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From the 1/14/2022 release of VAERS data:

Found 1,031,637 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 489 out of 10,317

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VAERS ID: 1894355 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 LA / IM

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

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

Write-up: On 11/22/21 mother requested a covid vaccine for her son Pfizer vaccine, after consent signed and identified the patient as patient and gave him the adult pfizer vaccine dose of 0.2ml to the left deltoid, patient tolerated the vaccine well and mom and patient waited minutes in the car no reactions noted and left. Patient was seven years old and should have received the pediatric formula dose. On 11/23/21 the patient mother was contacted and informed of error at which time mother confirmed he did to her his arm was a little sore but today it feels better and he was feeling just fine


VAERS ID: 1894378 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Product administered at inappropriate site
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

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

Write-up: The Pharmacist injected the vaccine slowly into the subcutaneous tissue, not the IM. Shortly after the vaccine, the site became hard and raised with pain. I now have a large red ring on my skin with a bump where the vaccine was injected. The red ring is getting larger. I spoke with the Pharmacist and was told to "massage the area and it will absorb."


VAERS ID: 1894379 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immunisation, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Confused MR/DD pt was given vaccine by MA without name and DOB being verified therefore she had the wrong patient. Pt was given moderna booster dose. After investigation, pt needed 1st dose. 2nd 0.25ml dose was given to equal primary dose. No adverse reactions noted with either dose. Staff was present with patient well over an hour.


VAERS ID: 1894424 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Product preparation error
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: Patient was given a concentrated dose without diluent. When followed up with, patient only exhibited sore arm, no other symptoms. Patient was informed they may have been given a concentrated dose and to follow up with doctor if they did exhibit any external concerning symptoms. Patient was counseled on possible reactions to Pfizer.


VAERS ID: 1894433 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 67F21A / 3 LA / IM

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

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

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


VAERS ID: 1894438 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-11-22
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 - / -

Administered by: Pharmacy       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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Acute exacerbation of chronic obstructive pulmonary disease (COPD) HTN (hypertension) Hypothyroid Obesity, Class II, BMI 35-39.9 S/p AAA repair Tobacco user Historical
Allergies: NKA
Diagnostic Lab Data: abbott rapid test
CDC Split Type:

Write-up: covid +


VAERS ID: 1894454 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-20
Onset:2021-11-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest discomfort, Computerised tomogram, Electrocardiogram, Fatigue, Headache, Oropharyngeal pain, Pharyngeal swelling, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec; birth control
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Blood work, EKG, chest x-ray, CT scan
CDC Split Type: vsafe

Write-up: That Saturday, I had a headache. On Sunday, I was fatigue and had a fever. On Monday, I wake and my throat was swollen. It was very painful. I could not talk. Around 11 am, I had a tightness in my chest. It felt like someone was squishing. I then contact the pharmacist where I got my vaccine from. They did not answer. So, I contacted my doctor and was advice to got to the ER. At the ER they did blood work, EKG, chest x-ray, and a CT scan. They diagnosed me with Pleuritic chest pain and Coryza.


VAERS ID: 1894465 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Basic cold, runny nose and drainage, cough from drainage
Preexisting Conditions: None
Allergies: Penicillins
Diagnostic Lab Data: None. Symptom began 2 hours after shot, consulted with pharmacy that issued vaccine, they recommended Benadryl and monitoring for respiratory distress. Consulted primary pediatric physician 14 hours after shot while symptom of rash persisted and they also recommended Zirtec instead of Benadryl, but same general advice to treat the symptom and monitor for fever or respiratory distress.
CDC Split Type:

Write-up: Moderate rash, red with raised white white spots, starting around midsection 2 hours after shot. Symptom abated with 5mg Children''s Benadryl, persisted into next day at time of this report with rash presenting in various places all over body. No respiratory distress.


VAERS ID: 1894470 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-24
Onset:2021-11-22
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 - / -

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: AdvAIR Diskus 250 mcg-50 mcg inhalation powder, 1 puff(s), Inhalation, bid atovaquone 750 mg/5 mL oral suspension, 750 mg= 5 mL, PO (oral), bid Auryxia 210 mg oral tablet, 210 mg, PO (oral), qDay calcium citrate, 667 mg, PO (oral), tid
Current Illness: Anemia Arthritis Back pain Cataracts, bilateral CHF (congestive heart failure) COPD (chronic obstructive pulmonary disease) Coronary artery disease Depression Diabetes mellitus GERD (gastroesophageal reflux disease) Glaucoma History of lumbar laminectomy Hyperlipidemia Hypertension Obesity, Class II, BMI 35-39.9 Obstructive sleep apnea Renal failure Renal failure (ARF), acute on chronic Tobacco user
Preexisting Conditions: Ongoing Anemia Arthritis Back pain Cataracts, bilateral CHF (congestive heart failure) COPD (chronic obstructive pulmonary disease) Coronary artery disease Depression Diabetes mellitus GERD (gastroesophageal reflux disease) Glaucoma History of lumbar laminectomy Hyperlipidemia Hypertension Obesity, Class II, BMI 35-39.9 Obstructive sleep apnea Renal failure Renal failure (ARF), acute on chronic Tobacco user
Allergies: unknown
Diagnostic Lab Data: rapid test
CDC Split Type:

Write-up: covid +


VAERS ID: 1894491 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Syncope, Vertigo, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient had episode of vertigo/syncope/emesis, patient was examined by onsite MD, patient was advised to rest and given fluids, patient recovered well and was sent home with responsible party.


