Headache, Lymph node pain, Lymphadenopathy, Musculoskeletal chest pain, Neck pain, Pain in extremity
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Olmesartan medox/hctz 12.5mg Medformin
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies: No
Diagnostic Lab Data: Lymphadenopathy
CDC Split Type:

Write-up: Enlarged and painful lymph node on left armpit. The size of a baseball on the second day after the 2nd dose of the COVID vaccine. The day after the vaccine I had Soreness to left neck, chest, arm and ribcage area. Chills and headache.


VAERS ID: 1738024 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 FF2589 / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Injection site rash, Injection site swelling, Injection site urticaria, Musculoskeletal stiffness, Rash erythematous, Rash pruritic, Wound
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Pfizer covid-19 dose. February 2021, 43 years old
Other Medications: Multi vitamin, B12,vitamin C,folic acid,iron,
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Tomato,latex
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Extreme swelling and pain in and around the injection site. Stiffness and pain in the elbow of the arm of injection site. Red, burning extremely itchy rash/hives, spreading from the injection site over the upper arm down to the elbow. Still ongoing 3 days after injection. Open sore at injection site. Treating with topical and oral antihistamines, and antibacterial ointment.


VAERS ID: 1738025 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 FF2388 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Extra dose administered, Induration, Pain in extremity, Skin warm, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (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: Same type of event; 1st dose Pfizer-BioNTech COVID vaccine December 2020; age 27
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Local reaction - arm soreness; area of induration starting the size of a mosquito bite (day 0) spreading to size of softball (post-vaccine day 4); warm, erythematous; no effect on range of motion or function of arm; no systemic reaction


VAERS ID: 1738041 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes, Hypertension , Cancer
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: blood pressure 209/107 9/25/21 @ 10:30am
CDC Split Type:

Write-up: Patient stated she was feeling dizzy approximately 15 minutes after immunization. Told patient to sit longer and offered water. Patient became increasingly dizzy then started getting short of breat. Took patients blood pressure which was 209/107. Offered to call 911 and patient accepted


VAERS ID: 1738043 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Patient''s wife called on 09/27/21 stating that patient''s arm is red, swollen, and a little bruised at the injection site but not itchy.


VAERS ID: 1738055 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (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:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient explained that within just hours of the vaccination administration she noticed the darkening of one of her toes. It continued to the color black and is continuing to move up the foot toward the ankle.


VAERS ID: 1738059 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Chills, Confusional state, Fatigue, Feeling abnormal, Headache, Injection site pain, Nausea, Pain, Pyrexia, Restlessness
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Saturday-headache, body felt like it was on fire, chills, aches and pains throughout, nausea, fatigue, site soreness, fever, restless. Sunday-headache, nausea, fatigue, brain fog Monday-tiredness, fatigue, confusion


VAERS ID: 1738068 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 FC3184 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Headache, Lymphadenopathy, Malaise, Pain, Pain in extremity, Sleep disorder
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide 25mg, 1T po d Atenolol 50mg, 1T po d
Current Illness: Status post breast cancer, 12 years
Preexisting Conditions: High blood pressure
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Entire arm sore, shoulder and elbow throbbing with pain. Underarm pit area swollen and sore. Severe headache interrupting and preventing sleep. Extreme malaise.


VAERS ID: 1738253 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 / 3 RA / IM

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

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

Write-up: no adverse event, dose given 1 day per calendar days early, during the six months there are 4 months with 31 days and 1 month 28 days, technically given 2 days post 6 months if you are counting actual days.


VAERS ID: 1738258 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Pt called stating she has having increased swelling and redness at injection site since administration of her second Moderna vaccine on 9/25/21. Pt stated she has tried oral/topical Benadryl, Tylenol, and iced down the area. She stated she had a bit of swelling after the first vaccine, but it is worse this time. She also stated that she has an adhesive allergy and she took off the bandage sooner after the first vaccine than she did after the second vaccine. I advised that injection site swelling/redness are common side effects but recommended she follow-up with her pcp regarding this. I also recommended she try ibuprofen as well for pain/inflammation. I requested pt follow-up with us to let us know how she is doing, she stated she would.


VAERS ID: 1738263 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site mass, Injection site pain, 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: B12, D3
Current Illness: UTI
Preexisting Conditions: Heart disease
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Below injection-sore, lumpy, raised skin about the size of a golf ball or a little bigger but not raised that high.


VAERS ID: 1738272 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-16
Onset:2021-09-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Adderral, wellbutrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Entire body is exhausted, non-stop muscle weakness, nothing helps


VAERS ID: 1738285 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure via breast milk
SMQs:, Neonatal exposures via breast milk (narrow)

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

Write-up: Breastfeeding infant had fever at 99-100.5 for 24 hours, extreme irritability/fussiness, decreased appetite and eczema flare up on ankles, wrists, bends of elbows and shoulders.


