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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 487 out of 8,753

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VAERS ID: 1714910 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 3182 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra - Prenatal Vitamin, Protonix - Been taking daily since March 2020
Current Illness: none
Preexisting Conditions: Barret''s Esophagus
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received my second shot on 9/13. I got my period on 9/17. 9 days before my next expected period. I track my period via app and ahve for almost 5 years. My cycle has always been between 25-27 days.


VAERS ID: 1714931 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-24
Onset:2021-09-16
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin, Amlodipine, Atorvastatin, Lasix, Losartan, Incruse Ellipta inhaler
Current Illness:
Preexisting Conditions: CHF, asthma, chronic use of oxygen at home, DM type 2 insulin dependent, hypertension, morbid obesity, obstructive sleep apnea, former smoker
Allergies: none mentioned in the EMR
Diagnostic Lab Data: COVID-19+ on 9/16/2021
CDC Split Type:

Write-up: hospitalization with COVID-19+


VAERS ID: 1714942 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Fever, Chills, Body Aches, Headache


VAERS ID: 1714948 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
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 FF2589 / 1 LA / IM

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

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

Write-up: Patient received wrong vaccine dose by clinic vaccinator 0.03mL instead of 0.3mL. Nurse was corrected onsite and reeducated on dosing practice. Patient was then asked if he would be ok receiving another vaccine with the correct dose and received the 0.3mL dose of COVID-19 Pfizer vaccine.


VAERS ID: 1714951 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Iowa  
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 035C21A / 2 LA / IM

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

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

Write-up: Patient recieved Pfizer on 8/26/2021 and then recieved Moderna on 9-16-2021 Patient was informed.


VAERS ID: 1714955 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Maryland  
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 041C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Erythema, Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Injection site warmth, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins A B comples, C, D-3, Biotin, Uva Ursi
Current Illness: N/A
Preexisting Conditions: cancer survivor; no cancer present as per recent CA 125
Allergies: latex, dyes, sulfites, saline solution, inset bites, bee/wasp stings, iodine, aversion to meds some spasmic responses
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 09/16/21 pm hours noted right deltoid injection site painful to touch, site warmth and increase in upper arm size. late am 09/17/21 chest tightness episode. early am 09/18/21 worsening right deltoid injection site swelling, hard to touch and increased pain with reddened circular area diameter 5-6 mm plus similar reddened areas 2 - 3 each leg on bilateral lower legs. Onset of throat tightness during late pm 09/18/21/early am 09/19/21.


VAERS ID: 1714956 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Florida  
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 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: weakened immune system
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received Pfizer for his 1st two shots but was given moderna as his 3rd dose


VAERS ID: 1714967 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Computerised tomogram, Magnetic resonance imaging head, Ultrasound Doppler
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin d3, calcium, culturally pre/probiotic, move free, Flonase, Pepcid
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: Brain mri-9/17 Ct scans-9/16 Us carotid artery?s-9/17
CDC Split Type: FC3182

Write-up: Stroke 6 days after vaccine


VAERS ID: 1714973 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Maryland  
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 939901 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received her 2nd dose of Moderna despite being 15 years old. This is because for her 1st shot (RX 7614085) she received Moderna erroneously. To maintain continuation of care the CDC recommends she receive another dose of Moderna.


VAERS ID: 1714980 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Maryland  
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 939901 / UNK LA / IM

Administered by: Pharmacy       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: Patient received her 2nd dose of Moderna despite being 15 years old. This is because for her 1st shot (RX 7614085) she received Moderna erroneously. To maintain continuation of care the CDC recommends she receive another dose of Moderna.


VAERS ID: 1714983 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New Jersey  
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 EW0187 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratadine 10 mg daily Prazosin 1mg each pm Seroquel 100 mg each pm Buprenorphine 8 mg daily
Current Illness: None
Preexisting Conditions: Asthama Hep C
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: None


VAERS ID: 1714996 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Limb mass, Rash, Rash erythematous, Rash pruritic
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Visual exam given by urgent care 9/20/2021 at approximately 9am
CDC Split Type:

Write-up: Red itchy rash on torso, groin, inner elbows on both arm, back of knee on both legs, fingers, chin line, along neck/chin line. Large (approximate circumference of 1-1/2 size of a silver dollarraised lump with blister ring surrounding lump on front side of ankle


VAERS ID: 1715008 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: North Carolina  
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 EW0187 / 1 LA / IM

Administered by: Other       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: Gabapentin 100mg twice a day Aspirin 81mg daily Losartan 25 mg once in am Tamsulosin .4mg once in am Lisinopril 10 mg once in am Glipizide 5mg once in am Metformin 1000mg twice a day Lipitor 80mg once in am Imdur 30mg once in am
Current Illness: None
Preexisting Conditions: Diabetic Dyslipidemia HTN
Allergies: No known drug allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: None


VAERS ID: 1715085 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Fatigue, body aches - patient informed that is an expected response. Patient referred for COVID testing


VAERS ID: 1715123 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-07
Onset:2021-09-16
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 2K9231 / 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? 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: Tested positive for Covid-19 on 9/19/21


VAERS ID: 1715137 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-19
Onset:2021-09-16
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: PATIENT HAD PFIZER VACCINE DOSES, Dose 1 date: 01/19/2021, Dose 2 date: 02/10/2021. PATIENT TESTED POSITIVE TO COVID.


VAERS ID: 1715160 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-11
Onset:2021-09-16
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 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: Patient swabbed at our offsite collection site. Please contact primary care provider for further questions.
Current Illness: Patient swabbed at our offsite collection site. Please contact primary care provider for further questions.
Preexisting Conditions: Patient swabbed at our offsite collection site. Please contact primary care provider for further questions.
Allergies: Patient swabbed at our offsite collection site. Please contact primary care provider for further questions.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated for and then tested positive for COVID-19


VAERS ID: 1715175 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-09
Onset:2021-09-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 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: Patient swabbed at our offsite collection site. No primary care provider listed.
Current Illness: Patient swabbed at our offsite collection site. No primary care provider listed.
Preexisting Conditions: Patient swabbed at our offsite collection site. No primary care provider listed.
Allergies: Patient swabbed at our offsite collection site. No primary care provider listed.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated for and then tested positive for COVID-19


VAERS ID: 1715192 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-17
Onset:2021-09-16
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 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: Patient swabbed at our offsite collection site. Please contact their primary care provider for further questions.
Current Illness: Patient swabbed at our offsite collection site. Please contact their primary care provider for further questions.
Preexisting Conditions: Patient swabbed at our offsite collection site. Please contact their primary care provider for further questions.
Allergies: Patient swabbed at our offsite collection site. Please contact their primary care provider for further questions.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated for and then tested positive for COVID-19


VAERS ID: 1715196 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Delaware  
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 ER8736 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Dysphagia, Joint stiffness, Paraesthesia oral, Soft tissue swelling, Swelling, Swelling face, X-ray
SMQs:, Anaphylactic reaction (broad), 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), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxyzine hcl, Pantoprazole, Miratapine
Current Illness:
Preexisting Conditions:
Allergies: ciproflaxzcin, acetaminophen, amitizia
Diagnostic Lab Data: Sept 16, 2021 - xrays of chest and soft tissue neck xray; low lung volumes reported
CDC Split Type:

