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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 478 out of 8,941

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VAERS ID: 1745466 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-17
Onset:2021-09-25
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Fatigue, Headache, Myalgia, Nausea, Oropharyngeal pain, Respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: duloxetine 60mg BID fluocinonide topical BID gabapentin 600mg HS glimepiride 2mg daily losartan 50mg daily metformin 1000mg BID
Current Illness: None documented
Preexisting Conditions: Type II Diabetes, Hypertension, Diabetic Neuropathy, Eczema
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated Headache, Sore Throat, Cough, Nausea, Chills, Muscle Aches, Fatigue, Congestion


VAERS ID: 1745470 (history)  
Form: Version 2.0  
Age: 45.0  
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 301308A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chills, Injection site erythema, Injection site nodule, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever of 102, chills, red and warm ring around injection sight. She called her dr office and they told her to put ice on it and take Motrin. The ring kept getting bigger until it became a big knot. She went to the dr and gave her some antibiotics


VAERS ID: 1745522 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Idaho  
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 FF2588 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye pain, Ocular hyperaemia, Photophobia, Uveitis
SMQs:, Anaphylactic reaction (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Ocular infections (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Severe eye pain and with redness and photophobia. Diagnosed with Uveitis


VAERS ID: 1745550 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Wisconsin  
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 301358A / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 - / IM

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

Write-up: body aches, fatigue, headaches, sore arm


VAERS ID: 1745585 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
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 - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: None


VAERS ID: 1745621 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-16
Onset:2021-09-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, prenatal vitamins, cough drops with zinc
Current Illness: Seasonal allergies
Preexisting Conditions: Hashimoto''s thyroiditis, seasonal allergies
Allergies: Gluten, potatoes, IV dye (CT scans)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tinnitus in right ear, beginning nine days after second Pfizer shot. Severity increases in the presence of loud environmental noise.


VAERS ID: 1745656 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-16
Onset:2021-09-25
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, C-reactive protein increased, COVID-19 pneumonia, Cough, Dyspnoea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Atorvastatin (LIPITOR) 20 mg Oral Tab ; Desipramine (NORPRAMIN) 100 mg Oral Tab; Gas Relief 80 simethicone, 80 mg Oral Chew Tab ; HYDROcodone-Acetaminophen (NORCO) 7.5-325 mg Oral Tab; Ibuprofen (MOTRIN) 600 mg Oral Tab; Lisinopril-hydroCHL
Current Illness: ADENOCARCINOMA, RECTUM (Chronic)
Preexisting Conditions: Hx of metastatic rectal cancer on Xeloda oral regimen; post-poliomyelitis syndrome
Allergies: Gabapentin
Diagnostic Lab Data: Results as of 9/29/2021 14:43 3/14/2020 12:06 CRP, SER QL: 20.6 (H) 9/26/2021 06:40 CRP, SER QL: 16.1 (H) 9/27/2021 06:45 CRP, SER QL: 10.3 (H) 9/28/2021 06:22 CRP, SER QL: 4.6 (H)
CDC Split Type:

Write-up: Admitted 9/25 for SOB, sx onset 9/15 Reports fever, body aches, cough; home sats readings 88-89% for 3 days prior to admission 67 Y male with a h/o smoking ( 10 pack years, quit last year), metastatic rectal cancer, claustrophobia, h/o post-polio syndrome admitted for acute hypoxemic respiratory failure 2/2 to COVID-19 PNA. Pt. being treated in the hospital x5 days w/ remdesivir and decadron x10days


VAERS ID: 1745688 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
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 FF2587 / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pain at injection site
Other Medications: Atenolol, Amlodipine, Lomotil, Atorvastatin, Restasis, mature multi vitamin, vitamin D, calcium, Ferrous Sulfate, ZyrTEC
Current Illness: None
Preexisting Conditions: None
Allergies: I?m urban, Remicade, Hydrochlorothiazide
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 100 degree fever & body aches started 26 hrs after injection (injection on 9/24/21 @ 3 PM, adverse event on 9/25/21 @ 5 PM). Fever ended 5 AM on 9/26/21. Felt fatigued the rest of the day, then totally fine on 9/27/21.


VAERS ID: 1745741 (history)  
Form: Version 2.0  
Age: 57.0  
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 (MODERNA)) / MODERNA 061E21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Severe fatigue, body aches, chills, nausea, headache, decreased appetite.


VAERS ID: 1745927 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
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 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram normal, Blood test, Chest X-ray normal, Chest pain, Echocardiogram normal, Electrocardiogram normal, 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Fever, malaise, myalgias (''flu like symptoms'') that were present for 2 days prior to onset of chest pain.
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Of note, I am the attending physician who saw this patient when he came in with chest pain. My summary is as follows: He had some constitutional symptoms for a day or 2 following vaccinations. As those symptoms were improving, he began developing chest pain with a quality consistent with pericarditis. We obtained blood work, EKG, chest x-ray and CTA chest. He had negative cardiac biomarkers and a normal EKG. He also got a CTA chest and a TTE (no effusion) as a part of his chest pain work up. Both were unremarkable. After speaking w/ the on call cardiologist, we elected to treat him presumptively for pericarditis based on his symptoms and work up that excluded other potential causes. He was prescribed colchicine and NSAIDs. Note: he did not have classic EKG findings of pericarditis or a pericardial effusion that would have helped clinch the diagnosis.


VAERS ID: 1746166 (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: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Decreased appetite, Headache, Joint stiffness, Myalgia, Nausea, Pain in extremity, Restless legs syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: 1st shot: Sore arm for 5 days and discoloration in skin at the injection area 2nd shot: Within 12 hours experienced chills, muscle aches and pains, restless legs, stiffness in joint, sore arm, headaches, nausea, loss of appetite, abdominal discomfort. Lasted for 2 days


VAERS ID: 1746175 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
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 30135BA / 1 LA / IM

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

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

Write-up: At Wellness Event, patient did not have a card with him or have a picture of the vaccine card and he said that he wanted a pfizer booster and double and triple check with him and he said he got the pfizer vaccine. Gave the patient the pfizer booster based on eligibility and pt came back 10 minutes later saying he remembered that he got moderna and not pfizer. Apologized to the patient and told him that he got pfizer and that it should not be any problems and if he would like to let his doctor know about what happened he can. The patient was fine he was not worry.


VAERS ID: 1746386 (history)  
Form: Version 2.0  
Age: 39.0  
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 - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Just soreness and redness at site


VAERS ID: 1746387 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Florida  
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 301358A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip discolouration
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 5mg. D3. Zi c. Vitamin c
Current Illness: NA
Preexisting Conditions: High blood pressure
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: The following morning I found what look like a bruise (a dark purple mark) on the left side of lower lip, about a 1/2 inch long. It was not sore and faded away a day later.


VAERS ID: 1746555 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Carolina  
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 - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Headache, Nausea, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Trouble breathing, high fever, chest tightness, severe headache, nausea and vomiting


VAERS ID: 1747554 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19 immunisation
SMQs:, COVID-19 (narrow)

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

Write-up: Systemic: already received J and J and did not tell pharmacy, Additional Details: pt received dose of J & J in April 2021 from another pharmacy. Did not report when making appointment for Pfizer


VAERS ID: 1747666 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Gait disturbance, Inappropriate schedule of product administration, Insomnia, Joint stiffness, Lethargy, Limb discomfort, Musculoskeletal discomfort, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (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:
Current Illness: Chronic pain (Suffers from chronic pain and patient is aware of pain of his body.)
Preexisting Conditions: Comments: Patient took muscle relaxer and NSAID for pain relief.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210952788

Write-up: RESIDUAL DISCOMFORT IN RIGHT HIP; LETHARGY; MUSCLE SORENESS; STIFFNESS IN RIGHT HIP; COULD NOT WALK WELL; COULD NOT SLEEP; INAPPROPRIATE SCHEDULE OF VACCINE ADMINISTERED; DISCOMFORT WITH RIGHT LEG; A UNIQUE HIP PAIN/ WHOLE LOT OF PAIN AND FELT LIKE A PRONOUNCED, EXAGGERATED WHEN HIP GETS TIGHT; This spontaneous report received from a patient concerned a 57 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: chronic pain, and other pre-existing medical conditions included: Patient took muscle relaxer and NSAID for pain relief. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 25-SEP-2021, and dose was not reported, administered on 24-MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 25-SEP-2021, the patient experienced stiffness in right hip. On 25-SEP-2021, the patient experienced could not walk well. On 25-SEP-2021, the patient experienced could not sleep. On 25-SEP-2021, the patient experienced discomfort with right leg. On 25-SEP-2021, the patient experienced a unique hip pain/ whole lot of pain and felt like a pronounced, exaggerated when hip gets tight. On 25-SEP-2021, the patient experienced inappropriate schedule of vaccine administered. On 26-SEP-2021, the patient experienced lethargy. On 26-SEP-2021, the patient experienced muscle soreness. On 27-SEP-2021, the patient experienced residual discomfort in right hip. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from stiffness in right hip, had not recovered from muscle soreness, lethargy, and residual discomfort in right hip, and the outcome of could not sleep, a unique hip pain/ whole lot of pain and felt like a pronounced, exaggerated when hip gets tight, could not walk well, inappropriate schedule of vaccine administered and discomfort with right leg was not reported. This report was non-serious.


