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

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



Case Details (Reverse Sorted by Onset Date)

This is page 49 out of 8,010

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VAERS ID: 1775987 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / UNK - / OT

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

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

Write-up: Received an expired dose; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Received an expired dose) in a 30-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048F21A) for COVID-19 vaccination. No Medical History information was reported. On 02-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Received an expired dose). On 02-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Received an expired dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medication was not reported. Treatment information was not reported.


VAERS ID: 1775988 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site induration, Vaccination site mass, Vaccination site pain, Vaccination site warmth
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE; FOLIC ACID; VITAMINS NOS
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Red hot hard lump on the right of the injection site/hot/still warm to the touch; Red hot hard lump on the right of the injection site; Red hot hard lump on the right of the injection site/hardness; Red hot hard lump on the right of the injection site/redness/still red; Soreness in the arm of the injection/her arm was more sore than before; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (Red hot hard lump on the right of the injection site/hot/still warm to the touch), VACCINATION SITE MASS (Red hot hard lump on the right of the injection site), VACCINATION SITE INDURATION (Red hot hard lump on the right of the injection site/hardness), VACCINATION SITE ERYTHEMA (Red hot hard lump on the right of the injection site/redness/still red) and VACCINATION SITE PAIN (Soreness in the arm of the injection/her arm was more sore than before) in a 73-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039D21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included LEVOTHYROXINE, FOLIC ACID and VITAMINS NOS for an unknown indication. On 02-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Oct-2021, the patient experienced VACCINATION SITE PAIN (Soreness in the arm of the injection/her arm was more sore than before). On 03-Oct-2021, the patient experienced VACCINATION SITE WARMTH (Red hot hard lump on the right of the injection site/hot/still warm to the touch), VACCINATION SITE MASS (Red hot hard lump on the right of the injection site), VACCINATION SITE INDURATION (Red hot hard lump on the right of the injection site/hardness) and VACCINATION SITE ERYTHEMA (Red hot hard lump on the right of the injection site/redness/still red). At the time of the report, VACCINATION SITE WARMTH (Red hot hard lump on the right of the injection site/hot/still warm to the touch) and VACCINATION SITE ERYTHEMA (Red hot hard lump on the right of the injection site/redness/still red) had not resolved and VACCINATION SITE MASS (Red hot hard lump on the right of the injection site), VACCINATION SITE INDURATION (Red hot hard lump on the right of the injection site/hardness) and VACCINATION SITE PAIN (Soreness in the arm of the injection/her arm was more sore than before) was resolving. Treatment information was not provided. Most recent FOLLOW-UP information incorporated above includes: On 04-Oct-2021: Follow-up was received and contains significant information; suspect product details, concomitant details, additional events were added.


VAERS ID: 1776048 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / UNK - / OT

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

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

Write-up: Administration of an expired dose; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration of an expired dose) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048F21A) for COVID-19 vaccination. No Medical History information was reported. On 02-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration of an expired dose). On 02-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Administration of an expired dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. Treatment medication was not provided by the reporter. On 01 Sep 2021,the vial was initially stored in the refrigerator with a use by date of 01 Oct 2021.


VAERS ID: 1776082 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-05
Onset:2021-10-02
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Intensive care
SMQs:

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

Write-up: hospitalization (ICU)


VAERS ID: 1776356 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-03-05
Onset:2021-10-02
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received J&J vaccine on 3-5-2021 then recevied Pfizer vaccine on 10-02-2021.


VAERS ID: 1776388 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-27
Onset:2021-10-02
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 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 positive test on 10/2/21 (approximate date)
CDC Split Type:

Write-up: vaccine breakthrough event


VAERS ID: 1776423 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-06
Onset:2021-10-02
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Fall, Fatigue, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg oral tablet acetylcysteine (MUCOMYST) 200 mg/mL (20 %) solution allopurinol (ZYLOPRIM) 100 mg oral tablet amoxicillin (AMOXIL) 500 mg oral capsule amoxicillin-pot clavulanate (AUGMENTIN) 87
Current Illness:
Preexisting Conditions: BPH CAD Lymphoma to colon Diabetes Hypertension Hypercholesteremia Lumbar disc disease Prostatic hypertrophy Rheumatoid arthritis OSA on CPAP Skin ulcer of right foot
Allergies: Lopid [Gemfibrozil] Niacin
Diagnostic Lab Data: Positive COVID test 10/8/21
CDC Split Type:

Write-up: 3 falls in the past 6 days. Shortness of breath and fatigue


VAERS ID: 1776484 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 RA / 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? 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: Patient experienced extreme pain in lower extremities prompting him seeking emergency room care.