Write-up: left jaw stiffness and swelling; tongue tingling; mild difficulty swallowing mild soft tissue swelling over left TMJ/parotid/angle of mandible/ submandibular area; mild fullness some radicular area, no mass or lymph node palpated. mildy tender there treatment: adminster H2 blocker, H1 blocker, solu-medrol, and IV fluids; Diphenhydramine hcl, methyprendenisolone na succ, prednisone (5 days)


VAERS ID: 1715205 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-12
Onset:2021-09-16
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient swabbed at our offsite collection site. Please contact their primary care provider, PA for further questions.
Current Illness: Patient swabbed at our offsite collection site. Please contact their primary care provider for further questions.
Preexisting Conditions: Patient swabbed at our offsite collection site. Please contact their primary care provider for further questions.
Allergies: Patient swabbed at our offsite collection site. Please contact their primary care provider, for further questions.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated for and then tested positive for COVID-19


VAERS ID: 1715282 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-07
Onset:2021-09-16
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haemoptysis, Pulmonary thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, venous (narrow), Infective pneumonia (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis 5mg , Flecainide 100mg ,Zyrtec 10mg as needed ,sildenafil 20mg , Lipitor 20mg ,verapamil 40 mg Vitamin C ,Vitamin d3, Zinc
Current Illness: no
Preexisting Conditions: Afib
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Coughing up dark blood on the 16th of September . went to ER and Discovered blood clots in lungs.


VAERS ID: 1715302 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-09
Onset:2021-09-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Vertigo
SMQs:, Anticholinergic syndrome (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: levothyroxine 50 MCG tablet sertraline 100 MG tablet
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dizziness-Vertigo, 5 days so far, not occurring in the morning, dizzy spells begin as the day goes on, by night a constant dizzy spell


VAERS ID: 1715325 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Decreased appetite, Extra dose administered, Fatigue, Headache, Hyperhidrosis, Malaise, Nausea, Pyrexia, Retching
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd shot of Moderna on 3/10/2021
Other Medications: I took 300mg Imatinib Mesylate that morning. At noon I took 600 mg Caltrate + D3, one Perservision tablet, and 1 - 1200mg fish oil with 360 mg Omega-3.
Current Illness: Just seasonal allergies and I took Zyrtek, when needed for that, but rarely. I didn''t take any the day of my Moderna vaccination.
Preexisting Conditions: I have leukemia - Chronic Myeloid Leukemia (CML)
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA - On Sept.15, I was given the injection, and felt nothing! No needle pick, nothing. Felt fine the rest of the night. Got up twice during the night to use the bathroom and get a drink of water, as I read to stay HYDRATED! Awoke at 7:00 a.m. Sept. 16, and was feeling weak, fatigued, nauseous (had the dry heaves off and on until 9:00 a.m.) with chills and sweats, achy joints, dull headache and just overall, terrible! I went back to bed and slept until 2:00 p.m. Upon getting up, I knew I needed to get fluids in my body so I drank a 16 ounce bottle of water with a packet of Emergen-C dissolved in it. This helped to jump start my electrolytes and from then until bedtime, I consumed a total of 64 ounces of water. At dinner time (evening meal) I had a bowl of Lipton chicken noodle soup and 5 soda crackers. This was the only meal I had all day. I slept well that night, but woke up with a dull headache on Friday, Sept. 17th. I still didn''t have an appetite, so I didn''t take any pills that day, either. I did have a cup of coffee and a small portion of cottage cheese and sliced peaches. I guess I did take Tylenol on the night of Sept. 16th. I had a low grade temp of 99.4 on the 17th.


VAERS ID: 1715336 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-09
Onset:2021-09-16
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chills, Cough, Dyspnoea, Dyspnoea exertional, Oxygen saturation decreased, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 9/16/21: Patient arrived to ER due to shortness of breath. Patient was discharged from our service on 09/09/2021 after being managed for COVID-19 infection and UTI. Patient was discharged on Keflex. Patient states that she was improving but then yesterday she started having acute shortness of breath that started at rest. She checked her O2 sat levels and it was 82%. Shortness of breath is worsened with movement, improved after administering supplemental oxygen in the ED. shortness of breath is associated with a generalized weakness, dry cough and chills.


VAERS ID: 1715341 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Pennsylvania  
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 052E21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Ativan, Zofran, Fiorcet, Wellbutrin
Current Illness: None Known
Preexisting Conditions: None Known
Allergies: NKDA
Diagnostic Lab Data: Not known
CDC Split Type:

Write-up: Patient complained of dizziness and fainted


VAERS ID: 1715394 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Tennessee  
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 EW0169 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Back pain, Depression, Dyspnoea, Headache, Hypoaesthesia, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), 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: aleve, tylenol, fluticasone
Current Illness: COVID-19 a couple weeks before
Preexisting Conditions: none
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported left arm, 3rd-5th digit numbness, depression, SOB, upset stomach, back pain, headache, and throat pain from day of receiving vaccine to today 9/20/21.


VAERS ID: 1715432 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Illinois  
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 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1715474 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

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

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

Write-up: Hives, severe rash throughout my body.


VAERS ID: 1715525 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-09
Onset:2021-09-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Aspartate aminotransferase increased, Band neutrophil count, Blood creatinine increased, Blood glucose normal, Blood urea increased, Brain natriuretic peptide increased, C-reactive protein increased, COVID-19, Dyspnoea, Extra dose administered, Fibrin D dimer, Inappropriate schedule of product administration, Laboratory test abnormal, Lymphocyte count decreased, Neutrophil count increased, Procalcitonin, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 9/16/21: Patient arrived to ER due to shortness of breath for the past day. He stated he thought he had a cold for a few days. He reports he and his wife testing positive for Covid yesterday and complaints of progressively worsening shortness of breath with 70% pulse ox reading on room air at home. He reports receiving 3 doses of the Covid vaccine as well as receiving Regeneron yesterday. He denies N/V/D, CP, abdominal pain, syncope, fever, chills, cough, HA or any other symptoms currently. Pertinent abnormal laboratory findings include neutrophils 72, bands 14, lymphocytes 10, D-dimer 1.47, glucose 110, BUN 46, creatinine 2.52, AST 58, LD 537, BNP 1495, procalcitonin 1.45 & CRP 153. Please note: Patient received first dose Pfizer vaccine on 1/13/2021 Lot # EL1283 and the second dose on 02/10/2021 Lot # EL9265 and the third dose on 9/9/2021 Lot # FF2587


VAERS ID: 1715536 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Connecticut  
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 FC3181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Tremor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none listed
Current Illness: none listed
Preexisting Conditions: Mom stated patient has history of seizures, but none since age 5
Allergies: none listed
Diagnostic Lab Data: not sure
CDC Split Type:

Write-up: Patient fainted. She had pulse and was breathing. She was in and out (eyes opening and closing). Customer nearby was an EMT and assisted before 911 arrived. Patient was shaking for a few seconds. She also vomited.


VAERS ID: 1715565 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Colorado  
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 FC3481 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, Chills, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 82, January 27, 2021, Covid-19, Pfizer
Other Medications: Crestor, Alendronate Sodium
Current Illness: Urinary infection - several weeks before
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Beginning 2-3 hours after injection on September 16, arm became painful and I began to feel poorly. Basically went to bed for next 48 hours. First evening and next day suffered chills and temperature reached 100 degrees. By September 18 fever and chills had gone, but felt weak. By September 19, was feeling pretty good until mid-afternoon when I felt quite nauseous and rested the remainder of the day. OK today.