VAERS ID: 1747684 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210955498

Write-up: ADMINISTRATION OF AN EXPIRED JANSSEN COVID-19 VACCINE; This spontaneous report received from a consumer concerned a 47 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 25-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-SEP-2021, the patient experienced administration of an expired janssen covid-19 vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired janssen covid-19 vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210955892.


VAERS ID: 1747693 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210955712

Write-up: ADMINISTRATION OF EXPIRED VACCINE; This spontaneous report received from a consumer concerned a 50 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 25-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-SEP-2021, the patient experienced administration of expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of expired vaccine was not reported. This report was non-serious.


VAERS ID: 1747699 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210955960

Write-up: FEELING ACHY; EYES SWELLED SHUT; LIPS SWELLED; FACE HAD TURNED BRIGHT RED; FACE SWELLED TWICE ITS NORMAL SIZE; CHILLS; FEVER; This spontaneous report received from a patient 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: 212A21A expiry: UNKNOWN) dose was not reported, administered on 24-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-SEP-2021, the patient experienced feeling achy. On 25-SEP-2021, the patient experienced eyes swelled shut. On 25-SEP-2021, the patient experienced lips swelled. On 25-SEP-2021, the patient experienced face had turned bright red. On 25-SEP-2021, the patient experienced face swelled twice its normal size. On 25-SEP-2021, the patient experienced chills. On 25-SEP-2021, the patient experienced fever. Treatment medications included: diphenhydramine hydrochloride. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the feeling achy, chills, fever, eyes swelled shut, lips swelled, face had turned bright red and face swelled twice its normal size was not reported. This report was non-serious.


VAERS ID: 1747734 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injury, Limb injury, Paraesthesia, Product administration error
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Arthritis (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: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1747736 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Back pain, Fatigue, Lethargy, Pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (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: Systemic: Body Aches Generalized-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: sewlling and join pain-Medium, Systemic: Weakness-Medium, Additional Details: Pt called today 09/29/2021 about AE to vaccine. She has been expereincing swelling in her hands and feet. gernalized pain on back and all over body. joint pain as well. Has been lasting since saturday. Does not have a PCP but advised her to find one or f/u with Phjysciian that knows her best. Pt will keep us updated and will f/u with provider.


VAERS ID: 1747757 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

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


VAERS ID: 1749372 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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: Florastor
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Went to the doctor on 9/28 when the shingles rash appeared
CDC Split Type:

Write-up: I came down with shingles


VAERS ID: 1749397 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-09-25
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood sodium increased, COVID-19, Computerised tomogram head normal, Confusional state, Dehydration, Epilepsy, Hyperglycaemia, Hypernatraemia, Hyperosmolar state, Hypertension, Intensive care, Laboratory test abnormal, Leukocytosis, Mental status changes, Nausea, SARS-CoV-2 test positive, Type 2 diabetes mellitus, Urinary tract infection, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (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:
Current Illness:
Preexisting Conditions: depression, hyperlipidemia, CAD, dementia, diabetes, COPD, CHF
Allergies: levora, lipitor
Diagnostic Lab Data: COVID test positive 9/26/2021
CDC Split Type:

Write-up: 74 year old female She was Admitted to ICU for DM II, Hyperglycemia, Nausea, Vomiting, Altered Mental Status, UTI, Leukocytosis, Dehydration, Epilepsy, Hypernatremia, Hyperosmolality, and Hypertension. I was Consulted by Dr. for Medical Management. Unable to get any history from the patient. She is confused. Patient was sent to the emergency room for abnormal labs. Patient was found to be severely hypernatremic sodium was 162. CT of the brain was negative for acute stroke. Patient was started on IV fluids nephrology id as well as Nephrology were consulted patient was admitted to ICU for further workup. Patient was also started on Glucommander. First vaccine given 1/6/2021


VAERS ID: 1749435 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-25
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cellulitis, Dysgeusia, Erythema, Fatigue, Feeling abnormal, Injection site pain, Injection site pruritus, Injection site rash, Mobility decreased, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Dementia (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I took women''s daily vitamin, magnesium, Gabapentin
Current Illness: nothing like that
Preexisting Conditions: i take gabapentin for fibromyalgia, i also use a cpap machine
Allergies: not that i''m aware of
Diagnostic Lab Data: Doctor took some bloodwork and called an antibiotic.
CDC Split Type: vsafe

Write-up: The following day after receiving the first shot, my arm was sore and it lasted a day of two and had tiredness. I had metallic strange taste in my mouth that went away and came back a few times but nothing more than that and not a big deal. I was perfectly fine after those 3 days. Up until the 25th and woke up that morning with arm being sore like and very difficult to move and thought it was very strange and lasted all day and I took Tylenol and into the next morning the 26th it was very sore. That morning I noticed a rash around my arm around the injection where I had the shot and was itchy and still sore. That was the extent of it, the redness continued to migrate down my arm so the next morning I was feeling off so I went to the Doctor that day to be seen. He gave me antibiotic and told me not to get the second shot until we figured it out. The next Tuesday my arm looked and felt better already. Dr. mentioned Cellulitis. I took the antibiotic and it made me very sick and didn''t take it anymore. Awaiting followup.


VAERS ID: 1749469 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysstasia, Hypertension, Hypoaesthesia, Lymphadenopathy, Palpitations, Rash, Vertigo
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (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), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow), 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:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Later that night he got vertigo he had a spinning sensation and was unable to stand. He has heart palpitations, a rash and swollen lymph node under left arm. Under heel of left foot has become numb. He went to the dr who dx him with vertigo and high blood pressure.


VAERS ID: 1749482 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-11
Onset:2021-09-25
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Oropharyngeal discomfort, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vraylar; Fluoxetine'' Vyvanse; Ativan; Hydroxyzine; Clonidine
Current Illness: none
Preexisting Conditions: chronic headache; reactive airway disease; obesity; bipolar 1 disorder
Allergies: ceclor
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, cough, loss of smell and taste, lots of miucus, cough feels like a tickle in throat. starting on 9/25/21


VAERS ID: 1749544 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2020-12-01
Onset:2021-09-25
   Days after vaccination:298
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram, multivitamin, fluticasone nasal spray
Current Illness: None
Preexisting Conditions: Overweight, depression
Allergies: None
Diagnostic Lab Data: Covid nasal swab
CDC Split Type:

Write-up: Positive COVID test on September 29, 2021


VAERS ID: 1749596 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest pain, Computerised tomogram, Dizziness, Dyspnoea, Electrocardiogram, Feeling abnormal, Headache, Pneumonitis
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Per patient - ''FLU(shot) - body ache, rash, headache, chills, fever"
Other Medications: N/A
Current Illness: Hashimoto''s Disease
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Per patient - "CT(chest), EKG, blood work"
CDC Split Type:

Write-up: Per patient - "chest pain, SOB , dizziness, headache, foggy, inflammation of lungs"