VAERS ID: 1894519 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-19
Onset:2021-11-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Body temperature increased, Electrocardiogram normal, Headache, Hypertension, Pain, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: normal fatigue and low grade fever and some ringing in ears with second dose
Other Medications: MTV
Current Illness: None
Preexisting Conditions: Acute Asthma
Allergies: NKDA
Diagnostic Lab Data: Urgent care locally stated no problem with EKG or bloodwork but likely due to shot. Gave something to make bp go down
CDC Split Type:

Write-up: Booster/ Came in next Monday reported high blood pressure, night after vaccine high temp of 103 and body aches with terrible headache and ringing in the ears. This was the same as the 2nd dose but he checked his blood pressure and it was 165/120. When he came into pharmacy I checked it and it was 165/105 11/22 12:10pm. Asked patient to go to PCP or urgent care so they could look at his heart and make sure there was no pericarditis. He had no SOB or wheezing


VAERS ID: 1894524 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-10
Onset:2021-11-22
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Chest pain, Computerised tomogram abdomen abnormal, Cough, Diarrhoea, Dyspnoea, Dyspnoea exertional, Myalgia, Paraesthesia, Pericardial effusion, SARS-CoV-2 test, Sinus disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ADMISSION DATE: 11/22/2021 - 48 y/o female with history of HTN who was diagnosed with Covid-19 on 11/15 who p/w sob. The patient notes symptoms started on 11/11 with a dry cough and sinus like symptoms. She states things seemed to progress, so she was tested at Urgent Care. She received monoclonal ab on 11/18. The patient is fully vaccinated with the J&J vaccine in Sept. She notes that over the past week she has had more DOE. She also has had myalgias and diarrhea. She endorses abd pain where the injections from the monoclonal ab were, but also states she has chest pain after she tries to catch her breath from any exertion. She notes some tingling in her arms/hands as well. Imaging with ct abd/


VAERS ID: 1894558 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

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

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

Write-up: Administration error: a full 0.5mL dose was administered when a booster half dose (0.25mL) should have been administered. Patient was notified of the error.


VAERS ID: 1894559 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM

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

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

Write-up: Received booster 1 day too early


VAERS ID: 1894594 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-11-22
   Days after vaccination:300
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Work       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? 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: 11/23/2021 SARS-CoV-2, NAAT, positive.
CDC Split Type:

Write-up: Breakthrough COVID-19.


VAERS ID: 1894596 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain, Pain, Sinus congestion, Sinus disorder
SMQs:, Extravasation events (injections, infusions and implants) (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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergies, Asthma, Skin Cancer, Anxiety, Depression
Allergies: Seasonal allergies, food allergies, mold, mildew, Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fatigue, sinus issues and congestion, headache, joint pain, body aches, pain at the injections site


VAERS ID: 1894602 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-11-19
Onset:2021-11-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: KCL 10 daily Metoprolol 50 mg daily Pantoprazol 40 mg daily Lisinopril 12.5 mg daily Finasteride 5 mg daily Rosuvastatin 40 mg daily
Current Illness: None
Preexisting Conditions: Elevated cholesterol High blood pressure Impaired renal function
Allergies: no known allergies
Diagnostic Lab Data: none - contacting his PCP today
CDC Split Type:

Write-up: Following Moderna booster on 11/19/2021, he reports developing a rash and itching on 11/22/20201 on his left little finger, right hand, and above the right elbow.


VAERS ID: 1894610 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Nausea, Refusal of treatment by patient
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (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: MMR, as a child she was sick for 4 days and as an adult she got a meassle like rash from the vaccine.
Other Medications: Celexa, Abilify, Adderall
Current Illness: none
Preexisting Conditions: Asthma
Allergies: Macrobid
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient felt nauseated and wanted to throw up fifteen minutes after the vaccination. The patient did not eat breakfast or lunch and she could not throw up anything, but felt like she needed to throw up and got flushed in the face. We offered her ice cold bottled water, a cool paper towel for her forehead, and a trash can to use just in case she needed to vomit. We offered to call 911 and she and her husband refused us to call 911. We offered an epi-pen injection and she refused to be injected. She waited another fifteen minutes and got up from her chair and said that she felt much better and not nauseated anymore. She wanted to go home. Her husband drove her home.


VAERS ID: 1894631 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Voltaren gel, diltiazem 180 mg, viagra 50 mg, valtrex 1g
Current Illness: None
Preexisting Conditions: BPH, displacement of lumbar intervertebral disc, GRD, herpes labialis, Raynaud''s, sciatica
Allergies: NKA
Diagnostic Lab Data: Non
CDC Split Type:

Write-up: Pt received Pfizer pediatric dose instead of J&J vaccine. PCP will notify patient and request that they come in for correct dose.


VAERS ID: 1894638 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain, Nausea, Pain, Sinus congestion, Sinus disorder
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)

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

Write-up: Extreme fatigue, sinus issues an congestion, headache, joint pain, body aches, pain at the injection site, and nausea.


VAERS ID: 1894658 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-11-22
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

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

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

Write-up: Tested PCR positive for COVID 11/23/21 after being fully vaccinated.


VAERS ID: 1894673 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-07
Onset:2021-11-22
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: Tested NAAT positive for COVID 11/22/21 after being fully vaccinated.


VAERS ID: 1894677 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-24
Onset:2021-11-22
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, Cardiac failure congestive, Chronic left ventricular failure, Condition aggravated, Diabetic wound, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: b complex-C-folic acid o amitriptyline 11/22/21 o amLODIPine 5 mg Oral o aspirin 81 mg Oral o atorvastatin 80 mg Oral o calcium acetate (PHOSLO) capsule/tablet 667 mg Oral TID o docusate sodium 100 mg Oral BID o doxycycline 1
Current Illness:
Preexisting Conditions: Diabetes, Stage III chronic kidney disease, chronic diastolic CHF, CAD
Allergies: Morphine, morphine related medications
Diagnostic Lab Data: 11/22/21 COVID-19 Result Detected Abnormal
CDC Split Type:

Write-up: 11/10-11/22/21 Pt was admitted to hospital for acute onset of chronic diastolic CHF and right foot diabetic wound. She was tested for COVID 19 before being transferred to a rehab facility. Her test came back positive, patient is asymptomatic. The patient remains in the hospital as case management works on placement in a rehab facility which will take COVID positive patients.


VAERS ID: 1894685 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 3 RA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Headache, Hypoaesthesia, Immediate post-injection reaction, Pain in extremity, Palpitations, Pyrexia, Sensory disturbance, Tinnitus, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna Covid vaccine April 2, 2021 (second dose) 4 days of adverse symptoms Age: 21
Other Medications: acidophilus
Current Illness: None
Preexisting Conditions: None
Allergies: Ampicillin, Flagyl. Cat and rabbit dander. Alternaria mold.
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had four days of adverse effects when I got the Moderna vaccine in April 2021. So I decided on the Janssen for my booster. My arm began hurting a lot almost immediately. By 8 p.m., I had a severe headache and took Tylenol, but it did not relieve the pain. At 11:30, I started throwing up. After I threw up six times, my heart began racing, my fingers lost all feeling, my head felt like knives were stuck in it, and my ears were ringing with a staccato sound. I had 103.5 degree fever. I called the emergency room, and they said to come in if I continued to have these symptoms an hour later. My fever went down to 102 by mid-morning the next day, and finally to 99 degrees at 2:30 p.m. the following day. My head still hurts and I have a metallic taste in my mouth.