VAERS ID: 1738625 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Oropharyngeal pain, Pain, Pain in extremity, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 09/25 morning: Fever, headache, body ache, chills, sore throat, sore arm, arm rash, fatigue


VAERS ID: 1738632 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Cough, Dyspnoea, Epistaxis, Injection site swelling, Pyrexia
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), 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: Fatigue and nosebleeds for two days
Other Medications: Carvedilol Amitryptaline Losartan Vitamin D Trulicity
Current Illness:
Preexisting Conditions: Diabetes High blood pressure
Allergies: Erythromycin Latex Nifedipine Claritin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme aches in all joints Swelling at injection site that continues to swell more even three days after injection High fever lasting three or more days Cough starting at day three after injection Repeated nosebleeds for first two days after injection Tightness in chest with difficulty breathing


VAERS ID: 1738634 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-22
Onset:2021-09-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye swelling, Hypoaesthesia, Muscle spasms, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: At 29 years old in August of 2019 I had the Hep A, Yellow Fever and another vaccine to which I cannot remember. Following those
Other Medications: Albuterol, Advair
Current Illness:
Preexisting Conditions: Asthma, psoriasis, eczema, endometriosis
Allergies: Food allergies including: bananas, avocados, fish, shellfish, pineapple, eggs, peanuts, tree nuts etc. The medication: Doxycycline
Diagnostic Lab Data: I reached out to my clinic and the on call doctor said ?if you are able to breathe there is no reason to go to the emergency room. If it gets worse go to urgent department
CDC Split Type:

Write-up: I have submitted a concern regarding the swelling of my eyes within 72 hours of receiving the Moderna vaccine but I have since had irregular numbing in my right cheek where my cheekbone is, irregular dizzy spells, and irregular swelling of my right hand and arm. I have also had muscle spasms in my right leg and thigh. I reported the eye swelling the day it started on Saturday. It is now Monday and it has continued to today.


VAERS ID: 1739741 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-16
Onset:2021-09-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Severe allergic reaction developed 8 days after vaccination- severe hives all over body, face with swelling and itching


VAERS ID: 1740003 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Pain, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: USJNJFOC20210950650

Write-up: SHAKING; BODY SORE FROM SHAKING; CHILLS; This spontaneous report received from a consumer concerned a 22 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, and batch number: 212A21A expiry: UNKNOWN) dose was not reported, administered on 25-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-SEP-2021, the patient experienced shaking. On 25-SEP-2021, the patient experienced body sore from shaking. On 25-SEP-2021, the patient experienced chills. The action taken with covid-19 vaccine was not applicable. The patient recovered from shaking, and chills on 25-SEP-2021, and the outcome of body sore from shaking was not reported. This report was non-serious.


VAERS ID: 1740556 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benazepril HCT, Fenofibrate, Lovastatin, Allopurinol
Current Illness:
Preexisting Conditions: Hypertension, Gout, Hypercholesteremia, Dedifferentiated Liposarcoma
Allergies: Tetracycline
Diagnostic Lab Data: none
CDC Split Type:

Write-up: vomiting, fever, chills, injection site pain


VAERS ID: 1740812 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-09-25
   Days after vaccination:219
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: 1740852 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 FD 0809 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Hypertension, Migraine, Respiratory rate increased, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid; Vit D prescription; Sngulair; Advair ; Flonase; B12; Zomig; Naratriptan; Benadryl.
Current Illness:
Preexisting Conditions: Migraine; Sinus; Hypothyroidism.
Allergies: Latex; Seafood; Shellfish; Silk tape; Iodine.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Increased respiration; headache evolving to migraine; increase in BP (109/78-183/113) syncope 15-20 min post vaccine.


VAERS ID: 1740912 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: GI upset for prior 3 days
Preexisting Conditions: Morbid obesity
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Not reported because of an adverse reaction. Reported because the patient received a 1 mL dose instead of the intended 0.5 mL dose. Patient tolerated the over-dosage while admitted in the ED per report. Was discharged shortly after.


VAERS ID: 1740919 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 FF8839 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Injection site reaction, Menstruation irregular, Pain, Vascular pain
SMQs:, Guillain-Barre syndrome (broad), Fertility disorders (broad)

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

Write-up: Visible, painful vein from injection site to left breast. Started menstruation over a week early. Aches and pains from head to toes including finger tips and toes. Weak.


VAERS ID: 1740942 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 3 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi Vitamin
Current Illness: None
Preexisting Conditions: Doesn''t have a spleen High Blood Pressure High Cholestorol
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Was given the incorrect vaccination. Went to get a booster vaccine and was given this by pharmacist. No possible side effects as of now.


VAERS ID: 1740980 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-23
Onset:2021-09-25
   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 FC3181 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methocarbamol, Trazodone, Gabapentin, Lisinopril/ Hctz, Duloxetine, Celecoxib, Omeprazole, Buspirone, Rosuvastatin,
Current Illness:
Preexisting Conditions:
Allergies: Biaxin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administered on 9/23/2021. Adverse event occurred 2 days later on 9/25/2021. Swollen painful right arm, 8'''' red spot at injection site ending just above elbow.


VAERS ID: 1741032 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 FE3592 / 2 UN / IM

Administered by: Other       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: On 9/25/21, at approximately 10:20am this FNP handed the 0.5ml syringe of the Moderna vaccine to the MA, informing her that it was for the patient requesting her 2nd Moderna. At approximately, 10:45am, MA informed me that she realized she had given the Pfizer vaccine to the patient instead of the Moderna and she had already let the patient leave after waiting 15 mins. The MA stated she verified with the patient her name and that she was there for the "Pfizer" vaccine and the patient replied, "Yes." The MA said, "Maybe the patient didn''t hear me well enough." The patient did not show signs/symptoms of adverse reactions following the vaccination administration during the 15 minute wait time. This FNP reached the pharmacy at approximately 11am to report the error and for further guidance. The pharmacist contact the clinical director and stated there is no further action to be taken at the time aside from notifying the patient. Once I arrived back at the pharmacy to drop off the vaccines at approximately 1:15pm, I attempted to reach the patient to inform her of the error. I was unable to reach her and did not feel comfortable leaving a voicemail message due to confidentiality/HIPAA rules.