VAERS ID: 1715589 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Burning sensation, Chills, Dizziness, Dyspnoea, Headache, Hyperventilation, Nausea, Pain, Presyncope, Pruritus, Pyrexia, Retching, Speech disorder, Tachycardia, Throat tightness, Tremor
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: History of "anaphylactic" reaction to TB skin test on 8/04/21, reports syncope, tachycardia, vomiting, hives, disorientation. "S
Other Medications: Singulair Allegra Zyrtec Multivitamin Vitamin D3 Yaz OCPs
Current Illness: None
Preexisting Conditions: None- History of COVID infection in May, has developed multiple food and medication allergies since COVID infection
Allergies: IV Contrast PPD skin test Advair Sulfa drugs Tramadol Melons Berries Broccoli Nuts
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient history of multiple allergies s/p COVID infection 5/2021, seeing allergist, who considered risks vs benefits and recommended patient receive the COVID vaccine. Patient given Janssen COVID vaccine on 9/16/21 at approximately 12:20PM. During 15 minute observation period, patient experienced "impending doom", starting breathing fast and felt nauseous. Was pacing to "try to prevent vaccine reaction". Reported left arm itching "feels like it is on fire" and difficulty breathing. 1227: BP 164/92, O2 99, HR 154, lungs CTA, reports dizziness and near syncope, hyperventilation 1231: placed in wheelchair and taken to an exam room Patient reported throat "tightness", nausea, labored breathing, pressured speech, dry heaving. Airway clear, no swelling noted. 1231: Benadryl 50mg IM administered R deltoid 1234: BP 155/100, O2 99, HR137 1235: 0.3mg Epinephrine administered Left thigh, EMS called 1236: BP 145/94, O2 99, HR 128-144 1237: HR 152 1239: BP 140/78, O2 99, HR 148 1240: Family Notified 1244: Patient transported to Emergency Department via EMS, patient breathing improved, teeth chattering and body tremors noted EMS: Zofran and duoneb administered. Hospital report: VSS, monitored for 4 hours, Atarax administered for itching, Ativan given for anxiety. NSR, discharged. 9/17/21- Patient called for follow-up, reports continued headache, fever, body aches, itching, tacycardia (115) 9/20/21- Patient called for follow-up, symptoms improved, does report random facial twitching


VAERS ID: 1715625 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Dizziness, Feeling of body temperature change, Gait inability, Illness, Impaired driving ability, Injection site pain, Musculoskeletal chest pain, Pain, Pain of skin, X-ray
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: MMR, 4 years old, passed out
Other Medications: Vitamin D&k Vitamin C Multivitamin Clonazapam
Current Illness: None
Preexisting Conditions: Multiple sclerosis
Allergies: Sulfa Zofran Cats Dogs Mold
Diagnostic Lab Data: X ray
CDC Split Type:

Write-up: Started with ant bite feeling around injection site and arm. Spread to entire body. Then chest became so tight it felt like my ribs were being crushed. I called the nurse line and they sent me to the ER. At the ER I was treated with steroids and benadryl. The stinging Started to go away. They did an x-ray and said my lungs and heart looked OK. Since being discharged I am still sick. Freezing then hot. Pain all over. My chest is till tight. Too dizzy to walk or drive. No energy.


VAERS ID: 1715636 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-12
Onset:2021-09-16
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 LA / IM

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

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

Write-up: Patient had a positive COVID test on 9/16/2021


VAERS ID: 1715638 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Pain
SMQs:, Dementia (broad)

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

Write-up: pt reported that she experienced tiredness, soreness for her entire body, head felt "cloudy",,,symptoms got better with tylenol. It happened one day after administering the vaccine


VAERS ID: 1715643 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-04
Onset:2021-09-16
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

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

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

Write-up: Patient had positive COVID test on 9/16/2021


VAERS ID: 1715644 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-16
Onset:2021-09-16
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM

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

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

Write-up: Pt received Pfizer x2. Pt was tested COVID + on 9/16 and hospitalized on 9/17/21. Pt was hypoxic and received remdesivir and dexamethasone.


VAERS ID: 1715648 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

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: Niacin, b3
Current Illness: No
Preexisting Conditions: No
Allergies: Silversuladiozine
Diagnostic Lab Data: Hives starting on the left side of my face on Thursday 9/16/2021 and progressing across the bottom half of my face and neck.
CDC Split Type:

Write-up: 206A21A


VAERS ID: 1715659 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-03
Onset:2021-09-16
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM

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

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

Write-up: Pt received Pfizer x2. Pt tested COVID + on 9/9/21 and admitted to hospital for COVID on 9/16/2021. Pt receiving remdesivir and dexamethasone.


VAERS ID: 1715681 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Rash, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient was taking Amoxicillin.
Current Illness: Patient was diagnosed with streptococcal pharyngitis on 09 Sep 21 and also began treatment with Amoxicillin same day.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient developed a head to toe body rash and facial swelling approximately 48-72 hrs after she received the vaccine. Began on bilateral legs on 15 Sep and progressed to full body by 16 Sep along with facial swelling.


VAERS ID: 1715697 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Feeling abnormal, Impaired work ability, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot, I stopped taking it at 2014 because I was feeling very sick, I did not feel like myself, when I had the vaccine I woul
Other Medications: Zinc; vitamin B12; vitamin C
Current Illness: None
Preexisting Conditions: Fibrocystic breast
Allergies: Percocet
Diagnostic Lab Data: None.
CDC Split Type: vsafe

Write-up: I went home and at about 7 pm I went twice to the bathroom, before 9 pm. I started feeling very sick. I was okay until Thursday. On Friday I could not get up to go to work. I was feeling feverish, achy, I had chills. I could not even get up to get something to eat. I do not feel like myself. I sent a text to my doctor on Thursday at 11:05 PM. He called me back at 11:33AM and I told him about my symptoms. He said that I should feel better in a couple of days. He said I should take Ibuprofen, which he sent to the pharmacy. I continued to go to work, except for today because I still have diarrhea. I am not my normal self. I was ok until Thursday before taking the vaccine. I do not feel right. I am not a person who gets sick. I am not taking any other vaccines.


VAERS ID: 1715719 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-09
Onset:2021-09-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Exposure during pregnancy, Pregnancy test, Sleep disorder, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (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: Prenatal Vitamins; Vitamin C; Iron Pills
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Tree Nuts-anaphylactic
Diagnostic Lab Data: EKG- Hospital, 09/16/2021. Pregnancy Test.
CDC Split Type: vsafe

Write-up: Five days after receiving the second dose of the vaccine I started to feel a wheezing dull chest pain that seemed like my heartbeat. It subsided and the feeling woke me up from sleep. It felt like a dull chest pain that lasts about two minutes. I went to the ER and it has happened about 6 times and it has been a week since my shot. I was discharged and advised to return if it gets worse. It has happened again, but it does not seem to be getting worse. Due Date-10/09/2021. Pregnancy-first.