VAERS ID: 1894689 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-19
Onset:2021-11-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: 3 days after receiving vaccine patient experienced hives on her chest, shoulders, and back. The hives have worsened over time.


VAERS ID: 1894746 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Nosebleeds


VAERS ID: 1894762 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Immediate post-injection reaction, Incorrect dose administered, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin
Current Illness: None
Preexisting Conditions: Esotropia of left eye
Allergies: NKDA
Diagnostic Lab Data: none, pt was watched in clinic after examined by Dr.
CDC Split Type:

Write-up: Pt was given 0.3ml of Pfizer adult dose, rather then childs dose. Pt immediately vomited


VAERS ID: 1894781 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / N/A LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid Pfizer 2nd dose
Other Medications: Claritin (allergy), Biotin, Vitamin D, Glucosamine Chondrotin, Multivitamin, Krill Oil.
Current Illness: None
Preexisting Conditions: Obesity
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body ache, chills, headache, fatigue. Taking Tylenol.


VAERS ID: 1894844 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Eye swelling, Feeling abnormal, Injection site pain, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin, Diltiazem ,metoprolol, morphine, Penicillin, Percocet, Tessalon Perles, Tramadol Doxycycline, gentamyacin, Levaquin
Diagnostic Lab Data: unknown what was done in the ER
CDC Split Type:

Write-up: While waiting after her booster shot Pt started feelin "funny" Her eyes felt like they were swelling and also her face. I was called in and she had no redness or edema around her eyes or face and she denied any SOB or feeling that her throat was swelling. Her vitals were all WNL and her oxygen sat was 98% .Because of her long history of adverse reactions to medications the decision was made to give her 50mg of Benadryl orally. She tolerated this well and said 10 minutes later that her face and eyes felt better but then at the 15 minute mark she C/O chest discomfort and a funny feeling around her eyes. Her B/P was 178/72 but no SOB. The ambulance was called and she was taken to the ER locally. She was released a few hours later and her daughter said "everything turned out OK. I called the next day and she was feeling well except for a sore arm at the injection site.


VAERS ID: 1894850 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-04
Onset:2021-11-22
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic 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? 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: Fully vaccinated with COVID breakthrough infection. Asymptomatic test with inpatient hospital stay.


VAERS ID: 1894860 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-15
Onset:2021-11-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Electroencephalogram, Generalised tonic-clonic seizure, Magnetic resonance imaging
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: MRI 11/23/2021 EEG 11/23/2021 Ct scan 11/22/2021
CDC Split Type:

Write-up: Grand Mal Seizure 1 week after vaccine


VAERS ID: 1894881 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-18
Onset:2021-11-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7335MA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aspartate aminotransferase increased, Brain natriuretic peptide increased, C-reactive protein increased, Chest X-ray normal, Chest pain, Dyspnoea, Echocardiogram, Echocardiogram normal, Ejection fraction normal, Electrocardiogram normal, Fibrin D dimer, Full blood count, Haematocrit decreased, Neutrophil count decreased, Platelet count normal, Red blood cell sedimentation rate normal, Respiratory viral panel, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Troponin I increased, Troponin increased, Ultrasound scan normal, White blood cell count decreased
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: October 2021: 1 day of malaise, headache, and bellyache December 2020: positive COVID test
Preexisting Conditions: Healthy and immunized
Allergies: No known
Diagnostic Lab Data: 11/22/21 US showed no pericardial effusion, EF grossly ok. Troponin $g2.6 (nl <0.03) and BNP 118; AST 51. CXR clear. Trop I HS 6,256 BNP 111 CRP <2.9 CBC: WBC 4.26, Hct 35.5, plt 177, ANC 1680 ESR 10 D-dimer 0.3 RVP negative Covid pcr negative Covid antibody positive ECG: normal Echo: normal 11/23/21 At DCH: Trop I HS 3,998 Trop I rand 3,262
CDC Split Type:

Write-up: Chest pain, shortness of breath


VAERS ID: 1894889 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chills, Echocardiogram, Electrocardiogram normal, Fatigue, Heart rate irregular, Tachycardia, Ultrasound scan normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiac arrhythmia terms, nonspecific (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamins
Current Illness: coughing
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CTI- Blood test - Ultrasound for the heart- ECG All test was good
CDC Split Type: vsafe

Write-up: heart rate went over 120 BPM and its called tachycardia- felt my heart is not beating properly chills fatigue admitted me in the hospital-a day/one night The doctors said the my heart is is perfect condition and what happened may be a result of the booster shot or other unknown casues.


VAERS ID: 1894899 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Headache, Lymphadenopathy, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Starting the next morning I had Chills, 99 temp, nausea, arm hurt (from top of shoulder to my fingers) and a general feeling of just not feeling good, the next day a little better, but a horrible headache, pain in under arm (lymph node I think), and 99 temp


VAERS ID: 1894903 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hyperhidrosis, Loss of consciousness, Muscular weakness, Thirst
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: Keppra 500mg twice a day, amitriptyline 50mg once a day
Current Illness: None
Preexisting Conditions: Asthma, epilepsy
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Exactly 13 hours after booster shot, I went to get water because I was extremely thirsty and had already drank 48 ounces of water between 10pm-1am. Shot at 12:07pm and black out at 1:07am. Once I filled up the water my knees started buckling, I grabbed the counter and blacked out completely. My boyfriend woke me up as I was laying face down on the living room floor. I kept falling in and out of consciousness for a few minutes. Established I was sweating from head to toe. Got in a shallow cool bath to regulate body temperature.


VAERS ID: 1894910 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK2157 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Given a Pediatric dose of the vaccine for 5-11 and patient is 14


VAERS ID: 1894911 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, Calcium-Magnesium, Zyrtec, Bentyl, Similase, Ibuprofen, Lidocaine, Melatonin, Cortisol, Singulair, Multivitamin, Omeprazole.
Current Illness:
Preexisting Conditions:
Allergies: Benzoin compound, NSAIDs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received COVID-19 vaccine on 11/22/2021 that had been reconstituted on 11/19/2021; so vaccine was out of 6-hour use range.