VAERS ID: 1741054 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: I experienced a little nausea and soreness into my left arm. I also had a headache.


VAERS ID: 1741069 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-29
Onset:2021-09-25
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Exposure during pregnancy, Monoclonal antibody unconjugated therapy, SARS-CoV-2 test positive, Sinus congestion, Sinus pain, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: cholecalciferol (VITAMIN D3) 1.25 MG (50000 UT) capsule TAKE 1 CAPSULE BY MOUTH ONE TIME PER WEEK ? doxylamine succinate (UNISOM) 25 MG tablet Take 1 tablet by mouth nightly as needed (Nausea). ? fluticasone (FLONASE) 50 MCG/ACT nasal
Current Illness: None
Preexisting Conditions: Currently 19 weeks pregnant
Allergies: Percocet
Diagnostic Lab Data: 9/27/21 SARS-COV-2 PCR - Detected
CDC Split Type:

Write-up: Sinus congestions and post nasal drip for several days (5-6). Has been doing neti pot, tylenol and ibuprofen, and afrin. Vapor inhaler was making her nose burn and drying it out. Afrin x2 days. Cough from post nasal drip, tenderness in the frontal sinuses. Denies fevers, body aches or chills Mild loss of taste and smell due to nasal congestion. Has had has COVID vaccines. Has had 2021 Flu shot 09/28/21-Patient received Regeneron infusion


VAERS ID: 1741119 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-14
Onset:2021-09-25
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, Chills, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Headache, Myalgia, Pleuritic pain, Productive cough, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Accu-Chek Softclix Lancets lancets Use. ? albuterol (PROVENTIL HFA;VENTOLIN HFA) 108 (90 BASE) MCG/ACT inhaler Inhale 2 puffs into the lungs every 6 (six) hours as needed for Wheezing ? allopurinol (ZYLOPRIM) 100 MG tablet ? a
Current Illness: No known illnesses
Preexisting Conditions: Benign essential HTN ? Cancer (CMS/HCC) 21 years CERVICAL CANCER <25 YRS ? CHF (congestive heart failure) (CMS/HCC) ? COPD (chronic obstructive pulmonary disease) (CMS/HCC) ? Coronary artery disease 5 STENTS ? Depression ? Diabetes mellitus (CMS/HCC) ? Hyperlipidemia ? Irritable bowel syndrome (IBS) ? Myocardial infarction (CMS/HCC) STATES SEVEN M I s ? Neuropathy 7/2015 ? Stroke (CMS/HCC) HX TIAs <5YRS AGO
Allergies: Aspartame, Aspartame and phenylalanine, codeine, hydrocodone/acetaminophen, ciprofloxacin, Nsaids
Diagnostic Lab Data: 9/25/21-SARS-CoV-2 PCR - IPOC Detected
CDC Split Type:

Write-up: 9/25/21-Episode onset: 5 days ago. The problem occurs hourly. The problem has not changed since onset.The cough is productive of sputum. There has been no fever. Associated symptoms include chills, headaches, rhinorrhea, myalgias, shortness of breath (increased from baseline) and pleuritic pain (left). Pertinent negatives include no chest pain, no sweats, no ear pain, no sore throat and no wheezing Exposure to covid through a child at her grandsons sporting event Positive for chills and malaise/fatigue. Negative for fever. HENT: Positive for congestion and rhinorrhea. Negative for ear pain and sore throat. Respiratory: Positive for cough, sputum production and shortness of breath (increased from baseline). Negative for wheezing. Cardiovascular: Negative for chest pain. Gastrointestinal: Positive for diarrhea. Negative for abdominal pain, nausea and vomiting. Musculoskeletal: Positive for myalgias. Neurological: Positive for headaches. Negative for sensory change. Covid positive today. No evidence of pneumonia on chest x-ray per my review however patient with increased shortness of breath, pleuritic pain, productive cough so will treat from a preventive standpoint as patient is very high risk for developing pneumonia. Patient does meet criteria for Regeneron infusion. Discussed with patient who is agreeable to have infusion. Discussed CDC isolation guidelines and advised to follow. Encouraged to continue supportive care. Patient advised to go to the emergency room for any worsening symptoms which were discussed in detail. Patient verbalizes understanding and agrees with treatment plan. 9/26/21-Regeneron infusion


VAERS ID: 1741122 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site nodule, Injection site rash, Injection site swelling, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt. states that after receiving the 3rd dose of Moderna Booster 09/24/2021, started experiencing symptoms 09/25/2021 of severe chills, fever (100.5), fatigued, knot swollen at injection site with rash, and severe pain throughout the left arm. Self-Treated with extra-strength Tylenol, Symptoms lasting until 09/27/2021. Knot at injection site still remains and self-treated area with Topical Creams. No noted Primary visit.


