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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 48 out of 8,010

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VAERS ID: 1765744 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

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

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

Write-up: Reporting a vaccine administration error. Patient was given a dose of Moderna vaccine that was expired at the time of administration. Vial that dose was drawn from was moved from freezer to fridge on 8/30/2021 at 8:45pm, starting a 30 day expiration per manufacturer. Error was discovered on 10/5/2021 after a subsequent vial from the same box was identified as being expired. Manufacturer was contacted on 10/6/2021 for guidance. Manufacturer indicated on 10/6/2021 that they will "conduct an analysis to determine if the vaccine administered past 30 days provided the necessary protection against a COVID-19 infection". Attempted to contact patient on 10/6/2021, and left voicemail for patient to call back to discuss error.


VAERS ID: 1766112 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-29
Onset:2021-10-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acoustic stimulation tests abnormal, Deafness unilateral, Sudden hearing loss
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Nerve pain in right arm.
Preexisting Conditions: Diabetes
Allergies: Biaxin
Diagnostic Lab Data: A hearing test and exam on 10/5/21. Distinct hearing loss in right ear.
CDC Split Type:

Write-up: Sudden hearing loss in right ear on 10/2/21.


VAERS ID: 1766129 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062EZ1A / 2 - / IM

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

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

Write-up: Supraclavicular gland swollen, rolling lump on collerbone


VAERS ID: 1766142 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Injection site erythema, Injection site pain, Injection site pruritus, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: The evening after immunization, patient reports to have redness, pain, and itching at site of injection. Patient had a fever that lasted for approximately 2 days. Patient also reports that the swelling on her arm is approximately the size of her palm. Patient went to urgent care on 10-4-2021 at which time she was diagnosed with cellulitis and given an antibiotic.


VAERS ID: 1766153 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-10
Onset:2021-10-02
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Exposure to SARS-CoV-2, Malaise, Pain, Respiratory tract congestion, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), COVID-19 (narrow)

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

Write-up: I got tested after my partner tested positive. At the time, I was experiencing 0 symptoms. When my test results came back, I still was asymptomatic. Only the following day which was 3 days after I was tested did I exhibit symptoms, runny nose, congestion, cough, body aches.


VAERS ID: 1766164 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 RA / SC

Administered by: Private       Purchased by: ?
Symptoms: Rash, Rash pruritic, Rash vesicular, 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: Hydrochlorothiazide/lisinopril Vitamin D2 1,000 units, turmeric 500mg
Current Illness:
Preexisting Conditions: Hypertension ( controlled by medication)
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash developed on upper left arm ( not the arm I received the vaccine injection) It is a urticaria rash in 4- 5 sites on my left arm. It is itchy and has small blisters . It is responding slowly to topical creams.


VAERS ID: 1767946 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Decreased appetite, Extra dose administered, Nausea, Product preparation issue, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: had typical side effects from second dose Pfizer (fever, body aches, headache)
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: It is believed that the patient was given a 0.3 ml dose of vaccine that was not reconstituted on Friday Oct 1, 2021. On Saturday Oct 2, patient complaint of fever off and on up to 102.1, nausea, vomiting, weakness, decreased appetite.


VAERS ID: 1767995 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

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

Write-up: Facility clinic thru pharmacy provider gave the HCW a booster Pfizer vaccine in the left arm 6 inches below the acromion process, which is below the deltoid muscle. The injection went into the tissue below the deltoid resulting in pain, discomfort, redness, swelling, and warmth to area from site of injection for 48 hours.


VAERS ID: 1767999 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-02
Onset:2021-10-02
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Breath sounds abnormal, C-reactive protein, COVID-19, Cardiomegaly, Chest X-ray, Decreased appetite, Dyspnoea, Fatigue, Fibrin D dimer, Full blood count, Incentive spirometry, Metabolic function test, Monoclonal antibody immunoconjugate therapy, Oxygen saturation, Pyrexia, SARS-CoV-2 test positive, White blood cell count decreased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen-codeine (TYLENOL #3) 300-30 MG per tablet ACIDOPHILUS LACTOBACILLUS PO apixaban (ELIQUIS) 5 MG TABS bisacodyl (DULCOLAX) 10 MG suppository bisacodyl (DULCOLAX) 5 MG EC tablet carBAMazepine (TEGRETOL) 100 MG chewable tablet car
Current Illness:
Preexisting Conditions: Multiple sclerosis (HCC) Trigeminal neuralgia Lymphedema of both lower extremities Spasticity Chronic pain Chronic deep vein thrombosis (DVT) of distal vein of lower extremity (HCC) Anemia Anxiety At risk of decubitus ulcer Depression History of pulmonary embolism COVID-19 virus infection Generalized weakness Wheelchair bound
Allergies: Augmentin and Carbamazepine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 10/2/2021; COVID-19 positive 10/2/2021; fully vaccinated ED note: 10/2/2021 Assessment/Plan DIAGNOSIS at time of disposition: 1. COVID-19 New Prescriptions No new medications prescribed this visit. ED Disposition ED Disposition Hospitalized MEDICAL DECISION MAKING Supervising Physician: Patient is a 72-year-old female with a history of multiple sclerosis presenting to the emergency department with shortness of breath, weakness. She was saturating in the high 80s at her living facility and placed on 2 L oxygen transported to the emergency department. On arrival, she was satting in the high 90s on 2 L of oxygen. She had coarse breath sounds bilaterally. She has chronic left-sided deficits due to her multiple sclerosis. She is minimally communicative due to her multiple sclerosis. I did obtain a complete blood count, CMP, chest x-ray, and COVID-19 test. COVID-19 test was positive. Labs were notable for white count 2.64. Labs are otherwise unremarkable. Chest x-ray showed no acute cardiopulmonary processes. She is given Decadron and remdesivir. I spoke with the on-call hospitalist was agreeable to admit the patient. Patient is admitted to the hospitalist service in stable condition with all questions answered. 10/4/2021 note: ASSESSMENT / PLAN: No new Assessment & Plan notes have been filed under this hospital service since the last note was generated. Service: General Medicine COVID-19 infection - Symptoms include reported fever, fatigue and anorexia - Saturating normally on room air despite reported history of desaturation at assisted living facility - Symptom onset: 10/2/21 - COVID-19 positive: 10/02/2021 - Vaccination status: 2 doses of Moderna in January and February of this year - CXR: Cardiomegaly without pulmonary vascular congestion. No consolidative pneumonia. - Patient is not a candidate for remdesivir or Decadron due to lack of hypoxia - Pt received monoclonal antibody infusion on 10/2 - Encourage incentive spirometry hourly - Supportive measures with antipyretics, analgesics, antiemetics and antitussives - Monitor continuous pulse oximetry - Trend BMP, complete blood count, CRP and D-dimer daily for 3 days - DC IVF. - PT/OT/SLP 10/6/2021 note: CHIEF COMPLAINT: COVID-19 virus infection Assessment/Plan ASSESSMENT / PLAN: COVID-19 infection - Symptoms include reported fever, fatigue and anorexia. Saturating normally on room air despite reported history of desaturation at longterm care facility. Symptom onset: 10/2/21. COVID-19 positive: 10/02/2021. Vaccination status: 2 doses of Moderna in January and February of this year - Patient is not a candidate for remdesivir or Decadron due to lack of hypoxia - Pt received monoclonal antibody infusion on 10/2 - Encourage incentive spirometry hourly - Supportive measures with antipyretics, analgesics, antiemetics and antitussives - Monitor continuous pulse oximetry Dispo: Placement back to home facility once out of isolation F/u tomorrow


VAERS ID: 1768008 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: None
CDC Split Type:

Write-up: Swelling the size of an orange under the armpit of the same arm that received vaccine dose two days following injection. Followed by swelling in same side hand 24 hours after swelling under armpit. Sought medical care and was told to take 600 mg, 3 times daily ibuprofen and to elevate hand. Hand was also wrapped to provide compression. After 2 days of beginning treatment, sx resolved.


VAERS ID: 1768032 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Chest discomfort, Dehydration, Electrocardiogram, Headache, Inflammation, Laboratory test, Mobility decreased, Pain
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: She had a upper respiratory infection 3 weeks prior started on Sunday ended on Wednesday she got tested for covid it was nag and strep it was neg sent out to get Cultured everything still came back negative
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: Went 10/04/2021 to extended care hours at family health they did vitals, listened to her lungs ordered a pulse ox . they did a EKG and a chest x-ray 10/05/2021 lab work , iv, Toradol , ekg 10/05/2021 at hospital. Started Saturday, October 2 till present she is still having the chest pressure and the headache and the weakness. She has been down since Saturday and Still down .
CDC Split Type:

Write-up: Body aches, headache, chest pressure, dehydration, inflammation on her chest walls, they did a EKG and a chest x-ray lab work , iv, Toradol. Started Saturday, October 2 till present she is still having the chest pressure and the headache and the weakness. She has been down since Saturday and Still down .