VAERS ID: 1894935 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK2157 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient got a pediatric dose for 5-11 and needed a regular dose 12 and up


VAERS ID: 1895112 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No illness
Preexisting Conditions: Data was not asked
Allergies: No known allergies
Diagnostic Lab Data: No lab work done. He just waited to come to the pharmacy to show it to us.
CDC Split Type:

Write-up: Patient had the Pfizer 1st dose on Sunday 11/21, he came to the pharmacy on Tuesday 11/23 complained of bleeding, he showed me the injection site, it looked red, tendeness, indentation, bleeding when he squeezed the surrounding areas. He said the skin arround the injection site was harden.


VAERS ID: 1895113 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Menstrual disorder, Menstruation irregular, Mobility decreased, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Fertility 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: No
Current Illness: No
Preexisting Conditions: N/A
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Menstrual cycle completely out of sync; have been hormonally grossly imbalanced since my anticipated period on the 1st of November (incidentally the same date of my first intramuscular vaccine injection). An irregular period has never happened to me in my life. I got a fever of 101 degrees F which has persisted to this moment; my arms were so debilitatingly sore I can no longer lift them up.


VAERS ID: 1895314 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Erythema, Injection site warmth, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: patient got booster dose of moderna on Saturday. Monday began experiencing redness, swelling, pain shooting to fingertips, hot to touch at the injection site. she was advised to see her physician by us. She had appointment and was confirmed cellulitis. patient was given antibiotic


VAERS ID: 1895318 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 59676-0580-15 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Feeling hot, Grip strength decreased, Hyperhidrosis, Impaired work ability, Insomnia, Limb discomfort, Pain, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (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: Zyrtec allergy day of Recoils green tee Friday before no sore throat or cough benefits
Current Illness: Not in the month within the year yes
Preexisting Conditions: Allergies, heart murmur
Allergies: Tomato sauce, dr. pepper, fig, pine tree plants, dust, cats, roaches, bee can be severe!
Diagnostic Lab Data: Shots tend to have unique. Seeing if temp raises and energy returns with strength. Needs time. Affect job
CDC Split Type:

Write-up: Warm flowing to fingers and neck. Like drinking soap warm and movement. Sharp pain in joint of hand. Drop in strength within a half hour. Drop in temperature 89. Shivered but sweeting. Pain and warm feeling stay day later not improving 24h later. Even holding s iPhone feels Unsecure in an awkward heavy feeling. Sleepy tingling feeling in arm. Most aches and pains are to the left side only. Fatigue and unable to sleep for long periods of time. Unable to put any pressure on the area. Even clothing being removed or added notice a increase of uncomfortable. Temperature next day 96


VAERS ID: 1895331 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Feeling cold, Gait disturbance, Pain, Skin warm
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Patient called the pharmacy on 11/23 and reported the following after receiving her second Moderna dose on 11/22: feeling cold, hot to touch, tired and achy, trouble breathing, difficulty walking. Pharmacist on duty recommended following up her physician.


VAERS ID: 1895540 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 2 LA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Interchanging COVID vaccine from mRNA to Janssen


VAERS ID: 1895551 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 5000IU vitamin D3 daily Women?s Multivitamin daily Propranolol 20 mg PRN
Current Illness:
Preexisting Conditions: Anxiety, IBS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient (myself) experienced tachycardia from 11pm-10am beginning the day of receiving a booster dose of the Pfizer vaccine. Average heart rate measured 130-150bpm via radial pulse. Patient did not have chest pain, shortness of breath, signs of anxiety or panic attack, or any other symptoms related to a fast heartbeat. The patient took a single 20mg dose of propranolol at 2:30am which is used for as-needed anxiety. The patient had no measurable decrease in heart rate with medication. The tachycardic episode resolved after 10am.


VAERS ID: 1895557 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Paraesthesia, Peripheral coldness, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Influenza made very sick (fever, dehydrated, headache, couldn''t eat)
Other Medications:
Current Illness: none reported
Preexisting Conditions:
Allergies: Ibuprofen causes hives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated without incidence on 11/22/21 in the vaccination center (including her 15 minute post-vaccination wait time). She came back to the center later in the afternoon complaining of hives and pruritis bilaterally on the medial thighs and that her left arm (vaccinated) was tingling and cold down to her fingers. She denied having a swollen tongue or difficulty breathing. Reported allergy to ibuprofen where she develops hives. No previous problems with other vaccines other than getting "very sick" after a flu shot (described as fever, couldn''t eat, dehydration, headache). I felt her hands and the left was colder to the touch than the right. Advised to her call employee health - she did so in the center and was advised to go to the emergency department for further evaluation. Pt left the center to go to the ED.


VAERS ID: 1895711 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / N/A RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Chills, headache, vomiting for 24 hours after booster shot.


VAERS ID: 1895726 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Atenolol, lisinopril-hydrochlorothiazide, aspirin
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chills, shaking lasting about 90 minutes. Symptoms stopped about 30 minutes after one dose of acetaminophen.


VAERS ID: 1896519 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Nausea, Syncope, Tinnitus
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient felt nauseous and then fainted for a few seconds. She woke up with dizziness and ringing in her ears. I kept monitoring her. I asked her if she had any trouble breathing. Patient said she just felt tired, dizzy and had ringing in her ears. Her symptoms started to resolve after 5 minutes. She finally felt 100% better after about 20 minutes. She left home with her mom. She declined for us to call 911 because she said this happens most of the time when she gets shots.