VAERS ID: 1749642 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-01
Onset:2021-09-25
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain lower, Back pain, Blood potassium decreased, COVID-19, COVID-19 pneumonia, Cholecystitis acute, Cholecystostomy, Flank pain, Hepatobiliary scan abnormal, Hypokalaemia, Nausea, Pain, Pyrexia, SARS-CoV-2 test positive, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet amLODIPine (NORVASC) 10 MG tablet omeprazole (PRILOSEC) 20 MG delayed release capsule potassium chloride SA (K-DUR, KLOR-CON M) 20 MEQ controlled release tablet sodium chloride flush 0.9 % syringe
Current Illness: ED 9.22.21 - for left flank pain and low serum potassium
Preexisting Conditions: Elevated liver enzymes Essential hypertension Female bladder prolapse Gastroesophageal reflux disease Mixed hyperlipidemia Obesity Polyp of colon Steatosis of liver Acute cholecystitis COVID-19 virus detected Fever Hypokalemia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.23.21); COVID-19 positive (9.25.21); Fully vaccinated Discharge Provider: MD Primary Care Provider: MD Admission Date: 9/23/2021 Discharge Date: Sep 26, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute cholecystitis [K81.0] Fever and chills [R50.9] Nausea and vomiting, intractability of vomiting not specified, unspecified vomiting type [R11.2] Left lower quadrant abdominal pain [R10.32] COVID-19 virus infection [U07.1] HOSPITAL COURSE: Patient is a 65 yo female with a PMH of HTN admitted for abdominal pain secondary to acute cholecystitis and COVID pneumonia. She presented with a 2 day history of acute abdominal pain radiating to her back associated with food intake. In the emergency department, a right upper quadrant ultrasound was obtained and concerning for cholelithiasis/CBD dilation/acute cholecystitis. General surgery was consulted and HIDA scan was obtained which confirmed acute cholecystitis. Patient was also noted to be febrile on admission for which she was started on Zosyn. She also tested positive for COVID, and other than fevers, she had no other COVID symptoms. Due to her COVID positive status, general surgery recommended IR consult for cholecystostomy tube placement with plans for cholecystectomy in 6 weeks. Cholecystostomy tube was placed successfully on 09/25. Patient was started on a diet and able to tolerate oral intake with no problems. She was discharged home stable condition on Augmentin to complete a 5 day course of antibiotics. She will follow-up with Interventional Radiology for drain management as well as General surgery for cholecystectomy. Of note, patient also was noted to have hypokalemia during admission, and was discharged on 5 days of supplementation with instructions to follow-up with PCP for repeat check. Discharge Disposition: home or self care Active Issues Requiring Follow-up: 1. Acute cholecystitis: Follow up with IR and General surgery to discuss plans for cholecystostomy tube removal and cholecystectomy plans 2. Hypokalemia: Follow-up with PCP for repeat potassium check


VAERS ID: 1749672 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-27
Onset:2021-09-25
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid positive community


VAERS ID: 1749676 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cardiac disorder, Chills, Headache, Hot flush, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu and tetnas vaccines
Other Medications: synthroid, methlytest and multi-vitamins
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: chills, hot flashes, sweats, weakness, heart trouble and headache


VAERS ID: 1749700 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-16
Onset:2021-09-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Dyspnoea, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sertraline, Metoprolol, Memantine, Melatonin, Diclofenac gel, Tylenol, Metamucil, Senokot, Latanoprost, Vitamin B12
Current Illness: None.
Preexisting Conditions: Alzheimer''s, Major Depressive Disorder, Anxiety, Insomnia, Hypertension, Hyperlipidemia
Allergies: Aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed shortness of breath on 9/25, went to the ED the next day and was diagnosed with a saddle submassive bilateral pulmonary emboli as well as bilateral lower extremity DVT''s and is receiving treatment with heparin in the hospital. Interventional Radiology refused intervention due to patient''s advanced age and CT surgery is consulting to see what they will do.


VAERS ID: 1749762 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-09-25
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Asthenia, Atelectasis, Blood folate normal, COVID-19, Chest X-ray abnormal, Dyspnoea, Fibrin D dimer increased, Hypoxia, Lung infiltration, Malaise, Oxygen saturation decreased, Pancytopenia, Pleural effusion, Pyrexia, SARS-CoV-2 test positive, Vitamin B12 normal
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (narrow), Asthma/bronchospasm (broad), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Myelodysplastic syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, aspirin, lopressor, multivitamin
Current Illness:
Preexisting Conditions: Coronary artery disease, macrocytic anemia, dyslipidemia, left bundle branch block, mild aortic stenosis, hypertension, hyperlipidemia, duodenitis, pacemaker, h/o heart artery stent, cirrhosis, portal hypertensive gastropathy.
Allergies: Levofloxacin
Diagnostic Lab Data: COVID detected swab on 09/25/21.
CDC Split Type:

Write-up: "Fully vaccinated patient admitted for shortness of breath. Provider discharge summary below: ""78 yo M, hx COPD, CD s/p stent placement x4, HFpEF w/ pacemaker, and severe aortic stenosis awaiting TAVR evaluation who was transferred here from Watervliet with hypoxia on ambulation. He presented to WV ED on 9/26 with fever, weakness, and general malaise. A CXR found L pleural effusion that was chronic and adjacent atelectasis or infiltrate. COVID test was positive. He was started on Remdesivir and Decadron. He was not requiring oxygen at rest at that time, but he would desaturate into the 70''s on ambulation. He was continued on his home inhalers for chronic COPD, not suspected to be in exacerbation. He was worked up for PE''s because of elevated D-Dimer and hypoxia, CTA showed no pulmonary emboli. Pancytopenia was noted, B12 and folate were WNL. Pancytopenia improved over time. He was given heart failure education before leaving the hospital to manage any heart failure symptoms at home. He continued to improve over the 2 days he was admitted, able to ambulate without desaturating. He is being discharged home in stable condition"""


VAERS ID: 1749810 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-22
Onset:2021-09-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain, Adverse drug reaction, Anxiety, Blister, Pruritus, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: pt called hospital call center reporting side effects after dose 1. Pt reports she had her 1st dose of Moderna on 09/22/21, next day woke with fever and noticed S/E 10-12 hrs started sharp abdominal pain, she took medical charcoal . During this 9/25/21 call, pt reports still has abdominal discomfort, states concerned abut her worse rash on hands, noticed blisters and itchy. Pt was advised to be reevaluated at ED


VAERS ID: 1749828 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 AR / SYR

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

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

Write-up: Severe diarrhea worsening to Clostridium difficile colitis (C. diff). Patient went to ER on 9/26/21 and returned to the ER on 9/29/21. Patient admitted to the hospital.


VAERS ID: 1749938 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-07
Onset:2021-09-25
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: PATIENT HAD COVID-19 VACCINE PFIZER Dose 1 date: 01/07/2021, Dose 2 date: 01/28/2021, AND TESTED POSITIVE TO COVID.


VAERS ID: 1749971 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-20
Onset:2021-09-25
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haemorrhage, Seizure like phenomena, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), 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: Synthroid Iron vitamin Vitamin d Magnesium Wellness Vitamins Legendairy Vitamins Prenatal Vitamin Ibuprofen
Current Illness: Migraines Currently breastfeeding
Preexisting Conditions: Hashimotos Anemia
Allergies: Cinnamon Omnicef
Diagnostic Lab Data: N/A Following up currently
CDC Split Type:

Write-up: Fainting Bleeding Seizure like activity


VAERS ID: 1749976 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-22
Onset:2021-09-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / SYR

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

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

Write-up: Swelling at and around injection site, hot to touch, severe itching and severe pain. Swelling continued to worsen for 48 hours.


VAERS ID: 1749990 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: INDIVIDUAL ATTENDED A COVID VACCINATION CLINIC ON 9/25/21. THERE WAS NO INTERNET ACCESS SO SIIS COULD NOT BE CHECKED TO SEE IF VACCINE WAS PREVOUSLY NOTED AS BEING GIVEN. THIS INDIVIDUAL ACKOWLEDGED 2 TIMES PER PERMISSION FORM THAT SHE HAD NEVER RECEIVED A COVID VACCINE AND THIS WAS HER FIRST. SHE RECEIVED PFIZER BOINTECH VACCINE ON THIS DATE WITHOUT INCIDENT. SHE WAS MONITORED FOR 15 MINUTES AFTER VACCINATION AND HAD NO SIDE EFFECTS REPORTED. DR. PUBLIC HEALTH PHYSICIAN WAS NOTIFIED. PHONE CALL TO PATIENT ASKING HER ABOUT RECIEVING J&J VACCINE ON 3/14/21 AS RECORDED. I ASKED IF SHE HAD RECEIVED THAT VACCINE AND SHE DENIED AT THAT TIME, SAID SHE HAD IT.


VAERS ID: 1750023 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-30
Onset:2021-09-25
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 2019 Novel Coronavirus RNA specimen collected 9/24/2021
CDC Split Type:

Write-up: hospitalized 9/25/21 for covid pneumonia


VAERS ID: 1750179 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Unknown  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Injection site reaction consisting of pain, redness and swelling through day 5. Redness, itching and pain are continuing. Contacted pharmacy where vaccine was given and pharmacist advised watching injection site and if continues to worsen or no signs of improvement to seek medical attention through local urgent care.


