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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 486 out of 8,753

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VAERS ID: 1708693 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ696AA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Injection site pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: injection site pain left and right arms beginning two hours after injection and worsening over the next 24 hours before gradually decreasing. Pain was worse in left arm versus right. Headache and chills around 3 AM the following morning post injection resolved within 3 hours. Significant right shoulder joint pain at 3 AM approximately 39 hours post injection. Pain was not relieved with 600mg Ibuprofen, stretching or postural changes. Pain eventually resolved spontaneously after about 2 hours.


VAERS ID: 1708694 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dyspnoea, Palpitations, Tachycardia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (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: Diclofenac topical albuterol singulair
Current Illness:
Preexisting Conditions: asthma
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: She began to experience tachycardia about 10mins after vaccine admin. She was brought over and assessed. The pt stated that her heart was racing and she felt like she was breathing through a straw. Initial vitals @ 1400: 112/86 (pt reports high for her), HR: 110 and 95% O2 sat. She continued to state, "I just can''t get a deep breath". Did not note pallor, no clammy skin, pt alert and oriented x 3. Doc assessed the pt who had clear lung sounds and a tachy but normal heart rhythm. At 1409, the pt''s BP: 114/78, HR: 105 and 93% O2 sat. The pt was moved to a chair for comfort at 1415 and states, "well that made me feel fuzzy". During the transition, her heart rate accelerated to 124. Her BP at this time was 117/82, HR: 109 and 92% O2 sat. At 1422: BP: 114/84, HR: 101, 91% O2 sat. No change in her symptoms at this time. Still "tight" in her throat. Doc reassessed at this time and the decision was made to administer epinephrine. She was given 0.3mg of Epinephrine at 1430 (Lot: OGM433, Exp: Sept 2022). The pt started to feel less tightness in her throat about 3 mins after the epi. BP to follow: 118/87, HR: 150, 95% O2 Sat. EMT team called, arrived at 1435 and transferred to hospital


VAERS ID: 1708709 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-12
Onset:2021-09-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

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

Write-up: Hives covering entire body 4 days post vaccination


VAERS ID: 1708726 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Electrocardiogram, Full blood count, Metabolic function test, Pruritus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: MMR, childhood and 2015, intramuscular
Other Medications: Benadryl was taken prior to the shot. Daily medications include yaz, escitalpram 10mg, and Zyrtec once daily. Flonase is also used 2 pumps per nostril in the morning.
Current Illness: Intermittent eustachian tube dysfunction
Preexisting Conditions: Depression
Allergies: Cephalosporins, sulfa drugs, and MMR vaccine
Diagnostic Lab Data: CBC with diff, CMP, and EKG all on 9/16/21
CDC Split Type:

Write-up: I began itching approximately 10 minutes post injection (approximately 9:45). Approximately 25 minutes post injection (approximately 10:00), I began feeling very dizzy, light-headed and itching worse. Orange juice was given, pulse, oxygen and blood pressure were taken by the pharmacist. Pulse and oxygen were within normal limits, but my blood pressure was 150/110, which is higher than my usual 120/80. Blood pressure was monitored for a few minutes, without any change and options were discussed. EMS was called for further evaluation, and I was taken to the ER. My dizziness and light-headedness continued for about 2 hours at which time it stopped. My blood pressure was never rechecked after triage, at approximately 11:10, when it was still elevated at 139/96. In triage, my pulse was 88, respirations were 20, oxygen saturation was 98 and temperature was 99.1F. Itching is still occurring even with benadryl being given every 4-6 hours since the vaccine was administered.


VAERS ID: 1708733 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: Second dose given was Moderna, First dose was Pfizer. No adverse events noted.


VAERS ID: 1708746 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Dyspnoea, Dysstasia, Seizure
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: After the vaccination, patient started to feel real DIZZY and could not stand. Also, patient started stretching her body similar to having a seizure. She kept complaining of trouble breathing. Patient was administered 0.3mg of Epinephrine to be on the safe side, BP was measured and it was 94/78. Once paramedics arrived they took over the situation and observed the patient. It was deemed by paramedics as an anxiety attack and patient walked away from the Pharmacy after prolonged wait time to be on the safe side.


VAERS ID: 1708756 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intense inner ear pain


VAERS ID: 1708776 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJZ51AA / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alaway, albuterol, amlodipine, aspirin, atenolol, atorvastatin, cetirizine, clindamycin topical, cyclobenzaprine, Dulera, fluticasone nasal, furosemide, hydrochlorothiazide, losartan, metformin, naproxen, omeprazole, potassium, Zaditor.
Current Illness: Unknown
Preexisting Conditions: Hypertension, systolic murmur, allergic rhinitis, moderate persistent asthma, chronic sinusitis, hyperlipidemia, non-insulin dependent type 2 diabetes, spinal stenosis with neurogenic claudication, gastroesophageal reflux disease, stress incontinence.
Allergies: No known drug or food allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient presented to pharmacy and requested influenza vaccine, but was given covid-19 vaccine in error. Patient realized mistake prior to leaving pharmacy. Was not previously vaccinated with any covid-19 vaccine. Was understanding and requested pharmacy staff still administer the intended influenza vaccine.


VAERS ID: 1708778 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Fatigue, Headache, Insomnia, Thirst
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi- Vitamin (Alive for Women)
Current Illness: None
Preexisting Conditions: None
Allergies: Morphine, balsamic vinegar
Diagnostic Lab Data: Did not go to hospital. Husband in critical care and I need to be available for him.
CDC Split Type:

Write-up: Headache, extremely thirsty, trouble breathing over night where I could not lay down or sleep, dizzy, fatigue.


VAERS ID: 1708780 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-19
Onset:2021-09-16
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tested positive for COVID 9/16/21 after being fully vaccinated.


VAERS ID: 1708781 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Hyperhidrosis, Muscular weakness, Nausea, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Fatigue, Nausea, Leg pain, ?jello? legs, sweaty palms


VAERS ID: 1708793 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-03
Onset:2021-09-16
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tested positive for COVID 9/16/21 after being fully vaccinated.