VAERS ID: 1768061 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-29
Onset:2021-10-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 OT / SYR

Administered by: Military       Purchased by: ?
Symptoms: Adverse event, Amnesia, Asthenia, Bradykinesia, Discomfort, Dizziness, Dysarthria, Fatigue, Feeling abnormal, Headache, Hypotonia, Joint lock, Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibprophen 800mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: I have not been seen for the above issues but have made a medical appointment to bring up and hopefully address these issues.
CDC Split Type:

Write-up: On the day of my adverse event I was getting my hair cut. I mentioned to my Barber that I was feeling light headed and extremely uncomfortable. I sat up and she had mentioned that she would get me a cold water. As she was coming back I was slouched in the barber chair unconscious. She was yelling "hey" multiple times and eventually I regained consciousness to her tapping my arm. She resumed cutting my hair and within 2 minutes time limit I had became unconscious again. This time convulsing in the barber chair, limbs locked. I was unconscious and convulsing for approximately 10-15 seconds. Once I regained consciousness my barber was mentioning she was going to call an ambulance. I told her not to and to just give me a minute. She escorted me back to my house where I felt extremely tired for the remainder of the day and what felt like not myself. Extremely delayed to reaction, slurring speech and very little energy to even walk or stand up. Since the vaccination I have had mild memory loss, finding myself loosing track of what I was thinking mid sentence and not being able to recall even what I was talking about. Also daily headaches and fatigue. Everyday I feel as if I am on the urge of passing out. I find myself challenged to even process what I am being told.


VAERS ID: 1768100 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Endocarditis, Hypertension, Injection site erythema, Injection site reaction, Injection site swelling, Injection site warmth, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Wellbutrin, effexor, crestor, aspirin
Current Illness: Hashimoto''s thyroiditis, anemia
Preexisting Conditions: Hashimoto''s thyroiditis, anemia
Allergies: Peanuts, latex, kiwi, levaquin, strawberries, bee sting,red dye
Diagnostic Lab Data: Mild endocarditis 10/03/2021
CDC Split Type:

Write-up: Chest pain, shortness of breath, tachycardia, high blood pressure, St elevations on an EKG, raised red swollen injection site hot to the touch.


VAERS ID: 1768134 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-01
Onset:2021-10-02
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Physical examination
CDC Split Type:

Write-up: Confirmed clinical diagnosis of shingles on 10/5/21. First symptoms appeared weekend of 10/2/21.


VAERS ID: 1768258 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3014501A / 3 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Feeling abnormal
SMQs:, Dementia (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: Shingrex shingles 08/20/2021
Other Medications: Albuteral, Baby Aspirin, B complex vitamin, D vitamin, Diclofenac, Diltiazem, Donepezil, Duloxetine, Famotidine, Furosemide, Gabapentin, Levothyroxine, Metoprolol, Multi vitamin, Omega 3, Omeprazole, Spironolactone, Symbicort, Tylenol
Current Illness: None
Preexisting Conditions: COPD, CHF
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe Covid fog. Because patient is 93 she was not able to recognize that something was wrong until late in the day when things keep going wrong. Even then it didn''t occur to her or her daughter that it was related to the vaccine. This was also the side effect patient suffered after her second Shingles shot in August.


VAERS ID: 1768279 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-01
Onset:2021-10-02
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 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? 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 was treated in the hospital for a positive COVID test after receiving both doses of Pfizer


VAERS ID: 1768286 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-06
Onset:2021-10-02
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, COVID-19, Diarrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (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), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Bacitracin, Lipitor
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to observation level of care on 10-2 with weakness, diarrhea and AKI. Patient is noted to be positive for covid upon testing at admission.


VAERS ID: 1768347 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1486744 / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Headache, Injection site inflammation, Injection site swelling, Injection site warmth, Muscular weakness, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Acid reflux
Allergies: Amoxicillin
Diagnostic Lab Data: Blood pressure was checked 10/4/2021 along with pulse and oxygen levels. Squeeze test on nurses fingers showing hand weakness. No other tests administered.
CDC Split Type:

Write-up: Arm was still inflamed, swollen and hot at the injection site on 10/4/2021. Fever has been ongoing on and off since 10/2/2021. Injected with higher dose ibuprofen and sent home on 10/4/2021. Pain in arm, hands, feet, head and back. Weakness in hands and legs. Taking OTC ibuprofen since 10/5/2021 with no pain relief.


VAERS ID: 1768353 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / UNK RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Bacterial infection, Cough, Diarrhoea, Fatigue, Headache, Migraine, Nausea, Pain, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Sinus operation, Sinusitis, Sneezing, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID-19 vaccine- Fatigue, 101 fever for five days, severe body aches and fatigue. Booster was worse.
Other Medications: Armour Thyroid Vitamin D Vitamin C Drops Albuterol ProAir inhaler Claritin Benadryl
Current Illness: Allergies Asthma Underactive Thyroid
Preexisting Conditions: Non essential tremors Thyroid IBS Heart Murmurs Asthma/allergies Third autoimmune issue yet to be identified
Allergies: Gluten, dairy, all decongestants, most daily asthma meds, Steroids, sulfa drugs, adhesives, dust, pollen, mold, mildew and smoke. Least allergic to horses and highly allergic to everything else.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Became very tired evening of 2 October, on 3-4 October had low grade fever 101, severe body/joint aches, migraine and fatigue, 5 October moderate migraine, normal temperature, started getting congested, coughing/wheezing and sneezing. On 6 October had sever runny nose, nausea from drainage going into stomach, diarrhea, fatigue, bad headache, 101 temperature and followed up with Physician. They thought it was sinus infection or bacterial infection and told me to use OTC meds and put me on Azithromycin 250mg. On 7 October mild headache, tired, mild cough and very nauseous. Feeling a little bit better.


VAERS ID: 1768377 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-19
Onset:2021-10-02
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood culture negative, COVID-19, Chest X-ray abnormal, Chest pain, Diabetic diet, Diarrhoea, Dyspnoea, Hypoxia, Lung disorder, Nausea, Oedema peripheral, Oxygen saturation decreased, Pyrexia, Respiratory distress, SARS-CoV-2 test positive, Staphylococcus test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), 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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler amLODIPine (NORVASC) 10 MG tablet apixaban (ELIQUIS) 5 MG tablet atorvastatin (LIPITOR) 80 MG tablet B Complex Vitam
Current Illness: 9.26.21: ED - diarrhea
Preexisting Conditions: Coronary artery disease Hypertension CHF (congestive heart failure) (HCC) Dyslipidemia Moderate COPD (chronic obstructive pulmonary disease) (HCC) Stroke (HCC) PVD (peripheral vascular disease) (HCC) OSA (obstructive sleep apnea) Avulsion fracture of femoral condyle, left, closed, with routine healing, subsequent encounter Cognitive impairment Bladder mass Diastolic dysfunction Hypotension Acute cholecystitis Acute respiratory failure with hypoxia (HCC)
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.29.21); COVID-19 positive (10.2.21); fully vaccinated Discharge Provider: DO Primary Care Provider: MD Admission Date: 9/29/2021 Discharge Date: Oct 3, 2021 HOSPITAL COURSE 84-year-old gentleman presented with one week of weakness, nausea, feeling like he could not breathe. Fever over 100?. Some chest pain that would come and go. See H&P for full details. EMS was called and he was found to be hypoxic on room air in the low 80s and in respiratory distress (is supposed to be on 2 L oxygen at home.) Chest x-ray showed bilateral airspace disease. COVID testing positive. Admitted for treatment. Received five days Remdesivir in five days Decadron. Symptoms markedly improved. One day before discharge she had increased lower extremity edema and received one dose Lasix 40 mg IV. By the day of discharge he felt well enough to return home. Lower extremity edema significantly improved. He will complete another five days of Decadron (which will be 10 days total.) He is on his home oxygen at discharge. The patient had some hyperglycemia due to steroids which was treated appropriately with insulin. The rest of the patient''s chronic medical issues were stable while here. PROCEDURES 9/29 BC x1: Staph epi 9/29 BC x1: Negative 9/29 CXR: Bilateral airspace disease Exam at discharge 36.3, 60, 20, 156/73, 93% 3 L Heart regular rate and rhythm Lungs clear to auscultation Abdomen nondistended nontender Extremities trace edema DISCHARGE RECOMMENDATIONS 1. Follow up with PCP in one week 2. Complete five additional days Decadron 3. Diabetic diet 4. Activity as tolerated Patient discharged home in improved and stable condition.


VAERS ID: 1768487 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-18
Onset:2021-10-02
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 - / -

Administered by: Pharmacy       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, hypertension, CKD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized with Covid 19


VAERS ID: 1768499 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-29
Onset:2021-10-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Arthralgia, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Blood bilirubin increased, Blood sodium decreased, C-reactive protein increased, Diarrhoea, Fibrin D dimer, Hepatic enzyme increased, Hyponatraemia, Inflammatory marker increased, Night sweats, Petechiae, Pyrexia, Rash, Serum ferritin increased, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril HCTZ
Current Illness: none
Preexisting Conditions: Hyperlipidemia Diabetes, type 2 Hypertension
Allergies: Tramadol
Diagnostic Lab Data: Labs were significant for hyponatremia and elevated inflammatory markers and liver enzymes. Na 129 AST 112 ALT 287 Alk Phos 279 Bilirubin 2.2 CRP 25.92 Ferritin 667 D dimer 1348
CDC Split Type:

Write-up: Patient received second dose of pfizer covid vaccine 8 days ago, developed symptoms 5days ago, and presented to the ER today with increasing severity of symptoms. Initial symptoms included fever, night sweats, arthralgias, diarrhea, and intractable vomiting. Upon admission, patient was noted to have a diffuse, painful, non-blanching petechial rash.