VAERS ID: 1741145 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-30
Onset:2021-09-25
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Diarrhoea, Headache
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Excederin; Duloxetine; Vitamin D; C; B12; Omeprazolel Fluticason; Fenofenadine; Rizatriptan; Gabapentin
Current Illness: none
Preexisting Conditions: GERD; history of breast cancer; colon polyps; vitamin d deficiency; obesity, migrane without aura; mixed dyslipidemia
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: diarrhea, cough. headaches starting on 9/25/21


VAERS ID: 1741168 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Confusional state, Insomnia, Interchange of vaccine products, Product administered to patient of inappropriate age
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Child was given the incorrect vaccination. He was previously given Pfizer for his first vaccine. Confusion, weak, vomiting, unable to sleep. He has to go back for observation on Monday 10/04/2021.


VAERS ID: 1741289 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-09-25
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / IM

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

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

Write-up: Hospitalization 9/11 symptom onset covid positive. COVID 19 pneumonia with hypoxic respiratory failure.


VAERS ID: 1741293 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-25
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Headache, Inappropriate schedule of product administration, Injection site pain, Myalgia, Rash, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: 09/26/2021-tested positive for SARS-cov-2 from pcr swab taken anterior nares. Barcode
CDC Split Type:

Write-up: Received Tdap vaccination on the same day approximately 4 hours before COVID vaccine on the opposite arm. Experienced soreness and muscle aches radiating from injection location for three days. Slight rash on arms and sore hips on and off over next two weeks. Tested negative for COVID using PCR test 6 days after vaccination. 12 days after vaccination, tested positive for COVID. Started experiencing headache on day 10 and muscles ached all over body. Peak of body aches experienced on day 13. No congestion, no cough, no sneezing, no runny nose, no sore throat, no loss of smell or taste, no difficulty breathing, no heavy chest.


VAERS ID: 1741362 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 30145BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Flushing, Hyperhidrosis, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Nausea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fever-Severe, Systemic: Flushed / Sweating-Mild, Systemic: Joint Pain-Medium, Systemic: Nausea-Medium, Additional Details: Patient came to the pharmacy on 9/27/2021 complaining that she was still experiencing a sore arm and hasn''t felt right since being vaccinated. States she has a fever as high as 102 F over the past two days, says has a very sore arm which is warm to the touch, experienced body aches, and nauseousness. States she wanted me to report this and was advised to tell a medical professional if symptoms worsened. I followed up with her later that day and she said she felt better but still had a sore arm.


VAERS ID: 1741414 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-22
Onset:2021-09-25
   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 - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram normal, Electrocardiogram normal, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen
Current Illness: Type 1 diabetes, fatty liver
Preexisting Conditions: fatty liver
Allergies: none
Diagnostic Lab Data: elevated troponins (peak 13), normal EKG and echo.
CDC Split Type:

Write-up: Patient developed chest pain 3 days after second dose of COVID vaccine (Pfizer). Seen in ED twice, admitted for management. Found to have elevaed troponins (13) He was given RTC ibuprofen x 3 days.


VAERS ID: 1741424 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Erythema, Eye swelling, Headache, Hypersensitivity, Lip swelling, Pyrexia, Swelling face, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 24 hours after shot chills and fever started. 36 hours after shot swelling of eyes, face, lips started. 48 hours after shot eyes were swollen shut, red to the face and still had chills, fever, headache. At this time on September 26th at approximately 11pm went to our local hospital emergency room. After seeing doctor determined I had a reaction to the shot. They prescribed Prednisone 10mg and sent home. On September 29th in the am all symptoms were gone.


VAERS ID: 1741457 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 RA / IM

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

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

Write-up: Site: Pain at Injection Site-Severe, Systemic: Fainting / Unresponsive-Medium


VAERS ID: 1741509 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-23
Onset:2021-09-25
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Arteriosclerosis coronary artery, COVID-19, COVID-19 pneumonia, Dyspnoea, Hiatus hernia, Lung opacity, Malaise, Myalgia, SARS-CoV-2 test positive, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Humira 40mg, Adalimumab 80 mg, aspirin 81mg, azaTHIOprine 50mg, vitamin B complex, Calcium+D, Pepcid 40mg, glucosamine-chondroitin, levothyroxine 175mcg, Toprol-XL 25mg, multi-vitamin, protonix, zocor 20mg, azulfidine 500mg, flomax 0.8mg
Current Illness: hypertension, hyperlipidemia, hypothyroidism, coronary artery disease s/p CABG, and ulcerative colitis on azathioprine/sulfasalazline
Preexisting Conditions: hypertension, hyperlipidemia, hypothyroidism, coronary artery disease s/p CABG, and ulcerative colitis on azathioprine/sulfasalazline
Allergies: Adhesive tape
Diagnostic Lab Data: COVID PCR Pos 9/15/21 CT Angio 9/25/21 Heart size is upper limits of normal. No acute aortic pathology. No pericardial effusion. Three-vessel coronary artery calcifications with surgical changes of CABG. No pulmonary embolism. Distended azygous vein. Small hiatal hernia. LIMA graft. Trace secretions within the trachea. Primarily peripheral groundglass opacities in an organizing pneumonia pattern of lung injury. No pleural effusion or pneumothorax.
CDC Split Type:

Write-up: Patient completed their COVID-19 vaccine series on 3/23/21. Patient was admitted to the reporting hospital on 9/25/21 for COVID pneumonia. Symptoms included malaise, shortness of breath, and myalgias. Patient had onset of symptoms on 9/13, tested positive on 9/15. He was seen in clinic on 9/21 and started on dexamethasone 4mg daily. Patient continues to be hospitalized.