VAERS ID: 1708816 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-12
Onset:2021-09-16
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bacteraemia, Blood creatinine increased, Blood culture positive, Blood potassium increased, COVID-19, Escherichia infection, Urine analysis, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zinc sulfate, trazodone, timolol ophthalmic solution, potassium chloride ER tablets, multivitamin, methocarbamol, latanoprost ophthalmic solution, Duoneb, furosemide, ferrous sulfate, divalproex DR, atorvastatin, aspirin, amiodarone
Current Illness:
Preexisting Conditions: hyperlipidemia, heart failure, BPH, glaucoma, gout
Allergies: sulfa antibiotics, Vimovo
Diagnostic Lab Data: 9/16 Blood culture positive for ESBL E. coli. Scr: 1.81 Potassium: 5.4 UA: WBC too numerous to count, many bacteria
CDC Split Type:

Write-up: Patient is being admitted for COVID-19, symptom onset approximately 1 week PTA. Patient also with Bacteremia. Patient is receiving meropenem and dexamethasone.


VAERS ID: 1708827 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Body aches, chills and joint and muscle pain started about 12 hours post injection. Fever between 102 and 103 for the next two days. Treated symptoms with ibuprofen.


VAERS ID: 1708829 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-09-16
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Headache, Interchange of vaccine products, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was mistakenly given Moderna Covid Vaccine. It was noticed by staff when patient was called for scheduling of second dose. Mom informed of med error and stated that patient developed the following symptoms after having received the first dose of the vaccine: fever (102 F), chills, headache, cough, runny nose for a couple of days after administration.


VAERS ID: 1708832 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-15
Onset:2021-09-16
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Scopolamine 0.33 MG/24 HR Patch, 1 Patch Transdermal Acetaminophen 650 mg suppository Morphine Sulfate 5 mg/1 ml solution, 5mg Sublingual Ativan 2 mg/1 ml solution, 0.5mg Sublingual q4h Fluticasone 0.05 mg/1 actuation spray into each nostr
Current Illness: Encounter for palliative care Resident?s on hospice care
Preexisting Conditions: Thrombocytopenia, unspecified Unspecified fall, subsequent encounter
Allergies: No known allergies/adverse reactions
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: No adverse events noted


VAERS ID: 1708851 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O35C21A / 1 LA / IM

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

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

Write-up: Moderna COVID19 vaccine administered to a 15 y/o.


VAERS ID: 1708859 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 9JD9K / N/A RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Anticoagulant therapy, Arthralgia, COVID-19 pneumonia, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Dehydration, Fibrin D dimer increased, Headache, Interchange of vaccine products, Lung consolidation, Lung opacity, Nausea, Pulmonary embolism, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Medication errors (broad), Infective pneumonia (narrow), Dehydration (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? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None but he did get the flu vaccine at the same time as the Covid vaccine on 15 Sep 2021
Current Illness: Covid-19 diagnosed 30 Aug 2021
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CTPE on 16 Sep 21: 1. Acute pulmonary embolism involving the left upper and lower lobar arteries with more significant thrombus burden in the left upper lobe. No evidence of right heart strain. 2. Multifocal patchy groundglass opacities and consolidative changes of the lungs bilaterally which are similar in distribution in comparison to prior, but have progressed in the interim. There are also more confluent changes in the left upper lobe. These findings may reflect progression of the patient''s known Covid pneumonia, although superimposed pulmonary infarct involving the left upper lobe cannot be excluded. 3. Similar mediastinal and hilar adenopathy which are likely reactive in etiology
CDC Split Type:

Write-up: Patient presented to the ED for 15 episodes of emesis in the morning of 16 Sep. The patient tested positive for COVID on August 30th. He was seen in the ED on 1 Sept and had a CT PE that was negative for clots at that time. He states that his main symptom of COVID was loss of appetite and he had lost approximately 15 lb in the past 3 weeks due to loss of appetite. He completed his quarantine and returned to work. On Wednesday 15 Sep 21, he received the first Pfizer vaccine as well as a Fluarix flu shot. He had a Headache and arthralgias after the shot. On 16 Sep 21 he woke up and vomited numerous times. He states that he has a mild cough still from Covid, but denies chest pain, shortness of breath dizziness or light headedness. He has been making urine and stooling appropriately though he has felt dehydrated on 16 Sep 21. In the ED on 16 Sep 21, the patient was found to have an elevated d-dimer of 3.13 and he underwent a new CTPE. This was positive for multiple pulmonary emboli in the left upper and lower lobar arteries. His nausea/tachycardia and clinical dehydration resolved with anti-emetics and intravenous fluids. He was started on heparin and then Xarelto for his pulmonary emboli. He never had shortness of breath or dyspnea on exertion. He was discharged home in about 24hrs after ED visit.


VAERS ID: 1708887 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysphagia, Movement disorder, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: She says she tends to get dizzy/feel like she will pass out after all shots.
Other Medications: Adderall and Benadryl
Current Illness:
Preexisting Conditions: Has negative reactions to every shot she has been given
Allergies:
Diagnostic Lab Data: Her blood pressure was taken and was 150/90, and I did listen to her lungs which sounded clear.
CDC Split Type:

Write-up: The patient starting feeling dizzy and like she might faint about 15 minutes after the shot, it progressed to feeling like she could not swallow and itching across her chest. I attempted to give her oral Benadryl, but was not working fast enough so I administered 50mg of IM Benadryl. She still complained of not being able to move her arms or legs and feeling tingling all over so I called 911. She declined going to the hospital and went home. I did call her today and she was feeling better.


VAERS ID: 1708899 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling cold, Headache, Hot flush, Hyperhidrosis, Pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None just went to dr on 11/16 and had fever came home and slept.
CDC Split Type:

Write-up: Woke up with fever, body aches, sweating around 3am. This continued all night, body hurt so bad, cold and hot flashes, shivering, SEVERE headache, sweating, fever above 100, went to dr. Told to rest and take aspirin for 3 weeks to prevent clot. Fever remained, exhausted, facial hives started around 5 pm slept from 9 am-2pm then slept again off and on until the next day on 11/17 woke up with no fever. Still sweating but almost all symptoms resolved aside from arm pain.