VAERS ID: 1768536 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 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-Severe, Site: Itching at Injection Site-Severe, Site: Pain at Injection Site-Medium


VAERS ID: 1768537 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-03
Onset:2021-10-02
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram, Angiogram pulmonary abnormal, Anticoagulant therapy, Blood creatinine increased, Brain natriuretic peptide increased, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chronic kidney disease, Cough, Dyspnoea, Echocardiogram abnormal, Electrocardiogram normal, Exposure to SARS-CoV-2, Fibrin D dimer, Headache, Hypertension, Hypoxia, Myalgia, Oropharyngeal pain, Oxygen saturation decreased, Pleural effusion, Pneumonia, Pulmonary oedema, Renal impairment, Treatment noncompliance, Troponin I, Urine output, Ventricular hypokinesia, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin EC 81 MG enteric coated tablet atorvastatin (LIPITOR) 40 MG tablet bumetanide (BUMEX) 1 MG tablet buPROPion (WELLBUTRIN XL) 150 MG 24 hr tablet calcitRIOL (ROCALTROL) 0.5 MCG capsule carvedilol (COREG) 12.5 MG tablet cetirizine (ZYR
Current Illness: ED visit on 10/2/2021: ED Disposition ED Disposition Discharge MEDICAL DECISION MAKING Supervising Physician: Dr. Patient seen evaluated complaining of concerns for COVID-19 infection. His son was diagnosed within the past week and he had significant exposure with his son. Vital signs are stable and oxygen saturation is in the upper 90s at rest. He did have desaturation to 89% with ambulation. COVID-19 swab performed and is positive. Chest x-ray is unremarkable. Twelve lead EKG notes a ventricular paced rhythm. Initial troponin was 31 a repeat troponin was 28 with a delta of -3. Remainder of laboratory studies are are significant for baseline chronic renal insufficiency. He does not have an elevated white count. He was given intravenous Decadron. Ambulated once again and had oxygen saturation between 89 and 90 at the lowest while ambulating. He does not wish to be admitted to the hospital. He is going to be sent home with a ambulatory pulse oximeter. Patient understands to monitor for desaturations and if he does have significant desaturations he is to return for further evaluation. The patient is comfortable with this plan and all questions are answered prior to discharge. With the nurse went to discharge the patient his blood pressure was 210/95. He is not having any symptoms. He was offered treatment for his hypertension. He notes that he has not taken his lunchtime or dinnertime dose of antihypertensives. He preferred to be discharged home. He is competent to make this decision.
Preexisting Conditions: Non-ischemic cardiomyopathy ASHD (arteriosclerotic heart disease) LBBB Hypertension Hyperlipidemia ICD (implantable cardioverter-defibrillator), biventricular, in situ GERD (gastroesophageal reflux disease) Allergic rhinitis Anemia in chronic kidney disease Diabetic neuropathy Type 2 diabetes mellitus Degeneration of lumbar intervertebral disc Degeneration of cervical intervertebral disc Depression, recurrent Transient cerebral ischemia, unspecified type Primary osteoarthritis of right shoulder ICD (implantable cardioverter-defibrillator) discharge Arthropathy of shoulder region Nonrheumatic mitral valve regurgitation SOB (shortness of breath) on exertion Chronic kidney disease, stage IV OSA (obstructive sleep apnea), mild Chronic bronchitis, unspecified chronic bronchitis type Lightheaded RUQ abdominal pain
Allergies: Trees/Grass, Sulfa drugs, Iv contrast, NSAIDs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 10/5/2021; COVID-19 positive 10/2/2021; fully vaccinated Admission note 10/5/2021 HISTORY OF PRESENT ILLNESS: Patient is a 80 y.o. male with a past medical history of non ischemic cardiomyopathy status post ICD, MR, CKD 4, coronary artery disease, hypertension, GERD, type 2 diabetes complicated by neuropathy, TIA who presents with COVID-19 pneumonia with acute hypoxic respiratory failure. Patient is vaccinated and was exposed to COVID-19 by his son and started having symptoms on 09/29 which included cough, sore throat, myalgias, headache. He was seen in the emergency department on 10/02 where he was tested positive for COVID-19 was given IV steroids. He was discharged home as he was satting in the 90s on room air while ambulating. He presented back to the emergency department with worsening shortness of breath. In the emergency department, he was noted to be hypertensive and hypoxic to the 70s on room air requiring up to 4 L oxygen by nasal cannula. Labs remarkable for creatinine 1.9, BNP 4000, troponin 28 with a peak of 193 and repeat 176, CRP 30, WBC 11.75, D-dimer 1160. A chest x-ray revealed moderate pulmonary edema that could be superimposed over COVID-19 pneumonia. CT angiogram thorax revealed no PE, revealed bilateral bronchopneumonia and very small bilateral pleural effusions. He was treated with Bumex with good urinary output. He was also started on dexamethasone, and was not started on remdesivir due to poor renal function. Due to patient''s rising troponin, patient was discussed with Cardiology in the emergency department who recommended heparinizing the patient and possible echo due to concern for NSTEMI. Patient''s transfer was delayed due to bid and transport availability. He was admitted to Hospital for further evaluation and management. Prior physician notes, labs, imaging reviewed. Note from 10/6/2021: Assessment/Plan ASSESSMENT / PLAN: Principal Problem: COVID-19 # COVID-19 -in the setting of known vaccination -symptom onset approximately 9/29, tested positive 10/2 -steroid started 10/2, now is day 5 of steroids -remdesivir started 10/6 -continue with supplemental oxygen, goal oxygen saturation greater than 92% -continue enhanced isolation precautions for now # Acute hypoxic respiratory failure -in the setting of COVID-19 -currently on 6 L saturating 96% -continue with management as stated above for COVID-19 -inflammatory markers slightly elevated today, CT PE study 10/5 negative for PE -monitor volume status closely, currently on bumetanide 1 mg daily # Elevated troponin I with concern for NSTEMI type 2 -cardiology involved, in the setting of known coronary artery disease with ischemic cardiomyopathy -currently chest pain free -EKG showed no acute ST or T-wave changes -patient''s echo shows approximately same ejection fraction but anterior wall appears hypokinetic -uncertain what to make of anterior wall hypokinesis -cardiology believes patient''s overall presentation more likely representative of COVID-19 infection, less likely ACS -recommendation to continue heparin for 48 hours, then DC last indication for therapeutic anticoagulation presents itself -continue aspirin, atorvastatin, carvedilol


VAERS ID: 1768542 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 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-Mild, Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild


VAERS ID: 1768567 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-10-02
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: presents with fever and shortness of breath, found to have COVID-19 infection patient received his 3rd vaccine on 10/6/2021


VAERS ID: 1768572 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Fatigue, Impaired work ability
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient presents to clinic on 10/07/2021 and states that he would like to make a report about his symptoms after the second dose of Pfizer COVID-19 vaccine on 09/30/2021. States that he has had fatigue and abdominal pain two days after the second dose and has not had any relief, but has not followed up with a PCP. States that he has not been able to go to work since the second dose. States that his supervisor told him to make a report at the place where he received his COVID 19 vaccines.


VAERS ID: 1768603 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: Patient came in today on October 6, 2021 stating she received the Pfizer covid vaccine on 10/1/21. Starting the next day she had a burning and itching feeling. The inject site looks like a little darken as if it was red before and healing. She had not done anything to help it but said it''s getting better. I told her to take ibuprofen for pain and benadryl if still itchy. If allergic site is larger see a doctor. Overall she ok.


VAERS ID: 1768622 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

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


VAERS ID: 1768681 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-10-02
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abortion threatened
SMQs:, Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: O20.0 - Threatened abortion


VAERS ID: 1768701 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Z37.1 - Single stillbirth


VAERS ID: 1768728 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: School       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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Increased heart rate on the next day of taking the vaccine. Usual heart rate 70-80 bmp at rest, but increased to 100-120 bmp on that day.


VAERS ID: 1768740 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Dyspnoea, Dyspnoea exertional, Echocardiogram normal, Electrocardiogram abnormal, Myocarditis, Pericarditis, Troponin increased
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Tests done on 10/3/2021: troponin elevated, EKG consistent with pericarditis, chest x-ray normal, echocardiogram normal
CDC Split Type:

Write-up: Myopericarditis. Symptoms included chest pain, shortness of breath, dyspnea on exertion starting 2 days after the 2nd dose of Moderna COVID-19 vaccine.


