National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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 488 out of 8,753

Result pages: prev   389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587   next


VAERS ID: 1720316 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-01
Onset:2021-09-16
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ProAir; Immodium; Claritan; Ondansetron; Acetaminophen, Citalopram; Lansoprazole
Current Illness: none
Preexisting Conditions: reflux esophagitis; diarrheal anal fissure; irritable bowel, anxiety; mild intermittent reactive airway, morbid obesity, BMI 45.0
Allergies: Cefzil; Septra; Erythromycin; bee sting
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, sinus congestion, sore throat, productive cough, body aches starting on 9/16/21. Seen in clinic on 9/17/21, tested negative for COVID at that time. Seen again on 9/21/21, tested positive for COVID. Husband tested positive on 9/15/21


VAERS ID: 1720343 (history)  
Form: Version 2.0  
Age: 29.0  
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 FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Fatigue, Musculoskeletal stiffness, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient received second dose of Pfizer on Wednesday 9/15/2021. She noticed some swelling by her collarbone the next day and stiffness in her arm when trying to raise it. She did experience body aches and fatigue from the vaccine as well. Around Sunday, 9/19/2021, she noticed the redness and swelling migrated from her collarbone to her neck/shoulder area. She has not taken anything yet, but states it has not gotten any better. The pain and swelling continues to be localized to this area and was palpated by pharmacist on duty today on 9/21/2021. It was noted not to be any warmer than the rest of that area, but was noticeably swollen, traveling along the lymphatic system in that area. It was recommended to try taking ibuprofen to help with the swelling and pain, but if it does not get any better or worsens to seek medical attention at an urgent care or emergency room.


VAERS ID: 1720693 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest X-ray abnormal, Electrocardiogram PR segment depression, Electrocardiogram ST segment elevation, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, Fish oil, N-acetyliene-Crystalline (per patient), CO-Q10,
Current Illness: None
Preexisting Conditions: Cough, Shortness of breath, March 2020
Allergies: Amoxicillin
Diagnostic Lab Data: EKG with Global ST elevation with PR depression also positive x-rays demonstrating pericarditis.
CDC Split Type:

Write-up: Pericarditis demonstrated within 15 mins of vaccine


VAERS ID: 1721191 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-30
Onset:2021-09-16
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis, Full blood count, Superficial vein thrombosis, Thrombosis, Ultrasound Doppler, X-ray
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: citalopram 30mg; Qunol 1500mg; D3 1000; zinc; vitamin C; Le-Vell Thrive 1-2-3
Current Illness: None
Preexisting Conditions: Celiac Disease; Vasovagal syncope
Allergies: Aspirin; Ibuprofen; All NSAIDS
Diagnostic Lab Data: 9/19/21 CBC, x-Ray, vascular ultrasound
CDC Split Type:

Write-up: Blood clots left arm (1 superficial and 1 DVT)


VAERS ID: 1721482 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Louisiana  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood test, Body temperature, Feeling abnormal, Influenza like illness, Metabolic function test, SARS-CoV-2 test, Seizure
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no change in lifestyle and had no allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210917; Test Name: Body temperature; Result Unstructured Data: 102.4 Degrees Fahrenheit; Test Date: 20210917; Test Name: Blood test; Result Unstructured Data: not reported; Test Date: 20210917; Test Name: Body temperature; Result Unstructured Data: Between 99 to 100 Degrees Fahrenheit; Test Date: 20210917; Test Name: CPK; Result Unstructured Data: not reported; Test Date: 20210917; Test Name: Comprehensive metabolic panel; Result Unstructured Data: not reported; Test Date: 20210917; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: not reported.
CDC Split Type: USJNJFOC20210935140

Write-up: CONVULSIONS; FLU LIKE SYMPTOMS; FEELING YUCKY; This spontaneous report received from a parent concerned an 18 year old white non Hispanic or Latino male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient had no change in lifestyle and had no allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808982, expiry: 21-SEP-2021) dose was not reported, 1 total, administered on 16-SEP-2021 to left arm for prophylactic vaccination. No concomitant medications were reported. On 16-SEP-2021, about an hour or two, patient started to feel yucky. On the same day, patient had convulsions and flu like symptoms throughout the day with a fever brought to the emergency room (ER) at 12:45 AM on 17-SEP-2021 with a temperature 102.4 Degrees Fahrenheit at the triage with severe back pain, vomiting and convulsing. The patient was administered Motrin, Phenergren and IV fluids. The blood works were performed, fast covid-19 screening, CPK and comprehensive metabolic panel. The patient was discharged at 3 AM and returned home. It was reported that flu like symptoms body ache, fever, back ache, nausea, vomiting and convulsing which got progressively worse as the day wore on. The temperature was fluctuating between 99 and 100 Degrees Fahrenheit. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from convulsions, and flu like symptoms, and the outcome of feeling yucky was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0:20210935140- covid-19 vaccine ad26.cov2.s-Convulsion & flu like symptoms. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1721940 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature, Eye irritation, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Corneal 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? 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: Sulfonamide allergy (Known allergies: Sulfa)
Allergies:
Diagnostic Lab Data: Test Date: 20210916; Test Name: Body temperature; Result Unstructured Data: Test Result:100.2; Comments: Low fever 100.2 at 07:30
CDC Split Type: USPFIZER INC202101218691

Write-up: Scratchy eyes; Achy; Sore arm; Low fever 100.2; This is a spontaneous report from a non-contactable consumer, the patient. A 66-year-old non-pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the right arm on 15Sep2021 at 13:00 (at the age of 66-years-old) as a single dose for COVID-19 immunisation. Medical history included allergy to sulfa. 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. On 16Sep2021 at 07:30, the patient experienced sore arm, low fever 100.2 (unspecified units), achy and scratchy eyes. The events did not result in 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 events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events sore arm, low fever 100.2 (unspecified units), achy and scratchy eyes were recovering at the time of report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1721946 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Guillain-Barre 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:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101219883

Write-up: Tingly feeling in nose (like that of water up the nose); Diminished sense of smell and taste, followed by total loss of smell and taste; Diminished sense of smell and taste, followed by total loss of smell and taste; This is a spontaneous report from a contactable consumer, the patient. A 34-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 16Sep2021 at 09:15 (at the age of 34-years-old) as a single dose for COVID-19 immunisation. The patient did not have any medical history and known allergies. 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. The patient did not receive any concomitant medications. On 16Sep2021 at 17:15, 7-8 hours after injection, the patient experienced tingly feeling in nose (like that of water up the nose) followed by diminished sense of smell and taste, followed by total loss of smell and taste. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. It was unknown whether any therapeutic measures were taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events tingly feeling in nose (like that of water up the nose) and diminished sense of smell and taste, followed by total loss of smell and taste was not resolved at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1722447 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 - / SYR

Administered by: Work       Purchased by: ?
Symptoms: Blindness transient, Chills, Discomfort, Dyspnoea, Eructation, Loss of consciousness, Tinnitus, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: FISH OIL, CALCIUM W/ VITAMIN D, B12 COMPLEX AND CENTRUM . ALL NATURE MADE BRAND PRODUCTS AND TAKEN DAILY FOR DECADES.
Current Illness: NO
Preexisting Conditions: ASPERGER''S
Allergies: NO
Diagnostic Lab Data: No tests, all symptoms have cleared up starting day 6. Full deep breathes enabled, zero redness in chest.
CDC Split Type:

Write-up: Passed out cold after 3 minutes of injection and lost my vision for about 30 seconds prior. Saw this intense bright white light beforehand and very loud white noise sound in my ears (same sound analog TVs made back in the day when no channel was available) before passing out . Hard time breathing and intense cold chills before losing consciousness. Recovered in 7 minutes from start to finish. Later developed light pressure a few inches below my collar bone and was unable to burp for days. Around day 5 all of a sudden burping about 30 times in a hour all of a sudden and now all pressure is gone and burping about 5 times an hour since then.


VAERS ID: 1722537 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Breast pain, Nipple pain
SMQs:, Lipodystrophy (broad), Sexual dysfunction (broad)

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

Write-up: Significant left breast and nipple pain


VAERS ID: 1722560 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-09-16
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Chest pain, Computerised tomogram abdomen, Computerised tomogram pelvis, Condition aggravated, Diarrhoea, Dizziness, Drug screen, Full blood count, Metabolic function test, Nausea, Palpitations, Pregnancy test urine, Tachycardia, Tremor, Troponin, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol 12.5mg daily Magnesium, calcium, zinc, vitamin D supplement daily Cimetidine 200mg daily Tylenol 500mg daily/PRN Motrin 800mg bedtime Benadryl 50mg bedtime
Current Illness: COVID positive
Preexisting Conditions: Intermittent, benign tachycardia of unknown origin
Allergies: None
Diagnostic Lab Data: CBC, CMP, TSH, Troponin, urine drug screen, urine pregnancy test, CT of abdomen and pelvis. (All negative/in normal range).
CDC Split Type:

Write-up: Uncontrollable tachycardia with palpitations and chest pain, intractable nausea, vomiting, and diarrhea; Tremors, dizziness.


VAERS ID: 1722576 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-08
Onset:2021-09-16
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain, Injection site reaction, Injection site swelling, Injection site warmth, Paraesthesia, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: At the injection site: swelling, red rash, heat, pain (3 days) Left forearm: rash, tingling, numbness (3 days) Left hand: tingling, numbness in fingers (3 days) Face: tingling, numbness (bell''s palsy like symptoms) (2 days)


VAERS ID: 1722619 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-20
Onset:2021-09-16
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Paranasal sinus discomfort, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID19 PCR NP swab collected at on 9/17/21 with positive result received 9/18/21
CDC Split Type:

Write-up: Patient fully vaccinated with Pfizer COVID vaccine at on 12/30/20 and 1/20/21. Pt. reports COVID symptoms of Sinus Pressure, Cough, Headache, runny nose starting on 9/16/21 and tested COVID PCR positive via NP swab on 9/17/21.