VAERS ID: 1715733 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Muscular weakness, Musculoskeletal pain, Pain in extremity, Pyrexia, Tinnitus, Trismus
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hearing impairment (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Tylenol , never taken Claritin before.
Current Illness: None
Preexisting Conditions: None
Allergies: PCN, SOMA
Diagnostic Lab Data: None
CDC Split Type: N/A

Write-up: Received Vaccine on Thursday the 16th approx 3:30 pm. Started having jaw clinching around dinner time that night., Arm was sore, was taking Claritin and Tylenol. Friday had pain in shoulder around shoulder blade jaw not working properly felt like it wasn''t working smoothly. trouble chewing, felt like she was having ringing in ears and pulsating in the other ear CAlled MD, around 5 pm, told could last 24-48 hours. Call health dept on Monday. Saturday felt tired , legs and knees weak. felt like the Claritin helped knees. felt feverish, never took temp. Sunday felt better, took 3 hour nap. feeling better today.


VAERS ID: 1715771 (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: 2021-09-20
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, Feeling abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Hypertension (narrow), Vestibular 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? Yes
Hospitalized? No
Previous Vaccinations: MMR - HIVES
Other Medications: BENADRYL 25MG 1 HOUR PRIOR TO SHOT
Current Illness: MODERNA COVID-19 1ST DOSE GIVEN 08/19/2021
Preexisting Conditions:
Allergies: SULFA, CEPHALOSPORINS, MMR - HIVES
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was monitored for 30 minutes instead of 15 due to her previous reaction of hives to an MMR. At 28 minutes after the vaccine was administered the patient got extremely foggy headed and thought she was going to pass out. I put a pulse ox on her (oxygen saturation was 99 and pulse was 84) and gave her an orange juice. I then took her blood pressure and it was 154/104mmHg. She says it normally runs 120/80mmHg. I took it with a different machine and cuff. It was 152/104mmHg. I let her sit a few more minutes, took her blood pressure on the opposite arm, it was 148/102mmHg. I asked the patient if she had a doctor, she said no. I asked her if I could call EMS. She said yes, she had no one else to help her. EMS arrived 5 minutes later and she was taken to hospital for further evaluation.


VAERS ID: 1715808 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: North Carolina  
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 050E21A / 3 LA / IM

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

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

Write-up: Patient came in and stated needed booster for moderna, had only been 6 months and booster not yet approved for patient type. Age 77 and a retired Physician but not Immunospressed or other as reported on news .


VAERS ID: 1715827 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-07
Onset:2021-09-16
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, Pharyngeal swelling, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: approx 9 days after dose 2 of Pfizer pt developed urticaria involving bilateral upper extremities, throat swelling, lip swelling which worsened at night and early in the morning. He has no known food allergies but notes it worsened after eating pecans. Denies any of these symptoms immediately after either covid vaccine dose. does have history of anaphylaxis to amoxicillin but has not been on any medications or supplements recently. He is currently being treated with benadryl, steroids, and is being referred to an allergist for further evaluation.


VAERS ID: 1715828 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / -

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? 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 10 years of age presented to clinic with Mother. Patient identifiers verified with specific age "10" not stated by Patient, or Patient''s Mother. Pre-vaccination screening questionnaire for COVID-19 Vaccine completed, consent signed by Patient''s Mother and witnessed by Staff Nurse. Staff Nurse proceeded to administer Pfizer COVID-19 Vaccine, 0.3mL intramuscular injection into Right Deltoid x1, to patient. completed follow-up with Mother upon discovery. Mother denies any adverse signs or symptoms, and/or illnesses with patient.


VAERS ID: 1716083 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood potassium decreased, Dizziness, Fatigue, Full blood count, Full blood count normal, Headache, Lipase normal, Metabolic function test, Muscular weakness, Nausea, Pain, Tinnitus, Vaccination site erythema, Vaccination site swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Tetanus, 5-6 years old
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Tetanus vaccines, cetirizine, and slight allergy to milk
Diagnostic Lab Data: CBC, CMP, and lipase performed on 9/17/21. All normal with just low potassium.
CDC Split Type:

Write-up: Nausea, lightheadedness, ringing in ears, body aches, tiredness, and headache leading to legs collapsing. Taken to ER, labs drawn, fluids given with zofran and sent home. Arm still red and swollen at vaccine site 5 days later and still having nausea, tiredness, body aches, and headache.


VAERS ID: 1716331 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Cough, Dyspnoea, Electrocardiogram, Loss of consciousness, Swelling face, Throat tightness, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 40mg, birth control LE, hydroxizine
Current Illness: None
Preexisting Conditions: Ovarian cysts
Allergies: None
Diagnostic Lab Data: ECG and x rays
CDC Split Type:

Write-up: My face swelled up didn?t think much of it, then my throat started to tighten or swell I had a coughing fit, couldn?t breathe passed out, my boyfriend found me unconscious and took me to the hospital. They said I had a severe reaction (anaphylaxis) and got me on IVs.


VAERS ID: 1716569 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-13
Onset:2021-09-16
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Laboratory test, Petechiae, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: developed rhabdomyolysis after pfizer vaccine #1 and subsequently diagnosed with Becker MD due to persistently elevated CKs aft
Other Medications: None
Current Illness: None
Preexisting Conditions: Recently diagnosed with metabolic myopathy (found to have mutation in DMD) - thought to have Becker MD (due to rhabdomyolysis after covid dose #1)
Allergies: None
Diagnostic Lab Data: Lab evaluation and heme consult.
CDC Split Type:

Write-up: On 9/16, developed petechiae and bruising. Went to urgent care, found to have platelet count of 3,000.


VAERS ID: 1717843 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Medication 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: MODERNA VACCINE
Current Illness:
Preexisting Conditions: Comments: No known daily medications.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210933337

Write-up: MEDICATION ERROR (RECEIVED JANSSEN COVID-19 VACCINE AFTER 1ST DOSE OF THE MODERNA VACCINE); This spontaneous report received from a pharmacist concerned a 47 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: No known daily medications. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 16-SEP-2021 for prophylactic vaccination. Concomitant medications included mrna 1273 for prophylactic vaccination. On 16-SEP-2021, the patient experienced medication error (received janssen covid-19 vaccine after 1st dose of the moderna vaccine). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of medication error (received janssen covid-19 vaccine after 1st dose of the moderna vaccine) was not reported. This report was non-serious.


VAERS ID: 1717866 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Lip swelling, Lymphadenopathy, Oropharyngeal pain, Pain in extremity, Pruritus, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USJNJFOC20210936053

Write-up: ENTIRE FACE PUFFY; LIPS SWOLLEN; JAWLINE ITCHY AND TENDER; UPPER LEFT ARM STARTED TO ACHE A BIT; GLANDS UNDER JAW STARTED TO SWELL; SCATTERED HIVES THAT ITCHED LIKE MADNESS INCLUDING A FEW ON FACE AND LIPS; THROAT STARTED TO HURT, SORE THROAT THAT FEELS LIKE SWALLOWING SHARDS OF GLASS; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 15-SEP-2021 10:50 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 throat started to hurt, sore throat that feels like swallowing shards of glass. On 16-SEP-2021, the patient experienced upper left arm started to ache a bit. On 16-SEP-2021, the patient experienced glands under jaw started to swell. On 16-SEP-2021, the patient experienced scattered hives that itched like madness including a few on face and lips. On 17-SEP-2021, the patient experienced entire face puffy. On 17-SEP-2021, the patient experienced lips swollen. On 17-SEP-2021, the patient experienced jawline itchy and tender. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from throat started to hurt, sore throat that feels like swallowing shards of glass, scattered hives that itched like madness including a few on face and lips, entire face puffy, lips swollen, and jawline itchy and tender, and the outcome of glands under jaw started to swell and upper left arm started to ache a bit was not reported. This report was non-serious.