VAERS ID: 1708932 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 EXP 1012 / 2 LA / IM

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

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

Write-up: Patient was supposed to get moderna second dose and she got pfizer second dose because of miscomunication


VAERS ID: 1709012 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Pain in extremity, Speech disorder, Vertigo
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Prediabetes
Allergies: Erythromycin, Milk, Minocycline
Diagnostic Lab Data: none. event self resolved.
CDC Split Type:

Write-up: From her email: " Yesterday, my sons and I had our 2nd dose of the covid vaccine. I had Moderna and expected the sore arm and headache that I got however at some point during the night I got up to use the bathroom and remember feeling like everything was spinning and the next thing I knew, my husband was crouched over me asking what was wrong (he was pretty panicked). I was laying across our bathroom floor and had zero recollection of how I got there. I had serious difficulty getting up and couldn''t talk. He later said my blood pressure was normal. I wouldn''t imagine this is a normal reaction to a vaccine. "


VAERS ID: 1709044 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-28
Onset:2021-09-16
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute sinusitis, Exposure during pregnancy, Full blood count, SARS-CoV-2 test, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC Prenatal Vitamin Amoxicillin
Current Illness: Acute sinusitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC was normal 9/16/21 COVID-19 molecular test 9/16/21 was NEGATIVE
CDC Split Type:

Write-up: Patient had vaccine on 8/28/2021. She was approx 13 weeks pregnant at the time. On 9/16/2021 Pt began to have swelling to posterior portion of neck and base of skull. The same are was very tender to palpation and with neck extension. Pt also start oral amoxicillin on 9/15/21 for acute sinusitis after having sinusitis symptoms x 10 days. No fever or other symptoms.


VAERS ID: 1709064 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / IM

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

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

Write-up: None stated.


VAERS ID: 1709113 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: patient passed out almost 7 minutes after getting the vaccine and she woke up within a moment.


VAERS ID: 1709154 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain, Injection site pruritus, Injection site reaction, Rash macular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Red icthy splotch with bruise-like pain appearing on left arm near injection site 3 days after injection.


VAERS ID: 1709192 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unconfirmed covid infection 3 weeks prior
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within the first 30 minutes my nose and cheeks went numb. The symptoms have reduced, but not completely normal yet.


VAERS ID: 1709194 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto, 20 mg; Furosemide 20mg.
Current Illness: strained latissimus dorsa
Preexisting Conditions: CLL, atrial-fibrillation
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives on upper left thigh and on lower left side of back


VAERS ID: 1709200 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, 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: UNKNOWN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: ADMINISTERED EARLIER THAN THE RECOMMENDED 21 DAY INTERVAL. DOSE ONE OF PFIZER/BIONTECH (LOT # FF2587) WAS ADMINISTERED TO PATIENT ON 09/01/2021 (LEFT ARM, DELTOID, IM). PATIENT HAD NO ADVERSE REACTION. VAERS REPORT SUBMITTED TO RECORD EARLY VACCINATION.


VAERS ID: 1709221 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Paraesthesia, Pharyngeal paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest tightness, chest tingling from mid sternum radiating to throat. Shortness of breath, labored breathing worsened with deep inspiration.


VAERS ID: 1709428 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Pt reported feeling dizzy 5 mins s/p vaccine administration. Pt was escorted to exam room for monitoring, VS taken, BP 112/70, HR 95, O2 sat 97% on RA. Pt given apple juice and monitored; no LOC. S/s resolved within 20-25 mins. Repeat vitals as follows: BP 112/73, HR 93, O2 sat 98% on RA. Pt ambulated out of clinic.


VAERS ID: 1709452 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-25
Onset:2021-09-16
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Inflammation, Joint swelling, Pain in extremity, Peripheral swelling, Rash, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline for acne.
Current Illness: Pre-diabetic
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Random swelling around elbow and inflammation spreading up the forearm and its painful and tender to the touch. Rash/swelling only on arms. No fever no itchiness just swelling and pain.


VAERS ID: 1709455 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: PMH significant for Sjogren''s disease, enlarged liver, hypothyroidism, DM. Other PMH/medications unknown to this writer.
Allergies: Pt w/ hx of allergy to Sulfa medications (hives).
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt w/ hx of allergy to Sulfa medications (hives). PMH significant for Sjogren''s disease, enlarged liver, hypothyroidism, DM. Other PMH/medications unknown to this writer. 3mins post vaccination, pt had a syncopal episode. Pt c/o feeling floppy, warm. Of note, the pt had nothing by mouth all day. Vitals: BP 169/98, HR 97, O2Sat 98% -- $g 148/90, 78. Pt symptons self resolved w/ in 5mins of monitoring."


VAERS ID: 1709465 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate decreased, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Feet are noticeably swollen. Veins always visible, not feet are slightly puffy and smooth. Heart rate dropped from typical 60-62bpm to 50bpm.


VAERS ID: 1709634 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 3 OT / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Aspartate aminotransferase increased, Blood chloride decreased, Blood glucose normal, Blood sodium normal, Chest injury, Chills, Eye contusion, Fall, Fibrin D dimer, Full blood count, Haemoglobin decreased, Head injury, International normalised ratio, Lymphocyte count normal, Monocyte count increased, Neutrophil count increased, Prothrombin time, Suture insertion, Syncope, Troponin increased, Urine analysis normal
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: Thalassemia minor
Allergies: NKA
Diagnostic Lab Data: D-dimer 8,833. PT, INR, APTT normal, UA neg, Chemistry Na 134, Cl 97, clucose 114, AST 52, Troponin <0.012, CBC Hgb 9.2, Neutrophil 94, lymphocytes 2.0, monocytes 2.0
CDC Split Type:

Write-up: at 0300 the patient developed rigors/chills. She got up from bed to find Tylenol and Aleve in her kitchen and when she looked up, she became syncopal and fainted, fell on R side, injured R rib and had a black eye. Felt better at 0600. At about 0900 she got up to the restroom only a few steps away from her bed and she had another syncopal incident where she hit the back of her head. She went to the hospital ER for sutures to the back of her head.


VAERS ID: 1709657 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: I?ve had an IUD - Mirena for 3.5 years which has caused my menstrual cycles to stop completely. I no longer get periods. 2 days after the shot I started a heavy period and am still on it. I didn?t think it had anything to do with the vaccine but I was worried something was wrong and needed to see a doctor until someone told me it could be from the shot. After some research I was told by the pharmacist that it?s an adverse reaction and suggested I report it.


VAERS ID: 1709845 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

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

Write-up: The patient came in for her 2nd dose of the Moderna COVID-19 vaccine. I neglected to double check the CDC COVID-19 vaccination card, her MCIR or let her know which vaccine she was receiving. after I gave her the vaccine and she had waited 15 minutes I was then able to check the billing information that the technician put in. this is when I noticed that the patient was suppossed to receive the Moderna vaccine and that I had given her the Pfizer COVID-19 vaccine instead. I contacted my boss, the patient''s doctor and the patient. The doctor had stated that they didn''t see any issue with the differing vaccines. The patient stated that she felt fine. The patient''s aunt followed up with the pharmacy manager from the vaccination site on 9-17-2021. There were no adverse events.