VAERS ID: 1768787 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-28
Onset:2021-10-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Respiratory arrest, Seizure
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Buproprion
Current Illness: Covid
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Scans ordered not performed yet
CDC Split Type:

Write-up: Siezure, First ever siezure, lasted over 3 minutes, loss of breathing


VAERS ID: 1768945 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-29
Onset:2021-10-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Follistim, menopur, clomid, ganirelix, prenatal vitamin, coq10, vitamin d, methylfolate, vitamins B6 & B12
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache multiple times per day every day


VAERS ID: 1768973 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-10-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Nausea, Pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: was not sent to do any medical test or lab work.
CDC Split Type:

Write-up: I received my second Pfizer vaccine on 9/29/21 The following day, I had very bad body aches, the second day I was extremely tired and nauseous. On the third day October 2nd at 5:30am I woke up full of hives, I went to the urgent care on Sunday the 3rd and received a steriod shot and was put on Prednisone. I then had an appointment with my DR on Tuesday the 5th. I explained to him that I have had hives ever since I have taken the vaccine. I have never had a food allergy or an allergy to any medication. It is October 7th and I still have hives.


VAERS ID: 1769056 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia oral, Swollen tongue, Tongue discolouration, Tongue erythema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast 10 MG, Levocetirizine 5 mg, calcium 600 mg x2, magnesium 500 mg x2, glucosamine chondroitin x2, potassium gluconate 595 mg x2, vitamin D3 125 mag x2, zinc 50 mg x2, Thyroid Action, B Complex with Vitamin C 60 mg, ashwagandha 230
Current Illness:
Preexisting Conditions: asthma
Allergies: cepholasporins, penicillins, sulfa drugs, sulfonamide derivatives, tetracyclines, epinephrine, cats, dogs, birds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up following morning with blue spot on top side of tongue. By Sunday morning, the underside of the tongue was a deep red and swollen, with numbness along the front and left side


VAERS ID: 1769070 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Chills, Fatigue, Headache, Neck mass, Neck pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Children''s Multi Vitamin, Vitamin D3
Current Illness:
Preexisting Conditions: IBS
Allergies: Sensitive to Dairy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm that moved up into neck area and down under arm below the arm pit area, feverish, chills, lump in neck area the size of a jelly bean, very tired, headaches. Went into the doctor''s office on Monday...starting to feel better but lump was still there. Dr said everything looked okay and to just keep watch that lump didn''t grow or move. As of today, still has the lump but no pain


VAERS ID: 1769275 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Headache, Myalgia, Respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), 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: Had the same side effects after the second dose of the Pfizer COVID19 vaccine in February 2021. Fatigue, muscle/joint pain, head
Other Medications: Oral contraceptive pill
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Woke up the day after getting my COVID booster shot with the symptoms of: fatigue, muscle aches, headache, congestion. Symptoms lasted between 12-24 hours.


VAERS ID: 1769515 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estilopril 10mg Allegra Emeperazol
Current Illness:
Preexisting Conditions: Asthma
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Massive headache, fatigue, body ache, fever, chills, nausea, swollen under arm on 10/08/2021


VAERS ID: 1769675 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Extra dose administered, Gait disturbance, Injection site erythema, Injection site pain, Injection site pruritus, Somnolence
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I had fever after getting the second shot. The second shot was done on February 3, 2021. It was also a Pfizer vaccine. I was 80
Other Medications: Pramipexole, Lisinopril, Clonazepam, Levothyroxine, Lipoic acid, minerals complex, vitamins B, K2 and D3, pancreatic enzymes, Berberine Complex
Current Illness: None
Preexisting Conditions: Insulin resistance, hypothyroidism, osteopenia, varicose veins
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: The place of injection became red, itching and painful I had fever I felt dizzy and unsteady I felt extremely weak and sleepy


VAERS ID: 1770016 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cardiac discomfort, Dizziness, Electrocardiogram, Feeling abnormal, Heart rate increased, Panic attack, Ultrasound scan, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: In the 3 separate trips to the ER on days 3 and 4 after the vaccine, there were 3 EKG?s given, an ultra sound, blood work done, fluids given, potassium given, Anti inflammatory given, Ativan given, and vitals taken. They said it ?could have been from the vaccine but there was no way to prove it.? My child has never had any medical problems before the vaccine.
CDC Split Type:

Write-up: On day 2 through day 6(which is today) after the Pfizer vaccine was given to my daughter (age 17), she had experiencing ongoing severe pressure in her heart (she specifically said it felt ?swollen?), increased heart rate (up to 160), dizziness, blurry vision, and a dreadful feeling that she most definitely has to be ?dying,? producing multiple panic attacks.


VAERS ID: 1770383 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-10-02
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Angina pectoris
SMQs:, Other ischaemic heart disease (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: USJNJFOC20211007392

Write-up: HEART PAIN; This spontaneous report received from a patient via social media via company representative concerned a patient of unspecified age and sex of unknown race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: Unknown) dose was not reported, 1 total administered on 02-OCT-2021, around 10 am in morning for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. As per the reporter on 02-OCT-2021, the patient experienced heart pain. The patient described as ''Heart pain 20 minutes after and has been coming and going all day. I do not like this feeling at all. Forced to do it or to be put out on the street''. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of heart pain was not recovered. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20211007392-Covid-19 vaccine ad26.cov2.s-Heart pain. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1771122 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental underdose
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: Patient didn''t receive the full dose, as some leaked out; This spontaneous case was reported by a pharmacist and describes the occurrence of ACCIDENTAL UNDERDOSE (Patient didn''t receive the full dose, as some leaked out) in a 19-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939906) for COVID-19 vaccination. No Medical History information was reported. On 02-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Oct-2021, the patient experienced ACCIDENTAL UNDERDOSE (Patient didn''t receive the full dose, as some leaked out). On 02-Oct-2021, ACCIDENTAL UNDERDOSE (Patient didn''t receive the full dose, as some leaked out) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were mentioned. No treatment details were reported. It was reported that second shot was scheduled for 31 Oct 2021. Most recent FOLLOW-UP information incorporated above includes: On 04-Oct-2021: Follow up received on 04-oct-2021 included updated reporter''s information.


VAERS ID: 1771132 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / UNK - / IM

Administered by: Public       Purchased by: ?
Symptoms: Tendonitis
SMQs:, Tendinopathies and ligament disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxychloroquine, Vitamin B complex, Fish oil, Aspirin.
Current Illness: None.
Preexisting Conditions: RA, MTHFR, undifferentiated connective tissue disorder.
Allergies: Septra.
Diagnostic Lab Data: Office visit on 10/7/21.
CDC Split Type:

Write-up: Tendonitis in Left upper arm extending to elbow.


VAERS ID: 1771154 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-31
Onset:2021-10-02
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 - / OT

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: ALBUTEROL [SALBUTAMOL SULFATE]; VITAMIN D3; OMEPRAZOLE; NAPROXEN
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: patient received shot from a vial punctured more than 12 hours ago; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (patient received shot from a vial punctured more than 12 hours ago) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 040D21A and 017E21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included SALBUTAMOL SULFATE (ALBUTEROL [SALBUTAMOL SULFATE]), COLECALCIFEROL (VITAMIN D3), OMEPRAZOLE and NAPROXEN for an unknown indication. On 31-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Oct-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced EXPIRED PRODUCT ADMINISTERED (patient received shot from a vial punctured more than 12 hours ago). At the time of the report, EXPIRED PRODUCT ADMINISTERED (patient received shot from a vial punctured more than 12 hours ago) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant naproxen from April. HCP did not know if patient still takes it. Treatment information was not provided.


VAERS ID: 1771195 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 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? 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1771459 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-18
Onset:2021-10-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

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

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

Write-up: Second dose given 1 week early


VAERS ID: 1771609 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Hot flush, Impaired work ability, Injection site bruising, Injection site erythema, Injection site pain, Injection site swelling, Lymph node pain, Lymphadenopathy, Pain, Pain in extremity, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, Flonase, b12, metformin
Current Illness: None
Preexisting Conditions: Elevated insulin, obesity, elevated cholesterol, occasional hypertension
Allergies: Codeine, Ceclor
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Temperature started to increase to 99.5 on 10/2/21 at 9:30am. Fever rose above 100 to 101 at 2:00pm. Chills started. Fever rose to 103.2 by 11:45pm on 10/2/21. Fever declined to 102 by 3am on 10/3/21. Fever decreased to 99.9 by 7am on 10/3/21 but fluctuated between 98.4 and 100 on 10/3/21. Fever stayed elevated bn 99 and 99.9 on 10/4/21. Fever decreased bn 98 and 99 on 10/5/21. Chills confined until 10/3/21 9am at which time, hot flashes occurred until 10/5/21. Body pain, headache, arm pain, swollen and painful lymph nodes of left arm pit occurred from 10/2/21 through 10/8/21. Woke up 10/8/21 with no symptoms except left arm injection site hurt to touch. Injection site was red and swollen from 10/2/21 to 10/5/21. Injection site was bruised 10/5/21 to 10/8/21. Treated symptoms with Tylenol, ibprofin, and ice pack. Sought medical care on 10/4/21 as still experienced symptoms. Dr said to start taking ibprofin and excused me from work for two days. Said to call back if symptoms still occurred after 10/6/21.