VAERS ID: 1896539 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-13
Onset:2021-11-22
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

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

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

Write-up: Significant rash and swelling at injection site (left arm) approximately 9 days after orange cap dosage for 7 year old


VAERS ID: 1896761 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064F21A / 3 LA / IM

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

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

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


VAERS ID: 1896781 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1896783 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Public       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto, lisinopryl, Lipitor, cardizem
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever


VAERS ID: 1896787 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Gait disturbance, Interchange of vaccine products, Pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Medication errors (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: See description in aforementioned vaccine info
Other Medications: Vitamin c Zinc Paxil 12.5 mg Vitamin d
Current Illness: None
Preexisting Conditions: None
Allergies: PCN, sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe Throbbing and stabbing pain and major joints including wrists, elbows, and knees. Severe sharp and burning pain from the scalp of the head all the way down to the ankles. Limited ability to walk and support self. Began at approximately 5 PM on the day of vaccine and continued in severity through approximately 12 noon the following day. Symptoms were treated with Motrin and heat. Please note that I received the Moderna series 1st with the last injection in January 2021. I opted to try the Pfizer vaccine for the booster because I had the same reaction with Moderna back in January. I was hoping to have a lesser reaction with the Pfizer


VAERS ID: 1896792 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache
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: headache pizer second shot 4/1/2021
Other Medications: cq-10100mg metformin 500mg jardiance 10mg lisinopril 20mg astrovastatin 20mg vitamin d 5000iu
Current Illness: none
Preexisting Conditions: none
Allergies: farciga hives
Diagnostic Lab Data: none
CDC Split Type:

Write-up: headache about 2 hours after booster shot this occurred with the second shot as well the headache was gone by the next morning


VAERS ID: 1896802 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-19
Onset:2021-11-22
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Chills, Cough, Decreased appetite, Diarrhoea, Dyspnoea, Headache, Hyperhidrosis, Malaise, Nausea, Pyrexia, Respiratory tract congestion, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: a 46 y.o. female with history of COVID vaccination with 4 days of COVID symptoms. Notes HA. N/V/Diarrhea/anorexia. Notes f/c/sweats. SOA/Cough/congestion. Admitted to hospital for COVID 19 pneumonia.


VAERS ID: 1896810 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Eye swelling, Fatigue, Headache, Hypersensitivity, Injection site bruising, Injection site erythema, Injection site pain, Lethargy, Mouth swelling, Oedema peripheral, Pain, Pharyngeal swelling, Swelling face, Swollen tongue
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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), Hypoglycaemia (broad)

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Headache-Medium, Additional Details: PATIENT REPORTS SHE HAD NECK BRUISING AND THROAT /UNDERARM SWELLING WHICH STARTED THIS MORNING ON 11/23/21. SHE CONFIRMED THAT SHE HAD NOT TAKEN ANY MEDS YET. RECOMMENDED TAKING OTC PAIN MEDICATION FOR PAIN AND SWELLING


VAERS ID: 1896969 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0641A21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Heart rate increased, Injection site pain, Injection site swelling, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna Dose 1,2; Shingles Dose 2
Other Medications: Vitamins D, B12, algae omega
Current Illness: None
Preexisting Conditions: Borderline hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site pain, swelling- 4 hours, Headache, fast heartbeat, chills - 12 hours, Low grade fever 99.7 - 100.2- 15 hours, Nausea - 18 hours, Vomiting, 1 time - 21 hours No treatment All resolved by 24 hours


VAERS ID: 1896971 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Headache, Impaired work ability, Pain, Vaccine positive rechallenge
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: daily multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: After my second and third dose, I experienced extreme fatigue, body aches and headache. It started a few hours after the injection and lasted for about 24-36 hours straight. I was unable to work or do anything really except lay in bed and wait for it to go away.


VAERS ID: 1896975 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

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

Write-up: noticed swelling under left arm about 33 hours after injection on same side. Underarm area is very painful, requiring tylenol (I cannot take nsaids) and preventing me from sleeping on that side. Still painful and swollen 36 hours after first appearance.


VAERS ID: 1896980 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Pain
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Systemic: Chest Tightness / Heaviness / Pain-Medium, Additional Details: Chest pain-felt like getting vaccine in chest area/breast last night (pinch/stabbing pain) and then changed to more of a dull pain today. pain scale 5 and now dropped to 3


VAERS ID: 1896990 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058FZ1A / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Dizziness, Headache, Lymph node pain, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirtazapine 30mg, quetiapine 25mgx2, propranolol 20mg, albuterol HFA as needed, acetazolamide 250mgx3, cimetidine 400mgx2, nexplonon 68mg implant
Current Illness: Headaches
Preexisting Conditions: Asthma, idiopathic intercranial hypertension, smoker, headaches.
Allergies: Nickel, Zoloft
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Upset stomach, dizziness, chills, headache. 4:45pm 11/22/2021 until 5am 11/23/2021. Arm pain with golf ball sized lump 11/23/2021- current 11/24/2021- pain is spreading to armpit lymph nodes.


VAERS ID: 1896997 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazadone, melatonin, restasis, Mucinex
Current Illness: I had a cold at the time of vaccination. I had treated negative for covid on a rapid test
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had a slightly painful rash on my left buttock. It lasted about a day and then improved on its own.


VAERS ID: 1896998 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-28
Onset:2021-11-22
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Chronic obstructive pulmonary disease, Respiratory syncytial virus infection, SARS-CoV-2 test positive
SMQs:, 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), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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 admitted as inpatient on 11/22 due to acute respiratory failure with hypoxia, suspect 2/2 COPD exacerbation d/t RSV/COVID. Patient was tested for COVID-19 and was positive on 11/22.


VAERS ID: 1897001 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-11-22
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

Administered by: Public       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? 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: hypothyroidism, hypertension, COPD
Preexisting Conditions: hypothyroidism, hypertension, COPD
Allergies:
Diagnostic Lab Data: covid + 11/22/21
CDC Split Type:

Write-up: breakthrough case


VAERS ID: 1897013 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chills, Extra dose administered, Headache, Injection site pain, Insomnia, Lymphadenopathy, Night sweats, Pain, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar side effects with the first two Covid-19 Pfizer vaccinations, with exception to the swollen lymph nodes occurring this t
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Pineapple
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The arm began to feel sore roughly 6 hours after injection. At approximately 10pm, took Tylenol and went to bed but had a tough time sleeping that evening, suffering from chills mostly. In the morning, woke with a headache, sore arm and body aches; had the day off from work so took it easy all day. By mid afternoon the day after receiving the booster, had a fever of 100.2, body aches, some tightness in his chest, and headaches throughout the remainder of the day; took ibuprofen on this day and it seemed to help temporarily with the arm pain. Went to bed that night and suffered from night sweats, woke the next morning to a very sore injection site and swollen lymph nodes in the left armpit. At the point of writing this information, it is the start of the third day after receiving the booster and he is still complaining of off and on chills & headaches, soreness throughout the body and swollen lymph nodes under the left arm.