VAERS ID: 1709856 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine, Metafolbic Plus, Ibanodrate sodium, Metronidazole gel, Gabapentin, Rosuvastatin, CBD, CoQ10, Curcumin phytosome, Krill oil, N-acetylcysteine, Vitamin D, AlgaeCal Plus, Melatonin
Current Illness: None
Preexisting Conditions: Circadian rhythm disorder, ADHD, Dysthymic disorder, Obstructive sleep apnea, Fibromyalgia, Restless Legs Syndrome, Sleep-related bruxism, Rosacea, Psoriasis, Osteoporosis, Raynaud?s syndrome
Allergies: None
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Swollen cheeks and upper lip


VAERS ID: 1710061 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Adverse reaction, Cognitive disorder, Cough, Dysarthria, Dyspnoea, Head discomfort, Hypersensitivity, Hypoaesthesia, Hypoaesthesia oral, Immediate post-injection reaction, Lip pain, Paraesthesia, Paraesthesia oral, Tremor, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor 40 mg - Levothyroxine 100 mcg - Aspirin 80 - Ibuprofen 500 mg - multi-vitamins - vitamin D - Vitamin E - Fish oil
Current Illness: High cholesterol (380 in July 2021 - take Lipitor 40 mg and aspirin 81) - Hypothyroid (levothyroxine 100mcg)
Preexisting Conditions: Hyperlipidemia and hypothyroid (long-standing conditions) Diagnosed in October 2020 with a condition involving the heart valve (mitral valve regurgitation - right side) mild case
Allergies: Allergy to cold medication (syrup) - to drug used in nuclear stress test - Allergy to paprika, green pepper, black pepper, white pepper, cumin, safran, spices, shrimp, celery, cabbage, broccoli, tomato sauce, avocado, carrageenan, annatto, canola oil
Diagnostic Lab Data: at 5:35 pm nurse on staff notes: numbness + tingling in bilateral (hands, feet, lips, and head, starting 2-5 minutes after IM injection - Moderna) + coughing , shortness of breath, feeling tremors/pain in lips and left upper abdominal area. 5:58 pm BP 122/75 - HR 57 6:15 pm BP 121/82 - HR 57 6:22 pm coughing persisting+ headache +tremors Assessment: lungs clear, no wheezing, hear sounds normal S1 S2, no swelling/edema
CDC Split Type:

Write-up: I got the first Moderna vaccine shot at 5:30 pm on 9/17/2021 approximately. Within seconds, I experienced an immediate adverse allergic reaction that required the nurses and professionals on staff to move me to an adjacent chamber and monitor my symptoms for the next hour: numbness, tingling in bilateral hands, feet, lips, and head; coughing, shortness of breath, tremors, pain in lips, and upper left abdominal, head pressure, tongue slowness/slurring words, blurred vision, slowed cognition? As the center was preparing to close for the day, the center staff warned me that I may need to go to the emergency room, if my symptoms persisted or worsened overnight. They also asked me to contact my Doctor and inform her of my immediate adverse reaction to the first dose of the vaccine. They alerted me, per CDC guidelines, that anyone experiencing such a reaction to the vaccine should not receive a second dose and directed me to update my Doctor. They also filed a report documenting this incident with Health Department and other related authorities. Two hours before receiving the vaccine, I met with my allergist/immunologist to determine whether I should be exempt from receiving the vaccine due to my allergies as she had stated to me in July 2021. Instead, she stated that I did not have an allergy to PEG and that I should proceed with receiving the Moderna vaccine as required by my employer.


VAERS ID: 1710800 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210931889

Write-up: SORENESS ALL OF HER RIGHT ARM IMMEDIATELY AS SHE WAS GETTING THE NEEDLE/PUNCHED IN THE ARM A FEW TIMES; LITTLE HEADACHE; This spontaneous report received from a patient concerned a 48 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 (suspension for injection, intramuscular, batch number: 202A21A expiry: UNKNOWN) dose was not reported, administered on 16-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 16-SEP-2021, the patient experienced soreness all of her right arm immediately as she was getting the needle/punched in the arm a few times. On 16-SEP-2021, the patient experienced little headache. The action taken with covid-19 vaccine was not applicable. The patient was recovering from little headache, and soreness all of her right arm immediately as she was getting the needle/punched in the arm a few times. This report was non-serious.


VAERS ID: 1710817 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BNT 162
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210932605

Write-up: OFF LABEL USE; JANSSEN COVID-19 VACCINE ADMINISTRATED TO A 15 YEARS OLD GIRL AS AN ACCIDENT; This spontaneous report received from a health care professional concerned a 15 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: 202A21A, and expiry: 31-OCT-2021) dose was not reported, administered on 16-SEP-2021 for prophylactic vaccination. Concomitant medications included bnt 162 for prophylactic vaccination. On 16-SEP-2021, the patient experienced off label use. On 16-SEP-2021, the patient experienced janssen covid-19 vaccine administrated to a 15 years old girl as an accident. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the off label use and janssen covid-19 vaccine administrated to a 15 years old girl as an accident was not reported. This report was non-serious.


VAERS ID: 1710824 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Sluggishness, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210933142

Write-up: FEELING SLEEPISH; SLUGGISH; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 15-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 16-SEP-2021, the patient experienced feeling sleepish. On 16-SEP-2021, the patient experienced sluggish. The action taken with covid-19 vaccine was not applicable. The outcome of the feeling sleepish and sluggish was not reported. This report was non-serious. This case, from the same reporter is linked to 20210931931.


VAERS ID: 1711068 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Injection site erythema, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lyrica, Cymbalta, lisinopril, diclofinac, tramadol, tizanidine, vit D
Current Illness: None
Preexisting Conditions: Hypertension; Fibromyalgia; Depression
Allergies: Wellbutrin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bodyaches, headache, fever, red area at injection site and painful arm.


VAERS ID: 1713194 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F / 2 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1713195 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

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

Write-up: Error: Improper storage/temperature.