VAERS ID: 1722643 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-30
Onset:2021-09-16
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, 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? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Anastrozole, aspirin, furosemide, pantoprazole, rosuvastatin
Current Illness: None Known
Preexisting Conditions: History of breast cancer, vitamin D deficiency
Allergies: Sulfa drugs (rash)
Diagnostic Lab Data: COVID-19 test positive on 9/16/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 9/16/2021 with shortness of breath. Reports symptoms started 9/6/21 and was tested for COVID-19 at an urgent two days prior to presentation. Covid-19 infection was confirmed and patient was admitted for further management. She was treated with remdesivir, dexamethasone, and supplemental oxygen. Patient improved and was discharged home on 9/20/2021.


VAERS ID: 1722652 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-31
Onset:2021-09-16
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cerebral infarction, Cerebral venous sinus thrombosis, Cognitive disorder, Computerised tomogram head abnormal, Dysphagia, Impaired self-care, Jugular vein thrombosis, Magnetic resonance imaging head abnormal, Mobility decreased, Transverse sinus thrombosis
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: 31 Aug 2021 pfizer covid #1, 9/16/21 new dural sinus thrombosis with associated cognitive deficits, dysphagia, weakness, and impairing mobility and self-care, no h/o covid, poss IBD? CT head: Unchanged hyperdense thrombus involving the internal cerebral veins, vein of Galen, straight sinus, left transverse sinus and left sigmoid sinus, as well as cortical/tentorial veins along the left tentorium. Additional hyperdense, nonocclusive thrombus within the right transverse sinus is unchanged. Retrospectively stable hyperdense thrombus within the upper left jugular vein (series 303, image 8). Increasing conspicuity of symmetric hypodensity within the bilateral thalami, which corresponds to diffusion restriction seen on comparison MRI. 1. Findings consistent with extensive deep cerebral vein and dural sinus thrombosis 2. Symmetric hypodensity of the bilateral thalami, corresponding to diffusion restriction seen on comparison MRI, consistent with evolving cerebral venous infarcts.


VAERS ID: 1722672 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Immobile
SMQs:, Retroperitoneal fibrosis (broad)

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

Write-up: Intense lower back pain and immobility


VAERS ID: 1722687 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PF2587 / 1 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Chest discomfort, Headache, Influenza like illness, Paraesthesia, Photophobia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal 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: Nexium, Singulair
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received my first of two doses of the mandatory Pfizer vaccination on 16 September at 8:00 am. Approximately one hour after receiving the shot I felt a squeezing tightness sensation in my chest for almost the entire day. Upon awakening the next morning (17 September) I felt what I could only compare to as flu-like symptoms and I produced a headache that lasted non-stop until 22 September. On 18 September I experienced sensitivity to sunlight all day, which I''ve never experienced before. I had to hide in my bedroom all day with the curtains drawn as the slightest glimpse of sunlight would intensify my headache immensely. On 20 September my right leg began to "fall asleep" randomly and continues to. All of these things minus the flu-like symptoms, I''ve never experienced prior to receiving the mandatory Pfizer shot.


VAERS ID: 1722733 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-12
Onset:2021-09-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Haematocrit decreased, Haemoglobin decreased, Platelet count decreased, Presyncope, White blood cell count increased
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 88k, HBG 5.0, HCT 15, PLT 41 (9/21/21)
CDC Split Type:

Write-up: Dizziness and presyncope


VAERS ID: 1722749 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-21
Onset:2021-09-16
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest pain, Chills, Cough, Deep vein thrombosis, Dyspnoea, Electrocardiogram, Pulmonary embolism, Pyrexia, SARS-CoV-2 test positive, Troponin
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: CHIEF COMPLAINT/REASON FOR VISIT Shortness of Breath HISTORY OF PRESENT ILLNESS Patient is a 36-year-old female with a history of prior PE and recent diagnosis of COVID presenting with worsened shortness of breath, weakness, cough, fevers and chills. Patient was first diagnosed with Covid-19 during ED visit yesterday. She initially presented after developing with shortness of breath while walking to work. Of note, she was diagnosed with DVT on 8/6 after presenting to ED with calf pain. She was unable to take prescribed Xarelto due to cost. She returned to the ED on 8/13 with shortness of breath and was found to have a segmental PE, which progressed on repeat ED visit 8/15. She was then able to take her anticoagulant. She was doing better until 1 week ago when she developed progressive shortness of breath and chest pain. EKG was unchanged, troponins were negative, SARS-CoV-2 was negative, CT demonstrated resolution of pulmonary emboli, and patient was discharged. Due to persistent symptoms, she returned to the ED with chest pain and shortness of breath yesterday. At that time, Covid-19 test resulted positive. She was discharged with outpatient followup


VAERS ID: 1722764 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Libido decreased, Sinus pain, Testicular pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Sexual dysfunction (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: Nones
Current Illness: Nones
Preexisting Conditions: Nones
Allergies: Nones
Diagnostic Lab Data:
CDC Split Type:

Write-up: Short of breath pain constantly on my testicular part?sinus ?.sexual desire down ?


VAERS ID: 1722778 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol HFA 108 (90 Base) MCG/ACT Aerosol Solution inhaler amphetamine-dextroamphetamine XR 20 MG Capsule Extended Release 24 Hour budesonide-formoterol (SYMBICORT) 160-4.5 MCG/ACT Aerosol inhaler clobetasol propionate 0.05 % Solution fin
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: Codeine Fire ant
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: A temperature excursion was discovered in our refrigerator, the high temp. was 48F


VAERS ID: 1722792 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-19
Onset:2021-09-16
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Fall, Joint dislocation, Ligament operation, Orthopaedic procedure, Radius fracture, SARS-CoV-2 test false positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Accidents and injuries (narrow), Osteoporosis/osteopenia (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL) 500 MG tablet acetaminophen (TYLENOL) 500 MG tablet albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler
Current Illness: NA
Preexisting Conditions: COPD (chronic obstructive pulmonary disease) (HCC) SIRS (systemic inflammatory response syndrome) (HCC) Albert''s Syndrome Acute blood loss anemia GI bleed Essential hypertension Chronic kidney disease (CKD), stage IV (severe) (HCC) Closed dislocation of left elbow Acute kidney injury superimposed on chronic kidney disease (HCC) Asthma COPD Environmental allergies Hypertension Glaucoma
Allergies: AmoxicillinRash, Unknown IbuprofenUnknown LatexUnknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.10.21); COVID-19 positive (9.16.21); Fully Vaccinated Discharge Provider: MD Primary Care Provider: MD Admission Date: 9/10/2021 Discharge Date: Sep 21, 2021 Discharge Disposition: home health care svc Active Issues Requiring Follow-up: 1. Let elbow dislocation- follow up with orthopedic surgery DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Dislocation of left elbow, initial encounter [S53.105A] Acute kidney injury superimposed on chronic kidney disease (HCC) [N17.9, N18.9] HOSPITAL COURSE: Pt. is a 97 y/o woman with PMH of hypertension, COPD, anemia, and GERD who presented to the ED on 9/10 after she had a fall backwards and suffered a closed left elbow dislocation. Patient is blind and walks with a walker at her assisted living facility. She missed the toilet when sitting down and landed on her left side. She was admitted to the ED observation unit. Orthopedic surgery was consulted and performed closed reduction of the left elbow under Deep/MAC sedation (received propofol). Initially Hospitalists were consulted for preop clearance. She then developed AKI on CKD so she was admitted to the internal medicine service. She underwent left radial head replacement and LCL repair with ortho who recommended NWB left arm, No aBduction or platform walker. She will need to follow up with ortho outpatient. Nephrology was consulted for patients AKI on CKD4. They recommended outpatient following. PT/OT recommended HHC. Patient did test negative for covid om 9/10, then positive on 9/15, then negative again on 9/17. The patient was not felt to have active covid. She has a history of covid in the past and has been full vaccinated with no current symptoms. Patient was recommended to follow up with her PCP and ortho outpatient. She was discharged home in stable condition. Discussed signs and symptoms of when to return to the ER. Consults: Orthopedics Nephrology Procedures: Closed reduction of the left elbow under Deep/MAC sedation Left radial head replacement and LCL repair


VAERS ID: 1722857 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Headache, Palpitations, Rash, Rash pruritic, Urticaria, Vaccination complication, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 75 mg Effexor XR 600 mg Gabapentin
Current Illness: None
Preexisting Conditions: Chronic bronchitis
Allergies: Aspirin Erythromycin Pollen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: racing heart (pulse 115), shortness of breath, vomiting, headache, itchy painful rash/hives. Both #1 and #2 injections gave me the COVID arm. Have ongoing headache still since these events, and extreme tiredness.


VAERS ID: 1722859 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt reports no meds
Current Illness: Pt reports no Illnesses
Preexisting Conditions: Pt reports no chronic conditions
Allergies: Pt report no allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fever, fatigue, muscle pain, pain at injection site


VAERS ID: 1722865 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-13
Onset:2021-09-16
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Sofia Antigen COVID-19 test with positive result
CDC Split Type:

Write-up: Patient received the Pfizer vaccine on 12/21/20 and 1/13/21 so was fully vaccinated when they tested positive for COVID-19 on 9/16/21.


VAERS ID: 1722877 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-02
Onset:2021-09-16
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR COVID-19 test with a positive result
CDC Split Type:

Write-up: Patient received the Moderna vaccine on 2/2/21 and 3/2/21 so was fully vaccinated when they tested positive for COVID-19 on 9/16/21.