VAERS ID: 1741530 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 EW0164 / 3 LA / IM

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

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

Write-up: Had swelling in her arm, 3-4 inch diameter bullseye around injection site, pain, redness, pain up into shoulder


VAERS ID: 1741628 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Neck mass, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Lump on the left side of neck . Swelling and it moves


VAERS ID: 1741667 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-22
Onset:2021-09-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling cold, Malaise, Night sweats, Pyrexia, Sleep disorder
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: Daily: levothyroxine, glucatrol, farziga,, metformin, pantoprozole, tribenzor, finasteride, januvia, fluvastatin Eyedrops: timolol, lumigan, plavix lo-dose aspirin
Current Illness: 5 weeks before was in hospital for toe amputation and angioplasty of leg.
Preexisting Conditions: glaucoma, diabetes, high blood pressure
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Woke from nap Saturday afternoon not feeling well.; felt very cold. Daughter insisted on taking temperature. Ran fever with high of 101.4. Tired and lower fever Sunday. Woke during Sunday night with chills, completely soaked in sweat, returned to sleep but same thing happened about 2 hors hater-4:30AM. Next morning felt good and temperature seemed to be normal. Had an active day Monday but seemed unusually exhaused as retired Monday night. Again awakened with chills and sweat twice during the night althougn not as bad as previous night. Again on Tuesday daytime feel okay. Tem at 4PM 96.6.


VAERS ID: 1741746 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-11
Onset:2021-09-25
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 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: 9/27 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1741820 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-04-14
Onset:2021-09-25
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: On 09/24/2021 I began showing signs of facial paralysis. I went to the ER the next day 09/25/2021 where they diagnosed me with Bell''s Palsy after some basic motor function tests. They prescribed me with Prednisone and sent me home. As of 09/28/2021 I am still experiencing full facial paralysis on the left side.


VAERS ID: 1741830 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Reports sore arm that lasted more than a few days that required multiple doses of over the counter acetaminophen. Patient also iced. When pharmacy examined arm, there was a dark, yet fading, bruise ~5" down from injection area. When arriving to pharmacy 9/26/21 the bruise was in healing process and patient wasn''t in pain.


VAERS ID: 1741839 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Eyelid function disorder, Glassy eyes, Movement disorder, Nasal congestion, Pain, Speech disorder, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Carbidopa-Levodopa Atorvastatin Miralax Fiber Ciprofloxacin
Current Illness: N/A
Preexisting Conditions: Parkinson''s Disease
Allergies:
Diagnostic Lab Data: Patient is hospitalized with Covid, per Kaiser Zion diagnosis at hospital.
CDC Split Type:

Write-up: Patient could not move his legs at all, intermittently; he had moderate nasal congestion; a persistent cough; glassy eyes that he could barely open or not open at all, intermittently; patient complained of "pain all over" on Sunday night; patient would not or could not verbally respond to questions or commands on Sunday (26th) night; patient was intermittently speaking in gibberish and kept repeating the same words over again on Monday (27th).


VAERS ID: 1741871 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-13
Onset:2021-09-25
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE 3592 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Chest X-ray, Chest discomfort, Chest pain, Dyspnoea, Dyspnoea exertional, Echocardiogram, Troponin
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Gerd, ptsd, COVID-19 infection 12/2020
Allergies: Opiates
Diagnostic Lab Data: 9/28. Trop: - Chest xray Echocardiogram
CDC Split Type:

Write-up: Chest pain and tightness starting 9/24. Exercised 9/25 could not catch breath and Sob. Went to Er on 9/28 with sob and elevated bp. 133/101. They said could not rule out paricarditis,


VAERS ID: 1741873 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-29
Onset:2021-09-25
   Days after vaccination:149
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: 1741875 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Chills, Dizziness, Feeling hot, Pallor, Panic attack
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: After 15 minutes of receiving injection, I had a panic attack. I felt as if I was going to pass out. So Informed the pharmacist she had me put my legs up, wasn?t helping. So i laid on the floor and put my legs on a chair. My body felt extremely hot, my husband said I lost coloring in my face. After about 30 minutes, I was able to get up and walk to my car with assistance. I had chills for 2 days. I am still having issues with anxiety attacks and consulted with my nurse practitioner. We are monitoring at home and if I feel I can?t manage, she will call in a prescription for me.


VAERS ID: 1741948 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 - / UNK LA / SYR
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER - / UNK RA / SYR

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

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

Write-up: Hives covering entire body (not itchy or hurting). They are faded after 3 days. I took Benadryl that night and in the morning they were faded a little.