VAERS ID: 1897021 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: High grade fever, stomach pain, and chills


VAERS ID: 1897022 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: headache, body aches Moderna 4/14/21
Other Medications: lisinopril, omeprazole, Synthroid, zoloft, vit D3, vit c, CoQ10, fish oil, krill oil, L-arginine, biocell collagen, bio complete 3
Current Illness: allergies, sinus
Preexisting Conditions: mctd
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, fever,body aches


VAERS ID: 1897027 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 2 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7384KA / N/A RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: migraine headaches, complex regional pain syndrome, OSA, DVT, morbid obesity, hyperlipidemia, Factor V Leiden, Roux En Y status post, TBI, Insomnia, Generalized anxiety D.O., Depression,
Allergies: animal dander (RUNNY NOSE), quinoa-kale-hemp, tree and shrub pollen, grass pollen, clindamycin, erythromycin (RASH/HIVES), povidone-iodine (BURN), fish, seafood, colored dyes, iodine contrast media, penicillins (ANAPHYLAXIS)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Due to h/o anaphylaxis was observed for 30 minutes post COVID vaccine. Received both COVID and flu vaccines. 10 minutes into observation reported generalized itching (arms, legs, back). Skin assessed. NO visible rash/hives/edema noted. Throat inspected. No edema noted. No complaints from pt. Benadryl 25mg self-administered after 20 minutes. VS obtained and stable. released at 30 minutes post.


VAERS ID: 1897036 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-01
Onset:2021-11-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Chills, fever, muscle aches and joint aches, nausea and severe headache


VAERS ID: 1897044 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Chills, Condition aggravated, Fatigue, Feeling abnormal, Headache, Hyperhidrosis, Injection site pain, Insomnia, Lymphadenopathy, Nausea, Night sweats, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar side effects with the first two Covid-19 Pfizer vaccinations, with exception to the swollen lymph nodes occurring this t
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: My arm began to feel sore roughly 6 hours after injection. Around 10pm, I took Tylenol and went to bed but had a tough time sleeping; I recall waking just after midnight soaking wet from sweat (abnormal for me). In the morning, I woke with a bad headache and sore arm so I took ibuprofen which seemed to work well; had the day off from work so took it easy all day. Went to bed early that night and slept a little better, but woke the next morning to a very sore injection site and swollen lymph nodes in the left armpit. I went to work on the second day after receiving the booster and felt poorly hard to pinpoint any main complaint, but felt pain in my shoulders, stomach pains, headache, fever, off and on chills, fatigue, and nauseous; I went to bed around 9pm last night and again suffered from night sweats. At the point of writing this information, it is the start of the third day after receiving the booster and my main complaint is of swollen lymph nodes under the left arm; there is also some mild pain at the injection site and an occasional headache. I have not notified a doctor at all since my husband and I are both dealing with similar side effects. From everything I have heard from others who received this booster, or been able to find online, we have not experienced anything abnormal. I would just like to mention that Pfizer''s 3rd dose has had the most negative effects on myself and my husband; we are both healthy, with no underlying health concerns, and have not had Covid-19 to our knowledge.


VAERS ID: 1897048 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Body aches, chills, headache, fatigue Age 67 Date received 4/1/2021 Pfizer 2nd dose - shot in left arm
Other Medications: Ramipril Excedrin
Current Illness: None
Preexisting Conditions: Controlled high blood pressure
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 1) All over body aches 2) Headache. 3)Chills. 4) Fever ( 100.6.). 5) Nausea


VAERS ID: 1897059 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066H21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: swollen lymphnode in underarm after flu shot this year on same side as shot
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, body ache (primarily back) - started ~ 10 hours after injection; almost fully resolved by day 2 after injection sore injection site, swollen injection site, red injection site - slight improvement 2 days after injection site but not resolved yet


VAERS ID: 1897077 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-24
Onset:2021-11-22
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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


VAERS ID: 1897082 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-11-22
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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


VAERS ID: 1897087 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-30
Onset:2021-11-22
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Exposure during pregnancy, Induced labour, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH/Chronic conditions include gestational HTN, insulin dependent gestational diabetes, obesity.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets criteria for vaccine breakthrough review. No noted COVID SxS. Admitted to L&D for induction; incidentally screened COVID+. Not yet given birth at time of report.


VAERS ID: 1897088 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chills, Condition aggravated, Cough, Decreased appetite, Fatigue, Headache, Injection site pain, Injection site swelling, Musculoskeletal stiffness, Oxygen therapy, Pain, Visual impairment
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (broad), Respiratory failure (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: Zoloft, Probiotic, APAP, naproxen, ibuprofen
Current Illness: Dx positive COVID19 on 09/30/2021; spent 12 days in hospital with COVID19 pneumonia, anxiety, Leukocytosis, Thrombocytopenia, acute respiratory failure, current oxygen use, thick white sputum and nasal discharge with specks of yellow/green, clear runny nose, cough.
Preexisting Conditions: Occupational asthma, hay fever, Hx bronchitis & pneumonia, GERD, anxiety.
Allergies: Thimerosol, narcotics, surgical skin prep, ASA, mold, hay fever, dairy intolerance
Diagnostic Lab Data: 11/22/-21 1800 through 11/24/2021 (0600) pulse oxymeter; oxygen saturation 85-88% on room air.
CDC Split Type:

Write-up: sore swollen upper left arm, body wide stiffness & aches, increased coughing , body wide chills, low grade temperature (96.1), headache, exhaustion, feeling chest heaviness, SaO2 85-88% on room air, no appetite, change in vision. I had to start using my oxygen (1L) again from night of 11/22/21 until mid morning of 11/24/2021. I have previously been off oxygen per nasal cannula during the day since 10/11/2021 and using oxygen at night until 11/14/21.


VAERS ID: 1897125 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-29
Onset:2021-11-22
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

Administered by: Unknown       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? 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: covid+ test
CDC Split Type:

Write-up: covid vaccine breakthrough case


VAERS ID: 1897142 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006021A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Disorientation, Dizziness, Fatigue, Nasopharyngitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (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: Sore arm following the first Moderna Covid 19 injection. Age 81 when injected on 01/12/2021. Moderna lot 013L20A. No further rea
Other Medications: Losartan 25mg, Terazosin 5mg, Finasteride 5mg, Multi Vitamin, Baby Aspirin, Vitamin D3 1000 IU, Calcium +D3 500/400, Glucosamine/Chondroitin.
Current Illness: None. Had Flu shot one month prior.
Preexisting Conditions: Kidney disease, Blood pressure monitoring following Open Heart surgery with 5 bypasses 6/2015.
Allergies: MSG, Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Cold, Disoriented, Dizzy, Fatigue, Chest discomfort starting the evening after the injection and continuing the day after until late that evening . All issues resolved starting the evening of 11/23.