VAERS ID: 1771643 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, 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: no adverse event experienced, vaccine administered one day past BUD


VAERS ID: 1771652 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-10-02
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Blood test, Computerised tomogram abdomen, Echocardiogram, Muscle strain, Pleural effusion, Pulmonary embolism, Pulmonary infarction
SMQs:, Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Klonopin 2mg qhs, Cogentin ER 2mg qhs, wellbutrin XL 300mg qd, risperidal 1.5 mg po bid, topamax 100mg bid, neurontin 300mg qd, lithium 450mg bid, metformin 500mg bid, xyzal 5mg qam, fish oil, melatonin, vitamin D, albuterol hfa 90 mcg 2 pu
Current Illness:
Preexisting Conditions: autism, ADHD, depression/anxiety, insulin resistance, allergies and asthma
Allergies: Amoxicillin/Penicillins
Diagnostic Lab Data: He was admitted to the hospital 10/5-6. He had CT of the abdomen and pelvis, and a CTA. He had numerous blood tests, he had an echocardiogram.
CDC Split Type:

Write-up: Patient had a pulmonary embolism and infarct to his right lung, pleural effusions bilaterally and right heart strain from the clot.


VAERS ID: 1771794 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-10-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Dyspnoea, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Routine medication- Synthroid medication
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Minocycline
Diagnostic Lab Data: CT scan of the chest; pulmonary emboli in my lungs.
CDC Split Type: vsafe

Write-up: I experienced extreme SOB 10/02/2021. I went to hospital (Unknown Hospital), had multiple pulmonary emboli in my lungs. I never had history of that before. I was hospitalized form 10/02/2021 to 10/04/2021 and I am now on blood thinner medication. I had a chest CT scan. I am in the process of recovering.


VAERS ID: 1771815 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

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

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

Write-up: no adverse event, vaccine administered one day past BUD


VAERS ID: 1771827 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-29
Onset:2021-10-02
   Days after vaccination:277
Submitted: 0000-00-00
Entered: 2021-10-08
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 PFIZER VACCINE 12/29/2020 and 01/27/2021, AND TESTED POSITIVE TO COVID.


VAERS ID: 1771860 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, 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: no adverse event, vaccine administered one day past BUD


VAERS ID: 1771862 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cyst, Pain
SMQs:

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

Write-up: THE RING FINGER ON MY RIGHT HAND HAS DEVELOPED A CYST LIKE HARD BUMP AT THE BASE OF MY FINGER AND IT IS BECOMING PAINFUL.


VAERS ID: 1771864 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

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

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

Write-up: no adverse reaction, vaccine administered one day past BUD


VAERS ID: 1771871 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, 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: no adverse event, vaccine administered one day past BUD


VAERS ID: 1771877 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, 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: no adverse event, vaccine administered one day past BUD


VAERS ID: 1771932 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-04-09
Onset:2021-10-02
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN N/A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized with COVID-19 symptoms after receiving the vaccination.


VAERS ID: 1771962 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKOWN / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Fatigue, Limb discomfort, Pyrexia, Speech disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular 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: ClonazePAM, Fish Oil, Niacin,Metatonin
Current Illness:
Preexisting Conditions: Autonomic System Failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: about 15 hrs followiing the Covid booster shot, experienced heavy shacking of arms and lower legs, low grade temperature, fatigue, had to search for words, no chills, poor balance. Symtems lasted2- 3 days


VAERS ID: 1772003 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Gingival swelling, Infectious mononucleosis, Leukoplakia, Lymphadenopathy, Mouth ulceration, Oral disorder, Oropharyngeal pain, Pain, Pyrexia, SARS-CoV-2 test negative, Speech disorder, Streptococcus test negative
SMQs:, Severe cutaneous adverse reactions (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Skin premalignant disorders (narrow), Oropharyngeal neoplasms (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: POTS
Allergies: sulfa
Diagnostic Lab Data: Step test, mono test, two covid swabs all tests came back negative
CDC Split Type:

Write-up: fever, white patches in mouth and mouth lesions inside mouth and on lips, gum swelling, swollen lymph nodes difficulty swallowing and talking. extreme pain two urgent care visits and a PCP visit. Amoxicillin, prednisone, Tylenol, ibuprofen, magic mouth wash, and cream for ulcers inside and outside of mouth. mouth lesions, gum swelling, and sore throat present 48 hours after first Pfizer vaccine.


VAERS ID: 1772007 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Blood iron, Blood test, Body temperature increased, C-reactive protein, Chest pain, Coagulation test abnormal, Diarrhoea, Dizziness, Electrocardiogram abnormal, Fatigue, Feeding disorder, Fibrin D dimer, Full blood count, Headache, Heart rate increased, International normalised ratio, Laboratory test, Mobility decreased, Nausea, Pain, Pain in extremity, Prothrombin time, Tremor, Troponin, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
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: Cryselle Vitamin C,D,E Echinacea Tumeric
Current Illness: no medical history
Preexisting Conditions: no medical history
Allergies: NKDA
Diagnostic Lab Data: 10/421- EKG 10/4/21- Blood work- troponin, d-dimer, cbc, iron studies, CRP 10/7/21- further blood work looking at coagulation studies PT/PTT/INR, CBC, and additional blood work
CDC Split Type:

Write-up: symptoms started at 1530- achy, sharp shooting left sided chest pain, HA, nausea, and dizziness. Progressed throughout evening, CP became more progressive, increase in HR, shaky uncontrollable all over, temp. 101.5 (9:15pm). Started vomiting and diarrhea by 9:26pm. CP, HA progressed throughout evening and into the next day. I was unable to get out of bed at on 10/3/21, couldn''t eat or drink. Called PCP 10/4/21 due to still having symptoms of CP, HA, severe dizziness and fatigue. Was seen by 9am on 10/4/21. PCP did labs and EKG which showed changes from baseline in 7/2021. Started on 325mg of ASA, decadron, zofran, and tramadol for HA. Dizziness, CP, and HA have persisted along with intermittent left calf pain. Currently under care of PCP, which was seen 10/7/21 for follow up and further lab testing as there have been changes to EKG, and clotting studies. Will continue to be monitored and further tests to come such as ECHO and blood work. Was started on Plavix 10/7/21 in addition to ASA.


VAERS ID: 1772073 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-10-02
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anticoagulant therapy, COVID-19, COVID-19 pneumonia, Chills, Condition aggravated, Deep vein thrombosis, Dyspnoea, Erythema, Hyperhidrosis, Malaise, Oxygen saturation decreased, Pain in extremity, SARS-CoV-2 test positive, Skin warm
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant 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), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler apixaban (ELIQUIS) 5 MG tablet apixaban (ELIQUIS) 5 MG tablet aspirin 81 MG enteric coated tablet atenolol (TENORMIN
Current Illness: 10.2.21: Urgent Care visit - Medical Decision Making: Patient is ill appearing and diaphoretic. Her oxygen is at 95%, she does appear slightly short of breath, but no respiratory distress. She is wearing a sweat sure and wrapped in a blanket, as she has significant chills. Lungs are clear bilaterally. Her rapid COVID test was positive. She is vaccinated. I do, however, have concern for the right lower extremity redness, warmth, and calf pain. She was also recently traveling on a 10 day bus trip. She has a history a blood clot during pregnancy many years ago. Discuss her increased risk of blood clot with these risk factors and recommend further evaluation in the emergency department. Patient stated understanding and is agreeable. She prefers emergency department. We did offer wheelchair transfer, but patient prefers to drive her car around the parking lot. Pre arrival placed.
Preexisting Conditions: Acute hypoxemic respiratory failure due to COVID-19 Acute deep vein thrombosis (DVT) of right lower extremity Elevated liver enzymes Mild persistent asthma Essential hypertension, benign Lesion of liver Pneumonia due to COVID-19 virus
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.2.21); COVID-19 positive (10.2.21); fully vaccinated Discharge Provider: MD Primary Care Provider: MD Admission Date: 10/2/2021 Discharge Date: 10/4/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient admitted with COVID and hypoxia related to. She is status post vaccination with Moderna. Low volume oxygen is required during his hospital stay, but was wean off oxygen prior to discharge. She was found to have lower extremity DVT which is treated by Eliquis. She will be placed on Eliquis for 3 months. She will also be given dexamethasone for 10 day period. She did receive remdesivir here for 2 does. But was asymptomatic at time of discharge Patient will be on for 3 months. Vaccine would be recommended at that time if boosters indicated. Patient is recommended to have a 10 day isolation.


VAERS ID: 1772079 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes simplex
SMQs:, Opportunistic infections (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: Vitamin D, multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: HSV-2 exacerbation


VAERS ID: 1772097 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-19
Onset:2021-10-02
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / 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: calcium carbonate 2000mg daily chlorthalidone 25mg daily cholecalciferol 2000IU daily epinephrine 0.3mg prn for anaphylaxis famotidine 10mg BID losartan 50mg daily metoprolol 12.5mg BID multivitamin daily rosuvastatin 10mg M,W,F
Current Illness: None documented
Preexisting Conditions: Hypertension, Low back pain, hip pain, seasonal affective disorder, pseudoexfoliation of lens capsule, hyperlipidemia, obesity, fibrocystic disease of the breast, urge incontinence of urine, chronic tophaceous gout, gout, depression, adenomatous polyp of colon
Allergies: Bee Stings - Swelling, Hives Lisinopril - Dry Cough
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated. Headache, Sweating, congestion, muscle aches, brain fog, loss of smell Booster shot Pfizer on 10/1/2021


VAERS ID: 1772132 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Appendicitis, Computerised tomogram, Ovarian cyst ruptured, Ultrasound scan
SMQs:

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: No
Current Illness: No
Preexisting Conditions: Asthma
Allergies: No
Diagnostic Lab Data: Ultrasound; CT Scan
CDC Split Type: vsafe

Write-up: I had a ruptured ovarian cyst and an inflamed appendix. I have been taking over the counter medication. I went to the ER where they did an ultrasound and CT scan. I have some follow up appointments with a PCP, OB/GYN and a general surgeon as well as some imaging scheduled.