VAERS ID: 1713222 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 4 RA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, MVI, Vit D3, eye health vitamin, calcium, famotidine
Current Illness: None
Preexisting Conditions: Hypertension well controlled
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: ADMINISTRATION ERROR! I went to the pharmacy to get my flu shot--- and at 3:10 p.m. on September 16th 2021 was given INSTEAD --- BY ACCIDENT OF THE TECHNICIAN---- THE PFIZER VACCINE INSTEAD OF THE FLU SHOT. I had the PREVIOUS 2 Pfizer VACCINES in FEBRUARY 2021 and a 3RD PFIZER (recent booster) in AUGUST 2021... ( I had my Pfizer vaccines in February 2021 and I had my booster August 8th 2021. ) SO THEREFORE I HAVE NOW RECEIVED A 4TH(FOURTH) PFIZER VACCINE BY ACCIDENT on September 16th 2021. That is 4 VACCINATION DOSES in all of the PFIZER VACCINES . I''m concerned because of getting that extra vaccination. I also got the flu shot afterwards on 9/16/2021-- because I asked that I receive the flu shot-- since that is what I came to the pharmacy to get originally before the mistake was made.


VAERS ID: 1713233 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

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

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

Write-up: low grade fever, chills, headache, fatigue


VAERS ID: 1713240 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Glossitis, Oral pain, Stomatitis, Tongue ulceration
SMQs:, Severe cutaneous adverse reactions (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Inflammation of tongue and sensitive mouth to spicy/acidic foods on Sept 16. Inflammation continued on Sept 17 with addition of sores/ulcers on tongue, inside of mouth. Sores and Inflammation still present on Sept 18th.


VAERS ID: 1713266 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816027 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bone pain, Chills, Condition aggravated, Electrocardiogram abnormal, Heart rate increased, Hot flush, Pain, Pyrexia, Sinus tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Osteonecrosis (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: Metoprolol, bupropion, and finished dose of flagyl
Current Illness: just finished medication course for yeast infection and BV
Preexisting Conditions: Tachycardia - controlled on metoprolol (normal 80-90), echo = normal, cleared by doctor to receive any vaccine PCOS GAD and depression - controlled on medication Binge eating disorder
Allergies: Intolerance to adhesive - rash with prolonged use
Diagnostic Lab Data: EKG on 9/16: Sinus tachycardia, 113 bpm.
CDC Split Type:

Write-up: Common side effects of vaccination including low grade fever, chills/hotflashes, and intense body/bone aches began approximately 9/15 at 2300. I awoke at 0600 noting my heart rate to be at 122 bpm via radial manual pulse, my smart watch, and pulse oximetry; after walking short distance to kitchen, my heart rate was then 140 bpm. I figured maybe I just need to take my metoprolol. I do have a history of tachycardia for unknown reasons at this time but my rates have been controlled between 80-90 or less... even with activity usually my heart rate stays below 120 bpm now. At that time, I took my metoprolol; the day before I had taken it at approximately the same time given that is when I had gotten up for work. I was able to fall back asleep within an hour. I woke up again approximately 120 bpm... I could feel instantly that my heart rate still felt elevated. I checked my watch and pulse oximetry again to find my heart rate was still around 120 bpm just having woke up, still laying in bed. This is quite uncommon for me given my rates have been well-controlled for months now. I ended up discussing with employee health at my workplace who urged me to seek care so I went to the Urgent Care. Heart rate documented at 127 bpm and other vital signs within normal limits. EKG was completed showing sinus tachycardia at 113 bpm. End result was to increase metoprolol dosage until symptoms passed; if they did not improve, pursue ER care. Taking an additional 25 mg on top of my 50 mg ER metoprolol brought my heart rate down for the remainder of the day to 90-100... still elevated from my normal but tolerable. The following day as common symptoms improved so did my heart rate. I understand this reaction is likely due to my bodies response to creating antibodies; however, elevated heart rate was not listed as possible side effect which is drastically important for someone like me who has these issues being managed chronically. Expecting tachycardia as a response would have changed possibly which vaccine I received as well as my medical treatment. Provider at Urgent Care stated that none of their provider''s were aware of tachycardia as a common reaction.


VAERS ID: 1713269 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-09
Onset:2021-09-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: Shoulder injury related to vaccine administration from Flu Vaccine
Other Medications: Vitamin C Once a Day
Current Illness: None
Preexisting Conditions: Left Torn Rotator Cuff, Bulging Discs, Endometriosis
Allergies: Peanuts, tree nuts, Ibuprofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right arm redness, rash, and itching at injection site


VAERS ID: 1713270 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Diarrhoea, Headache, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingles caused by flu vaccine at 18y/o
Other Medications: Armour Thyroid 30mg Estradiol 2mg Progesterone 100mg
Current Illness: None
Preexisting Conditions: Osteoporosis
Allergies: None
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Severe abdominal pain, fever, nausea, vomiting, diarrhea, headache, myalgia. Symptoms have remained severe since onset and now for 48hrs since vaccine. Tx?Zantac 360mg bid, peptobismol q6hrs, omeprazole 40mg.


VAERS ID: 1713272 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Arthralgia, Back pain, Feeling cold, Muscle spasms, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nausea medicine, pain and fever relievers and digestive or stomach medicine
Current Illness: None
Preexisting Conditions: None
Allergies: Some foods but it happens rarely
Diagnostic Lab Data:
CDC Split Type:

Write-up: Around 05 pm the pain and fever slowly started and by around 10 pm i started to have cold and hot fever, joint pain, lower back pain and followed by cramping and stomach uncomfortably and a serious pain. Medicine used for treatment: stomach such as omeprazole and anti acids, nausea tabs and pain and fever relievers but really nothing worked because of the nuasea


VAERS ID: 1713305 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatine phosphokinase normal, Blood electrolytes normal, Chest X-ray normal, Chest discomfort, Electrocardiogram normal, Full blood count normal, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: At ED on 9/17/21, his temperature was 37.7 C, BP 104/82 mmHg, HR 84, RR 18, SPO2 98% on room air. He was given a dose of motrin at 4:30 pm which alleviated his discomfort. ECG was normal with no ST changes, CXR showed clear lungs and no cardiomegaly. CK, electrolytes, and CBC were unremarkable. High sensitivity troponin was elevated to 92 prompting his transfer to another Hospital.
CDC Split Type:

Write-up: Patient presented with chest discomfort. No other symptoms.