VAERS ID: 1750192 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, 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: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Penicillin.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Severe itching all over my body (scalp, behind ears, neck, chest, arms, stomach, back, & legs). Started roughly 12 hours after receiving the vaccine on 9/25 and still hasn''t fully gone away, though it has improved some (today is 9/30). Rash like bumps on chest, stomach, and back that weren''t there before - also some hives. Not sure if it is directly related to the vaccine, but I have not changed anything else about my routine - using the same laundry detergent, soaps, hair products, makeup, deodorant, lotion, perfume, etc. Haven''t eaten any new foods that may have caused it either. Husband was also vaccinated and did not have this reaction. I have been taking Benadryl to help with the itching.


VAERS ID: 1750212 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / SYR

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

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

Write-up: Heart rate increased to 80-90 BPM from normal 72 BPM? this remained for about 36 hours?


VAERS ID: 1750226 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain, Sleep disorder
SMQs:

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

Write-up: Constant very severe headaches and body aches requiring advil every 3-4 hours. Painful enough to wake from sleep. Severe fatigue.


VAERS ID: 1750292 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / IM

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

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

Write-up: Patient is too young to receive Moderna, as she is 17.


VAERS ID: 1750342 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 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: na
Current Illness: none
Preexisting Conditions: arthritis, diabetes
Allergies: none
Diagnostic Lab Data: no adverse effects from the vaccine.
CDC Split Type:

Write-up: Patient got a 3rd dose although she did not fall under the current guideline for moderna, We did not have an attestation form on file. She had no ill effects from the vaccine and wanted a booster.


VAERS ID: 1750346 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Disorientation, Dizziness, Hypoaesthesia, Hypoaesthesia oral, Paraesthesia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Factor v Leiden May thurner syndrome Psoriasis
Allergies: None none of
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives all over face and neck some of body Very red and itchy Swollen tongue Numbness in throat, tongue, hands, legs Pins and needles over whole body Very faint, disorientated


VAERS ID: 1750558 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

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

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

Write-up: After immunization, patient fainted. He was unconscious approximately 1 minute. I had him remove his mask and gave him a bottle of water. I sat with him for 10 minutes, then had his girlfriend sit with him another 15 minutes. After that time he felt fine and they left the phamacy area.


VAERS ID: 1750574 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patient received third dose (booster shot) for Moderna. Patient did not qualify for booster dose


VAERS ID: 1751741 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Wrong technique in product usage process
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210956201

Write-up: VIGOROUSLY SHOOK THE VACCINE VIAL BEFORE ADMINISTERING; This spontaneous report received from a patient concerned a 23 year old male. The patient''s weight was 132 pounds, and height was 68 inches. 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: 204B21A expiry: 11-DEC-2021) dose was not reported, administered on 25-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-SEP-2021, the patient experienced vigorously shook the vaccine vial before administering. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vigorously shook the vaccine vial before administering was not reported. This report was associated with product quality complaint 90000195049 This report was non-serious.


VAERS ID: 1751742 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210957133

Write-up: EXPIRED LOT VACCINE ADMINISTERED; This spontaneous report received from a pharmacist concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043A21A, and batch number: 043A21A expiry: 19-SEP-2021) dose was not reported, administered on 25-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-SEP-2021, the patient experienced expired lot vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired lot vaccine administered was not reported. This report was non-serious.


VAERS ID: 1751782 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2052A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210958570

Write-up: ADMINISTERED EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 46 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 2052A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 25-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-SEP-2021, the patient experienced administered expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administered expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958564, 20210958534, 20210958784 and 20210959706.


VAERS ID: 1751790 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210958784

Write-up: ADMINISTERED EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 50 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 205A21A, and expiry:21-SEP-2021) dose was not reported, administered on 25-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-SEP-2021, the patient experienced administered expired vaccine. The action taken with covid-19 vaccine was not applicable. The outcome of administered expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958564, 20210958534, 20210958570 and 20210959706.


VAERS ID: 1752214 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Feeling abnormal, Hypoacusis, Tinnitus
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRAVASTATIN; AMLODIPINE BESYLATE
Current Illness: Blood pressure high; High cholesterol
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101275717

Write-up: he could hear himself talk/ he could bearly hear; tightness in chest; ringing in ears; had an echo in his head; This is a spontaneous report from a contactable consumer (patient). A 53-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration, administered in Arm Left on 24Sep2021 19:00 at 53-years-old (Batch/Lot Number: FF2588) as DOSE 2, SINGLE for COVID-19 immunization. Medical history included ongoing High cholesterol, ongoing high blood pressure. Vaccination Facility Type: Pharmacy/Drug Store. Concomitant medications included pravastatin taken for High cholesterol from an unspecified start date and ongoing; amlodipine besylate taken for high blood pressure from an unspecified start date and ongoing. The patient previously took bnt162b2 on 03Sep2021 in the left arm at 53-years-old (Batch/Lot Number: FC3182) as DOSE 1, SINGLE for COVID-19 immunization. The patient also previously took shingles vaccine for Immunization and never had any reactions; flu vaccine for Immunization and never had any reactions. The patient started having tightness in chest 25Sep2021 along with ringing in ears, etc.. He have never experienced this before. He might go to his doctor or ER if it does not let up by this Monday. He''s calling about the Covid 19 vaccine. He had his second Covid 19 vaccine on Friday, 24Sep2021. He went to work Saturday, 25Sep2021 and it was the weirdest thing, on Saturday night, 25Sep2021, he started having ringing in his left ear, he could hear himself talk, he had an echo in his head, and he could barely hear. He bought some over the counter medicine to help with the ringing in his ear called Lipoflavonoid daytime and night time pills. He states he gets all his regular medication too and he received his Covid 19 vaccines. He is asking if this is normal. He reports it''s a little bit better today, 27Sep2021. He states he had to miss work because of this. He tried to get an appointment with a specialist, an Ear, Nose, Throat doctor but the earliest date he could be seen was 04Oct2021. He decided to wait it out. He wasn''t seen by any other doctor and it''s better now compared to Saturday night, 25Sep2021. He is seen at the Healthcare Center but his regular doctor is no longer at the practice. He sees any doctor that is available if he needs to be seen. No further contact details provided by the caller. The patient experienced he could hear himself talk/ he could bearly hear on 25Sep2021 with outcome of not recovered, tightness in chest on 25Sep2021 with outcome of unknown, ringing in ears on 25Sep2021 with outcome of recovering, had an echo in his head on 25Sep2021 with outcome of recovering. No follow-up attempts are possible. No further information expected.


VAERS ID: 1753038 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenopia, Cardiac discomfort, Eye pruritus, Fatigue, Feeling hot, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Corneal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRESCRIPTIONS FLOVENT HFA - 2X Daily NORVASC Amlodipine Besylate 2.5 Mg TAB ASCE - 1 by mouth daily VENTOLIN HPA (Albuterol sulfate inhalation aerosol) ? use as needed during an Asthma attack VITAMINS CENTRUM SILVER FOR WOMEN ? 1 Daily
Current Illness: None except back pain
Preexisting Conditions: High blood pressure, asthma, obesity, scoliosis
Allergies: IV dye and latex
Diagnostic Lab Data: None yet. If the hive don''t disappear or stop itching I will make an appointment with my doctor.
CDC Split Type:

Write-up: On the day of the vaccination, in 30 minutes my eyes felt heavy. and I felt a warmth throughout my body down into my vagina. Later, in the day, and since I felt tired sometimes. On Tuesday, September 27, 2021, late afternoon, broke out in hives on my right forearm to right above my elbow. I called by doctor and she asked questions and suggested I take Benadryl or an antihistamine. Later, there was a small hive on my left arm, then another developed on my left arm. My heart feels different and I feel itchy all over. I will report this to my doctor. I took two Benadryl. The next day I took one benadryl at bedtime.


VAERS ID: 1753237 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0273-99 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache
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: Blood pressure and cholesterol medication
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, exhaustion and chills for 36 hours. Then symptoms returned after 48 hours for approximately 6 hours and returned again for 4-6 hours 24 hours after that.


VAERS ID: 1753317 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-19
Onset:2021-09-25
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Headache, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ATORVASTATIN; SERTRALINE; L-ARGININE; OMEPRAZOLE; TRAZODONE
Current Illness: None
Preexisting Conditions: GERD; Hyperlipidemia; Depression; Seasonal Allergies; Asthma, Restless Legs
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, loss of taste, loss of smell, headache, deep cough, and body aches, starting on 9/25/21.


VAERS ID: 1753335 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-09
Onset:2021-09-25
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053EZIA / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: I just woke up bruises all over my body. I haven''t treated it yet.