VAERS ID: 1722885 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-08
Onset:2021-09-16
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NA / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NA / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dehydration, Fall, Mental status changes, Pneumonia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (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: N/A
Current Illness: Pneumonia
Preexisting Conditions: HTN, Renal disease
Allergies: Amoxicillin, B complex, CREST, Codeine, Corylus, Hydrochlorothiazide, Hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to ER on 9/16/21, dx with pneumonia and discharged Presented to ER on 9/17/21 with complaints of a fall and was discharged Presented to ER on 9/19/21 with altered mental status, dehydration, and was admitted to telemetry


VAERS ID: 1722902 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: HIV test false positive, HIV test negative, HIV test positive
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: Adderall
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/16 HIV blood test resulted as reactive on 9/16. Blood sent for further testing on 9/16. Results came back negative on 9/22
CDC Split Type:

Write-up: 9/16 HIV blood test resulted as reactive on 9/16. Blood sent for further testing on 9/16. Results came back negative on 9/22


VAERS ID: 1722903 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH TRS / 2 UN / IM

Administered by: Work       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Injection site pain, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (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: Pt reports no medication at this time
Current Illness: Pt reports no illnesses
Preexisting Conditions: Pt reports no chronic illnesses
Allergies: pt reports NKA , records review shows no allergies on pt AHLTA record.
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, nausea, Fatigue, diarrhea, Muscle pain, Pain at injection site. SIQ 24 hours


VAERS ID: 1722923 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Extreme Nausea, Fatigue, Cough, Fever, Inflammation


VAERS ID: 1722973 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Muscle spasms
SMQs:, Dystonia (broad)

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

Write-up: I get a muscle spasm in my right thigh about 4 times a day that lasts for 3 minutes.


VAERS ID: 1722986 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-09-16
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Presented to the ED with complaints of increased shortness of breath and fever. Tested positive for COVID-19 recently Prior to presenting at the ED, was given monoclonal antibody infusion Was given dexamethasone, insulin, rocephin, and zithromax Got better on room air. Awaiting discharge


VAERS ID: 1722989 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Chest discomfort, Chills, Diarrhoea, Headache, Pain
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Lipodystrophy (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Diarrhea, chills ,aches, really bad head aches, tightness in my chest, shooting Bain in my left breast, Last 3 days Headaches remain


VAERS ID: 1723017 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not relevant
Current Illness: Not relevant
Preexisting Conditions: Not relevant
Allergies: Not relevant
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received the Pfizer vaccine as her second dose 21 days after receiving the Moderna vaccine as her first dose.


VAERS ID: 1723123 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Blood test, Discomfort, Dizziness, Dyspnoea, Dysstasia, Electrocardiogram, Epistaxis, Fatigue, Feeling abnormal, Feeling hot, Headache, Hypoaesthesia, Hypotension, Loss of consciousness, Mobility decreased, Musculoskeletal stiffness, Pain, Paraesthesia, Throat tightness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: Latex
Diagnostic Lab Data: Blood work , ekg,
CDC Split Type:

Write-up: I was completely Healthy I had ate and drank water, I went to get vaccine in my left arm. I got the shot and sat down to wait the 15mins, left arm starting tingling then going numb, I felt a warm sensation going across my chest then my right arm started tingling . I started feeling hot and so I put my hair up and then I was waking up on the floor i had passed out my blood pressure was low and they couldn?t get my pulse. I could not move my whole body was tingly and numb and my hands and fingers went stiff and I could not move them from that position. I haven?t had issues with my blood pressure before it?s usually textbook and my bp was 70/50. The first responder tried to sit me up and I almost passed out again I was taken to the hospital on the way I was given an ekg and saline. I still could not move , my body was heavy and my throat was starting to feel like it was closing it was hard to breathe. At the hospital I was given more saline and blood was taken I could not stand for about 4 hours and my blood pressure was still very low. When my bp got up they sent me home. I was very tired and achy. The next day 9/17/21 I was still very drained and weak I also had 2 nosebleeds ( never really had for no reason ) and I felt really bad , headache and a little dizzy. I have a follow up appointment with my primary In a few days.


VAERS ID: 1723154 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-06
Onset:2021-09-16
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/17 tested PCR positive for COVID
CDC Split Type:

Write-up: Patient became ill and tested PCR positive for Covid $g 14 days after the completion of Pfizer vaccine series


VAERS ID: 1723167 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 2 UN / -

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

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

Write-up: 9/15/21 patient received vaccine at outside facility. On 9/16/21 patient became tachicardic and severe headache started.


VAERS ID: 1723193 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Heart rate increased, Muscle twitching
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid Vaccine Dose #1
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chest pain- no treatment provided 2 days Left face twitching- 6 days, on going Increased heart rate 5 days


VAERS ID: 1723227 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-16
Onset:2021-09-16
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Cough, Ear pain, Exfoliative rash, Fatigue, Headache, Influenza like illness, Lymphadenopathy, Nausea, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test negative, Streptococcus test
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Warfarin, Synthroid, Methotrexate, Folic Acid, Famotidine, Zyrtec, Magnesium, Zinc, Vitamin C, Baby Aspirin
Current Illness: None
Preexisting Conditions: Ulcerative Colitis (colon and rectum removed, w/ permanent ileostomy), Inflammatory Arthritis, Hypothyroid, BRCA2 genetic mutation with history of breast cancer and Thymus cancer. (Breasts and Thymus removed) RAD50 genetic mutation. ( History of stroke and pulmonary embolism. PFO in heart.
Allergies: Cipro, Adhesives, Avocado, Cilantro
Diagnostic Lab Data: Covid PCR 9/19 (negative), Rapid strep 9/20 (negative), Chest x-ray 9/20 (not reported yet).
CDC Split Type:

Write-up: Suspected pneumonia (bad cough), high fever, sore throat, ear pain, swollen, painful glands, nausea, fatigue, headache, clear, textured rash.(The rash began about a week after the vaccine.) Currently on day 7 of flu-like symptoms. Started Azithromicin yesterday. Still sick.


VAERS ID: 1723265 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: Patient experience dizziness following 2nd pfizer covid shot while sitting down during the 15 mins observation period. Patient advise to lie down and subsequently felt better although paramedics were called as a precaution


VAERS ID: 1723318 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-31
Onset:2021-09-16
   Days after vaccination:259
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: PATIENT HAD PFIZER VACCINE Dose 1 date: 12/31/2020, Dose 2 date: 01/21/2021, AND TESTED POSITIVE TO COVID.


VAERS ID: 1723397 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-25
Onset:2021-09-16
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arrhythmia, Chest pain, Electrocardiogram abnormal, Headache, Heart rate increased, Hypertension, Pain, Supraventricular extrasystoles, Ventricular extrasystoles
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Ventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), 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? No
Previous Vaccinations:
Other Medications: Junel oral contraceptive 81mg baby aspirin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 12 lead EKG
CDC Split Type:

Write-up: Rapid pulse, abnormal high BP, chest pain, high resting heart rate, abnormal heart rhythms (PACs and PVCs on EKG. Headaches, body aches. Cardiologist prescribed Metoprolol for BP and performed 12 lead EKG


VAERS ID: 1723428 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Full blood count, Groin pain, Metabolic function test, Pain in extremity, Paraesthesia, Red blood cell sedimentation rate, Spinal X-ray, Urine analysis
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxin, Norco, methocarbamol, pantoprazole
Current Illness: none
Preexisting Conditions: OSA, morbid obesity, labile BP, hypothyroidism, chronic LBP w/ DJD
Allergies: Amoxicillin- allergies
Diagnostic Lab Data: CBC, BMP, UA, ESR, LS spine x-ray 09/22/2021
CDC Split Type:

Write-up: Severe mid and low back pain with radiation to BILATERAL legs and tingling in toes. Pain then into groin 3 days after injection.


VAERS ID: 1723806 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Red, painful, itchy arm distal to injection site


VAERS ID: 1723809 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-09
Onset:2021-09-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Dyspnoea, Hypertension, Nervousness, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan-50mg, Multi vitamin, curcumin, Advil pm
Current Illness:
Preexisting Conditions: Tremors in legs while standing, no official diagnosis yet.
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: High blood pressure spikes, shortness of breath, shaky, dizziness and weakness started exactly one week after 2nd vaccine shot. Had fever of 102 for 3 days after vaccine.


VAERS ID: 1723824 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Muscle spasms, Myalgia, Pain, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Painful muscle spasms on and off for 48 hours, vomiting, chills, head ache, body aches


VAERS ID: 1723848 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-09-16
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea, Lung opacity, PCO2 increased, Pulmonary function test decreased
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: history of pulmonary sarcoidosis currently on the heart-lung transplant list. Presents with COVID-19 a was diagnosed on September 15th presents with increasing dyspnea on oxygen required up to 5 L. Chest x-ray demonstrates a right suprahilar opacity in left mid lung opacity. His pCO2 is 56. Due to his marginal lung function and oxygen requirement increasing he will be admitted to the hospital for further workup evaluation and management


VAERS ID: 1723856 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-09-16
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Hypoxia, Pyrexia
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)

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

Write-up: presents with several weeks of worsening shortness of breath, now with cough, and subjective fevers. She was mildly hypoxic upon initial evaluation which improved with 2.5 L nasal cannula oxygen.


VAERS ID: 1724312 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gingival swelling, Headache, Mouth swelling, Neck pain, Toothache
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine 100mcg, Advil, allergy medicine.
Current Illness: seasonal allergy
Preexisting Conditions: Hypothyroid controlled since 2001, breast cancer survivor 2012
Allergies: penicilline
Diagnostic Lab Data: My primary care doctor told me to see an allergic specialist before the 2nd dose in 3 weeks (waiting for the referral to contact them).
CDC Split Type:

Write-up: later that night my mouth and gums swollen inside and active strong pain on my 2 wisdom teeth ,also pain on head and neck took a lot more advil then took loratadine 10mg took the whole weekend to feel better


VAERS ID: 1724442 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-01
Onset:2021-09-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Doctors appt 9/24/2021
CDC Split Type:

Write-up: Tinnitus. Increase in volume. Sounds like fog horns in both ears


VAERS ID: 1724457 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Cardiac flutter, Disturbance in attention, Dyspnoea, Dyspnoea exertional, Head discomfort, Nervousness, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Depression (excl suicide and self injury) (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: famotidine 20mg per day Vitamin C 1000mg per day Vitamin D3 2000 iu per day ibuprofen tablet 200mg, one before exercise at gym twice a week
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None. Called my doctor''s office and requested a call back.
CDC Split Type:

Write-up: Heart palpitations intermittently starting about 3rd day after vaccine dose. Continuing through now, evening of 9-22-2021. No chest pain, but uncomfortable feeling of heart flutter and and pressure in head. Sometimes lasts for one or two hours. Slight sensation of having to concentrate harder to do a task, and body feeling "nervous". Tend to feel slightly breathless after moving around. At time of vaccine dose on 9-13 no problems. Day after only slightly sore shoulder, which faded in a day or so. Thought I was doing better than most people with body''s response to mRNA vaccine....until fluttery chest around 9-16. Slightly sore shoulder returned a week later on 9-20, at which time the fluttery heart feeling became more persistent and often.