VAERS ID: 1717869 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia, Nervousness
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), 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:
Current Illness: Alcohol use (Yes every day.); Non-smoker
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210936112

Write-up: NERVOUS; MUSCLE ACHE; HEADACHE; FATIGUE; This spontaneous report received from a patient concerned a 38 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: alcohol user, and non smoker. The patient received covid-19 vaccine (suspension for injection, route of admin, and batch number were not reported) 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 nervous. On 16-SEP-2021, the patient experienced muscle ache. On 16-SEP-2021, the patient experienced headache. On 16-SEP-2021, the patient experienced fatigue. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine was not applicable. The patient was recovering from muscle ache, headache, and fatigue, and the outcome of nervous was not reported. This report was non-serious. This case, from the same reporter is linked to 20210936062.


VAERS ID: 1717874 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Louisiana  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Pain, Pyrexia, Rash, Skin disorder, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic reaction to antibiotics (GI cocktail.); Gastrooesophageal reflux disease
Preexisting Conditions: Medical History/Concurrent Conditions: Hives; Comments: The patient had no trouble with his breathing.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210936199

Write-up: CHANGE THE TEXTURE OF HIS SKIN; WARM TO THE TOUCH; ACHINESS; CHILLS; RASH; FEVER; This spontaneous report received from a patient concerned a 38 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included: hives, and concurrent conditions included: acid reflux, and amoxicillin allergy, and other pre-existing medical conditions included: The patient had no trouble with his breathing. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and batch number: 203A21A 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 change the texture of his skin. On 16-SEP-2021, the patient experienced warm to the touch. On 16-SEP-2021, the patient experienced achiness. On 16-SEP-2021, the patient experienced chills. On 16-SEP-2021, the patient experienced rash. On 16-SEP-2021, the patient experienced fever. Treatment medications included: diphenhydramine hydrochloride, ibuprofen, and paracetamol. The patient recovered from achiness, chills, and fever on 18-SEP-2021, had not recovered from rash, and the outcome of change the texture of his skin and warm to the touch was not reported. This report was non-serious.


VAERS ID: 1718377 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Nasopharyngitis
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: Medical History/Concurrent Conditions: Asthma; Blood pressure high (HBP)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101218962

Write-up: Real fatigue; Light headache; Cold; This is a spontaneous report from a contactable consumer, the patient. A 47-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3183) via an unspecified route of administration in the left arm on 15Sep2021 at 12:00 (at the age of 47-years-old) as a single dose for COVID-19 immunisation. Medical history included high blood pressure (reported as HBP) and asthma. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications were not reported. The patient previously took promethazine (PHENERGAN), for an unknown indication, from an unspecified date and experienced drug allergy. On 16Sep2021, at 07:00 the patient experienced real fatigue, light headache and cold. The adverse event did not result in a visit to the doctor or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the reported events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events real fatigue, light headache and cold was not recovered, at the time of this report.


VAERS ID: 1718570 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Flushing, Hyperhidrosis, Myalgia, Palpitations, Pulse abnormal, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril/Herzl 20-12.5mg Euthyroid 150mcg Montelukast 10mg
Current Illness: None
Preexisting Conditions: High blood pressure Seasonal allergies
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, muscle aches, heart rate 110, pounding heart, weakness, flushed skin hot to touch. Sweating. Chills began in early morning and lasted about 4 hours. Then skin was flushed and hot. Heart racing and pounding, muscle aches lasted until the next day. Then on the second day weak pulse rate over 100 and heart pounding and break into a sweat with any activity all day. The third day all symptoms had subsided.


VAERS ID: 1718571 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: palpitations lasting through the night


VAERS ID: 1718755 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-24
Onset:2021-09-16
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Dyspnoea exertional, Hypoxia, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient is a 92 year old male who has past medical history significant for full vaccination with COVID vaccine a few months back. Patient also has history of essential hypertension. He also has past medical history significant for history of dyslipidemia and prostatic hypertrophy. Patient comes into the hospital for the reason of shortness of breath. He claims that he has been having cough and fever for last few days and has been increasingly short of breath. He was evaluated ED for the same reasons as he was brought to the hospital and was noted to have COVID positive status and was recommended admission. He was also hypoxic and his sats were in low to mid 80s on room air. He denies any chest pain. Denies any loss of sense of smell or taste. He denies any relieving and aggravating factors and he thinks that he might have been exposed to COVID at charge upon further questioning. He does have dyspnea on exertion and no significant orthopnea otherwise.


VAERS ID: 1718760 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-09-16
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID-19 test on 9/10/2021. confirmed by DOH.
CDC Split Type:

Write-up: Patient presented to facility with shortness of breath and cough. Patient stated symptoms started 9 days prior to admission. patient stated he tested positive prior to admission six days ago. Patient stated he also started Regeneron treatment.


VAERS ID: 1718785 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE 3183 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Swollen tongue, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: setraline 150 mg daily vitamin D-3
Current Illness: none
Preexisting Conditions: very good
Allergies: sulfa
Diagnostic Lab Data: Took high dose of benedryl.
CDC Split Type:

Write-up: Scratchy throat and swelling tongue.


VAERS ID: 1718850 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SC

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Chills, Confusional state, Dyspnoea, Emotional distress, Eye pain, Feeling abnormal, Hyperhidrosis, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Myalgia, Nervousness, Pain, Pain of skin, Palpitations, Pyrexia, Restlessness, Sleep disorder, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol 0.05 patch, Lisinopril 25mg, Valacyclovir, daily multivitamins.
Current Illness: No illness
Preexisting Conditions: PVC''s
Allergies: Sulfa meds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site redness, swelling, itching, pain and unable to use or touch right arm from the pain. 1 hour after injection, symptoms continue to get worse over the next 6 hours. Heart racing, fevers, joint and muscle pain, sweating, chills, brain fog/confusion, eye pain, body aches, scalp tenderness, nervous,emotional, restlessness, unable to sleep well due to sweating, body pain and short of breath when trying to walk from my bed to the bathroom. In bed for 3 days trying to recover. I took Tylenol and ibuprofen to try and reduce fever and pain. It took 2 days for the fevers to break. My husband had to leave work to help me. I was healthy before the vaccination. Still recovering slowly.


VAERS ID: 1718855 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-06
Onset:2021-09-16
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Haemorrhoids thrombosed
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

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

Write-up: Thrombosed Hemorrhoids


VAERS ID: 1718909 (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: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Productive cough, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: Jardiance 25mg (once daily) Novolog (3-6 times daily)
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: Dilaudid
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vomiting, fever , sent false readings to blood sugar meeting, coughing up mucous.


VAERS ID: 1718914 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Pfizer- rash that started later after receiving vaccine.
Other Medications: Valtrex
Current Illness: None
Preexisting Conditions: Genital herpes
Allergies: KNDA
Diagnostic Lab Data: Unknown- seen in urgent care
CDC Split Type:

Write-up: Rash on bilateral arms. Reports itching inside. No breathing concerns/throat swelling/angioedema. No anaphylaxis.


VAERS ID: 1718933 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E214 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 0.137 mg
Current Illness: NA
Preexisting Conditions: Hashimotos Disease, Hypothyroidism, Infertility
Allergies: All Fruits, Nuts. Seasonal. Penicillin, Magnesium, Latex,
Diagnostic Lab Data: NA. Doctor appointment tomorrow on 9/22 with my OB provider
CDC Split Type:

Write-up: Three days after I received the vaccine I got my period. It has now been 6 days and I still have my period. Usually my period is between 2-4 days (max). It has been heavy and bright red this entire time.