VAERS ID: 1753460 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-05
Onset:2021-09-25
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, Blood albumin decreased, Blood calcium decreased, Bradycardia, COVID-19, COVID-19 pneumonia, Cardioactive drug level, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Cyanosis, Diarrhoea, Dizziness, Dyspnoea, Electrocardiogram abnormal, Fatigue, Heart rate decreased, Lung opacity, Nausea, Pain, Procalcitonin, Productive cough, Respiratory symptom, Rhinorrhoea, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Tenderness, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization albuterol (PROVENTIL, VENTOLIN, PROAIR) 108 (90 BASE) MCG/ACT inhaler allopurinol (ZYLOPRIM) 300 MG tablet amitriptyline (ELAVIL) 25 MG tablet asco
Current Illness: 9.23.21 - COPD with acute exacerbation office visit 9.25.21 Shortness of breath - office visit - COVID-19 positive - then send to ED and admitted Hospital: Essential hypertension Permanent atrial fibrillation COPD (chronic obstructive pulmonary disease) OSA (obstructive sleep apnea) Hypothyroidism Diffuse large B-cell lymphoma of lymph nodes of multiple regions CAD in native artery Chronic diastolic (congestive) heart failure Acute hypoxemic respiratory failure due to COVID-19 Pneumonia due to COVID-19 virus
Preexisting Conditions: Headache Lyme Disease - 1990s Pleural effusion on left Edema due to hypoalbuminemia Elevated alkaline phosphatase level CHF (congestive heart failure) Bilateral lower extremity edema Incisional hernia, without obstruction or gangrene Squamous cell carcinoma of skin of scalp Dyslipidemia
Allergies: AspirinAnaphylaxis, Other Budesonide-formoterol FumarateNausea and Vomiting ErythromycinHeadache, Nausea and Vomiting Erythromycin EthylsuccinateNausea Only MacrolidesOther No Known Iodine AllergyOther OmeprazoleOther, Nausea and Vomiting Prilosec [Omeprazole]Nausea Only QuinidineNausea and Vomiting Quinidine GluconateHeadache
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.25.21); COVID-19 positive (9.25.21); Fully Vaccinated HISTORY OF PRESENT ILLNESS: Patient is a 72 y.o. male chronic obstructive pulmonary disease on nightly 2 L O2 nasal cannula, OSA on CPAP, chronic diastolic heart failure, permanent atrial fibrillation on Xarelto, history of B-cell lymphoma (2019), orthostatic hypotension, hyperlipidemia, hypothyroidism and depression who presents upper respiratory symptoms for the past 8 days and worsening dyspnea, subsequently found to be COVID-19 positive. He was fully vaccinated with Pfizer in February 2021. Symptoms began 8 days ago with rhinorrhea, body aches, fatigue, few episodes of diarrhea, nausea and 1 episode vomiting. Yesterday, he first noticed increasing shortness of breath and a mildly productive cough. Today, he came to the emergency department when feeling significant dizziness and noticing oxygen was 87% on 2 L nasal cannula. He had a negative rapid COVID test on 9/20 and was seen at urgent care on 09/23 where he was diagnosed with chronic obstructive pulmonary disease exacerbation along with possible cellulitis due to new, bluish discoloration at the distal aspect of his left foot. Discolored area is tender to palpation, but patient is unaware of any trauma to the region and is never had similar symptoms. He was discharged with prednisone and Keflex which is taken for the last 3 days. No fevers, rigors, chest pain, spreading rash, syncope or history of PE. He has been compliant with all his medications including Xarelto during this time. During my exam, patient''s heart rate is decreasing to the 30s- 40s briefly before returning to the high 50s. He is asymptomatic during this. On arrival to the emergency department, patient''s vital signs were unremarkable with exception of SpO2 93% on 4 L nasal cannula. Heart rate was intermittently dropped to 30s to 40s. Labs remarkable for calcium 7.2 this, albumin 1.8, procalcitonin 0.07, normal WBC digoxin level 1.0. COVID-19 a detected. Chest x-ray shows mild bilateral patchy opacities in a reticular pattern which is mildly increased from prior along with chronic blunting of the left costophrenic angle. Independent review of EKG shows atrial fibrillation with bradycardia and QTC 423 milliseconds. He was given dexamethasone 6 mg. Admitted to hospital medicine for acute hypoxic respiratory failure secondary to COVID-19 pneumonia Acute on chronic hypoxic respiratory failure COVID-19 pneumonia COPD with baseline oxygen at 2L NC nightly, not exacerbated -Fully vaccinated Pfizer 2/2021 -Symptom onset 8 days ago -Positive test 9/25 -Procalcitonin 0.07, no leukocytosis -CXR patchy opacities both lungs, only mildly increased from prior lung findings -Check film array -Monitor off antibiotics -Dexamethasone 6 mg daily -Out of window for remdesivir -Continue spiriva and albuterol prn -Maintain O2 sats 88-92%


VAERS ID: 1753470 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-05
Onset:2021-09-25
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, Aspiration, Blood pressure increased, Breath sounds abnormal, COVID-19, COVID-19 pneumonia, Cerebrovascular accident, Cognitive disorder, Computerised tomogram abdomen abnormal, Condition aggravated, Cough, Culture, Dyspnoea, Faecaloma, Feeding tube user, Foaming at mouth, Heart rate increased, Hemiparesis, Mental status changes, Muscle rigidity, Pyrexia, SARS-CoV-2 test positive, Speech disorder, Spinal stenosis, Ulcer, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Convulsions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (narrow), Gastrointestinal ulceration (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler ascorbic acid (VITAMIN C) 500 MG tablet aspirin 50 MG/ML compounded suspension atorvastatin (LIPITOR) 10 MG tablet buPROPion (WELLBUTRIN XL) 300 MG 24 hr
Current Illness: 9.1.21 - ED COUGH / SOB (per ems, pt from nursing home. nurse reports inc Hr and BP. noticed frothing at mouth needing suctioning and coughing. diminished lower breath sounds. CVA 1 week ago with L sided deficits and nonverbal. r/o aspiration.) and Aspiration
Preexisting Conditions: Dyspnea on exertion Decreased diffusion capacity of lung Atrial fibrillation (HCC) HTN (hypertension), benign Posture imbalance Chronic kidney disease, stage 2 (mild) Non-ischemic cardiomyopathy (HCC) Chronic diastolic congestive heart failure (HCC) Hyponatremia At high risk for injury related to fall Cough Mitral valve insufficiency and aortic valve insufficiency Falls frequently Bruit Encephalopathy Mixed hyperlipidemia Major depressive disorder Anxiety TIA (transient ischemic attack) Left-sided weakness Cervical spinal stenosis Presence of Watchman left atrial appendage closure device Decreased level of consciousness Acute cystitis without hematuria Precordial pain AMS (altered mental status) Encephalopathy acute
Allergies: Imdur [Isosorbide]Other Ace InhibitorsCough
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.19.21 - present); COVID-19 positive (9.25.21); fully vaccinated Elderly woman with recent long admission with progressive mental status decline. No obvious etiology identified despite workup with neurology service. She was discharged on tube feeds through corpak with plans for hospice if not improving. She is actually still improved from her baseline when I saw her last and discharged her. At that time she could not speak, except to say, "hi" and could not follow commands. She can now follow some commands and can say a few words and seems oriented to person and place. I''m not sure there is significant evidence of encephalopathy given her improvement from discharge still. Can treat for possible UTI given concerns from her facility, but will need to further discuss with her husband regarding goals of care. Given her marked limitations and illness,would continue to recommend hospice. In regards to her rigidity, doubt this is related to Parkinsonism. She has severe spinal stenosis which can result in spacticity and alterations in resting tone. On one leg she has fairly normal tone (left) which is almost flaccid, which would be odd and atypical for Parkinson''s to affect only 3/4 limbs. We will ask neurology (not neuro psych) about Sinamet trial given she is admitted and they have been consulted overnight, but would defer to their expertise in this matter. I evaluate her ulcer at bedside, doesn''t look infected. Does look worse than prior. Unlikely to heal. Monitor cultures. Reviewed her CT images personally with large stool burden. Add bowel regimen. Overall poor prognosis. Resident Hospitalist Significant Event Addendum Date of Service: 9/26/2021 5:27 PM Hover for details Patient did test COVID positive on 09/25/2021. Attempted to call husband to update him however he was unavailable. Patient unable to be transferred to Nursing Home due to new COVID-19 diagnosis, they will not accept her until 10 days after positive diagnosis. Consulted palliative care given most recent discussions about hospice consideration, may need to be considered for hospice in the hospital. Care manager is aware. Patient may qualify for regeneron therapy however in the setting of hospice considerations, but not recommended at this time. Follow-up medicine team will need to follow up conversations with DPOA husband. Will need to follow-up with palliative Care recommendations for further steps, appreciate their input. ASSESSMENT / PLAN: Patient is a 83 y.o. female with a PMH of Afib s/p watchman placement, hyperlipidemia, hypertension, HFrEF (33%), mild mitral regurgitation, prior CVA/TIA who presented to the ED on 09/19/21 for fever and altered mental status. #COVID 19 PNA Pt tested positive for COVID-19 on 09/25/21. Patient was recently visited by husband who was also COVID positive, unclear source of COVID pneumonia for patient. Ongoing discussions with the DPOA, husband , will need to be conducted. Dispo: Patient covid + on 9/25 and needs 10 days of isolation before facility will take her. Plan hospice at discharge with hospice at facility, Corpak will need to be removed. Husband hospitalized at Hospital for Covid infection currently.