VAERS ID: 1741999 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-24
Onset:2021-09-25
   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 30145BA / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Arthropathy, Condition aggravated, Grip strength decreased, Pain, Pain in extremity, Sleep disorder
SMQs:, Arthritis (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: Trazodone
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I have an appointment on 9/29 at 10:20 am with Doctor
CDC Split Type:

Write-up: I am having intense pain in the joints of my right (dominant) hand and it impacts all of my fingers and my ability to grip/grasp things. It started immediately after the first shot I received on 9/1, but it wasn?t too intense and was almost gone when I got the second shot on 9/24. After that second shot the pain has been very intense and progressively getting worse. I am losing my ability to grasp object and the pain is spreading as time progresses. I have an appointment with my doctor tomorrow (9/29) to find out if anything can be done to help because it is keeping me up at night (even if I take 3 trazodone pills) and my hand is totally throbbing during the day. I can?t grasp or grip small to medium size objects (pens, silverware, knives, handles of pots/pans or milk cartons, dog leashes, etc) or put pressure on the joints in the palm of my right hand. The pain (since the second shot) is also radiating up my arm. I also had joint issues in my left ankle on the second day (after the second shot) that was just as intense, but it only lasted a day and has not returned.


VAERS ID: 1742000 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-10
Onset:2021-09-25
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation delayed
SMQs:, Fertility disorders (broad)

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

Write-up: Missed period


VAERS ID: 1742144 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 FF8839 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: (LOT#: FF8839) received 2nd dose of Pfizer on 9/25/21. Patient alerted nurse at 0915 while getting vaccinated that he felt lightheaded. Patient was given a juice and nutrigrain bar. Patient stated that the same thing happened to him when he got the first dose but it was sudden and symptoms subsided within 10 seconds. EMT took patient pulse. HR: 53. PHN recommended that patient stay for an extra 30 minutes for observation. Patient agreed to stay. Patient was also given an ice pack to help cool down. Patient was diaphoretic. EMT took patients vital signs at 0923. BP: 132/82, HR: 79, 02: 98%. Patient stated that he did not eat breakfast and that he came straight from work. EMT assessed patient. Patient stated that his dizziness was at a 3/10 and his symptoms were getting better. EMT reassessed and retook patients vital signs. BP: 132/86, HR: 86, O2: 100%. Patient stated that ate yesterday at 5:00pm and has no water since. Patient was given another nutrigrain bar. Patient finished both nutrigrain bars and water provided to him. At 0930 patient stated that his dizziness is at a 0/10 now and was not nauseous. EMT observed that patients skin was warm and dry. At 0933 EMT reassessed and retook patients vital signs. BP: 142/78. HR: 66. Patient stated he was feeling a lot better. EMT reassessed and retook patients vital signs at 0940. BP: 142/78, HR: 83, O2: 99%. Patient stated that his symptoms were completely gone 0/10 on lightheaded/dizziness. EMT reassessed and retook patients vital signs. BP: 144/84, HR: 64, O2: 100%. Patient stated he did not feel any other symptoms 0/10 lightheaded/dizziness. At 0948 PHN educated patient about high blood pressure and to make an appointment with PCP. Patient verbalized understanding and agreed to making appt with PCP regarding blood pressure. PHN educated patient on side effects of COVID vaccine and when to call EMS. Patient verbalized understanding of education.


VAERS ID: 1742180 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dry throat, Feeling cold, Pain, Pyrexia, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol Er Succinate 50mg, amlodipine 5mg, escitalopram 10mg, losartan 50mg
Current Illness: None
Preexisting Conditions: Low back injury
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Big red body rash, fever, body aches, cold chills, diarrhea, bad dry throat


VAERS ID: 1742352 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   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 301358A / N/A LA / IM

Administered by: Public       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None disclosed.
Current Illness: None disclosed.
Preexisting Conditions: None disclosed.
Allergies: None disclosed.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Clinical deviation of Pfizer mixed with Moderna. Patient received "booster" of Pfizer after Hx of Moderna Dose #1 1/9/21 & Moderna Dose #2 2/6/21. Not considered immunocompromised. F/U with patient on 9/27/21 and patient verbalized no S/S.


VAERS ID: 1742752 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levaxin, Eliquis, Metaprolol, Atorvastatin, Plaqueoff, Lithium Orotate, garlic, magnesium, multivitamins
Current Illness: Cold (upper respiratory infection)
Preexisting Conditions: Low thyroid after radiation for tongue-base cancer 11 years ago
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red itchy spots on legs, arms (even one palm), shoulders


VAERS ID: 1742991 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-01
Onset:2021-09-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tooth abscess, X-ray
SMQs:, Osteonecrosis (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: Vitamins-d,e,c,prostate vitamin ,co-q10
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: X-ray - 9/28/21
CDC Split Type: 204B21A

Write-up: About 5 days , I ended up with an abscess tooth and now I need a root canal . Not sure if it is connected but I have never had any trouble with my teeth .


VAERS ID: 1743471 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse drug reaction
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210950556

Write-up: ALMOST DIED; This spontaneous report received from a parent via a company representative concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 25-SEP-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 25-SEP-2021, the patient experienced almost died. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of almost died was not reported. This report was non-serious. .


VAERS ID: 1744144 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Diarrhoea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Abdominal Pain-Medium, Systemic: Diarrhea-Medium, Systemic: Weakness-Medium, Additional Details: Pt has fully recovered. talked to patient about general reactions/ ae from vaccine. No major reaction


VAERS ID: 1744145 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Diarrhoea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Abdominal Pain-Medium, Systemic: Diarrhea-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Weakness-Medium, Additional Details: Talked to patient over the phone. Has fully recovered.