VAERS ID: 1725416 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 - / OT

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

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

Write-up: Expired vaccine administered beyond 12 hours after first puncture; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours after first puncture) in a 30-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062E21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours after first puncture). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours after first puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. The vial was punctured at 9 AM on 15-Sep-2021 and used beyond the 12 hour expiry date in room temp on 16-Sep-2021. No concomitant medications were reported. No treatment medication was reported.


VAERS ID: 1725418 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / OT

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

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

Write-up: Administered a dose from a vial that had expired; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administered a dose from a vial that had expired) in a 43-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 026C21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administered a dose from a vial that had expired). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Administered a dose from a vial that had expired) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported No treatment medications were reported. It was reported that that there was no expiration date on vial but reporter assumed that it was 15-Oct-2021.


VAERS ID: 1725568 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-01
Onset:2021-09-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7488 / 2 RA / -

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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101225680

Write-up: 2 and 3 days after second shot having extreme dizziness; This is a spontaneous report from a contactable consumer, the patient. A 48-year-old non-pregnant female patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FA7488) via an unspecified route of administration in the right arm on an unknown date in Sep2021 (at the age of 48-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history. The patient had no known allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any medication within two weeks of vaccination. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FF2587) via an unspecified route of administration in the right arm on 08Aug2021 (at the age of 48-years-old) as a single dose for COVID-19 immunisation. On 16Sep2021 at 14:00, 2 and 3 days after second shot, the patient experienced extreme dizziness. The event did not result in a visit to the doctors or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the event. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event 2 and 3 days after second shot having extreme dizziness was unknown at the time of the report.


VAERS ID: 1725583 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: SARS-CoV-2 test, Vaccination site erythema
SMQs:, 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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Birth control; COVID-19 (Prior to vaccination, was the patient diagnosed with COVID-19?:Yes)
Allergies:
Diagnostic Lab Data: Test Name: Nasal swab; Test Result: Negative
CDC Split Type: USPFIZER INC202101226406

Write-up: Arm is getting progressively redder at injection site and each day the red area is growing larger/spreading further; This is a spontaneous report from a contactable consumer, the patient. A 39-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 15Sep2021 at 16:15 (at the age of 39-years-old) as a single dose for COVID-19 immunisation. Medical history included COVID-19 and birth control. The patient had no known allergies. Prior to the vaccination, the patient was diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID-19 vaccine. Concomitant medications included unspecified birth control medication from unknown date and unknown if ongoing and unspecified vitamins for unknown indications from unknown dates and unknown if ongoing. On 16Sep2021, the patient''s arm was getting progressively redder at injection site and each day the red area was growing larger and spreading further. The patient was documenting it with pictures. The event did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the event. Since the vaccination, on an unknown date, the patient underwent nasal swab test for COVID-19 and the result was negative. The clinical outcome of the event arm is getting progressively redder at injection site and each day the red area is growing larger/spreading further was not recovered at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1725601 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH JDAMH / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Nausea, Neck pain, Pain, Pain in extremity, Sinus pain, Somnolence, Spinal pain, Vaccination site erythema, Vaccination site pruritus, Vaccination site warmth
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (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:
Preexisting Conditions: Medical History/Concurrent Conditions: Sulfonamide allergy (Known allergies: Sulfa).
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101227756

Write-up: Chills; Aches; Drowsiness; Dizziness; Nausea; Extreme pain starting from left arm up the left side of neck; Extreme pain starting from left arm up the left side of neck; Pain shooting down spine; Pain jabs in right side sinus cavities; Pain jabs in right side of frontal lobe; Itchy, red, hot spot where injected; Itchy, red, hot spot where injected; Itchy, red, hot spot where injected; This is a spontaneous report from a contactable consumer, the patient. A 38-year-old non-pregnant female patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: JDAMH) via an unspecified route of administration in the left arm on 15Sep2021 at 17:00 (at the age of 38-years-old) as a single dose for COVID-19 immunisation. Medical history included sulfa allergy and no other medical history. 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 included unspecified birth control medicines (MANUFACTURER UNKNOWN). The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FD8448,) via an unspecified route of administration in the left arm on 25Aug2021 at 16:45 (at the age of 38-years-old) as a single dose for COVID-19 immunisation. On 16Sep2021 at 03:30, the patient experienced chills, aches, drowsiness, dizziness, nausea, extreme pain starting from left arm up the left side of the neck, pain shooting down the spine, pain jabs in the right side of sinus cavities, pain jabs in the right side of the frontal lobe and the patient also developed itchy, red, hot spot where vaccine was injected. The events did not result in 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 events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events chills, aches, drowsiness, dizziness, nausea, extreme pain starting from left arm up the left side of the neck, pain shooting down the spine, pain jabs in the right side of sinus cavities, pain jabs in the right side of the frontal lobe and itchy, red, hot spot where vaccine was injected was not resolved at the time of this report. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1725622 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Back pain, Body temperature, Diarrhoea, Fatigue, Headache, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: YAZ
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210916; Test Name: Body temperature; Result Unstructured Data: Test Result:102; Comments: Fever
CDC Split Type: USPFIZER INC202101233848

Write-up: Arm sore; Fever of 102 for 2 days; Back aches; Diarrhea/upset stomach; Diarrhea/upset stomach; Headache; Fatigue; This is a spontaneous report from a contactable consumer, the patient. A 24-year-old non-pregnant female patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3184) via an unspecified route of administration in the left arm on 15Sep2021 at 16:45 (at the age of 24-years-old) as a single dose for COVID-19 immunisation. The patient did not have any medical history. The patient had no known allergies. Prior to vaccination, it was unknown whether the patient was diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications included drospirenone/ ethinylestradiol betadex clathrate (YAZ) started from an unknown date taken daily for birth control. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FD8448) via an unspecified route of administration in the left arm on 27Aug2021 at 15:30 (at the age of 24-years-old) as a single dose for COVID-19 immunisation. On 16Sep2021 at 13:15, the patient experienced arm sore, fever of 102 for 2 days, back aches, diarrhea/upset stomach, headache and fatigue. The events did not result in 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 events. On 16Sep2021, the patient underwent lab test body temperature and the result was 102 (units unspecified). Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events arm sore, back aches, diarrhea/upset stomach, headache and fatigue were resolved on an unknown date in Sep2021; while the event fever of 102 for 2 days was resolved on 18Sep2021, after the duration of 2 days.


VAERS ID: 1725990 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: USJNJFOC20210933744

Write-up: DEVELOPED BLOOD CLOTS; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin was not reported, and batch number: Unknown, expiry: Unknown ) dose was not reported, 1 in total, administered on 16-SEP-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 16-SEP-2021, the patient took the covid shot and developed blood clots and now patient had to take Xarelto. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of developed blood clots was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0. 20210933744-COVID-19 VACCINE AD26.COV2.S.- Developed blood clots. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.


VAERS ID: 1726158 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Dizziness, Fatigue, Loss of consciousness, Nasal congestion, Nausea, Respiratory tract infection, SARS-CoV-2 test negative, Secretion discharge, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Infective pneumonia (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: Rapid test Negative for COVID on 9/20
CDC Split Type:

Write-up: Nausea, fatigue, congestion, cough, mucus, spitting up blood and mucus, fainted/dizziness/blacked out, respiratory infection.


VAERS ID: 1726200 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-26
Onset:2021-09-16
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 UN / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 UN / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose normal, COVID-19, Cerebrovascular accident, Cheilitis, Chest pain, Computerised tomogram thorax normal, Cough, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram abnormal, Electroencephalogram normal, Fatigue, Hemiparesis, Intensive care, Intervertebral disc degeneration, Laboratory test normal, Magnetic resonance imaging head normal, Magnetic resonance imaging spinal normal, Magnetic resonance imaging thoracic abnormal, Oropharyngeal pain, Pain, Pyrexia, Rash, Respiratory tract congestion, Sinus tachycardia, Spinal deformity, Spinal stenosis, Tachycardia, Tachypnoea, Visual field defect
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), 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), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Optic nerve disorders (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Osteoporosis/osteopenia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler ascorbic acid (VITAMIN C) 1000 MG tablet betamethasone dipropionate 0.05 % cream cloNIDine (CATAPRES) 0.1 MG tablet dicyclomine (BENTYL) 20 MG tablet esci
Current Illness: Office visit with PCP on 9/16/2021: Patient presents to the office for the CC of cough and congestion x 2 days. Cough is dry. Mildly sob. Symptoms started with shaking chills and body aches yesterday and have since progressed. Nasal congestion and rhinorrhea. Sore throat. NVD. Weak. Fatigued. +exposure covid19 and HFM. Denies rash. Suspect underlying viral etiology. Recommend supportive care. APAP/IBU for pain/fever. Albuterol PRN. Push fluids. COVID19 test ordered.
Preexisting Conditions: Past medical history obstructive sleep apnea, hypertension, morbid obesity, anxiety and depression, ADD
Allergies: Zithromax
Diagnostic Lab Data: Neurology note: -MRI brain without contrast - motion degraded exam, possible artifactual diffusion hyperintensity in the posterior right hippocampus. -MRV Brain - Moderately motion degraded exam, however the venous sinuses are patent -MRI C spine with contrast - No evidence of focal spinal cord signal abnormalities or abnormal enhancement. No significant spinal canal or neural foraminal narrowing -Repeat HCT 24hr post-tPA administration stable with no signs of bleed. -Echo - LVEF 55%, unclear visualization of LA due to suboptimal windows. -Repeat MRI Brain with and without contrast with no evidence of infarct, lesion or abnormal enhancement -EEG report with no epileptiform abnormalities noted. Normal study MRI Spine lumbar 9/20/21: 1. Motion degraded exam. 2. No significant spinal canal or neural foraminal narrowing. 3. No acute fracture or malalignment of the lumbar spine. 4. Minimal nonspecific facet joint fluid bilaterally at L4-L5. Findings may relate to degenerative changes, joint hypermobility, and/or altered biomechanics. Correlate for facet joint pain. MRI Spine thoracic 9/22/21: 1. Multilevel degenerative disc disease with extensive prominent epidural fat resulting in moderate spinal canal narrowing from T6-T7 through T10-T11. 2. No significant neural foraminal narrowing. 3. Unchanged minimal T1 and mild T2 superior endplate deformities. 4. Otherwise, no evidence of acute fracture or malalignment of the thoracic spine
CDC Split Type:

Write-up: Hospitalized 9/1/2021; COVID-19 positive (9/16/2021); fully vaccinated Patient is a 26 y.o. male who presented with fatigue, fever and chest pain. Patient has a history of HTN, OSA, and obesity. Patient had onset fever, body aches and fatigue night of 9/14/2021. Patient took tylenol and motrin with continued symptoms. Cough and congestion started on 9/16/21 with increasing shortness of breath. Notified of recent work exposure for COVID and was found to be positive on 9/16. Patient is fully vaccinated with moderna in early 2021, with sister who was also vaccinated ended up intubated with COVID 1 month prior. Patient also reported rash onset 9/17 after recent exposure to son who had HFMD. Rash is found on face, hands, feet, and truck with sores to inner lips and sore throat. Increased shortness of breath, chest pain and cough on night of 9/17, in which prompted him to seek further care. Patient denies abdominal pain, nausea, vomiting or urinary symptoms. In the ED, patient was found to have unremarkable laboratory findings. EKG showed sinus tachycardia with normal tropinins. CT thorax completed without evidence of PE. Although no acute findings, patient was admitted to hospitalist service for COVID due to continued tachypnea and tachycardia for continued monitoring and symptomatic treatment. 9/19/2021 at 0304 I patient with acute stroke findings. Last known normal established das 0247 when RN administered tylenol. BP 145/96, glucose 131. Patient with obvious left side hemiparises, no facial asymmetry, protecting airway, led visual field defect. NIH 14. STAT imaging ordered at 0311. Nursing escorted patient down to CT. Neurology and recommended tPA if no bleed or other contraindication and transfer to neuro ICU barring large vessel occlusion. Radiology called backed, no bleed noted on CT head, normal perfusion Study, CT angio with some findings felt 2/2 poor timing of contrast. tPA ordered and administered. He is transferred in stable condition via ground to another facility on 9/19/21. Currently hospitalized, Patient stable now, awaiting discharge to inpatient rehab.


VAERS ID: 1726380 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-09-16
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute left ventricular failure, Acute respiratory failure, Ageusia, Alanine aminotransferase increased, Anosmia, Aspartate aminotransferase increased, Asthenia, Blood albumin decreased, Blood alkaline phosphatase increased, Blood creatinine increased, Blood glucose increased, Blood sodium decreased, Blood urea increased, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chest pain, Chills, Condition aggravated, Decreased appetite, Diarrhoea, Dizziness, Dysgeusia, Electrocardiogram, Fibrin D dimer, Headache, Hypophagia, Hypoxia, Lung opacity, Malaise, Myalgia, N-terminal prohormone brain natriuretic peptide normal, Productive cough, Pulmonary oedema, Pulmonary sarcoidosis, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Tachypnoea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL) 500 MG tablet albuterol sulfate (PROAIR RESPICLICK) 108 (90 Base) MCG/ACT inhalation powder allopurinol (ZYLOPRIM) 100 MG tablet aspirin 81 MG tablet atorvastatin (LIPITOR) 40 MG tablet brimoni
Current Illness: 9.15.21 - called with symptoms 9.16.21 - COVID-19 positive 9.21.21 - antibody infusion
Preexisting Conditions: Non-Hospital Anxiety Retinal neovascularization Degenerative progressive high myopia Dyslipidemia Gastroesophageal reflux disease Granuloma present on biopsy of liver Migraine headache Posterior vitreous detachment Histoplasmosis Hematuria CHF, chronic (HCC) MGUS (monoclonal gammopathy of unknown significance) Gout of left foot, unspecified cause, unspecified chronicity
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.21.21 - present); COVID-19 positive (9.16.21); fully vaccinated HISTORY OF PRESENT ILLNESS: Patient is a 65 y.o. female with a past medical history of sarcoidosis, OSA not on CPAP, CKD 3B, MGUS, and morbid obesity who presents today with hypoxia. Her current symptoms started on 9/14. Symptoms include fevers, chills, rigors, anorexia, dysgeusia, cough, weakness and diarrhea. She has not taken the majority of her medications in 1 week. She confirmed that she had not taken her Lasix in 1 week. The patient received a COVID test on 09/16 which was positive. She was to have the monoclonal antibody infusion today. When she went to her appointment, her oxygen level was noted to be in the 60s on room air and was sent to the ER. The patient arrived on 6 L of oxygen by nasal cannula. Her oxygen level at arrival was 77% on the 6 L. she was placed on non-rebreather at 15 L. She was transitioned to high-flow nasal cannula with an FiO2 of 90%. She was noted to be tachypneic in the ER with a respiratory rate of 30. She was also tachycardic with pulse of 107. Labs significant for sodium 133, BUN 25, creatinine 1.66, glucose 234, alk-phos 159, albumin 2.9, AST 137 ALT 100. CRP was 152.8. D-dimer 470. CXR with bilateral perihilar and left basilar opacities. This could represent central pulmonary edema. An atypical infection would be a differential consideration, although the distribution would be atypical for Covid 19 pneumonia. Patient was given 6 mg of Decadron as well as 40 mg of IV Lasix. ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Acute Respiratory failure with Hypoxia Lung Sarcoidosis Acute Systolic Congestive Heart Failure -CXR with bilateral perihilar and left basilar opacities. This could represent central pulmonary edema. An atypical infection would be a differential consideration, although the distribution would be atypical for Covid 19 pneumonia. Symptom onset: 9/14 - positive COVID-19 test 9/16 Symptoms: Chills, fevers, rigors, myalgias, head aches, anorexia, loss of taste and smell, productive cough, dizziness, chest pain, diarrhea, chest pain. Treatment: Remdesivir (starting 9/21 - will need to monitor kidney function and liver function daily), Decadron (started 9/21), Pulmonology consult (hx of Sarcoidosis), VTE prophylaxis with weight based Heparin, Prone PRN, IS, continuous pulse oximetry, supportive care with PRN Imodium, PRN anti-tussives, PRN anti-emetics, PRN albuterol inhaler. Given abnormal appearance of chest X-ray will continue IV Lasix 40 mg daily (adjust as necessary) -Not on current treatment for Sarcoidosis - has not taken her Lasix in one week 2/2 to poor oral intake/diarrhea -Daily weights with I/O, monitor urine output -Given reported chest pain - will obtain EKG now and place on telemetry -Pulm note 8/2021 regarding Sarcoidosis: Multiorgan involvement of sarcoidosis: liver, renal, lung. PET ct in July 2020 w/o evidence of sarcoidosis in heart. MTX stopped July 2020 and her PFTs have been stable since this. NOte from 9.23.21: Pneumonia due to COVID-19 virus Acute Respiratory failure with Hypoxia H/o pulmonary Sarcoidosis - CXR showed bilateral perihilar and left basilar opacities. - Symptom onset: 9/14, positive COVID test 9/16 - Remdesivir started 9/21 - plan to complete 5 day course - Decadron started 9/21 - plan to complete 10 days - Pulmonology consulted (hx of Sarcoidosis) - VTE prophylaxis with weight based Heparin - Encourage prone positioning and IS - Supportive care with anti tussives and anti emetics - Lasix decreased to 40mg IV daily Acute on chronic Systolic Congestive Heart Failure - ECHO from 2019 with LVEF 45-50%, normal diastolic function - LHC from 2020 without any significant arterial disease. EF not noted. - Takes Lasix 40mg PO daily at home - has not taken in one week - Pro BNP normal though may be falsely low due to BMI. CXR suggestive of pulmonary edema. - Continue on Lasix IV as above - Monitor daily weights, I&Os Pulmonary sarcoidosis - Per pulm note 8/2021 regarding Sarcoidosis: Multiorgan involvement of sarcoidosis: liver, renal, lung. PET ct in July 2020 w/o evidence of sarcoidosis in heart. MTX stopped July 2020 and her PFTs have been stable since this. - Not on active treatment - Pulm following - no need for an acute treatment. - Albuterol INH PRN CKD IIIB - Follows with Nephrology as outpatient - Creatinine is near baseline at 1.6 - GFR 38 - Monitor closely while diuresing and on Remdesivir - Lasix dosing as above - Daily weights, I/O


VAERS ID: 1726520 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-09-16
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient was admitted to the hospital with COVID symptoms and was treated with typical COVID medications. Patient remains in the hospital.


VAERS ID: 1726539 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-09-16
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Diabetes type 2, Atrial fib
Allergies: NKDA
Diagnostic Lab Data: Positive Nasal swab
CDC Split Type:

Write-up: Breakthrough case


VAERS ID: 1726551 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-07
Onset:2021-09-16
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations:
Other Medications: not known
Current Illness: none known
Preexisting Conditions: not known
Allergies: not known
Diagnostic Lab Data: PCR + for Covid on 9/21/2021 Client received infusion of antibodies on 9/22 at hospital.
CDC Split Type:

Write-up: Client had Pfizer vaccines for Covid on March 7* and April 7, 2021. *Client not sure of date for #1 but says it is about a month before #2 and of that date she is certain. Developed Covid symptoms on 9/16/2021: fever, headache, fatigue. Tested PCR + for Covid Reported as a case of breakthrough Covid illness in a previously vaccinated person


VAERS ID: 1726564 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-01
Onset:2021-09-16
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations:
Other Medications: not known
Current Illness: none known
Preexisting Conditions: not known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid on 9/21
CDC Split Type:

Write-up: Client received Pfizer vaccines for Covid on * March 7 and April 7, 2021. *Client not sure of exact first dose date but states it was about a month prior to 2nd dose and she is sure about date of second dose. Developed Covid symptoms on 9/16: fever, headache, fatigue. Reported as a case of breakthrough Covid in a previously vaccinated person. Client received treatment of antibody infusion on 9/22/2021.