VAERS ID: 1753492 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration, Injection site induration, Injection site pruritus
SMQs:, Drug abuse and dependence (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: The patient was seen by her provider. The patient said the site is rock hard. The provider advised her to use over-the-counter Calamine lotion on the site to control the itching.
CDC Split Type:

Write-up: The patient felt that the location site of where the vacation was actually given was too low.


VAERS ID: 1753546 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-16
Onset:2021-09-25
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, COVID-19 pneumonia, Cough, Diarrhoea, Pyrexia, SARS-CoV-2 test positive, Sepsis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 108, aspirin low dose 81mg, Lipitor 40mg, Coreg 25mg, Plavix 75mg, Voltaren 1% Gel, Lisinopril 10mg, melatonin 10mg, multi-vitamin, Spiriva 18mcg, Nitroglycerin 0.4mg
Current Illness: CAD s/p PCI, aortic stenosis s/p TAVR in October 2020, HFrEF with EF 45%, chronic kidney disease stage 3, spinal stenosis on chronic low dose prednisone
Preexisting Conditions: CAD s/p PCI, aortic stenosis s/p TAVR in October 2020, HFrEF with EF 45%, chronic kidney disease stage 3, spinal stenosis on chronic low dose prednisone, two admissions for sepsis this year (April and July 2021)
Allergies: Zolpidem, Ceftriaxone, Niacin, oxycodone, vancomycin
Diagnostic Lab Data: COVID 19 NP Swab positive 9/23/21
CDC Split Type:

Write-up: Patient finished COVID-19 vaccine series on 2/16/21. Patient arrived at reporting hospital with reports of weakness and cough. Other symptoms included fever and diarrhea. Patient was admitted on 9/23/21 with COVID-19 pneumonia with acute hypoxemic respiratory failure and discharged 4 days later on 9/27/21.


VAERS ID: 1753770 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-02
Onset:2021-09-25
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: The employee tested positive for Covid-19 after being fully vaccinated.


VAERS ID: 1753773 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-01
Onset:2021-09-25
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Headache, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test positive, Streptococcus test negative
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cardizem, Lipitor, flonase, albuterol
Current Illness: None
Preexisting Conditions: SVT, asthma, hyperlipidemia
Allergies: Sulfa, iodine, seasonal allergies
Diagnostic Lab Data: 27 Sep Rapid strep- neg
CDC Split Type:

Write-up: Tested pos for Sars cov2 on the 27th. Symptoms started on the 26th w headache. Sore throat and stuffy nose


VAERS ID: 1753783 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain lower, Dizziness, Dyspnoea, Headache, Hypoaesthesia, Pain in extremity, Paraesthesia, Pharyngeal swelling, Swelling, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole 20mg
Current Illness: unknown
Preexisting Conditions:
Allergies: clarithromycin (hives), cefaclor (hives)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported that within seconds of getting the vaccine (1st dose), he had immense pain and rush to back of head with swelling. Could only walk 10 feet before getting short of breath and lightheaded. Noted throat swelling. Sharp sensation in arms, numbness and tingling in hands. Noted tachycardia until next day. Continues to have lower abdominal pain that started evening after his injection.


VAERS ID: 1753859 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Pain in extremity, Vomiting
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: Losartan, Montelukast, Omeprazole, Fluticasone Propionate, fish oil, Allegra Allergy, Caltrate 600+D3 chewable, low dose aspirin, Simply Saline, Systane ultra eye drops, Refresh Optive gel eye drops
Current Illness: None
Preexisting Conditions: High blood pressure, AFib, perennial and seasonal allergies,
Allergies: Biaxin, Humibid, IV contrast dye, Flagyll, Ciprofloxacin eye drops
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache - 12 hours Nausea - 8 hours Vomiting- 1 hour Fatigue - 3 days Sore arm - 2 days


VAERS ID: 1753904 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-13
Onset:2021-09-25
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood urine present, Full blood count abnormal, Hydronephrosis, Metabolic function test, Protein urine present, Pyelonephritis, Ultrasound kidney abnormal, pH urine abnormal
SMQs:, Acute renal failure (broad), Haematopoietic leukopenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (narrow), Chronic kidney disease (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 30mg XR, Adderall 10mg IR, fluoxetine 60mg, spironolactone 100mg BID, metformin 1000mg BID
Current Illness: None
Preexisting Conditions: PCOS
Allergies: Bee venom
Diagnostic Lab Data: 09/30/2021 UA- pH 8.5 Blood and protein in urine CBC- low MPV High absolute immature granulocytes BMP- high calcium High albumin Renal ultrasound : 1. Mild bilateral hydronephrosis, worse on the right. If there is concern for distal ureteral obstruction, CT could evaluate further. Notably, both ureteral bladder jets were seen. 2. Debris in the urinary bladder. Correlate with urinalysis.
CDC Split Type:

Write-up: Pyelonephritis, severe Hydronephrosis mild and slight Blood in urine Protein in Urine Altered urine pH


VAERS ID: 1754067 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754137 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754140 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754262 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient


VAERS ID: 1754265 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A AR / IM

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

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

Write-up: Vaccine affected by temperature excursion administered to the patient.


VAERS ID: 1754307 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Oral herpes
SMQs:, Oropharyngeal infections (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, Sotalol, Amlodopine, Losartan, Tylenol
Current Illness: None
Preexisting Conditions: Heart disease, high blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I broke out with cold sores/fever blisters on my lip. This also occurred after my 2nd dose but I thought it was just coincidence. My second dose was also Pfizer Lot EN6198. I do get cold sores so I know I have the Herpes thing that causes them. So it appears the vaccination aggravated that like I know sometimes sun, stress, colds, etc. will. This is not a serious adverse event but I know studies are being done on the vaccine and it''s relationship to Herpes Zoster or something so I felt I should report this. I still have the fever blisters from the third shot but I''m sure they will resolve over the next few days.


VAERS ID: 1755746 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-09-25
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PROGESTERONE
Current Illness: Alcoholic (Patient had some red wine last night (on 29-SEP-2021)); Fibroids (Medications- progesterone (bioequivalent) and vitamins); Non-smoker; Perimenopause (Medications- progesterone (bioequivalent) and vitamins)
Preexisting Conditions: Comments: The patient had no known allergies, and no any drug abuse/illicit drug usage. Medication for fibroids and perimenopause- vitamins.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211000495

Write-up: SLIGHT HEADACHE AT THE BASE OF THE HEAD (WAS STILL LINGERING BUT VERY MILD), THEN IT GOT WORSE; FEELING TIRED; FEVER; BODY ACHES, (WAS LITTLE BIT SORE); CHILLS; This spontaneous report received from a patient concerned a 48 year old female. The patient''s weight was 135 pounds, and height was 64 inches. The patient''s concurrent conditions included: fibroids, alcohol consumer, non smoker, and perimenopause, and other pre-existing medical conditions included: The patient had no known allergies, and no any drug abuse/illicit drug usage. Medication for fibroids and perimenopause- vitamins. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 211A21A, expiry: UNKNOWN) dose was not reported, administered on 25-SEP-2021 for prophylactic vaccination. Concomitant medications included progesterone for perimenopause, and fibroids. On 25-SEP-2021, the patient experienced body aches, (was little bit sore). On 25-SEP-2021, the patient experienced chills. On 25-SEP-2021, the patient experienced feeling tired. On 25-SEP-2021, the patient experienced fever. On 26-SEP-2021, the patient experienced slight headache at the base of the head (was still lingering but very mild), then it got worse. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from body aches, (was little bit sore) on 27-SEP-2021, and fever on 26-SEP-2021, had not recovered from slight headache at the base of the head (was still lingering but very mild), then it got worse, and feeling tired, and the outcome of chills was not reported. This report was non-serious.