VAERS ID: 1772182 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-10-02
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C2LA / 1 LA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Cardiac flutter, Cardiac monitoring abnormal, Fear, Heart rate increased, Hypertension, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: I had an averse reaction to both shots (excessive fever, pain, muscle pain) that took me approximately 4 days to fully recover. After that, I noticed my heart starting to flutter, and beat very fast. I didn''t think too much of it because according to Moderna, this may occur and "goes away" on his own. Well, it hasn''t gone away at all for me 3+ months later. I recently took my physical (October 4th) , where my doctor noticed that my heart resting rate was at 115. I have since been taking measurements of my heart pulse and have been consistently over 100. As you know having a consistent resting rate over 100 is an independent predicator of all-cause and cardiovascular death/heart disease. I do believe the cause of this is the vaccine as I have a track record of great health (which my medical record can speak to), I do not smoke, drink or take medication. The only change I have done is take this vaccine and since then all these problems started to pop up. Now I have to watch what I do because my pressure is so high and this is taking a negative toll on my everyday life., as now I am scared I can have a heart attack or stroke.
Allergies: None
Diagnostic Lab Data: Physical examination (October 4, 2021) - heart resting rate at 115. I use a heart monitoring machine every day and my resting rate continues to be over the normal range, which is supposed to be between 60 - 90. I am consistently in the 100s.
CDC Split Type:

Write-up: Moderna Covid 19 Vaccine EUA I had an averse reaction to both shots (excessive fever, pain, muscle pain) that took me approximately 4 days to fully recover. After that, I noticed my heart starting to flutter, and beat very fast. I didn''t think too much of it because according to Moderna, this may occur and "goes away" on his own. Well, it hasn''t gone away at all for me 3+ months later. I recently took my physical (October 4th) , where my doctor noticed that my heart resting rate was at 115. I have since been taking measurements of my heart pulse and have been consistently over 100. As you know having a consistent resting rate over 100 is an independent predicator of all-cause and cardiovascular death/heart disease. I do believe the cause of this is the vaccine as I have a track record of great health (which my medical record can speak to), I do not smoke, drink or take medication. The only change I have done is take this vaccine and since then all these problems started to pop up. Now I have to watch what I do because my pressure is so high and this is taking a negative toll on my everyday life., as now I am scared I can have a heart attack or stroke.


VAERS ID: 1772185 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135A / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Illness, Impaired work ability, Malaise, Paraesthesia, Pruritus, Thermal burn, Thinking abnormal
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: She got all the symptoms, fever, nausea, vomiting, like she had covid. Her skin on her hands and toes were peeling after the va
Other Medications: None.
Current Illness: None.
Preexisting Conditions: Lung nodules, possible pheochromocytoma.
Allergies: Penicillin.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, 24 hours later she woke up with her skin tingling and she has a burn under her left eye. She has not felt well at all, sick, almost like she has COVID. She saw her doctor and that it was a reaction to the vaccine. She has a massive headache, diarrhea, cold chills to the point that she could not get warm, thought problems. Has not been able to work due to these symptoms. She has a very sensitive immune system, and told Occupational health and she was denied an exemption. She works at Hospital and it was mandatory to take the vaccine. She has been itching all over. Her doctor told her to use St. Ive''s Aloe Vera, OTC, which has helped some.


VAERS ID: 1772347 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-10-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dermatitis contact, 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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Painful skin rashes, allergic contact dermatitis during a week and I don?t feel better now


VAERS ID: 1772579 (history)  
Form: Version 2.0  
Age: 0.08  
Sex: Female  
Location: California  
Vaccinated:2009-09-28
Onset:2021-10-02
   Days after vaccination:4387
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO185 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Blepharospasm, Blood test normal, Computerised tomogram normal, Facial paralysis, Glassy eyes, Headache, Loss of consciousness, Petit mal epilepsy, Seizure, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Viral cold
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: CT scan on 10/3/21 normal blood work came back normal as well.
CDC Split Type:

Write-up: Seizure around 10:30, Started experience left eye twitching, along with absence seizure, followed with her mouth going unintentionally to the right. Glaze eyes and after getting conscious she didn?t have any recollection of what had happened. Follows with a very sever headache and vomiting.


VAERS ID: 1772760 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Injection site swelling, Myalgia, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin women''s one, CoQ10, fish oil, iron, vitamin D, nature one advance dual action probiotic, Nortrel birth control pill.
Current Illness:
Preexisting Conditions: Anemia, hypoglycemia, possible mitochondrial disease (biological son had Miri).
Allergies: Sulfa drugs, dairy, eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchiness all over, getting worse a week after the shot. Especially at injection site. Swelling/rash at injection site, worsening a week after vaccine. severe muscle aches in left arm and along back and neck, day-of vaccine for two more days.


VAERS ID: 1772767 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-10-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Expired product administered, Headache, Hyperhidrosis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Vaccine was placed in fridge on 8/19, and therefore expired 9/18. Date was not marked appropriately on the box, and was administered to the patient past it''s beyond use date. I contacted patient. She stated she experienced chills, sweating, vomiting, headache, fever and dizziness. I explained what happened and recommended repeating her dose. Patient declined, she felt as though she had adequate response to the vaccine.


VAERS ID: 1772998 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-20
Onset:2021-10-02
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017EZ1A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Thrombosis, Ultrasound Doppler abnormal, Ultrasound scan
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (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: Lipitor, Myrbetriq, Tamsulosin, wixela, Methocarbamol
Current Illness: none
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: Ultrasound Right Leg Venous Doppler DVT Deep vein thrombosis present in veins
CDC Split Type:

Write-up: Diagnosis Blood Clot Blood Thinner


VAERS ID: 1773422 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-10-02
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211015057

Write-up: PUNCTURED VACCINE STORED IN REFRIGERATOR FOR LONGER THAN 6 HOURS APPROXIMATELY 24 HOURS PASSED; ADMINISTERED VACCINE STORED LONGER THAN 6 HOURS APPROXIMATELY 24 HOURS HAD PASSED; This spontaneous report received from a pharmacist concerned a 31 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 212A21A expiry: 21-DEC-2021) dose was not reported, administered on 02-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-OCT-2021, the patient experienced administered vaccine stored longer than 6 hours approximately 24 hours had passed. On an unspecified date, the patient experienced punctured vaccine stored in refrigerator for longer than 6 hours approximately 24 hours passed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the administered vaccine stored longer than 6 hours approximately 24 hours had passed and punctured vaccine stored in refrigerator for longer than 6 hours approximately 24 hours passed was not reported. This report was non-serious.


VAERS ID: 1773424 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-10-02
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211015205

Write-up: PUNCTURED VACCINE STORED IN REFRIGERATOR FOR LONGER THAN 6 HOURS APPROXIMATELY 24 HOURS PASSED; ADMINISTERED VACCINE STORED LONGER THAN 6 HOURS APPROXIMATELY 24 HOURS HAD PASSED; This spontaneous report received from a health care professional concerned a 24 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 212A21A, and expiry: 21-DEC-2021) dose was not reported, administered on 02-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-OCT-2021, the patient experienced administered vaccine stored longer than 6 hours approximately 24 hours had passed. On an unspecified date, the patient experienced punctured vaccine stored in refrigerator for longer than 6 hours approximately 24 hours passed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the administered vaccine stored longer than 6 hours approximately 24 hours had passed and punctured vaccine stored in refrigerator for longer than 6 hours approximately 24 hours passed was not reported. This report was non-serious. This case, from the same reporter is linked to 20211015057.


VAERS ID: 1773520 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-05
Onset:2021-10-02
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Condition aggravated, Crying, Dysgeusia, Pain
SMQs:, Taste and smell disorders (narrow), Depression (excl suicide and self injury) (broad)

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

Write-up: crying and scare; sharp body pains in her body; that food is tasting like ashes / has a nasty taste in her mouth; chills; symptoms are getting worst with time; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (sharp body pains in her body), DYSGEUSIA (that food is tasting like ashes / has a nasty taste in her mouth), CHILLS (chills), CONDITION AGGRAVATED (symptoms are getting worst with time) and CRYING (crying and scare) in a 20-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039d21a and 048F21A) for COVID-19 vaccination. No Medical History information was reported. On 05-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Oct-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 02-Oct-2021, the patient experienced PAIN (sharp body pains in her body), DYSGEUSIA (that food is tasting like ashes / has a nasty taste in her mouth), CHILLS (chills) and CONDITION AGGRAVATED (symptoms are getting worst with time). On an unknown date, the patient experienced CRYING (crying and scare). The patient was treated with IBUPROFEN for Adverse event, at an unspecified dose and frequency. At the time of the report, PAIN (sharp body pains in her body), DYSGEUSIA (that food is tasting like ashes / has a nasty taste in her mouth), CHILLS (chills), CONDITION AGGRAVATED (symptoms are getting worst with time) and CRYING (crying and scare) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medication was not reported. This case was linked to MOD-2021-339129 (Patient Link).