VAERS ID: 1726614 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Underdose
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No adverse events reported, only reporting an administration error. When giving the vaccine, the needle came loose from the syringe and less than half of the dose was given in the patient''s right deltoid. I contacted Moderna support and was advised that if less than half the dose was administered the first time then to re-administer the full dose of the vaccine in opposite arm. So I administered the full dose of 0.5mL in the patient''s left deltoid. Patient has not reported any adverse events from this situation.


VAERS ID: 1726690 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-05
Onset:2021-09-16
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi Vitamin, E, A, Biotin, Turmeric, Zyrtec
Current Illness: None
Preexisting Conditions: Auto immune disease
Allergies: Tetracycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles


VAERS ID: 1726701 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0412C21A / 3 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Blood iron decreased, Blood test, Cardiac disorder, Head injury, Loss of consciousness, Pain in extremity, Serum ferritin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: OTC Multi Vitamin Birth Control Pill atorvastatin
Current Illness: None
Preexisting Conditions: Seasonal Allergies High cholestrol
Allergies: NSAIDs
Diagnostic Lab Data: See by the Doctor about 6 hours later; performed blood work indicated low iron and high ferritin had previously had bloodwork 3 months prior with no issues at all. Also, showed cardiac concerns referral to cardiologist.
CDC Split Type:

Write-up: Normal sore arm; but the following day about 16 hours later I woke up and passed out and fell and hit my head. This is not normal behavior for me.


VAERS ID: 1726750 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased, Hyperhidrosis, Presyncope, Sleep disorder, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Within 5 minutes of the shot: Nearly passing out/blurred vision/intense sweating, went away within a few minutes. Several hours after the vaccine, however, I had a severely increased pulse, as well as a growing inability to breathe overnight, by ~4:30AM I was struggling to breathe the most (nearly bad enough to go to the hospital) and had over a 120 bpm pulse (over double my average). This happened for most of the night (I was not able to sleep), and only mostly went away by the next night.


VAERS ID: 1726831 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Chills, Condition aggravated, Dizziness, Fall, Feeling cold, Myalgia, Pain in extremity, Presyncope, Tremor, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (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: None
Current Illness:
Preexisting Conditions: Low Platelets on blood draw but no PMH otherwise reported
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Patient received first dose Pfizer, approx 4 minutes later reported feeling faint. Patient c/o of feeling dizziness and ""shaky"" and ""cold"" to observation nurse. Pt had near syncopal episode and fell to floor. Per pt, no LOC as he remembers everything that happened. Taken by nursing staff to clinic room. Mentions symptoms have happened with previous blood draws in the past. Reports to have had low platelets on a previous blood draw but no known medical hx. No medications taken. Charge RN, ANM, onsite provider notified. @1301: BP 91/41 HR 65 RR 14 O2 99%. Patient placed in recliner. Pt denied n/v, SOB, headache. AOx4. Pt continue to c/o of feeling shaky. Continued monitoring by observation RN. Patient able to tolerate drinking water. @1309: BP 116/74 HR 79 O2 99% Continued observation. Patient states feeling better. Pt able to ambulate and per provider, continued monitoring outside in observation area. Denies nausea, vomiting, CP, SOB. @1348: Patient states feeling left side chest pain and ""shaky"" again. Per provider recommendation, pt ambulated back to triage area with observation RN for further assessment. @1401: BP 140/89 HR 79 O2 98% @1409 Per provider recommendation, transport was called to escort pt to urgent care for further evaluation of L side chest pain that is unimproved with rest. @1421 Patient still reported feeling ""shaky"". Pt escorted to Urgent Care for further evaluation there, by transport via w/c, accompanied by friend. ED Course: Pt developed vomiting and reports a near syncopal episode. Per pt, no LOC. Reports never happening before and has received vaccines in the past. He continues to report leg pain and shakiness in the legs, lightheadedness and chills. Denies fever, HA, SOB, trouble breathing, rashes, swelling in the face or neck, paresthesias or paralysis. Pt observed and discharged 9/17 @1:38AM. Plan: -Advised pt to establish PCP as his Hgb, HCT and RBC were low and IFP high which pt reports he is aware of. -advised pt to take advil and tylenol as needed for myalgia in the legs. -Return to ED if symptoms persist or worsen -Strict return precautions discussed such as increased edema, throat itching, rash/hives, or difficulty breathing and patient verbalized understanding of these return precautions Diagnosis and disposition discussed with patient at length. Patient to be discharged in stable condition. Patient was in agreement with this care plan and verbalized understanding of it."


VAERS ID: 1726863 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea, Retching
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: brimonidine (ALPHAGAN) 0.2 % ophthalmic solution instill 1 Drop to right eye 2 times a day 10 mL 7 ? brinzolamide (AZOPT) 1 % DrpS instill 1 Drop to both eyes 2 times a day 10 mL 7 ? dorzolamide-timoloL (Cosopt) 2-0.5 % Drop instill 1 Dro
Current Illness:
Preexisting Conditions: PMH Significant for recurrent endometrioid adenocarcinoma, Hepatitis B, pre-diabetes, glaucoma, and eye bleed.
Allergies: Allergies: PCN and Iodinated Contrast Media
Diagnostic Lab Data:
CDC Split Type:

Write-up: 22mins post vaccination, pt reported Nausea and dry heaves to observation nurse. Pt was taken to triage area. Charge RN onsite provider notified. Pt denied CP, SOB, headache. Vitals: @12:21 BP 153/88, HR 66, RR 20, O2 Sat 100% -- $g @12:29 140/86, 62, 18, 99% -- $g @12:45 139/91, 68, 16, 99% After sitting in a recliner chair for ~20mins, pt reported that nausea subsided and was able to tolerate drinking water. The patient was able to ambulate out of the chair w/o assistance. Patient was educated to seek further ER services if sxs worsen. Pt verbalized understanding. Pt stable and released from the vaccination site.


VAERS ID: 1726989 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-20
Onset:2021-09-16
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Write-up: Covid positive contact unknown


VAERS ID: 1727187 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Eye pain, Headache, Hypoaesthesia, Hypoaesthesia oral, Laboratory test normal, SARS-CoV-2 test negative
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), COVID-19 (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, percocet
Current Illness: none
Preexisting Conditions: Lupus
Allergies: latex, potato, apple, carrots, tomato''s
Diagnostic Lab Data: neg covid test completely normal chemistries 08/17/21
CDC Split Type:

Write-up: Headache shortly after injection, 16 hours later chest pain , facial and mouth numbness. days later sharp eye pain


VAERS ID: 1727194 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Blood test normal, Chest pain, Dyspnoea, Electrocardiogram normal, Fatigue, Headache, Hypoaesthesia, Influenza like illness, Pyrexia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Patient expereinced flu like symptoms: fever, headache, fatigue 4 hours after vaccination. 4 days after vaccination, developed numbess in hands, feet and knees and shortness of breath. Also complained of right upper quantrant pain with inspiration. Was evaluated in an urgent care setting and had a negative work up for blood clot and normal labs, ECG, et.


VAERS ID: 1727236 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Arthralgia, Blood gases, Chest X-ray normal, Chronic obstructive pulmonary disease, Condition aggravated, Echocardiogram abnormal, Ejection fraction decreased, Extra dose administered, Fibrin D dimer normal, Full blood count normal, Metabolic function test, Myalgia, Procalcitonin normal, Prohormone brain natriuretic peptide increased, Respiratory viral panel, Troponin normal
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, albuterol, aspirin, coreg, famotidine, gabapentin, imdur, linzess, lorazepam, reglan, omeprazole, crestor, entresto, brilinta, stiolto respimat, ambien
Current Illness: coronary artery disease requiring stent
Preexisting Conditions: COPD, CAD with bypass and stents, protein calorie malnutrition, previous history of stomach cancer and prostate cancer
Allergies: ace inhibitors, atorvastatin, morphine
Diagnostic Lab Data: 9/19/21 - echocardiogram (EF was 30-35% which was decreased from 40-45% 1 month earlier) and chest x ray - no acute abnormality. 9/19/21 and 9/20/21 - CBC, BMP, troponin, respiratory pathogen panel, procalcitonin, d-dimer, arterial blood gas were all normal. Pro-BNP was elevated at over 4000. I personally did not take care of patient at the time of his admission from said adverse event. I am placing the report after he told me during a follow up hospitalization.
CDC Split Type:

Write-up: 1 day after receiving the flu vaccine and the COVID booster shot, Pt developed acute hypoxic respiratory failure as well as myalgias and arthralgias. This required hospitalization for COPD exacerbation.


VAERS ID: 1727266 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-03-18
Onset:2021-09-16
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Cough, Electrocardiogram normal, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CENTRUM multi-vitamin; Simvastatin; Finasteride; Tamsulosin; Olmesartan; Amlodipine Besylate
Current Illness: None
Preexisting Conditions: High blood pressure, urinary continence problems
Allergies: None
Diagnostic Lab Data: 3 COVID test- all negative, chest x-ray clear, EKG- normal.
CDC Split Type: vsafe

Write-up: On 09/16/2021 I started having coughs and chest congestion. Then I started running a fever. I took some medication for the fever, and it went down. The congestion and coughs got worse. We went to the emergency room, and they did a COVID test, chest x-ray, and EKG. The chest x-ray was clear, and the EKG was normal. The COVID test came back negative. They did not prescribe any medications. The following Sunday 09/19/2021 I got 2 COVID tests, one short and one long term, which both came back negative as well. The following week we went out on vacation. 3 of us tested positive for COVID and 3 are still waiting for the results. I should know by tomorrow my results. I am still congested a little bit and I still have a cough. I received the flu vaccination this fall.