VAERS ID: 1713310 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Malaise, Nausea, Oropharyngeal pain
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec 10 mg one tab daily Singulair 10 mg one tab daily Synthroid 150 mcg one tab daily
Current Illness: Asma, hypothyroidism
Preexisting Conditions: Asma, hypothyroidism, status post papillary thyroid cancer 2 year free of cancer
Allergies: Penicillines, sulfas, iodine, bethadine, kiwi, strawberry, latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: today is the 3rd day with persistent headache, mild nauseas, sore throat, malaise and tiredness. Relieved by Acetaminophen use 1000 mg every 8 hrs


VAERS ID: 1713312 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest discomfort, Chest pain, Dyspnoea, Electrocardiogram normal, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Levothyroxine (low dose for low thyroid); Vitamins/minerals: D3, zinc, C, iron, biotin (hair, nails, skin supplement)
Current Illness: None
Preexisting Conditions: Mild asthma that is well-controlled with albuterol inhaler; hadn''t used in at least three months leading up to vaccination though
Allergies: animal dander (dogs being the biggest one); environmental/seasonal; hay
Diagnostic Lab Data: Results came back from ER on 09/16/21 for running blood work twice and there was no evidence of blood clot or heart attack. EKG was performed twice and I was told it was normal. Follow up with primary care doctor is scheduled for 09/20/21.
CDC Split Type:

Write-up: At 4:30 PM on 09/16/21 I began to feel short of breath and easily winded with some chest discomfort. By about 5 PM I used my rescue inhaler. Around 5:30 PM I called for a ride to the ER because chest pain was getting worse. At the ER they ran a number of tests including blood work and EKGs. Chest pain got worse while at the ER. Fever spiked while in ER. I was given Tylenol and ibuprofen. Results came back from running blood work twice and there was no evidence of blood clot or heart attack. EKG was performed twice and I was told it was normal. I will follow up with my primary care provider on 09/20/21 for more information. As of today (09/18/21), I continue to have some chest discomfort and tire extremely easily. Breathing is still more labored also.


VAERS ID: 1713323 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Electrocardiogram normal, Laboratory test normal, Painful respiration, Pericarditis, Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Kepra
Current Illness: Central core myopathy
Preexisting Conditions: Epilepsy
Allergies: Sulfa
Diagnostic Lab Data: EKG was normal and routine labs normal and chest x ray normal
CDC Split Type:

Write-up: Stabbing chest pain 10 hours after vaccine. Pain worse when lying down and deep breathing. Doctor believed that symptoms were pericarditis and gave antii-inflammatory and pain meds. Also started menstrating. I am in menopause and have not had a period in 5 years and I started a period the day I got the vaccine. Do not know outcome as I?ve just started meds and rest today and just left the ER


VAERS ID: 1713352 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), 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: Lisinopril, Acid Reducer, Claritin, Vitamin D
Current Illness:
Preexisting Conditions: High Blood pressure, High Cholosterol
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low grade fever, chills, extreme body aches, headache, nausea, and diarrhea


VAERS ID: 1713363 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Pain, Pain in extremity, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zinc, Quercetin, Vitamin D3 and High Blood Pressure medication
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1st day = chills in early morning, leading to fever like body aches. 2nd day = body aches all day 3rd day = headache in the morning 4th day = left arm still sore since day one, hard to sleep on left side


VAERS ID: 1713443 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Rash, Throat irritation, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Famotidine, Protonix, Magnesium, Imitrex, Benadryl
Current Illness: None
Preexisting Conditions: Migraines
Allergies: Aspirin, Naproxen, Ibuprofen, Pepto Bismol, Hydromorphone, Gabapentin, Excedrin Migraine, Cipro, Flagyl, Carmen lip balm, Vibramycin, Meclizine, Pertussis, Latex, Adhesive tape, Bee stings
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives, rash, itching tight feeling in throat, trouble swallowing( Anaphylactic reaction) 340pm vaccine given, 740pm woke up with symptoms went to emergency room arrived approximately 810pm MD ordered IV Solu-Medrol, 1 L normal saline, famotidine, PO Benadryl, with good effects and complete resolution of symptoms monitor for couple hrs released


VAERS ID: 1713467 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Feeling cold, Headache, Inappropriate schedule of product administration, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore Arm and headache after second dose of Pfizer
Other Medications: Alsace, Crestor, Zetia, Flonase, Vitamins B and D
Current Illness: None
Preexisting Conditions: I have had two Coronary Bypass operations in 1976 and 1995 and a procedure to address and aortic aneurism in 2020.
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: This was not a major adverse event, but I thought CDC should have for its records. The shot was Wednesday, September 15 at 4:30 pm. The next morning I had a very sore arm. In the course of the day I developed a minor fever and a headache. I treated these with IBuprofin as recommended, and the drug seemed to work. I went to bed very chilled on the night of September 17, but awoke on September 18 with no fever or chills. I should note that I also had a flu shot for seniors on September 16. All in all, it was a little more painful with more fever, if mild, than the second shot. I just wanted you to have complete records.


VAERS ID: 1713573 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Lymphoedema, Vaccine positive rechallenge
SMQs:, Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

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

Write-up: New onset lymphedema in L ankle. L ankle also hurt after receiving both my first and second Pfizer vaccines.


VAERS ID: 1713578 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Erythema, Rash
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: None
Current Illness:
Preexisting Conditions:
Allergies: Paxil, some laundry soaps.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Red non itchy rash on arms, legs, back, stomach. Out of breath easily


VAERS ID: 1713620 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Depression, Pain, and Anxiety
Allergies: Codeine, Penicillin, Hydrocodone, and Imitrex
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Her arm started hurting the night of the shot. It was a little swollen the next day so she started using a hot wash cloth on it. It has been slowly getting worse and today (9/17) the site was swollen about 3-4 inches across, red, and painful. Advised patient to see MD.


VAERS ID: 1713626 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 - / SYR

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

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

Write-up: Following both first and second doses in my right arm. I received a baseball sized rash that hurt to the touch and itches. The rash lasted 8 days after the first dose and went away. The rash reappeared the day of the second dose (9/16/21) and hasn?t responded to antihistamines.


VAERS ID: 1713628 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Palpitations, Vertigo
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (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: Fish Oil, multivitamins, vitamin D,
Current Illness: None
Preexisting Conditions: MLB anemia, fibromyalgia, fatigue due to iron deficiency
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe vertigo 4 hours after shot and continuing 72 hours now. No improvement. Heart palpitations. Chills (expected). Treatment - lots of water and benadryl. No relief.