VAERS ID: 1744289 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Fatigue, Nausea, Pain in extremity, Swelling, Vertigo
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling , redness and pain in arm; Vertigo and nausea; Tiredness


VAERS ID: 1744346 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injected limb mobility decreased, Muscular weakness, Nausea, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Arm soreness started early morning following vaccine. Pain grew and patient was unable to use left arm. Muscle weakness was noted and she was unable to lift her arm above shoulder level. Ice packs and pain relievers were used which seemed to help a little with the soreness, but arm weakness and pain was still present and at times the pain was excruciating. Patient had bouts of dizziness and slight nausea. These symptoms persisted throughout the day on Saturday (vaccine was given Friday, early afternoon). These symptoms gradually dissipated on Sunday morning and were almost completely gone by Sunday afternoon. No fever was present during this time.


VAERS ID: 1744410 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-14
Onset:2021-09-25
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2, Fatigue, Headache, Nasal congestion, Pain, Productive cough, Sinus congestion, Sinus operation
SMQs:, Infective pneumonia (broad), COVID-19 (narrow)

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

Write-up: headache, productive cough, body aches, sinus congestion, nasal congestion, post nasal drainage. she also has fatigue. starting on 9/25/21. Her 3-year-old son tested positive yesterday for Covid. (9/27/21)


VAERS ID: 1744449 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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: Same reaction- PFIZER #1 and #2
Other Medications: Propranolol 120mg PO QD Topiramate 25mg PO BID Phentermine 15mg PO QD Desmopressin 0.2mg PO QD Furosemide 20mg PO BID
Current Illness: Denies
Preexisting Conditions: Migraines Von Willebrand''s PONV Cholecystectomy Hysterectomy Ortho surgeries
Allergies: Compazine Promethazine Codeine NutraSweet MSG
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received PFIZER COVID vaccine at approximately 1100. Reported history of itching and tightness in throat after dose #1 and dose #2 (did not disclose on screening form). Patient pre-medicated with children''s Benadryl (reports she is allergic to the dye and some medication coatings). 11:23 patient reported itching in throat, given water and taken to exam room. patient reported "feels like water is getting stuck". Last Benadryl 11:15AM. Declined IM Benadryl. 11:30 BP 115/80, O2 99%, HR 65- no obvious airway swelling or malformation Patient talking and conversating normally, no respiratory distress, wheezing or stridor. 11:38 BP 121/86, O2 99%, HR 64 11:40 Feels better, requesting to go home.


VAERS ID: 1744458 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prescription: Lamotrigine
Current Illness: none
Preexisting Conditions: 1 previous seizure, at the age of 21
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: SEIZURE: patient had a seizure within 1 minute of receiving the vaccine- both I, her mother, and the pharmacist observed. Healthy individual with only one prior seizure. Seizure lasted 1-2 minutes. Body stiffened, moaning, eyes wide open. Was weak for 15-20 minutes afterward.


VAERS ID: 1744597 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-16
Onset:2021-09-25
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 210416-072 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID19 test 9/22/21
CDC Split Type:

Write-up: Hospitalization on 9/25/21 for COVID19


VAERS ID: 1744667 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-12
Onset:2021-09-25
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Patient developed chest pain and was evaluated in the ED. After work-up, diagnosis of pericarditis was given.


VAERS ID: 1744669 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ataxia, Chills, Diarrhoea, Headache, Hyperhidrosis, Nausea, Skin warm
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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: Synthroid, mobic, tylenol, cymbalta
Current Illness: None
Preexisting Conditions: Hypothyroidism, obesity, osteoporosis
Allergies: Hypersensitivity to narcotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe frontal headaches, ataxia, chills, diaphoretic, forehead warm to touch, but afebrile. Anything that I put in mouth went straight through bowels. Nausea,starting 12 hours after injection, has continued for 5. Days. Am now in ED for eval for dehydration


VAERS ID: 1744760 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-28
Onset:2021-09-25
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS JL5C3 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Facial pain, Facial paralysis, Head discomfort, Headache, Neck pain
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Glaucoma (broad), Hearing impairment (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: Vascular malformation Breastfeeding
Preexisting Conditions: Vascular malformation
Allergies: N/a
Diagnostic Lab Data: 2 doctors office visits to rule out stroke one on Monday 9/27 and Tuesday 9/28.. Head pressure, neck pain facial pain and headache. If not better by Friday will go to ER
CDC Split Type:

Write-up: Facial droop-bells palsy


VAERS ID: 1744973 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Extra dose administered, Headache, Injection site pain, Pain
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: Associate received the Pfizer booster shot on 9/24/21 and on 9/25/21 she began to experience symptoms of chills, headache, body ache, and a fever of 99.0 degrees F. She also experienced pain at the injection site.


VAERS ID: 1745057 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-09-25
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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: 1745084 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Symbicort, OTC multivitamin
Current Illness: none
Preexisting Conditions: Asthma
Allergies: Hydrocodone, Codeine
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Swollen lymph node left axillary region, headache


VAERS ID: 1745127 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-09-17
Onset:2021-09-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram abnormal, Facial discomfort, Laboratory test, Limb discomfort
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No Known medications
Current Illness: No illness noted at time of vaccination or up to one month prior.
Preexisting Conditions: Smoker, High Cholestrol
Allergies: No none allergies
Diagnostic Lab Data: Labs were obtained and EKG. EKG showed large MI including Inferiorposterior and lateral aspects of heart. Pt. was immed. transferred to higher level of care/
CDC Split Type:

Write-up: On 09/25 pt. presents to ER with substernal chest pain with onset 1 hour prior with discomfort radiating to Left jaw and left arm. Incidentally documented that pt. had his 2nd Covid Moderna vaccine on 09/17/2021. Pt. has no prior cardiac hx.