VAERS ID: 1727402 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-01
Onset:2021-09-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Penile swelling
SMQs:, Angioedema (broad), Hypersensitivity (broad)

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

Write-up: As of 1 week ago penis has grown by approximately 3 inches. Penile function remains intact. No other symptoms.


VAERS ID: 1727415 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-05
Onset:2021-09-16
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Aspiration, Blood creatinine increased, Blood lactic acid, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Cardiomegaly, Chest X-ray abnormal, Computerised tomogram head normal, Computerised tomogram thorax, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Emphysema, Endotracheal intubation, Foreign body in throat, Glomerular filtration rate decreased, Hiatus hernia, Hypertension, Hypoxia, Intensive care, Lung infiltration, Lung opacity, Mechanical ventilation, Mental status changes, Oxygen saturation decreased, Retching, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications amLODIPine (NORVASC) 5 MG tablet diazepam (VALIUM) 10 MG tablet fluticasone (FLONASE) 50 MCG/ACT nasal spray gabapentin (NEURONTIN) 800 MG tablet gabapentin (NEURONTIN) 800 MG tablet HYDROmorphone (DILAUDID) 4 MG tabl
Current Illness: NA
Preexisting Conditions: Hospital Acute respiratory failure with hypoxia (HCC) Pneumonia due to COVID-19 virus Aspiration pneumonia (HCC) Hypothyroidism Essential hypertension Chronic pain Encephalopathy Acute thrombosis of superficial vein of both upper extremities
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.16.21); COVID-19 positive (9.16.21); Fully Vaccinated HISTORY OF PRESENT ILLNESS: Pt is a 81 y.o. female who presents today with aspiration event and COVID-19 pneumonia. Patient has a history of HTN, hypothyroidism, chronic pain requiring dilaudid, gabapentin, valium, and insomnia on Ambien. She lives at home with her husband. She was eating a bagel this morning, started gagging, coughing, and having difficulty breathing. EMS was called, and upon arrival she had saturations in the 70s, improved to 80% on a non rebreather. Arrived in the ER, was given fluid bolus. Food was removed from the posterior pharynx. She was intubated for hypoxemia and altered mental status. COVID-19 PCR was positive on routine work up, she did have bilateral infiltrates on CXR. WBC 12, lactate 2.2, BNP 600, Cr of 1.27, GFR on 40 (unclear baseline), and negative CT head. Unasyn and vancomycin were given in the ER. They also gave narcan but no significant improvement. Upon arrival to the medical ICU, patient was awake, but not following commands on propofol drip. She required minimal ventilator support, 5/5, fio2 of 35%. Hypertensive and otherwise hemodynamically stable and afebrile. Pneumonia due to COVID-19 virus. ASSESSMENT / PLAN: 81 year old female with history of HTN, hypothyroidism, chronic pain on opioids and benzodiazepines, insomnia on Ambien, presents with acute hypoxemic respiratory failure in the setting of aspiration event, and bilateral pulmonary infiltrates and tested positive COVID-19. She was intubated 9/16/21 for hypoxemia and altered mentation Assessment & Plan Unclear when patient developed symptoms. Incidentally tested positive 9/16/21. Has bilateral pulmonary infiltrates on CXR. Start Remdesivir (FD 9/16/21) Start Decadron 6 mg daily (FD 9/16/21) Note from 9.23.21: Acute hypoxic respiratory failure-Felt secondary to COVID infection as well as aspiration pneumonia COVID 19 infection COVID test was positive 9/16 and symptom onset was also 9/16 Patient was intubated from 09/16 to 9/17 Was previously on 4 L of oxygen, weaned down to 2 L and then was off during the daytime yesterday. She had required oxygen overnight and also requiring 2 L of oxygen this morning Will consult pulmonary rehab to evaluate for home oxygen Completed remdesivir Continues on Decadron Continue incentive spirometry CT angiogram thorax did not reveal any evidence of pulmonary embolus but showed severe pulmonary emphysema/large hiatal hernia and mild cardiomegaly as well as hazy ground-glass opacity in the posterior right lung


VAERS ID: 1727475 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Body temperature increased, Face oedema, Nausea, Rash, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Temp 102.6, head to toe body rash, syncope episode, facial edema, nausea, vomiting


VAERS ID: 1728715 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Influenza, Mobility decreased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol (PROAIR/PROVENTIL/VENTOLIN) 90 mcg/actuation Inhl HFAA rOPINIRole (REQUIP) 0.25 mg Oral Tab Lisinopril (PRINIVIL/ZESTRIL) 40 mg Oral Tab Famotidine (PEPCID) 40 mg Oral Tab amLODIPine (NORVASC) 5 mg Oral Tab hydroCHLOROthiazide (ES
Current Illness: August 2021 - Flare up of Meniere''s disease
Preexisting Conditions: INTERMITTENT ASTHMA SEVERE OBESITY HYPERTENSION ALLERGIC RHINITIS CHRONIC PAIN HX OF TOTAL HYSTERECTOMY FIBROMYALGIA OCCULT BLOOD IN STOOL HX OF DVT HX OF PULMONARY EMBOLISM ON LONG-TERM ANTICOAGULATION THERAPY BILAT CATARACT BILAT HEARING LOSS RESTLESS LEGS SYNDROME LEFT ACOUSTIC NEUROMA ATHEROSCLEROSIS OF AORTA HX OF LACUNAR STROKE PULMONARY NODULE LEFT VENTRICULAR HYPERTROPHY HX OF ADENOMATOUS COLONIC POLYPS HX OF PRIMARY HYPERPARATHYROIDISM RIGHT MENIERES DISEASE AGE-RELATED ATROPHY OF BRAIN
Allergies: ? Atorvastatin Muscle Ache ? Chlorhexidine Rash Patient experienced rash to upper chest after use of SAGE CHG wipes. Other chlorhexidine products (IV preparation without rash). Pt reports highly sensitive skin. ? Codeine itching ? Gabapentin fatigue ? Pravastatin Muscle Ache ? Prozac [Fluoxetine Hydrochloride] Mental active crazy thoughts, "tripping"
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: From her email "I just wanted to let you know anyway, that last Thursday, Sept. 15th, I received the Booster shot. About 2 hours after receiving it I started to not feel good, like flu symptoms, I was so achy I could hardly get up off the couch. I felt feverish, but I didn''t have a fever. This has lasted now a week, and I am still not feeling good. I''m taking Advil and Tylenol. Kinda interchanging it. It helps but of course not totally. I''m very concerned because this happened to me when I took both Covid injections 6 months ago, except not as bad as this last injection. (Pfizer). I guess it''s just going to have to take its course? This is terrible. I feel so horrible, and for it to last this long. The other 2 injections I had the effects only lasted 2 days. But this one..........wow."


VAERS ID: 1728736 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-21
Onset:2021-09-16
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001821A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Condition aggravated, Dizziness, Electrocardiogram normal, Headache, Heart rate irregular, Migraine, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Hypertension (narrow), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Testosterone hormone
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: Urgent Care - did a work up of vital signs - the blood pressure then my readings at home - on both top and bottom and caused me to wonder if my cuff was reliable. It was low range of the low range of high blood pressure- I had an irregular pulse and asked if I had A Fib and said yes a number of years ago that I did have that condition. She prescribed a mild Diuretic and made sure to send notes to your doctor. I had a visit schedule with PCP on Wednesday - He checked my vitals and blood pressure - it was similar - it was high but in the low range of high blood pressure again. He did an EKG and said that came back normal - snapshot - so said it wasn''t conclusive. He wrote a prescription for Licinopram -have not started yet. He wants me to get a blood test to establish a baseline and then come back in 60 days for follow up.
CDC Split Type: vsafe

Write-up: The first symptoms was a headache - it was not a migraine but it was persistent and it continued into Friday, the 17th. I usually take Acetaminophen but it didn''t go away. On the 17th, I got dizzy going up the stairs. I had to lay down for an hour or so. Dizziness was sporadic and lessened but it persisted along with the headache. I experienced a visual event - an optical migraine - the doctor called it. I took my blood pressure and I had higher readings then I had ever seen before. However, my blood pressure had been creeping up the last 12-18 months and had been a topic of concern with my doctor - but this time it was high enough to go to an Urgent Care, I believe - Friday, the 17th. I am doing fine with my symptoms now. They completely abated on the 18th - no headache and felt fine that morning and have felt fine since then.


VAERS ID: 1728748 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Chills, Fatigue, Headache, Immediate post-injection reaction, Pain, Pyrexia, Tenderness
SMQs:, Peripheral neuropathy (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta 60mg, multivitamin, vitamin D, Zinc, magnesium, echinaccea
Current Illness: None
Preexisting Conditions: Fibromyalgia
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Immediate burning of arm at site and throughout arm. Soreness/tenderness for a few days after. Within first several hours developed chills and body aches. Low-grade fever presented in morning (101) and persisted rest of day, though relieved with Tylenol. Extreme fatigue and slight, persistent headache that lasted about 3 days.


VAERS ID: 1728752 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-20
Onset:2021-09-16
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Had covid 3 days prior to schedule of 2 nd shot
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tinnitus


VAERS ID: 1728759 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dry skin, Flushing, Nausea, Skin warm
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Dehydration (broad)

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

Write-up: Pt c/o dizziness, nausea and feeling flushed. Vital signs BP 160-90; HR 79; Resp 16 O2 Sat 99% Skin warm and dry ; good cap refil; breath sounds clear bilaterally; no wheezing. Pt rested in supine position. Given Water and provided reassurance. Rested for 15 min. Moved to upright position, denies nauses or dizziness. BP146/90, HR 78, Reso 16, O2 sat 99%. Patient discharged home with husband.