VAERS ID: 1718953 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-03
Onset:2021-09-16
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Cough, Dyspnoea, Electrocardiogram, Full blood count, Laboratory test, Metabolic function test, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: tramadol, rosuvastatin, furosemide, cyclobenzaprine, fosamax, aspirin
Current Illness:
Preexisting Conditions: anxiety, CAD, MI,
Allergies: niacin, hydroxyzine, latex
Diagnostic Lab Data: CBC,CMP, Cardiac Profile, CXR, EKG, Rapid COVID
CDC Split Type:

Write-up: SOB, cough, weakness- given oxygen, tessalon perles and decadron


VAERS ID: 1719018 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Pruritus, 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: Rosuvastatin Levothyroxine Saw Palmetto Vitamin C Vitamin D Zinc Quercetin Fish Oil Alpha Lipoic Acid
Current Illness: subdural hematoma
Preexisting Conditions: hypothyroidism hyperlipidemia
Allergies: Seasonal allergies. Some allergy to thin-skinned fruits and vegetables.
Diagnostic Lab Data: None yet. Will schedule appt with doctor if symptoms continue for a few more days.
CDC Split Type:

Write-up: Beginning after about 1 day after vaccination, and up until the writing of this report, experiencing itching (intense at times) on arms, hands, chest and back, including intermittent, small hives/lesions, mostly on back of hands and forearms. Called primary care physician after 2 days and I have been taking an over-the-counter antihistamine , 2-3x per day. Itching has continued, but hasn''t gotten worse.


VAERS ID: 1719022 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Headache, Injection site erythema, Injection site swelling, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (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: Venlataxine .88 mg Effexor XR 75 Estradiol 2mg Aspirin 81 mg Fish oil Hylands leg cramp Vitamin D3 50 mg
Current Illness: None
Preexisting Conditions: Graves diseas
Allergies: Statins
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nausea, vertigo, weakness, swollen left arm at site of injection with large red circle around it, headache


VAERS ID: 1719041 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-03
Onset:2021-09-16
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, 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: Multi-vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Menstrual cycle started sooner than expected.


VAERS ID: 1719071 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Asthma, Chills, Cough, Fatigue, Pain
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Taste and smell disorders (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: pain, asthma, loss of smell and taste, chills, fatigue and cough


VAERS ID: 1719099 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-21
Onset:2021-09-16
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A231A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 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: hypertension medicine diabetes medicine
Current Illness:
Preexisting Conditions: Diabetes; hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: tested positive for COVID 19 09/16/2021


VAERS ID: 1719108 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Laboratory test, Lip swelling, Pharyngeal swelling, Speech disorder, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: Various Test Ran
CDC Split Type:

Write-up: Swollen lip, tongue, throat and face. Unable to speak. Numbness in both arms and feet.


VAERS ID: 1719153 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-30
Onset:2021-09-16
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cough, Oxygen saturation decreased, Respiratory rate increased
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acidophilus Probiotic Blend oral capsule: 1 cap(s), PO (oral), qDay, # 30 cap(s), 0 Refill(s), Bactrim DS 800 mg-160 mg oral tablet: 1 tab(s), PO (oral), bid, # 28 tab(s), 0 Refill(s), Diflucan 150 mg oral tablet: 150 mg = 1 tab(s), PO (
Current Illness: HTN HLD Rheumatoid arthritis
Preexisting Conditions: Morbid Obesity HTN HLD Rheumatoid arthritis
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Oxygen demands, rapid breathing, dry cough, COVID pneumonia


VAERS ID: 1719191 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 02221486 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anosmia, Cough, Decreased appetite, Fatigue, Headache, Pyrexia, Respiratory tract congestion, Secretion discharge
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Congestion, headache, fatigue, coughing, mucus, fever, exhaustion, no appetite, no smell.


VAERS ID: 1719217 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-15
Onset:2021-09-16
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple Vitamin (MULTI-VITAMINS PO)
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillins
Diagnostic Lab Data: SARS-CoV-2 PCR - IPOC : Detected
CDC Split Type:

Write-up: 36 year old male presenting with chills, fever, and loss of taste and smell for 1 week, symptoms improving. Had at home covid test 3 days ago, positive. Brother has covid and whole family at Labor Day party sick with it now. No prior covid infections. Non smoker. Covid vaccinated. Hx allergies and HTN. Treating with cold meds, has not taken in past 3 days. Needs positive test officially for work. Body mass index is 32.78 kg/m?. I wore mask, gloves, and eye protection for entire duration of visit. Patient wore a mask entire duration of visit.


VAERS ID: 1719268 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN J&J 1808982 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Delirium, Full blood count, Myalgia, Nausea, Seizure, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: severe nausea severe vomiting severe back ache severe muscle pain delirium convulsions


VAERS ID: 1719281 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Depressed level of consciousness, Dizziness, Hypoacusis, Pallor, Visual impairment
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (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: n/a
CDC Split Type:

Write-up: 31 year old M received first dose of Pfizer vaccine to left deltoid at 1622. About 5 minutes later after sitting down in a chair for observation pt c/o dizziness, pt stated he "started to loose sense of hearing and sight, and started to loose consciousness" but did NOT have syncopal episode. Pt also c/o "weird sensation in chest" but when inquired about chest statement pt denied CP, any radiating pain, pt denied like an elephant was sitting on his chest. Pt did state "weird sensation in chest" could of been related to anxiety but was not too sure. Upon nurse assessment pt had pallor look skin, very noticeable on the lips. Pt was immediately brought ice water, vital signs (VS) taken, fan was applied towards patient, ice pack applied on back of patient''s neck, legs were propped up on a second chair for venous return. VS taken at 1628 were as followed 141/120. SpO2 100 RA, HR 61, VS at 1635 95/35 (61), SpO2 100% RA, HR 65. Pt stated he did not have a good source of nutrition/meal the day of the vaccine. He reported he are two hours prior to the vaccine and he stated he only ate "a smallpiece of bread, hard candy, pumpkin butter, and cereal for breakfast". Pt educated and adviced on importance of having a nutritious meal on the day of the vaccine. Pt was taken down to nurse treatment room via wheelchair and report was given to charge RN in nurse treatment room. Pt reported symptoms were improving and he felt better as well. Pt''s skin color and lip color was improving and pallor was resolved.


VAERS ID: 1719307 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Hypoaesthesia oral, Pharyngeal paraesthesia
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, Atenolol, MVI, Vit D
Current Illness: No
Preexisting Conditions: Pre-Diabetic, HTN
Allergies: Dogs, Tuna, Horses, Roaches
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient reported tingling in throat, slight headache, and numbness in upper lip. No SOB noted. Pt drank water and her symptoms subsided.


VAERS ID: 1719315 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / IM

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

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

Write-up: "Pt w/ no significant PMH. 2mins post vaccination, pt c/o dizziness. Denies any other symptoms. Vitals: @12:15 BP 100/60, HR 59, RR 18, O2 Sat 98% -- $g @12:20 101/57, 65. Pt given fluids and moved to observation room to lay down. Pt reports improvement in dizziness. Denies any other symptoms. Returned to general observation for remainder of observation time. Pt ambulates independently, gait steady. Pt stable and released form vaccination site."