VAERS ID: 1713669 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Injection site inflammation, Injection site reaction, Pain, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Phentermine 37.5 mg
Current Illness: None
Preexisting Conditions: Autoimmune therapists (hashimoto), asthma
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, increasing redness and inflammation at the injection site, itchiness (rash) at injection site, soreness around left clavicle


VAERS ID: 1713730 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

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

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

Write-up: Red rash and swollen around injection site


VAERS ID: 1713747 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Fatigue, Headache, Injection site pain, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin Vitamin D Vitamin A Vitamin C
Current Illness: Ine
Preexisting Conditions: Psoriasis on scalp
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Symptoms started next day ( Sept. 16th) at 0600 upon waking up Severe Headache Severe Fatigue and weakness Severe Joint Pain and pain at sight of injection (right upper arm) Skin felt like glass Moderate to Severe Nausea with vomiting after eating x1 Symptoms lasted until 1030pm same day (Sept. 16th)


VAERS ID: 1713825 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Diarrhoea, Headache, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Chest pain, headache, nausea, injection site pain all lasting 3 days, Diarrhea ongoing


VAERS ID: 1713828 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-01
Onset:2021-09-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Electrocardiogram normal, Oxygen saturation decreased, Sinus rhythm
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin d Multi Vitamin Apple cinder vinegar Exedrin migrain
Current Illness: Had a virus
Preexisting Conditions: Fybromyalgia High blood pressure
Allergies: Tree nuts Latex No narcotics Codeine
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Chest feels like it is a vise and can''t catch breath, pulse ox below 90 but ekg is normal slightly sinius rhythm


VAERS ID: 1713869 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, 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), 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: Arm swelling after flu vaccine 1990
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, dizziness, fatigue, arm swelling last for 12 hours


VAERS ID: 1713899 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-02
Onset:2021-09-16
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Malaise, Nasopharyngitis, Paranasal sinus discomfort, 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: 09/17/2021 - Nasal Swab completed 09/18/2021 - Nasal swab reported as positive through Vikor Scientific
CDC Split Type:

Write-up: Sinus pressure, cold symptoms, not feeling well


VAERS ID: 1713901 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid #2 on 4/2/2021 same reaction but lasted 4-5 days
Other Medications: Thyroxine Paxil Calcium Magnesium B12
Current Illness:
Preexisting Conditions: Inflammatory arthritis Osteoarthritis Hypothyroid
Allergies: Aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever Nausia Body aches Pain /bruise at injection site Lasted 3 days Tylenol to keep fever down


VAERS ID: 1713940 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-22
Onset:2021-09-16
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #EJ1685 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #EK4176 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unk
Preexisting Conditions: unk
Allergies: unk
Diagnostic Lab Data: Antigen test positive on 9/13/21
CDC Split Type:

Write-up: Employee was tested positive for COVID-19 on 9/13/21. Employee was removed from work 9/13-9/22.


VAERS ID: 1713976 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / UNK - / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Headache, Memory impairment, Pain
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), 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:

Write-up: Overall body aches headache memory issues brain fog


VAERS ID: 1713992 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-20
Onset:2021-09-16
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site discolouration, Injection site erythema, Injection site pain, Injection site scar
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient noted no sx for 2 months after vaccination- just hyperpigmented scar at site of injection right upper arm- approx 3 days ago noted darkening of site and then pain with erythema- extending approx 2cm- neg exam for joint/shoulder pain


VAERS ID: 1714035 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / IM

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

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

Write-up: Patient stated injection site is itching , swollen and warm.


VAERS ID: 1714037 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-05
Onset:2021-09-16
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin 10 mg orally every other day Ezetimibe 10 mg orally every other day Propranolol 40 mg orally once daily Vitamin D 2,000 IU orally once daily Coenzyme Q10 100mg/ Vitamin E 68 mg once daily
Current Illness:
Preexisting Conditions: Exercise induced supraventricular tachycardia Benign essential tremor Hypercholesterolemia Myopia/Presbyopia/Astigmatism
Allergies: Simvastatin
Diagnostic Lab Data:
CDC Split Type:

Write-up: On September 16, I was awakened by itching, particularly bad in the axillae and pubic area but also notable in the hands, inner wrists, scalp. Scratching evoked dermatographic urticaria. On September 17, I had the sensation of a pill being stuck in my esophagus, unable to be cleared by forcing fluids or eructation. This symptom cleared the following day, September 18th. Since September 17, I have had severe, intermittent itching of my palms and fingers associated with redness and swelling. On the morning of September 19, I noted urticarial wheals on both dorsal aspects of my ankles. I initiated treatment with loratadine 10 mg orally once daily on September 17 with only partial relief. Cold packs applied to the hands afford partial temporary relief.


VAERS ID: 1714074 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, Lamoitrigne, Pregabalin
Current Illness: N/a
Preexisting Conditions: Neuropathy, seizure
Allergies: Mangos, papaya, fresh pineapple, seafood, airborne tilapia allergy, morphine, stadholder, topamax, max alt, diclofenac
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seizure less 15 min


VAERS ID: 1714148 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site urticaria, 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: Metformin
Current Illness: no
Preexisting Conditions: PCOS
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives started at the vaccine injection site then wide spread over entire body


VAERS ID: 1714209 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-30
Onset:2021-09-16
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Hypomenorrhoea, Nausea, Polymenorrhoea
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad)

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

Write-up: Started period the day after shot but expecting one anyways but then on 9/16 period started again and was very heavy for two days. This period was very heavy and short, not like usual periods. Much more cramping and some nausea.


VAERS ID: 1714217 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site warmth, Malaise
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: injection site became red, warm, and itchy the day after the shot was received. 2 days after the shot, the patient had some malaise as well.


VAERS ID: 1714327 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-16
Onset:2021-09-16
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Amenorrhoea, Muscle spasms
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad)

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

Write-up: Have not gotten my period, bloated, cramps


VAERS ID: 1714360 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-02
Onset:2021-09-16
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully vaccinated employee began having symptoms on 9/16/21