VAERS ID: 1897157 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C; Calcium chews; IC Albuterol HFA ProAir inhaler (as needed)- not used since refilled in April 2021.
Current Illness: N/A
Preexisting Conditions: Acid reflux; cough variant asthma;
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Received Pfizer booster. Order of side effects- sore left arm Nov. 21 and 22nd, fatigue/tiredness and headache;Nov. 22 late morning and fever evening 101.4. Fever record: Nov.22nd 6 p.m.: 101.4 8.p.m. :99.1 (aspirin) 9:30 p.m.: 99.2 ( took aspirin) Nov. 23 (called off from work) 7.a.m. : 99.1 9 a.m.: 99.4 (asprin) 1 p.m.:99.1 4:15 p.m.: 99.4 8:20 p.m. : 100.1 (aspirin) Nov.24 : 6:15 a.m. 98.5 (feel better) no fever


VAERS ID: 1897160 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 RA / 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? 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: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine stored in fridge starting on 10/20/2021. According to the manufacturer it is good to be stored in the fridge for 31 days. The expiration date of 31 days was on Saturday, 11/20/2021. The dose was drawn up and given. After dose was given and paperwork was being filled out, the vaccine administrator realized that the dose was technically past the 31 day mark. Patient notified and told that they would be contacted about next steps or if a repeat dose would need to be given once the manufacturer was contacted. Pfizer was contacted and advised that they had no data related to this type of event and that we shouldn''t do anything until a form was filled out and a representative from Pfizer contacted us. We are currently waiting on that information.


VAERS ID: 1897162 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Balance disorder, Gait disturbance, Hypotension
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN AMIODARONE AMLODIPINE ATORVASTATIN CLOPIDOGREL DIGOXIN DULOXETINE ELIQUIS GABAPENTIN lamotrigine lisinopril magnesium oxide METFORMIN METOPROLOL NTG SL PRN NOVOLIN 70/30 NOVOLIN R SERTRALINE TAMSULOSIN VITAMIN D3
Current Illness: WHEN EVALUATED BY PROVIDER FOR COMPLAINTS, HE ADMITTED TO BEING LIGHTHEADED, DIZZY AND LOW PULSE FOR A WHILE PRIOR TO VACCINE. REPORTS FALLING AND HEADACHES, AS WELL, PRIOR TO VACCINE.
Preexisting Conditions: ATRIAL FIB HYPERLIPIDEMIA ISCHEMIC CARDIOMYOPATHY HEMIPLEGIA AND HEMIPARESIS FOLLOWING CVA LEFT SIDED WEAKNESS NEUROPATHY PULMONARY EMBOLUS AND THROMBOSIS OF OTHER SPECIFIED DEEP VEIN OF LEFT LOWER EXTREMITY DIABETES II HYPERTENSION
Allergies: SHELLFISH NEOSPORIN AF
Diagnostic Lab Data: VITAL SIGNS. TRANSFERRED TO LOCAL HOSPITAL FOR FURTHER EVALUATION AND WORK UP. LOCAL HOSPITAL TRANSFERRED PATIENT TO DIFFERENT HOSPITAL
CDC Split Type:

Write-up: STATES INABLITY OF NOT BEING ABLE TO MAINTAIN HIS BALANCE OR WALK STEADILY. DOES HAVE H/O L SIDED WEAKNESS POST CVA. HYPOTENSION PER VITAL SIGNS. HEADACHES, LIGHTHEADEDNESS, AND LOW PULSE COMPLAINT PRIOR TO VACCINE. UNSURE SYMPTOMS ARE VACCINE RELATED VS CHRONIC ILLNESSES.


VAERS ID: 1897172 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Headache, Pain, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi Vitamin - Men over 50
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: This was my booster. I had swelling in my left arm for 3 days, fever, body ache and headache


VAERS ID: 1897179 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-09
Onset:2021-11-22
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

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

Write-up: Patient vaccinated against and then tested positive for COVID19


VAERS ID: 1897191 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWD185 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Feeling cold, Injection site pain, Nausea, Sleep disorder
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: multivitamin sertraline 12.5mg trazadone 25mg junel fe
Current Illness: none
Preexisting Conditions: slight hypoglycemia
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm was sore at the injection site, but around bed time (~10pm) it became so sore I described it as feeling as though I was stabbed in the arm with a knife, or hit with a bullet it was so painful. Around the same time, my body temperature became so cold I had to layer clothes. Normally I sleep in shorts and a t-shirt, but I put on sweat pants, a sweat shirt and socks, sleeping under two blankets, and I was still shivering. The next day this coldness continued, and I added another layer on top and a knit hat. I felt tired apart from the poor sleep, and a little nauseous at times. My appetite was reduced. I finally took my temperature in the afternoon on Nov 23 and it was 99.8. This elevated temperature continued until Nov 24 when I returned to normal.


VAERS ID: 1897193 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Decreased appetite, Fatigue, Headache, Heart rate increased, Immediate post-injection reaction, Injection site pain, Limb discomfort, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Age 3 or 4; stiffness in legs and unable to walk, fever, body aches and pains, overall feeling unwell after tetanus vaccine
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to tetanus vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine received approx 8:40 am, heavy arm feeling started immediately; other side effects started approx 1:00 pm same day. Side effects include: fast heart rate, injection site pain, extreme tiredness, moderate headache, joint pain, fever of 102� that occurred two separate times between 1:00 pm and 11:00 pm, overall feeling unwell, decreased appetite, body aches and pain Side effects last until approx 3:00 pm 11/23/2021


VAERS ID: 1897194 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-06
Onset:2021-11-22
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 RA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1897240 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: suspected COVID 19
Preexisting Conditions: childhood obesity
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was given an adult dose of Pfizer that was diluted using 1.3mL of sodium chloride and drawn up to administer a 0.2mL dose. Patient was observed for 15 minutes with no signs of allergic reactions. Patient''s parents were contacted by Dr. and they report only injection site soreness.