VAERS ID: 1719344 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Pt w/ PMH significant for positive PPD in 2019.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/ PMH significant for positive PPD in 2019. 13mins post vaccination pt c/o Dizziness. Vitals: @17:42 BP103/47, HR 67, RR 21, O2 Sat 100% -- $g @17:52 110/69, 63, 18, 100% PT given H2O and taken to Med Room via WC to lay down. VS taken and WDL. Apple juice given. Dr and family at bedside. PT reported no dizziness and denied other symptoms and stated he was feeling better. PT educated, ambulated independently with steady gait. Left building accompanied by family. NAD.


VAERS ID: 1719352 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-23
Onset:2021-09-16
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Dehydration (broad), Hypokalaemia (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: N/A
Current Illness: N/A
Preexisting Conditions: hypertension, autonomic dysfunction, stroke
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted for dizziness and hypotension


VAERS ID: 1719356 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Angina pectoris, Cardiac disorder, Cardiac flutter
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Tachyarrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (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: prenatal
Current Illness: none.
Preexisting Conditions: none
Allergies: latex
Diagnostic Lab Data: none; was advised to call my physician if pain persists into the the next week
CDC Split Type:

Write-up: I am 9 weeks pregnant. First evening after receiving 1st dose of Pfizer, I felt sharp discomfort in my heart lasting 1-3 minutes, medially and inferiorly, while at work and resting at home, no exercise, no sob. That same night, I had heart flutters that woke me up from my sleep, it felt like my heart went out of rhythm and was trying to get back into normal rhythm. The next day (Day 2, 9/17/2021), I had sharp pains again with duration unchanged but occurred ~ ~4 times, at work and at home; no exercise, no sob. The 3rd day (Saturday 9/18/21), I woke up at 6am with sharp pains again and paged by OBGYN right away; was advised to call my physician if pain persists into the the next week. Day 4 (9/19/21), frequency had lessened. Day 5 (9/20/21) and Day 6 (9/21/21) sharp discomfort occurred less duration and frequency.


VAERS ID: 1719366 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Taste disorder
SMQs:, Taste and smell 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: Xarelto Venlofaxine Nortryptoline Xydra drops
Current Illness: None
Preexisting Conditions: Factor V Leiden Neuropathy
Allergies: Bee stings
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After receiving the 3rd dose, I noticed the next day that I could not taste properly. Food tastes bland or no taste at all. Very spicy food can be tasted. It has been going on for 7 days now.


VAERS ID: 1719387 (history)  
Form: Version 2.0  
Age: 101.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-09-16
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram normal, COVID-19, Computerised tomogram abdomen, Depressed level of consciousness, Hypotension, SARS-CoV-2 test positive, Urinary tract infection, Urine analysis abnormal, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 101 y/O female resident of nursing facility sent to ER due to decreased LOC. Baselinr mental status unknoewn. She was found to be hypotensive and received IV fluids. WBC count wa noted to be very high approx 380000, Abd ct angio was neg. UA was positive for UTI. patient was treated for COVID infection in another faciliti from 9/3-9/12 and discharged. Code status assumed full code. 9/16/2021 tested positive


VAERS ID: 1719390 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-15
Onset:2021-09-16
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anaemia, Asthenia, Blood alkaline phosphatase increased, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Computerised tomogram abdomen normal, Computerised tomogram head normal, Cough, Fall, Flank pain, Hyperbilirubinaemia, Hyperglycaemia, Hypoalbuminaemia, Hypomagnesaemia, Laboratory test abnormal, Loss of personal independence in daily activities, Mobility decreased, Pyrexia, SARS-CoV-2 test positive, Thrombocytopenia, Transaminases increased, Tremor, Urinary tract infection
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 77-year-old male with past medical history of hypertension, hyperlipidemia, diabetes mellitus, nicotine dependence, and depression presented to the emergency department complaints of worsening weakness. Patient was usual state of health until approximately few days ago when he started having weakness and flank pain. Patient came to the emergency department at that time. He was diagnosed with urinary tract infection and was discharged with a prescription for Keflex. Patient also had a CT abdomen due to transaminitis which was negative. Patient was discharged and over the last few days, has had significant worsening in his weakness. Has had multiple falls. Over the last 24 hours, patient''s weakness has room medically worsened and he has been having a hard time doing basic activities such as getting up from the toilet seat. Last night, patient laid down on the bathroom floor for over 40 minutes as he was unable to get up. Eventually was able to do so with the help of his wife and grandson. His wife was worried therefore, brought him to the emergency department for further evaluation. Upon arrival to the emergency department, patient was found to have COVID-19 pneumonia. Chest x-ray consistent with atypical multifocal pneumonia. CT head otherwise unremarkable for any acute intracranial process. Lab work negative for leukocytosis. Patient did have anemia and thrombocytopenia. Rest of the lab work consistent with hyperglycemia, hypoalbuminemia, hypomagnesemia, transaminitis, and hyperbilirubinemia. Also noted to have significantly elevated alkaline phosphatase levels. Patient reports that at baseline, he is able to exercise and works in his yd and mows his lawn. Has not been able to do any of this in over the past week. Patient reports that he has had no shortness of breath however, does have some nonproductive cough. No nausea/vomiting/diarrhea. Patient reports that he gets occasional fevers/chills/shakes. Of note, patient had CT abdomen on 09/10/2021 were common bile duct was noted to be normal caliber. In the emergency department today, patient ambulated to the bathroom and back and maintain his O2 saturations on room air. Tested positive on 9/16/2021


VAERS ID: 1719392 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: chest pain, short of breath, and fatigue


VAERS ID: 1719394 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-14
Onset:2021-09-16
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood glucose decreased, Blood lactic acid increased, COVID-19, Cerebral atrophy, Cerebral small vessel ischaemic disease, Chest X-ray abnormal, Chronic kidney disease, Cognitive linguistic deficit, Computerised tomogram head abnormal, Condition aggravated, Endocarditis, Enterococcal bacteraemia, Fibrin D dimer increased, Hypoglycaemia, Hypoxia, Lung consolidation, Mental impairment, Mental status changes, Pleural effusion, Pleural fibrosis, Pyrexia, SARS-CoV-2 test positive, Sepsis, Speech disorder, Tachycardia, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: aortic valve endocarditis, medically managed, surgery declined , non-insulin-dependent diabetes, atrial fibrillation on anticoagulation, history of prostate cancer post TURP and XRT, lung cancer post chemo and XRT, dyslipidemia, hypothyroidism, GERD, pulmonary nodules, anxiety
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 84-year-old male with PMH of aortic valve endocarditis, medically managed, surgery declined , non-insulin-dependent diabetes, atrial fibrillation on anticoagulation, history of prostate cancer post TURP and XRT, lung cancer post chemo and XRT, dyslipidemia, hypothyroidism, GERD, pulmonary nodules, anxiety and completion of Johnson Johnson COVID-19 vaccine who was originally admitted to hospital on August 23rd for generalized weakness, fever, decline in function, patient was COVID positive. During that admission he was admitted for overall generalized weakness, aortic valve endocarditis, Enterococcus faecalis bacteremia. Id was consulted and he completed a course of IV antibiotics, continues to be on Bactrim for endocarditis, he also completed course of remdesivir, received and finished his course of 10 days of dexamethasone. Patient never had significant respiratory distress on that admission. Pt had an elevated D-dimer and is on a course of 21 days of full-dose aspirin Negative for PE. Patient had a decline in function neurologically with worsening mental status. He had a negative stroke work up at that time as well. He was d/c to nursing home on 09/02/21. He presented today via EMS after being found unresponsive at Nursing Home. Blood sugar was found to be 28 and was treated with amp of D50. Pt had been on Metformin and glipizide at the nursing home. Repeat blood sugars have fluctuated from the 60s to 120s. Patient appears alert but when asked questions he mumbles without cognitive words. ER provider was told that this is his baseline from the nursing home/EMS provider. I have called the patient''s wife and left a message. History is obtained from chart review. Today his laboratory evaluation is significant for hypoglycemia, elevated lactic acid, CKD stage 2. Patient has been tachycardic and lactic acid is elevated. Sepsis is present on admission. Patient continues to be COVID positive. He has been hypoxic in the emergency room requiring oxygen at 4 L nasal cannula. Chest x-ray significant for bilateral lower lobe and left upper lobe consolidations with small bilateral pleural effusions and biapical pleural parenchymal scarring. CT of the brain with no acute intracranial process. Cerebral volume loss with sequela of small vessel ischemic changes is noted.