VAERS ID: 1756102 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dysphagia, Oropharyngeal pain, Pain, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

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: USPFIZER INC202101276231

Write-up: kind of difficulty swallowing or numb; numb is associated with difficulty in swallowing; having some tingling in her mouth; soring in the throat; pain moving up radiating up to the ear; tingling thumb; This is a spontaneous report from a contactable pharmacist. A 42-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) at the age of 42-years-old, via an unspecified route of administration, administered in Arm Left on 25Sep2021 (Batch/Lot Number: FC3183; Expiration Date: Oct2021) as dose 1, single for COVID-19 immunization. The patient medical history was not reported. There were no concomitant medications. The patient experienced having some tingling in her mouth kind of difficulty swallowing or numb, numb was associated with difficulty in swallowing of but an increased hard time swallowing so they gave the patient some Benadryl 25 mg as treatment. The patient had difficulty in swallowing, some soring in the throat, tingling thumb and pain moving up radiating up to the ear. The events occurred on 25Sep2021. Her second dose was scheduled on 16Oct2021. The outcome of the events was not recovered.


VAERS ID: 1756406 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alopecia, Neck pain, Pain, Pain in extremity, Sneezing, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1st Dose COVID-19 Pfizer 30145BA
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: NO
CDC Split Type:

Write-up: 12-14 hours after the injection, I felt arches all over my entire body more to the left side of the body from neck down to the legs. veins popped up in dark blue color on my left arm and upper chest more to the left side. the aches lasted about 2 days and the dark blue veins disappeared about the same time. Since this injection, I have been sneezing more often and hair falling in bunches more than usual.


VAERS ID: 1756525 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypertension, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Dehydration (broad)

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

Write-up: hypertension (150/110) onset at 2am with tachycardia (138) that continued through the morning of the 25th into the next day. Tachycardia and hypertension improved the afternoon of the 27th.


VAERS ID: 1756535 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

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

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

Write-up: Patient was given Moderna for a 3rd dose instead of Pfizer


VAERS ID: 1756624 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain lower, Chills, Fatigue, Headache, Lymphadenopathy, Nausea, Pain, Pyrexia, Toothache, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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: ESTRACE, XYZAL MSM, VIT D, CALCIUM, PLANT STEROL/STANOL,
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: Intolerance to NSAIDs - GI distress
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever, chills, severe headache, body aches (teeth also) nausea and vomiting, low abdominal pain, fatigue, some symptoms lasted for 3 to 4 days. Lymphadenopathy. Took Tylenol and aspirin for fevers and pain. Took protonix to protect stomach from aspirin.


VAERS ID: 1756736 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain, Injection site pruritus
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild, Additional Details: Patient still has bruising in the arm in which the vaccine was administered. It does not hurt, but covers a majority of the shoulder. Counseled to ice and use heat to reduce brusing as well as to apply lidocaine wound gel. Patient will follow-up with primary care physician.


VAERS ID: 1756837 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Injection site erythema, Injection site pain, Injection site swelling, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer Covid 2 Similar but Less intense symptoms
Other Medications: Metoprolol
Current Illness: None
Preexisting Conditions: Hypertension Mild obesity
Allergies: Penicillin Neomycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever chills headache muscle aches weakness starting about 12 hours after the shy Also left arm pain swelling and redness at the injection site


VAERS ID: 1756899 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 3 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Laboratory test, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Metform in HCL 100mg tab 2X daily Glimepiride 4mg tab 1 daily Alogliptin 25mg tab 1 daily Hydrochlorothiazide 25mg 1/2 tab daily Amlodipine 10mg tab 1 daily Lisinopril 40mg tab 1 daily Simvastatin 40mg 1/2 tab daily Tamsulosin Hydrochloride
Current Illness: MDS Diabetes High blood
Preexisting Conditions: MDS High blood Diabetes
Allergies:
Diagnostic Lab Data: ER took tests
CDC Split Type:

Write-up: High fever all day every day for 8 consecutive days. Fatigue Sleeping


VAERS ID: 1756913 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Chills, Diarrhoea, Fatigue, Flatulence, Headache, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (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: Vitamin D, 5000 units daily
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: No tests done
CDC Split Type:

Write-up: Initially I had pain at the site for 2 days which was very mild. However, I developed headache, chills, fatigue and bloating 9/25-9/28/2021. Due to bloating, I ordered out lunch from hospital Cafeteria. I had chicken soup. I ate one small piece of chicken and drank the broth at 1PM and 4 PM. I also had 16 ounces of a smoothie consisting of papaya, pineapple and mango . At 1 AM 9/27/2021 I had sever diarrhea, about 10 watery stools in the course of one hour. No bleeding. I was then able to sleep. The next day I was able to work. At dinner 9/27/2021 I ate half of an organic chicken breast. From 7pm until 11 PM I had explosive severe diarrhea times 10+ without blood, cramping and copious flatus. I slept about 6 hours and was able to work. ''When I woke up 9/28/21 I had one small loose stool and no further diarrhea. After moving office hours, I was able to get 2 liters of intravenous lactated ringers from 10:50 until 11:50. I proceeded to work at my endoscopy center without any further issues. I also had nausea many days after the booster vaccine but never vomited. I am not sure if the vaccine caused the diarrhea or did I have a infection from the takeout chicken noodle soup and fruit smooths. I was very close to going to the ER if the diarrhea didn''t stop.


VAERS ID: 1756915 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Dysmenorrhoea, Euphoric mood, Menstruation irregular, Pain, Palpitations, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Fertility disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine 37.5mg Levora birth control pill
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 4 hours after receiving the vaccine I started to have heart palpitations that lasted roughly 8 hours. During that time there were moments where I found myself confused and not sure what I was doing almost as if I was high. It would last a few minutes then I would come back to myself again. Then, the next morning after receiving the vaccine I woke up to find I had vaginal bleeding. I was not on my period so I should not have been bleeding. For the following 4 days, I experienced cramping pain.


VAERS ID: 1757077 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Axillary pain, Chills, Headache, Myalgia, Nausea, Pain, Photopsia, Tenderness, Thrombosis, Vaginal haemorrhage
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Retinal disorders (narrow), 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: Sumatriptan
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chills, muscle aches, shooting pains in calves, hamstrings and back, rash on neck and side, spotting and blood clots coming from vagina when not time for regular mensural cycle, abdominal cramping, severe headache, flashing light when closing eyes, tenderness and pain under armpits, nausea all lasting over a week after vaccine.


VAERS ID: 1757088 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-12
Onset:2021-09-25
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Anaemia, Heavy menstrual bleeding, Oligomenorrhoea
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: My menstrual cycle has become longer, extremely heavy and gave me symptoms of anemia during my heaviest flow days. My cycle has always lasted 5 days with a medium flow since 12 years old. My first cycle after getting the first dose of the vaccine is currently at 9 days and has not stopped yet.


VAERS ID: 1757157 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Heart rate increased, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Went to work in the Emergency department as a nurse at 08:30. While doing nothing at rest, began to have palpitations. Checked Watch and HR was 134. My resting HR is usually 50-60 BPM. I also got lightheaded and dizzy while walking after the palpitations began. I hooked myself up to a cardiac monitor in the ED and it appeared to be sinus tachycardia. I had a HR of 130-140 for 20 minutes with palpitations, nausea, and dizziness. It went away on its own after 20 minutes. For the next 8 hours at work though, anytime I walked around, my HR went back up into the 120s-130s and I felt dizzy with intermittent nausea. I drank about 4 large cups of water in that time and it didn?t help my symptoms. Eventually, the symptoms went away after going home and resting around 9pm that same day. I have never had anything like this happen to me before with a HR that high while not doing anything.


VAERS ID: 1757245 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 20 mg., Valsartan & Hydrochlorothiazide 160 & 25 Centrum Silver, Citracal, Preser Vision Areds 2
Current Illness: none
Preexisting Conditions: arthritis in hands
Allergies: none
Diagnostic Lab Data: Perscriptions which cleared up side effect rash- Prednisone 20 mg., Cetirizine, Famotidine
CDC Split Type:

Write-up: Very itchy Rash on face, arms, leg- began day after shot and continued. I tried taking Benadryl and using Cortizone 10 . They were not helpful. I saw my physician and was given medication which effective.