VAERS ID: 1897244 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 RA / IM

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

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

Write-up: Patient is an 11 yo child accompanied by his mother to a vaccine Clinic. This patient was administered the Moderna Booster dose of 0.25cc instead of the intended Pfizer pediatric dose for his age. Error identified after 15minute observation at exit. There were no adverse symptoms reported prior to exit from clinic and follow-up at 48 hours confirmed by patient''s mother that child has not had any symptoms develop since vaccination. Plan for scheduling second dose for Pfizer pediatric at 28 days per CDC recommendations.


VAERS ID: 1897246 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-02-03
Onset:2021-11-22
   Days after vaccination:292
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Inappropriate schedule of product administration, SARS-CoV-2 test positive
SMQs:, Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: morphine
Diagnostic Lab Data: 11/22/2021 positive COVID-19 PCR test result
CDC Split Type:

Write-up: Hospitalization with COVID-19 following COVID-19 vaccination. Vaccinated with Moderna COVID-19 vaccination on 2/3/2021 and 3/4/2021.


VAERS ID: 1897256 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-02
Onset:2021-11-22
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Impaired self-care, SARS-CoV-2 test positive
SMQs:, Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient was admitted to HCF on 11/22/2021 as observation due to weakness and inability to care for herself at home. Patient was tested for COVID19 prior to hospitalization which returned positive.


VAERS ID: 1897264 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-11-09
Onset:2021-11-22
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood chloride, Brain natriuretic peptide, Computerised tomogram head, Differential white blood cell count, Dizziness, Electrocardiogram, Full blood count, Metabolic function test, Nausea, Sinusitis, Troponin I
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg Oral EVERY 6 HOURS PRN 650 mg Oral 3 TIMES DAILY Allopurinol 300 mg Oral DAILY Amiodarone HCl 200 mg Oral DAILY Apixaban 5 mg Oral 2 TIMES DAILY Aspirin 81 mg Oral DAILY Atorvastatin Calcium 40 mg Oral DAILY C
Current Illness: Type 2 diabetes mellitus with other circulatory complication, without long-term current use of insulin E11.59 ASHD (arteriosclerotic heart disease) I25.10 Chronic diastolic congestive heart failure I50.32
Preexisting Conditions: Hypertension I10 Congestive heart failure I50.9 Hx of CABG Z95.1 Type II diabetes mellitus E11.9 DJD (degenerative joint disease), lumbar M47.816 Lumbosacral spondylosis without myelopathy M47.817 CAD (coronary artery disease) I25.10 Cardiac murmur R01.1 Obesity E66.9 Dyslipidemia E78.5 Proteinuria R80.9 Bilateral carotid artery stenosis I65.23 Recurrent major depressive disorder, in partial remission F33.41 Chronic narcotic dependence F11.20 Chronic diastolic left heart failure, NYHA class 2 I50.32 Allergic rhinitis J30.9 Esophageal reflux K21.9 Gouty arthropathy M10.9 Insomnia G47.00 Osteoarthrosis M19.90 Restless legs syndrome G25.81 Chronic back pain M54.9, G89.29 Carcinoid tumor of abdomen D3A.098 Facet degeneration of lumbar region M47.816 ASHD (arteriosclerotic heart disease) I25.10 Degeneration of lumbar intervertebral disc M51.36 Spinal stenosis of lumbar region M48.061 Pain management contract signed Z02.89 S/p TAVR (transcatheter aortic valve replacement), bioprosthetic Z95.3 Need for SBE (subacute bacterial endocarditis) prophylaxis Z29.8 TIA (transient ischemic attack) G45.9 Atrial flutter I48.92
Allergies: Tetanus antitoxin Clindamycin
Diagnostic Lab Data: EKG 12-lead 1302 Comprehensive metabolic panel CBC and differential Troponin I Pro B-Type Natriuretic Peptide 1310 Sodium Chloride 500 mL 1343 CT Head or Brain wo Contrast
CDC Split Type:

Write-up: Weakness. Dizziness. Nausea. Sinusitis


VAERS ID: 1897279 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-27
Onset:2021-11-22
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chills, Dizziness, Headache, Laboratory test, Malaise, Pain, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Migraine medication - zomeg, birth control, adderall
Current Illness:
Preexisting Conditions: Migraine, ADHD
Allergies: Ancef and amoxicillin
Diagnostic Lab Data: Chest xray and labs on 11/24
CDC Split Type:

Write-up: After vaccine - normal body aches, headache. 14 hours after vaccine had a syncopal event. Dizziness afterwards, Feeling unwell afterwards with subjective fever and chills.


VAERS ID: 1897284 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient came to the counter and complained that her "throat is tighter than normal." I instructed her to remain an additional 15 minutes (30 min. total). I provided her with water and 25mg diphenhydramine. At the end of her 30 minute wait, she stated her throat was still feeling tight, but there was no additional swelling or difficulty breathing. She stated she was going to the Urgent Care across the street to get checked out.


VAERS ID: 1897288 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: A booster dose was administered instead of 2nd dose on 11/22/2021. Pt was made aware of error and dose was repeated on 11/24 according to cdc guidelines


VAERS ID: 1897296 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zyrtec 10mg, zyzal 5mg, acetaminophen 500mg
Current Illness: none
Preexisting Conditions: none
Allergies: latex, bananas, seafood
Diagnostic Lab Data: none
CDC Split Type:

Write-up: hives on torso, arms, and legs. Soreness to injection site


VAERS ID: 1897306 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications being taken at the time of the medication
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient experienced a fever (101.3 F), substantial nausea and vomiting. Starting approximately 10 hours post vaccination.


VAERS ID: 1897312 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-04
Onset:2021-11-22
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

Administered by: Public       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? 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: Covid + on 11/22/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1897337 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

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

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

Write-up: No adverse event. Vaccine was administered ~1 hour after expiration time. (Vaccine diluted at 0850 and expired at 1450 and was drawn up at the time of the appointment) Vaccine was administered at 1600. Our Medical director reached out to Pfizer about the stability of vaccine - they said treatment recommendations is the discretion of the provider.


VAERS ID: 1897354 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-11-22
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Hypoxia, Pyrexia, Respiratory tract congestion
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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presents and is admitted to a local hospital with cough, congestion, fever, and shortness ofbreath. Hx of copd. States she is vaccinated for covid 19. Hypoxic on ems arrival in the 60s. 84% on room air


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