VAERS ID: 1773538 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / OT

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: Patient received an invalid dose of vaccine. Vaccine past it''s beyond use date.; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient received an invalid dose of vaccine. Vaccine past it''s beyond use date.) in a 51-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039D21A) for COVID-19 vaccination. No Medical History information was reported. On 02-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient received an invalid dose of vaccine. Vaccine past it''s beyond use date.). On 02-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Patient received an invalid dose of vaccine. Vaccine past it''s beyond use date.) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. It was reported that vial of COVID-19 vaccine was punctured on 01 Oct 2021 at 12 Noon. A dose of the vaccine was administered to a patient at 12:25 on 02 Oct 2021. It was reported that the vial was initially stored in the refrigerator on 27 Sep 2021.Date and time vial was first punctured at 12:00 on 01 Oct 2021.Date of administration of vaccine 12:25 on 20 Oct 2021. The vial was stored post puncture under refrigeration. The vial did not undergo any temperature excursion. Total amount of time the vial was exposed to room temperature range (8? to 25?C= 46? to 77?F) about 2 minutes. No concomitant medications were reported. No treatment medications were reported.


VAERS ID: 1773648 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-08
Onset:2021-10-02
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211002; Test Name: Nasal Swab; Test Result: Positive
CDC Split Type: USPFIZER INC202101311727

Write-up: COVID-19; COVID-19; This is a spontaneous report received from a contactable nurse. A 63-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; lot number and expiry date were not reported) dose 1, single on 18Mar2021 and dose 2, single on 08Apr2021; both given via unspecified route of administration, at the age of 62-year-old, for covid-19 immunisation. The patient medical history was not reported. The patient had no concomitant medications. The patient is not pregnant at the time of vaccination. The patient did not receive other vaccine in four weeks and was not previously diagnosed with COVID. On 02Oct2021, the patient experienced Covid-19. The event resulted in doctor or other healthcare professional office/clinic visit. The patient underwent lab test and procedures which included nasal swab which showed positive result on 02Oct2021. Therapeutic measures taken in response to the event included administration of monoclonal antibodies. Outcome of the event was not recovered. The lot number for [BNT162B2] was not provided and will be requested during follow-up.; Sender''s Comments: Based on the information currently available,The casual association between the reported event "Covid-19" and suspected vaccine BNT162B2 cannot be completely excluded.


VAERS ID: 1774958 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Lip swelling, Paraesthesia oral, Pharyngeal swelling, Swollen tongue, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlfaxine 150 mg daily, xyzal 5 mg daily, melatonin 5 mg daily
Current Illness: None
Preexisting Conditions: Chronic urticaria, history of aTBI with anxiety, history of severe Covid 19
Allergies: None
Diagnostic Lab Data: 10/2/21 routine vital signs including pulse oximetry, pulse, temperature, bp completed
CDC Split Type:

Write-up: Approx. 1 AM on 10/2/21 noticed throat was itching and tongue felt full. Self administered 2 benadryl and went back to sleep. Awakened at 3 am with lip, tongue and throat swelling and called for assistance. Epinephrine 0.3 mg IM administered and prednisone 60 mg orally administered with improvement of throat swelling /tongue swelling . Lip swelling improved however continued to be mild for an additional 8 hours. Patient given prednisone taper and benadryl q4 hours along with certirizine 10 mg bid and famotidine 20 mg bid prescribed for 1 week. By approx 6 pm on 10/2/21 all symptoms had resolved .


VAERS ID: 1774975 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anosmia, COVID-19, Extra dose administered, Malaise, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Elequist. Norco Advanostatin Hydroclorothidizide
Current Illness: Arthritis
Preexisting Conditions:
Allergies: Penicilin
Diagnostic Lab Data: Tested positive for Covid a week later
CDC Split Type:

Write-up: This was my third vaccination. That night felt a little sick. Lost sense of smell


VAERS ID: 1775001 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 AR / IM

Administered by: Public       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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Saturday 9/2/21 patient came to receive 2nd dose of vaccine and did not have an appointment and forgot his vaccine card. Patient requested pfizer but system showed that patient received Moderna 1st dose at his last visit. This was explained to patient and he insisted he received Pfizer. Patient was again informed by the nurse that he cannot receive the Pfizer vaccine today as the system shows he received Moderna and there is no way to verify with his card what he received. Patient decided to receive the Moderna vaccine and signed the 2nd dose consent form. Today 9/9/21 patient returned with the original card which states he received Pfizer for his first dose. I had the nurse practitioner educate him on both vaccines and CDC guidance on potential mixing of mRNA vaccines. She took his vitals and glucose which all came back normal as well. NP advised if he has any additional side effects to consult his PCP. Vaers report completed as well.


VAERS ID: 1775084 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-25
Onset:2021-10-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angioedema, Extra dose administered, Mechanical urticaria, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: St. John''s Wort, nasonex, estrogen patch, progesterone, naratriptan prn
Current Illness: Nothing other than mild allergic rhinitis to dust mites.
Preexisting Conditions: 8-10 years ago I had a workup for joint pains and stiffness, chronic debilitating fatigue, unusual large purple oral ulcers that were not apthus. My father went on disability for various autoimmune diseases. I saw a rheumatologist, allergist, ENT, PCP and had extensive lab testing, imaging, allergy testing which was all negative, however autoimmune disease was suspected. Because I am a physician engaged in patient care and have hx of suspected autoimmune disease, as recommended by CDC, I took a third Moderna vaccine 8 months after my second Moderna vaccine. 1 week later, I began getting itchy crops of bumps, which I mistook for bug bites. This progressed to extensive urticaria, dermatographia, and even very mild angioedema of my throat. It improved significantly with claritin. I finally realized this is probably due to Moderna vaccine since this began 1 week after the vaccine, and I''ve never had these problems before.
Allergies: I have had extensive allergy testing in the past which was mildly positive for dust mites, otherwise negative. No hx of urticaria. I am a physician, Internal Medicine. I am not reporting name, address due to fear of your website being hacked, as I have had my identity stolen multiple times due to companies I do business with being hacked.
Diagnostic Lab Data: I have not gotten any evaluation of this yet, as I am a physician who works PRN and do not have any health insurance currently. If symptoms persist, I will get an evaluation. The urticaria is moderately severe, and if I were not a physician myself, I certainly would have seen a physician for evaluation by now. Some people may have gone to the ER for symptoms that I''ve experienced due to the severity, including my brief mild angioedema of the throat.
CDC Split Type:

Write-up: I took a third Moderna vaccine 8 months after my second Moderna vaccine. 1 week later, I began getting itchy crops of bumps, which I mistook for bug bites. This progressed to extensive urticaria, dermatographia, and even very mild angioedema of my throat. It improved significantly with claritin. I finally realized this is probably due to Moderna vaccine since this began 1 week after the vaccine, and I''ve never had these problems before. It is now 2 weeks after my Moderna vaccine, and I am still having urticaria, worse with pressure.


VAERS ID: 1775131 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

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

Write-up: Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe


VAERS ID: 1775187 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Tinnitus, Vaccine positive rechallenge
SMQs:, Hearing impairment (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: Shingrix vaccine. I did submit a report on this.
Other Medications: Metformin Vasepa Prilosec Pravastatin Lisinopril Lantus insulin Humalog insulin
Current Illness: None
Preexisting Conditions: Diabetes High blood pressure GERD
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Ringing in ears. It sounded like a steam whistle. I thought something was on the stove. I had ringing in my ears with the second dose too but I didn?t think much of it and did not report it.


VAERS ID: 1775213 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Paranasal sinus discomfort, Pyrexia, Restlessness, Tenderness, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: unknown
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immunization received on Friday, fever and chills on Saturday all throughout the day, took Tylenol to manage symptoms. Sinus pressure, tenderness in neck. Restlessness. Patient states feeling "Kind of in a fog." Patient took 50mg Benadryl on Monday. Hives started on Wednesday morning. Counseled patient on vsafe.cdc.gov resources. Recommended to go to doctor for allergic reaction management such as for steroid therapy.