VAERS ID: 1714392 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia oral, Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Client received her 2nd dose of the Covid19 Pfizer vaccine (Lot#FF8839) at 18:30 pm on 09/16/21. After receiving the injection, the client and her father proceeded to the observation area to sit for 15 minutes. At approximately 18:45, client alerted EMT she started to feel numbness in her lips and tongue around 4-5 minutes prior. EMT immediately requested Lead RN come over to assess the client. At 18:46, Lead RN observed the client sitting upright in a chair, in no apparent distress. Client communicated she was not experiencing shortness of breath, difficulty breathing, or chest pain. Client also stated she was not having trouble swallowing. Client indicated she felt a tickle on her tongue and her lips felt like they were getting numb, but she was not experiencing any swelling in those areas. Lead RN requested the client open her mouth to observe the client?s tongue and throat with a pen light, and observed that the client?s tongue and throat were not swollen. Client stated she did not experience any of these effects after receiving her 1st dose of the Covid19 Pfizer vaccine, but did experience a headache and some nausea. Client stated she has no underlying health conditions, takes no medications, and has no known allergies. She did state that 4 years ago she took Sumatriptan for migraine headaches and experienced minor numbness in her face, arm, and tongue, but no swelling. Client also stated she did not take anything to treat those symptoms, but did drink a lot of water and they went away. She also did not seek treatment, but her HCP recommend she no longer take the medication. EMT took client?s vitals at 18:55 (BP: 122/88, HR: 75, SPO2: 98%). Client indicated she normally has low blood pressure. She also stated that the numbness was starting to subside and confirmed that she was still not experiencing any swelling. The client was provided with a bottle of water per her request, which she began drinking. Lead RN requested the client sit for another 10-15 minutes for observation and the client agreed. At 19:06 the client stated the numbness in her lips was almost gone and she was no longer experiencing a tickle on her tongue. At 19:08 EMT, Ali, took the client?s vitals (BP: 120/80, HR: 74, SPO2: 97%). Client communicated ?the numbness is pretty much gone,? and she felt fine. Lead RN educated the client and her father on both the potential side effects and adverse effects of the vaccine, when to seek medical attention, and ER precautions. Lead RN observed the client and her father leave the observation area at 19:12. The client was walking with a steady gait.


VAERS ID: 1714394 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Decreased appetite, Fatigue, Feeling abnormal, Headache, Joint range of motion decreased, Limb discomfort, Mobility decreased, Nausea, Pain, Pain in extremity, Pyrexia, Restless legs syndrome, Vaccination site nodule, Vaccination site warmth
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Synthroid, Propranolol, Spironolactone, Krill oil, vit d, multivitamin, zyrtec, vit c, zinc, adipex
Current Illness: None
Preexisting Conditions: Cortisol intolerant, insulin resistance, hypothyroidism, chronic migraines, chronic back problems
Allergies: Clindamycin, Bee stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: The day of vaccine I developed headache, body aches all over, pain in left arm, restless legs, pain in legs off and on, out of body like experience, nausea, loss of appetite, fatigue, low grade fever. The day after I still had headache, body aches all over, pain in left arm - unable to raise above my shoulder, pain in arms and legs off and on, nausea, loss of appetite, fatigue, weakness, loss of appetite, low grade fever. The 2nd day I still had the same symptoms as the day before but also started developing a knot where the vaccine was given and was fevered, pain in the left arm (where the vaccine was given) feels like a ton of bricks and can''t lift anything nor lift my arm to my shoulder nor above my shoulder. The 3rd day after I still had the same symptoms previously mentioned but now have a golf ball size knot where the vaccine was given and unable to use my arm and pain in the left arm (where the vaccine was given) feels like a ton of bricks and can''t lift anything nor my arm to my shoulder nor above my shoulder.


VAERS ID: 1714398 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Flushing, Pruritus, Rash, Swelling face, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (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: flu
Other Medications: Trikafta, Vitamin D, Zenpep, Botox injections for migraines
Current Illness: Cystic Fibrosis Cystic Fibrosis related Diabetes Migraines
Preexisting Conditions: Cystic Fibrisos CF related diabetes
Allergies: Vancomycin - red man syndrome (anaphylaxis) Sulfa drugs - hive shrimp - facial swelling and hives, wheezing amoxycillan - hives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Facial swelling, rash, itching, wheezing, flushing Solumedrol 125mg, Benadryl 50mg


VAERS ID: 1714406 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Headache, Hot flush, Influenza like illness, 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: Celexa, 40mg daily Saxenda 0.6 mg daily
Current Illness: None
Preexisting Conditions: Depression, obesity
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms began at approximately 3:00AM on 09/16/2021, 18 hours after the vaccine was administered: Flu like symptoms-fever of 100.7, chills, hot flashes, body aches, fatigue, headache. All lasting approximately 24 hours. Treated with acetaminophen 500mg for fever and pain every 4 hours. Fatigue, loss of appetite, and intermittent nausea lasting for an additional 72 hours. No treatment given.


VAERS ID: 1714491 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Magnetic resonance imaging heart, Myocarditis, Syncope, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: troponin, echocardiogram, cardiac MRI
CDC Split Type:

Write-up: Myocarditis, presented with chest pain and syncope 3 days after second pfizer vaccination. Initial trop 3.3, peaked at 18. Currently hospitalized


VAERS ID: 1714493 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cognitive disorder, Headache
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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 shot 2007, muscle aches for 8 hours
Other Medications: Iron, calcium, amitriptyline, Claritin
Current Illness: None
Preexisting Conditions: Anemia, endometriosis
Allergies: Bee sting allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache (non migraine) duration 48 hours. Impaired cognition duration 36 hours.


VAERS ID: 1714533 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Guam  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 RA / IM

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

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

Write-up: Nurse inadvertently administered 2nd dose to patient, 1 day short of her 12th birthday. Patient monitored for 15 minutes, post vaccination.


VAERS ID: 1714639 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-01
Onset:2021-09-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Full blood count normal, Induration, Lymph node pain, Lymphadenopathy, Metabolic function test normal
SMQs:, Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: has cold sores attributed to stress
Preexisting Conditions: probable undiagnosed sleep apnea
Allergies: penicillin zithromax
Diagnostic Lab Data: CBC and CMP done to r/o lymphoproliferative disorder, normal.
CDC Split Type:

Write-up: Pt presented with painful adenopathy in the posterior occiput midline , initially treated without effect with doxycycline, only to have it spread to symmetrical shotty nodes only in the posterior neck symmetrically, with a single 1.5 solid node palpated in each supraclavicular fossa . No axillary adenopathy. All very tender and firm. Pt has " cold sore" on lip, nonspecific. Works in healthcare setting. This occurred after first injection, no known previously known covid infection.


VAERS ID: 1714715 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F / 2 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1714716 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F / 1 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1714717 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F / 3 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1714718 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F / 2 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1714726 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

Administered by: Unknown       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: Lortab
Current Illness: None
Preexisting Conditions: Spinal Stenosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles/Herpes Zoster


VAERS ID: 1714892 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-30
Onset:2021-09-16
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Haemorrhage, Heavy menstrual bleeding, Muscle spasms, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad)

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

Write-up: Heavy period, painful cramps, headache, on and off bleeding


VAERS ID: 1714893 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / 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:
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Client originally received Moderna COVID-19 vaccine


VAERS ID: 1714895 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-22
Onset:2021-09-16
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed COVID-19 post-vaccination requiring hospitalization.


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