VAERS ID: 1719445 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-22
Onset:2021-09-16
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Nasal congestion, SARS-CoV-2 test
SMQs:, 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: OBC NAPROXEN VALTREX
Current Illness: NONE DOCUMENTED
Preexisting Conditions: UNKNOWN
Allergies: NONE DOCUMENTED
Diagnostic Lab Data: COVID RAPID TEST, NASOPHARYNGEAL SWAB
CDC Split Type:

Write-up: NASAL CONGESTION


VAERS ID: 1719450 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache, Hot flush, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?- not a patient but a temporary employee, information not available
Current Illness: Temp agency employee so don''t know all of his personal health information
Preexisting Conditions: Marfan''s syndrome and heart murmur
Allergies: ? information not available this is a temp agency employee
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt received the vaccine at 9:00am. He reported that he felt dizzy and had a headache at approximately 1000 Pt informed a coworker that he was not feeling well, and he felt dizzy. The coworker told him to talk to a staff nurse. Pt proceeded to the nurse''s office and informed her that he had a slight headache, Nurse informed pt that she does not have any Tylenol at this time and to ask the other Triage Nurses. Pt proceeded to the triage office where he apparently took some Tylenol voluntarily. At 1142 he sent a Text to a coworker stating that he does not feel well and he feels dizzy and he was instructed to see a staff nurse. Around 1300 PT then asked his coworker for some more Tylenol, She gave him her private bottle which he then took more meds voluntarily not understanding the full background of his issues. Person then followed up with PT, while he was sitting next to someone else, MA and he stated that he felt fine. Around 1415 PT then expressed to a coworker that he is still not feeling well and felt dizzy and she then informed him to go to Dr. Around 1431 a nurse obtained his vital signs BP: 133/74, HR:77, Temp:98.0, Pulse Ox 100% on RA. PT was feeling, we offered Epi and informed him that based on his symptoms of ( nausea, hot flashes, dizziness) he would go by Ambo. PT did not want to go by Ambo, however, we informed him that after the administration of EPI, pts tend to be tachycardic and it is ideal that they are sent out by Ambo. Pt stated that he just wants this feeling to go away and if we need to administer the Epi we can. Pt informed two nurses that he has Marfans syndrome along with a Heart Murmur and we would rather not take the Epi. 911 was called and all pertinent information and vitals were given. PT Ambulated via Ambo at 1530. Pt opted to walk stating that he was not going to get on the stretcher. The paramedics asked him if he was okay, he responded saying yes and exited through the back staff door. Prior to his departure with the paramedics, PT vitals were obtained by RN, at 1511. BP:136/77, HR:75, 98% on Room Air. Pt declined ambo ride to the hospital due to the hospital that he wanted to go to was on alert. Pt instead left the parking lot via his personal car.


VAERS ID: 1719454 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-11
Onset:2021-09-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blindness, Conjunctivitis, Eye haematoma, Eye haemorrhage
SMQs:, Severe cutaneous adverse reactions (broad), Haemorrhage terms (excl laboratory terms) (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (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: Prevastatin 20mg once daily and Muti- vitamin, CoQ10 300mg, D3 1,000mcg daily, fish oil 600 mg, Milk Thistle 600mg daily, Calcium plus D3 500 mg daily
Current Illness: No
Preexisting Conditions: Ci-diff one prior
Allergies: Morphine, Lipitor and Crestor, Neomycin- Antibiotic
Diagnostic Lab Data: Observation for objects and cleaning of the eye and she could not see anything.
CDC Split Type: vsafe

Write-up: 09/16/2021 AM Awoke to find the hematoma Conjunctivitis - broken blood vessels and given eye drops - Ciprofloxacin 10mg two drops every two hours for first two days, then two drops for times a day for five days. Observation for objects and cleaning of the eye and she could not see anything. Hematoma of the eye.


VAERS ID: 1719495 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Slight sore arm at injection site for 1-2 days. Moderate to extreme tiredness 1 day after injection lasting 24 hours. Headache. No fever.


VAERS ID: 1719498 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Cough, Headache, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: 042za18

Write-up: It?s been nearly a week and I I am continuously having high-grade fever terrible headache hives all over her legs and arms and now I have recently developed a dry cough


VAERS ID: 1719539 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dysphonia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: cyclobenzaprine, duloxetine, ibuprofen
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Hoarseness next day, itchy throat, cough


VAERS ID: 1719541 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 544522 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Dizziness, Fatigue, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: High Fever, Chills, Muscle Aches, Fatigue, Nausea, Stomach Cramps, Dizziness


VAERS ID: 1719649 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Higher than authorized dose volume administered. No ADR


VAERS ID: 1719831 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

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

Write-up: PATIENT REPORTED BRUISING AT INJECTION SITE FOLLOWED BY BRUISING GOING DOWN ARM


VAERS ID: 1720038 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen 800, simvastatin 20mg, duloxetine 60mg, estradiol 0.01% vag cream, lisinopril 20mg, escitalopram 10mg
Current Illness: Hypertension, hypercholesterolemia,
Preexisting Conditions:
Allergies: Penicillin allergy
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: patient complained of a red, raised hard circular lump at injection site. she states her arm is sore from shoulder to elbow. she went to doctor on 9/20/2021 and he said it was alright and to apply cool or warm compresses and it would heal over time. she stopped into the pharmacy and showed her arm and the redness was gone at that time. we will follow up with her thursday 9/23/2021


VAERS ID: 1720085 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Feeling hot, Induration, Pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: red, hard, sore, hot to the touch, irritation applied warm compresses, tylenol 325 mg as needed for pain


VAERS ID: 1720305 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood culture, Culture urine, Fatigue, Headache, Influenza A virus test negative, Influenza virus test negative, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3 B12 Iron 325mg Dandelion Capsule 450mg Multi Vitamin
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: Emergency room visit Monday 9/20/21 Covid test negative Flu A and B negative Blood Cultures pending Urine Culture pending
CDC Split Type:

Write-up: Received vaccine on Thursday and by evening, fatigue, achy, headaches and fever. Friday was worsening of those symptoms. Continued through Monday when I went to Emergency room with temp 103.9 and headaches.


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