VAERS ID: 1728821 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pruritus, Lethargy, Ophthalmological examination, Rash, Vaccination site swelling
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient received vaccine on Wednesday 9/15 felt very tired and laid in bed. Mom said she complained of itching and swelling under arm of vaccination site. Next day 9/17, patient had huge rash all over arm and upper body. Presented to Pediatrician who believed it to be related to the injection. Extremely large, painful rash. Patient extremely lethargic. Missed 4 days of school. Given 10ml of Diphenydramine every 6 hours and mupirocin 2% topical ointment.


VAERS ID: 1729056 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Crying, Injection site mass, Injection site pain, Musculoskeletal pain, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control pill Tumeric Fish oil Iron supplement Ferrofood
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa Cipro Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Very sore injection site with small lump for a week. The day after the vax my arm was hurting quite badly from my shoulder down to my hand, into my left shoulder blade, and around and under my arm just above the armpit. That is the part that was super painful to the point of tears. I couldn?t stand to move my arm or hand or lay on my back or on my left side.


VAERS ID: 1729309 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Computerised tomogram
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: the Pfizer vaccine
Other Medications: Adderrall XR Goli Daily Vitamins
Current Illness: None
Preexisting Conditions: Living Kidney Donor
Allergies: Seasonal Allergies
Diagnostic Lab Data: On 9/22 the ER ran numerous blood tests and performed a CT without contrast. Nothing revealed anything to explain the spike in my blood pressure
CDC Split Type:

Write-up: Pfizer Vaccine - caused blood pressure to spike to 180/100 and it is still high. I have no history of high blood pressure. I visited the ER and my blood pressure went down to 154/90. my normal blood pressure range is 120/70 to 120/175.


VAERS ID: 1729443 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Full blood count, Metabolic function test, Muscular weakness, Seizure like phenomena, Toxicologic test abnormal, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Zoloft; Wellbutrin; Vitamin D; Tapazole; marijuana
Current Illness:
Preexisting Conditions: Psoriasis; vertigo; subclinical hyperthyroid
Allergies: NKA
Diagnostic Lab Data: 09/18/2021- toxicology - marijuana positive CMP/CBC- WDL
CDC Split Type:

Write-up: 3 days post vacc.- began mild Bilateral upper extremitie shaking/tremors 5 days post vacc.- seizure like activity lasting approximately 30minutes before medications were given in the Emergency Department 10 days post vacc- continuing upper extremity shakiness and began mild full body tremors with weakness to bilateral lower extremities


VAERS ID: 1730212 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker; Penicillin allergy; Sulfonamide allergy
Preexisting Conditions: Comments: The patient did not have any history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210944346

Write-up: RASH AT GROIN AREA (INITIALLY IN MINOR AMOUNT, OINTMENT MADE IT WORSE); This spontaneous report received from a patient concerned an 81 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: non alcohol user, non smoker, penicillin allergy, and sulfa allergy, and other pre-existing medical conditions included: The patient did not have any history of drug abuse or illicit drug use. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 042A21A, expiry: UNKNOWN) dose was not reported, administered on 14-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 16-SEP-2021, the patient experienced rash at groin area (initially in minor amount, ointment made it worse). On 21-SEP-2021, treatment medications included: hydrocortisone. The action taken with covid-19 vaccine was not applicable. The patient was recovering from rash at groin area (initially in minor amount, ointment made it worse). This report was non-serious.


VAERS ID: 1730715 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: feels a fever coming on/fever; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (feels a fever coming on/fever) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 15-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced PYREXIA (feels a fever coming on/fever). At the time of the report, PYREXIA (feels a fever coming on/fever) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant medications were provided. No treatment medications were provided. Reporter did not allow further contact Most recent FOLLOW-UP information incorporated above includes: On 16-Sep-2021: Follow up received on 16 Sep 2021 contains updated consent information.


VAERS ID: 1730717 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-09-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: joint pain; muscle pain; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of ARTHRALGIA (joint pain) and MYALGIA (muscle pain) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On 01-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Sep-2021, the patient experienced ARTHRALGIA (joint pain) and MYALGIA (muscle pain). At the time of the report, ARTHRALGIA (joint pain) and MYALGIA (muscle pain) outcome was unknown. No concomitant drug information was provided, No Treatment drug information was provided,


VAERS ID: 1730722 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 - / OT

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

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

Write-up: patient received a third Moderna dose of an expired vaccine; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (patient received a third Moderna dose of an expired vaccine) in an 85-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 058E21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Sep-2021 at 10:31 AM, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021 at 10:31 AM, the patient experienced EXPIRED PRODUCT ADMINISTERED (patient received a third Moderna dose of an expired vaccine). On 16-Sep-2021 at 10:31 AM, EXPIRED PRODUCT ADMINISTERED (patient received a third Moderna dose of an expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant Medication was provided. No treatment was provided. On 16/Sep/2021, a nursing supervisor reported that the vial had been punctured at 10:41 AM on 15/Sep/2021 and stored in refrigerator for the interim administered at 10:31 AM, 16/Sep/2021. A punctured vial was administered just under 12 hours past expiration.


VAERS ID: 1730738 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-04-07
Onset:2021-09-16
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Product dose omission issue
SMQs:, Medication errors (broad)

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

Write-up: 1st dose 07Apr2021, no 2nd dose yet; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (1st dose 07Apr2021, no 2nd dose yet) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On 07-Apr-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (1st dose 07Apr2021, no 2nd dose yet). At the time of the report, PRODUCT DOSE OMISSION ISSUE (1st dose 07Apr2021, no 2nd dose yet) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment information was provided.


VAERS ID: 1730747 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-24
Onset:2021-09-16
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bone pain, Hyperhidrosis, Lymphadenopathy, Migraine, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Osteonecrosis (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: a massive migraine; sweats; every bone in my body ached, like I got hit by Mack truck; body aches; I have a lymph node on my right collarbone that looks like a goiter; This spontaneous case was reported by an other health care professional and describes the occurrence of MIGRAINE (a massive migraine), HYPERHIDROSIS (sweats), BONE PAIN (every bone in my body ached, like I got hit by Mack truck), MYALGIA (body aches) and LYMPHADENOPATHY (I have a lymph node on my right collarbone that looks like a goiter) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 047C21A and 025B21A) for COVID-19 vaccination. No Medical History information was reported. On 24-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 16-Sep-2021, the patient experienced MIGRAINE (a massive migraine), HYPERHIDROSIS (sweats), BONE PAIN (every bone in my body ached, like I got hit by Mack truck), MYALGIA (body aches) and LYMPHADENOPATHY (I have a lymph node on my right collarbone that looks like a goiter). At the time of the report, MIGRAINE (a massive migraine), HYPERHIDROSIS (sweats), BONE PAIN (every bone in my body ached, like I got hit by Mack truck), MYALGIA (body aches) and LYMPHADENOPATHY (I have a lymph node on my right collarbone that looks like a goiter) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was provided. No treatment information was provided.


VAERS ID: 1730929 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-18
Onset:2021-09-16
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills
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: VALSARTAN HCTZ; ACTOS; BABY ASPIRIN; GLIMEPIRIDE; SIMVASTATIN; OMEPRAZOLE; VITAMINS NOS
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: I''m having chills,on and off today; This spontaneous case was reported by a consumer and describes the occurrence of CHILLS (I''m having chills,on and off today) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 043B21A and 050E21A) for COVID-19 vaccination. No medical history was provided by reporter. Concomitant products included HYDROCHLOROTHIAZIDE, VALSARTAN (VALSARTAN HCTZ) for Blood pressure, PIOGLITAZONE HYDROCHLORIDE (ACTOS), ACETYLSALICYLIC ACID (BABY ASPIRIN), GLIMEPIRIDE, SIMVASTATIN, OMEPRAZOLE and VITAMINS NOS for an unknown indication. On 18-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 16-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced CHILLS (I''m having chills,on and off today). At the time of the report, CHILLS (I''m having chills,on and off today) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No treatment medications were provided. Reporter did not allow further contact Most recent FOLLOW-UP information incorporated above includes: On 16-Sep-2021: Follow up received on 16 Sep 2021 contains no new information.


VAERS ID: 1730943 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-04
Onset:2021-09-16
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: Expired dose was administered; This spontaneous case was reported by a medical assistant and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired dose was administered) in a 34-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 016B21A) for COVID-19 vaccination. No Medical History information was reported. On 04-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired dose was administered). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Expired dose was administered) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment information was not provided. Most recent FOLLOW-UP information incorporated above includes: On 17-Sep-2021: In follow-up information reporter detail, patient demographic , Vaccine Information (i.e.: first dose detail and Dose Number for second dose ) were updated .


VAERS ID: 1730967 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injection site reaction, Nausea, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal tablet, Herbal supplement for lactation ( Mother''s milk tea, Fenugreek, Moringa capsules)
Current Illness: NKA
Preexisting Conditions: NKA
Allergies: NKA
Diagnostic Lab Data: NKA
CDC Split Type:

Write-up: Wheal on injection site (4cmx3cm), low grade fever, chills, nausea


VAERS ID: 1731190 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-14
Onset:2021-09-16
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Appetite disorder, Cough, Dizziness, Neck pain, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic conditions include DM2, hyperlipidemia, tinnitus.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets criteria for vaccine breakthrough review. SxS include dizziness, neck pain, cough, change in appetite.


VAERS ID: 1731199 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-21
Onset:2021-09-16
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Cough, Hallucination, olfactory, Headache, Oropharyngeal pain, Pyrexia, Taste disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, Sore Throat, New olfactory and Taste Disorder''s, Headache, and Cough


VAERS ID: 1731236 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

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

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

Write-up: Pt was seen for vaccination and consented to Pfizer. Stated this was the first vaccine he ever received. After administration , he stated that he J&J Janssen in April but he did not have any record of it.


VAERS ID: 1731361 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Ocular discomfort, 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: Duloxitine
Current Illness: none
Preexisting Conditions: chronic pain in left knee from major dislocation 20 years ago.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 102 f fever for 8 hours; chills; headache; pressure behind my right eye.


Result pages: prev   389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=488&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166