VAERS ID: 1757299 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood test normal, Chest X-ray normal, Chest discomfort, Chills, Electrocardiogram normal, Headache, Lung disorder, Pain, Palpitations, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ritual Women''s 18+ Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG, chest x-ray, bloodwork - September 26, 2021. All came back normal.
CDC Split Type:

Write-up: 8 hours after the vaccine was administered, I started feeling some tightness in my chest. The following day, I felt very weak with typical side effects (chills, headache, body aches, low fever), as well as persistent tightness in my chest and an occasional racing heart. I went to the ER that evening where an EKG and chest x-ray were done, as well as bloodwork. Everything came back normal. Now, a week later, I am still feeling a tightness and weakness in my chest and lungs, though I have never had a real problem breathing.


VAERS ID: 1757471 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Cellulitis, Pain in extremity, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, vitamin D3, B12, potassium, metoprolol, Venlafaxine, Metformin, Triamterene/Hydrochlorothiazide, paroxetine, Atorvastatin, Multivitamin, fish oil, vitamin C, Hair skin and nails, calcium with magnesium and zinc Had taken Flu sh
Current Illness: None
Preexisting Conditions: High blood pressure, diabetes,
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I had the regular standard temperature for a couple of days but then my left arm started hurting and noticed it was raised red sore and feverish. Went to ER to have it looked at and it was cellulitis. Was put on Keflex four Per day for seven days


VAERS ID: 1757589 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest discomfort, Computerised tomogram head, Dizziness, Dyspnoea, Electrocardiogram, Paraesthesia, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control - Junel
Current Illness: none
Preexisting Conditions: none
Allergies: Food: honey
Diagnostic Lab Data: Tuesday 9-28-21 Hospital (Emergency Room) provided some blood tests, chest xray, CT scan of brain, EKG and provided IV for possible dehydration. Recommended to eat well and stay hydrated. Doctor could not tell why the hives appeared on my face.
CDC Split Type:

Write-up: Saturday 9/25/21- around 6pm I started feeling tingling on my left hand Sunday 9/26/21- woke up with tingling on my left hand, pain on my left arm, shortness of breath at night. Monday 9/27/21- tingling on my left hand, shortness of breath, chest pressure, lightheaded, Hives on my face and neck. Called my doctor whom advised to go to the hospital if symptoms persist. Tuesday 9/28/21- Went to the ER for shortness of breath, lightheaded, and tingling on both hands at this point. Got sent home , to drink lots of fluids and rest. Wednesday 9/29/21- tingling and cramps on both my hands, shortness of breath Thursday 9/30/21- tingling and cramps on my hands, shortness of breath Friday 10-1-21 - went to my doctor''s office with shortness of breath & pressure on chest. Tingling on my hands stopped. Saturday 10-2-21 - shortness of breath and pressure on chest Sunday 10-3-21 still experiencing shortness of breath and small chest pressure.


VAERS ID: 1757609 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Missouri  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

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

Write-up: This spontaneous case reported by a pharmacist, describes the occurrence of administered expired product (healthcare worker left a voicemail stating they gave an expired vaccine to a patient) in a patient, of an unknown age and gender, who received mRNA-1273 (Moderna COVID-19 vaccine) for COVID-19 immunization. No medical history reported. On Sep 25, 2021, patient received the first dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On Sep 25, 2021, patient administered expired product (healthcare worker left a voicemail stating they gave an expired vaccine to a patient). At the time of the report, administered expired product (healthcare worker left a voicemail stating they gave an expired vaccine to a patient) resolved. The reporter did not provide any causality assessments. The expiration date for the 1st dose: Sep 18, 2021. Date the vial was initially stored in the refrigerator: Friday, Sep 24, 2021. They didn''t know how much time the vial was exposed to room temperature, or whether the vial had undergone any temperature excursions. No concomitant medications or treatment information reported. Most recent follow-up information incorporated: On Sep 27, 2021: Follow-up received on Sep 27, 2021: Reporter information, vaccine start date, event date and details updated.


VAERS ID: 1757634 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-17
Onset:2021-09-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D supplement, 1500 IUD; Synthroid, 75mcg; Omeprazole, 20mg; Atorvastatin, 10mg; Biotin, 500mcg.
Current Illness: None
Preexisting Conditions: Hashimoto disease
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine Rash developed around 7-9 days after shot. Extends from torso to arms and legs, around a pimple/square inch. Some painful, many itchy. Prescribed triamcinolone 0.1% cream - not effective. Antihistamines, standard dose - somewhat helpful. No overall reduction in symptoms at time of reporting (10/4/2021).


VAERS ID: 1757756 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-04
Onset:2021-09-25
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hypersomnia, Myalgia, Off label use, Vaccination site warmth
SMQs:, Rhabdomyolysis/myopathy (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: warmth at injection site; I slept longer then normally I do; soreness; Received 3rd dose being not immunocompromised; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 27-Sep-2021 and was forwarded to Moderna on 27-Sep-2021. This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (warmth at injection site), HYPERSOMNIA (I slept longer then normally I do), OFF LABEL USE (Received 3rd dose being not immunocompromised) and MYALGIA (soreness) in a 70-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 034C21A, 013M20A and 23M20A) for COVID-19 vaccination. No Medical History information was reported. On 04-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 25-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 25-Sep-2021, the patient experienced OFF LABEL USE (Received 3rd dose being not immunocompromised). On an unknown date, the patient experienced VACCINATION SITE WARMTH (warmth at injection site), HYPERSOMNIA (I slept longer then normally I do) and MYALGIA (soreness). On 25-Sep-2021, OFF LABEL USE (Received 3rd dose being not immunocompromised) had resolved. At the time of the report, VACCINATION SITE WARMTH (warmth at injection site), HYPERSOMNIA (I slept longer then normally I do) and MYALGIA (soreness) outcome was unknown. No concomitant medications were reported. No treatment medications were reported. Patient reported that she was not immunocompromised however she was given third shot. Patient does not recall the site of administration for doses 1 and 2. This case was linked to MOD-2021-333240, MOD-2021-333346 (Patient Link).; Sender''s Comments: This case concerns a 70-year-old, male patient with no relevant medical history, who received the third dose of Moderna COVID-19 Vaccine, however, the patient was not immunocompromised, therefore, it is considered to be Off label use. The patient experienced the unexpected events of vaccination site warmth and hypersomnia, as well as the expected event of myalgia. The events occurred after the third dose of Moderna COVD-19 Vaccine, however, the temporal relationship was unknown as the start date of the events was not provided. The rechallenge was not applicable, since the patient received the third dose of the vaccine and no additional doses will be given. The company causality for Off label use is not applicable. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report.


VAERS ID: 1757866 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: FUROSIMIDE; ATORVASTATIN; ASPIRIN COMPOUND [ACETYLSALICYLIC ACID;ASCORBIC ACID.]
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Shaking of legs; Nausea; This spontaneous case was reported by a consumer and describes the occurrence of TREMOR (Shaking of legs) and NAUSEA (Nausea) in a 79-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014F21A) for COVID-19 vaccination. Concomitant products included ACETYLSALICYLIC ACID, ASCORBIC ACID (ASPIRIN COMPOUND [ACETYLSALICYLIC ACID;ASCORBIC ACID]) for Anticoagulant therapy, ATORVASTATIN for Cholesterol, FUROSEMIDE (FUROSIMIDE) for Hypertension. On 25-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 25-Sep-2021, the patient experienced TREMOR (Shaking of legs) and NAUSEA (Nausea). At the time of the report, TREMOR (Shaking of legs) and NAUSEA (Nausea) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Carbetolol is used as concomitant medication for hypertension. No treatment information is provided.


VAERS ID: 1758702 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-04
Onset:2021-09-25
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A, 038K20 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Fatigue, Loss of consciousness, Pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Syncopal episode, weakness, body aches, fatigue for the last week to 2 weeks. Passed out woke up on the floor.


VAERS ID: 1758734 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain lower, Decreased appetite, Diarrhoea, Dizziness, Fatigue, Headache, Hot flush, Intermenstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Fertility disorders (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Irregular mensuration, spotting, chronic headache, dizziness, fatigue, loose bowl movements, upset stomach, hot flashes, loss of appetite, lower abdomen cramping.


VAERS ID: 1758755 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-05
Onset:2021-09-25
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Oropharyngeal pain, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient started with symptoms on 9/25 and admitted on 10/02 symptoms include fever, sore throat, cough, mild sob. Tachycardia. Room air., not hypoxic. Started on remdesivir & decadron


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