VAERS ID: 1745144 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Federated States of Micronesia  
Vaccinated:2021-02-10
Onset:2021-09-25
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinated patient hospitalized with COVID-19.


VAERS ID: 1745147 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-11
Onset:2021-09-25
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, Chest discomfort, Fatigue, 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen albuterol amLODIPine atenolol
Current Illness: None
Preexisting Conditions: DM, HTN, Obesity, Asthma.
Allergies: Latex Ace Inhibitors Aspirin Citrus C Insulin Lisinopril
Diagnostic Lab Data: COVID test Positive. Chest-X-ray.
CDC Split Type:

Write-up: Chest pressure, Fatigue. Treatment: No anti-Covid treatment needed at this time. Maintain COVID isolation.


VAERS ID: 1745148 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-20
Onset:2021-09-25
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood glucose increased, Cerebral haematoma, Computerised tomogram head abnormal, Dysarthria, Facial paresis, Grip strength decreased, Hyperhidrosis, Pallor, Screaming
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic pressure ulcer of Left foot Muscle weakness Diabetes Type II Epilepsy Tachycardia
Allergies: No known drug allergies
Diagnostic Lab Data: CT Per follow-up nurses note: Note: resident admitted with intraparenchymal hematoma of brain left without loss of consciousness per CT at hospital. the patient is now being taken to hospital to ICU
CDC Split Type:

Write-up: The patient was eating lunch, began yelling out, the speech was slurred, right side of the face drawn, grips unequal (right side), pale and diaphoretic. FBS 148. the resident was alert. vitals obtained 198/109, pulse 88, o2 98% RA. notified EMS of emergency - Sent to ER to R/O Stroke


VAERS ID: 1745217 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-29
Onset:2021-09-25
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Trimethoprim,
Current Illness: CAD, CABG, ANxiety, CHF depression, GERD, PE
Preexisting Conditions: CAD, CABG, ANxiety, CHF depression, GERD, PE
Allergies: Penicillin
Diagnostic Lab Data: covid rapid test
CDC Split Type:

Write-up: COVID positive


VAERS ID: 1745281 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Chest X-ray normal, Electrocardiogram normal, Heart rate increased, Laboratory test, Pregnancy, Ultrasound scan normal
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Normal pregnancy conditions and outcomes (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: Covid a month prior
Preexisting Conditions:
Allergies: No
Diagnostic Lab Data: EKG, chest X-ray, ultrasound, lab work came back normal 9/25/21.
CDC Split Type:

Write-up: When I got home couple hours later I felt my heart beating fast and started getting stomach pains. Went to the ER where I found out I was pregnant less than 6 weeks.


VAERS ID: 1745370 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Fatigue, Feeling abnormal, Headache, Impaired work ability, Pain, SARS-CoV-2 test negative
SMQs:, Taste and smell disorders (narrow), Dementia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Estradiol, Trintellex, magnesium, Iron, multi vitamin, cranberry
Current Illness: N/A
Preexisting Conditions: Pacemaker for sick sinus syndrome Hypertension
Allergies: N/A
Diagnostic Lab Data: 9/28/2021 at home Covid test negative 9/29/2021 rapid test at dr office negative
CDC Split Type:

Write-up: Took shot on Friday, 9/24/2021. Woke up 9/25/2021 unable to smell or taste and with headache, body ache and fatigue. Progressively got worse. Unable to go to work. Took home test for Covid on 9/28/2021 and was negative. Talked to nurse through my insurance company who said if I still had symptoms the next day to follow up with a doctor. I did that today, 9/29/2021. Tested negative at dr office with rapid test. Still feel like crap, no smell or taste and headache, extreme fatigue, body aches.


VAERS ID: 1745377 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Chest pain, Lymph node pain, Lymphadenopathy, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: received shot on Thursday evening, Saturday morning I started feeling swelling and pain under armpit, associated with chest/ breast pain. as per my employee covid center on Monday symptoms were still present as per command center seek medical attention. on monday evening i went to see my primary who told me lymph node pain and swelling is expected after vaccination. pain and swelling is still noted 6 days later.


VAERS ID: 1745430 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Clinical exam. September 28, 2021.
CDC Split Type:

Write-up: Patient presented to office for left axillary swelling following administration of vaccine.


VAERS ID: 1745461 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3784 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose decreased, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (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: Humalog 3 x daily, Lantus , Anastrozole , famotidine, levothyroxine, nadolol, losartan, amlodipine, vitamin D ,
Current Illness: no
Preexisting Conditions: diabetic 2 enlarge artery high blood pressure , breast cancer survivor . CiDP nerve attacks .
Allergies: latex , codeine , lactose
Diagnostic Lab Data:
CDC Split Type:

Write-up: Glucose dropped to 40 . Dizzy and light headed . Lasted about 20 mins


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