VAERS ID: 1775268 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2389 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Headache
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Difficulty breathing for up to 7 days afterwards, headache for up to 7 days afterwards, headache for up to 7 days afterwards


VAERS ID: 1775319 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Full blood count, Metabolic function test, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: apixaban, benazepril, carvedilol, cholecalciferol, cyanocobalamin, fluticasone propionate, spironolactone, Vitamin C
Current Illness: None
Preexisting Conditions: Mastectomy, Arrhythmia, history of transfusion, leukocytosis, hysterectomy, appendectomy, back surgery
Allergies: amlodipine, gabapentin, amoxicillin
Diagnostic Lab Data: On 10/9/2021 pt seen in ED and CMP, CBC, UA completed
CDC Split Type:

Write-up: Pt stated "I received the Pfizer vaccine on last Friday and I have had increased weakness and it''s been harder to breath since the Saturday after I got the vaccine"


VAERS ID: 1775369 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chills, Dyspnoea, Feeling hot, Hypertension, Paraesthesia, Paraesthesia oral, Product after taste, Tinnitus, Tremor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingrix Vaccine - 2019 - Complete flu-like symptoms. Sick for 10 days.
Other Medications: Premarin Calcium with Vitamin D
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Monday, 10/04/2021, vitals checked at Doctor''s office. Blood pressure very high. Recommended to rest all week, drink plenty of fluids and return for follow-up in a week.
CDC Split Type:

Write-up: Within minutes of leaving the pharmacy, I had a rininging in my ears. Followed by a tingling feeling of my lips, tongue, neck and side of my face. At the same time, my chest felt heavy/tight, and I was having difficulty breathing. I returned to the pharmacy, where the kind and knowledgeable Pharmacist kept a close watch over me. I had severe chills and shaking, then a few minutes of heat followed by chills. Also, a bitter/medicinal taste in my mouth. My husband attempted to reach my Doctor, at the recommendation of the Pharmacist. As it was a Saturday, my Doctor was not in. The on-call Doctor recommended that I spend the weekend resting. The Pharmacist keptxwatch over me, until he felt that I was OK to leave. However, he strongly urged me to follow-up with my Doctor on Monday and have her check my heart and vitals. If my condition worsened, I was to go to the emergency room.


VAERS ID: 1775400 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Migraine, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BUSPIRONE, FOLIC ACID, IRON, VITAMIN B12, MAGNESIUM, N-ACETYL
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: ZOLOFT
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Extreme fatigue, intense body aches, migraine, lack of appetite.


VAERS ID: 1775530 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-28
Onset:2021-10-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Pruritus, Rash, Rash pruritic, Speech disorder, Swollen tongue, Tongue pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: Xeljanz (but stopped on day of vaccination), Hyxroxycholorquin (had stopped but restarted on day of vaccination), Atenolol, Estradiol, Colace, Pantoprozol, Latanaprost drops.
Current Illness: None
Preexisting Conditions: Psoriatic Arthritis.
Allergies: Steroids, Levoquin, Lisinopril, sensitive to Sulfa Drugs and adhesives.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The first two days after the injection I had the normal symptoms (felt tired and really run down), however on day 5 is when my scalp started itching. The next day my husband (a physician) noticed welts/bumps on my sides and back. They weren?t as itchy as the ones on my scalp. I started taking Benadryl and after two days they seemed to be dissipating. On day 6 my tongue started to itch and on day 7 (4 Oct) my tongue swelled to the point where I was lisping. I took some more Benadryl and over the course of a couple hours it started to go down to a normal size. I also began taking my Xeljanz again on this day hoping that it would help normalize my symptoms. Once the swelling in my tongue went down and I started the Xeljanz everything was back to normal. Note: My husband is a Physician (MD).


VAERS ID: 1775555 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Migraine
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: none
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Migraine lasting over a week, nonstop. No history of migraine.


VAERS ID: 1775682 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exercise tolerance decreased, Fatigue, Feeling abnormal, Lymphadenopathy, Pain
SMQs:, Dementia (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: Microgestin 24 fe once daily Prozac 20 mg once daily
Current Illness: I had COVID-19 in January 2021. Staph infection in my nose about 6 weeks prior to vaccination.
Preexisting Conditions: endometriosis which I take the birth control for, and anxiety and depression for which I started taking Prozac beginning September 21, 2021.
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have been fatigued and achy all over since 6:00 PM on the day I received the shot. It has been eight days. My lymph nodes at my collarbone and under my arm on my left side or swollen. That began the day after, Sunday, October 3. They are currently smaller but still swollen. I still ache all over and I feel terrible. I have tried to stay moderately active. I normally work out six days a week. I have done just three very light workouts this past week, thinking that might help. But it hasn?t. I have drank lots of water and tried to eat right. I am afraid of getting the second shot because I still feel so bad from the first. This is almost as bad as having Covid back in January.


VAERS ID: 1775720 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
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: no known allergies
Diagnostic Lab Data: None: patient had no side effects from higher dose.
CDC Split Type:

Write-up: NS dilusion was done incorrectly. Only 0.8 ml was drawn up and mixed with the concentrated PFizer vial. Patient was still given the 0.3 ml injection but the concentration was stronger (approximately 2 times normal dose). Patient was called a few days later (5 days) after mistake was realized. Patient had no abnormal side effects and said she felt completely fine. Following phone call will be done with patient after another 7 days. Primary care physician was contacted about dose given.


VAERS ID: 1775734 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Discomfort, Extra dose administered, Injection site pain, Lymphadenopathy, Vaccination site discomfort
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine. Pain and redness (red circle) around injection site.
Other Medications: Multivitamin, calcium, turmeric supplements
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received third dose of Pfizer Biontech vaccine. I had was sleeping and felt uncomfortable under the left arm where the vaccine was administered. For three days I had a minor swollen lymph node and slight irritation. And, slight pain at the injection site. No other problems. It went away.


VAERS ID: 1775756 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blindness transient, Condition aggravated, Dry mouth, Eye movement disorder, Fibromyalgia, Incomplete course of vaccination, Lymphadenopathy, Migraine with aura, Pain, Pyrexia, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: aimovig, lyrica, baclofen, vit d,
Current Illness:
Preexisting Conditions: asthma, migraine w/aura, fibromyalgia, continued side effect in chest from bad respiratory virus caughtMay2019
Allergies: caffeine, some medication fillers,augmentin
Diagnostic Lab Data: Seeing the Neurologist on Tuesday going to schedule and discuss tests.
CDC Split Type:

Write-up: 1st dose vaccine received on Saturday, w/in 15-20mins of receiving the injection while leaving office an aura w migraine began. Multiple auras & addtl pain came on over the next 24 hrs, migraine pain continued thru Monday evening with the migraine pressure continuing thru Friday. As expected swollen glands, Fibro flared more, dry mouth and feverish sun-thurs. HOWEVER Tues evening while sitting had frightening episodes of eye balls involuntarily moving around in separate directions-couldnt focus or make it stop, each episode ended with vision going totally black.Each episode was abt 30secs. Contacted Neurologist. I am hypersensitive to things and absolutely am not able to do the 2nd one.


VAERS ID: 1775759 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-10-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness unilateral, Dizziness, Ear pain, Fatigue, Fear, Headache, Inflammation, Joint swelling, Muscle spasms, Pain in extremity, Rash, Sudden hearing loss, Tinnitus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dystonia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Per doctor''s orders, my RA medication (Xeljanz) was held for a week after third dose. I was taking prilosec, vitmain D, calcium, probiotic.
Current Illness: none
Preexisting Conditions: I have autoimmune disease, rheumatoid arthritis.
Allergies: none
Diagnostic Lab Data: Complete hearing test 10/4/21
CDC Split Type:

Write-up: After third COVID booster shot, I initially had no reaction just like the first two previous doses except for sore arm, little tiredness. 5 days later I got a rash and swelling/inflammation on both my ankles. I reached out to my rheumatologist as I had stopped my RA medication this time and reported it and she didn''t think vaccine caused it. On Day 9, I awoke with sudden complete hearing loss in right ear and left ear sounded like freight train/jet in my head. I immediately went to Urgent Care and was put on prednisone. I followed up with three doctors (Audiologist, ENT, and rheumatologist). Hearing was restored next day but pain in ear, muscle spasms, headaches, dizziness still occured. One doctor thinks it is vaccine related and that I was off my RA medication and I have weakened immunity system but other doctor thought it was a coincidence. I wanted to report this to you!! I am still on prednisone and will have CT scan of my sinuses next week if still not resolved. Very scary!!


VAERS ID: 1775770 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, SARS-CoV-2 test negative, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data: Patient is taking diphenhydramine to treat hives. Patient reports effective, but returns the next morning. Patient has been taking Theraflu for other symptoms. Patient does not have insurance, and has been reluctant to see a doctor about symptoms.
CDC Split Type:

Write-up: The patient developed hives the day after injection that are persistant. Other symptoms include fatigue, headache and chills. Patient denies fever. Patient''s job tests for COVID twice a week, all results negative.


VAERS ID: 1775869 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Extra dose administered, Pruritus, Rash erythematous, Rash maculo-papular, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asprin, amlodipine, Zoloft, multivitamin, fiber supplement, vitamin D
Current Illness: None
Preexisting Conditions: Hx of heart attack
Allergies: Clarithromycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Itchy, pink/red welts on bilateral lower extremities (below knee to ankle) that appeared approximately 24 hours after 3rd dose. Transitioned to itchy, red, macular papular rash, that has yet to resolve over one week later


VAERS ID: 1775986 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / UNK - / OT

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: administration of an expired dose; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administration of an expired dose) in a 36-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048F21A) for COVID-19 vaccination. No Medical History information was reported. On 02-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administration of an expired dose). On 02-Oct-2021, EXPIRED PRODUCT ADMINISTERED (administration of an expired dose) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. No treatment information was reported.


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