VAERS ID: 1776687 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-02
Onset:2021-10-02
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: OSA (on 2 L HS w/ CPAP) HLD Recurrent Nephrolithiasis, Calcium Oxalate stones Vitamin D Deficiency Morbid Obesity Class III Provoked DVT in 2014 Hx of Obstructive Uropathy, R Ureter
Allergies: Iodine, latex, soy, adhesive tape, corn, peanut, porcine
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated for covid; hospitalized


VAERS ID: 1776741 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Fatigue, Mobility decreased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, metoprolol,, fluocinonide, centrum silver vitamin, preservision a reds 2, raloxifene hcl, fluticasone propionate nasal spray
Current Illness: None
Preexisting Conditions: Cough
Allergies: Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Exhaustion, fever, diarrhea, loss of appetite, could do nothing but rest in lounge chair and drink water., could not eat. Gradually got well as week progressed


VAERS ID: 1776782 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Lip blister, Lip swelling, Myalgia, Paraesthesia oral, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever following Shingrix vaccine. Also chills, fever, fatiigue, joint aches after Pfizer 1 and 2.
Other Medications: Losartan, Levothyroxine, Duloxetine, Famotidine, Ca, Mg
Current Illness: None
Preexisting Conditions: hypertension, hypothyroid, anxiety, acid reflux, back pain
Allergies: Aspirin, Sulfa: bleeding; Flagyl, neurological
Diagnostic Lab Data: None done. Did not consult a doctor.
CDC Split Type:

Write-up: Right side of inner lower lip swelled up, developed several large flat blisters (white areas), first noticed evening of 10/2/21. Tingling feeling. Rinsed / soaked with warm salted water several times for a couple of days. Cleared up completely in about 3 days. (In item #5 above, the timing is for the uncommon oral reaction, which I didn''t get with the first two Pfizer shots. I also had the common reactions of fever--which reached 100.9 around noon on the day after the shot, before I took acetominophen, and was 100.4 upon getting up on the second day after the shot, but normal 97.8 on the third day--also fatigue, joint pain throughout body, muscle pain in upper torso.)


VAERS ID: 1776811 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-26
Onset:2021-10-02
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, COVID-19, Cough, Decreased appetite, Dyspnoea, Fatigue, Oxygen saturation decreased, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Arthritis (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient is a 72 y.o. male with a history of GAVE on tranexamic acid, GERD, OSA, type II DM, CKD stage IV and HTN that was admitted to hospital on 10/2 for symptoms of cough, weakness and fever that began on 9/23. He tells me the fever was for only one day. He had O2 sats in the 80s on RA at the time of his initial admission. He was found to be COVID positive. He was started on dexamethasone and received Tocilizumab on 10/4. He was not eligible for Remdesivir due his poor baseline renal function. He had increasing O2 needs and was becoming increasingly fatigued from a respiratory standpoint and wished to remain full code and was therefore transferred to another hospital for further management. In discussions with hematology prior to transfer, it was recommended the tranexamic acid be held due to the thrombotic risk. On arrival here, he mainly complains of shortness of breath. He did not lose his sense of smell and taste at all. He has not had any N/V or diarrhea, but has had a poor appetite. He admits to chronic right ankle pain, but denies any leg pain.


VAERS ID: 1776865 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: COPD Heart Failure Diabetes High Blood Pressure Chronic Back Pains
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Shoulder pains and muscle aches.


VAERS ID: 1776966 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Headache, Nasal congestion
SMQs:, Anaphylactic reaction (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: PCN allergy reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports a cough that started the day after vaccination, which still lingers (9 days later). He''s also experienced a "sporadic headache", which he believes is from coughing so much. "Stuffiness" started 2-4 days ago. He was advised to follow up with his doctor.


VAERS ID: 1776971 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-03
Onset:2021-10-02
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C32A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Myalgia, Oropharyngeal pain, Pain, Pyrexia, Respiratory tract congestion, Sinus disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: fever, muscle aches, congestion, sinus problems, body aches, sore throat, loss of taste and smell, cough


VAERS ID: 1777065 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest pain, Electrocardiogram, Pain in extremity, Palpitations, Troponin normal, Vertigo
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: Sulfa; OMNICEF; aspirin; possibly eggs
Diagnostic Lab Data: They did EKG; blood work; electrolytes and did Troponin levels twice and everything came back normal.
CDC Split Type: vsafe

Write-up: Vertigo symptoms on Saturday morning - off and on for a few days. It''s gotten better. It was worse over that weekend - it''s gotten better after the last several day. I had a little bit today - very mild. Started having chest pain on Wednesday, the 6th - and left arm pain. ER, no treatment - and then I saw my doctor the next morning and she ordered a stress test that I''ll have at the end of this week. Chest pain is gone but have just have had some heart palpitations which actually I had after the second shot as well.


VAERS ID: 1777131 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-27
Onset:2021-10-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 LA / IM

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

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

Write-up: Patient called on 10/11/21 to report a rash on her arm that started several days following Moderna vaccination. Rash appears as 2 circular inflamed spots: 1 right around injection site and 1 down the arm a few inches away. The patient reported that it is itchy but has had no problems with breathing, rash anywhere else, or closing of the throat.


VAERS ID: 1778787 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Culture throat, Dyspnoea, Headache, Influenza virus test, Pneumonia, Restlessness
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest xrays, throat culture, and flu swab
CDC Split Type:

Write-up: Pneumonia, headache, breathlessness, chest pain, restless


VAERS ID: 1778997 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Contusion, Headache, Injection site erythema, Injection site reaction, Laboratory test, Palpitations, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Red welts appeared on her arm at the injection site. Started breaking out in hives in different places also in her face. Welts on her forearm turn into a black and blue bruise. Left side of face became swollen and hives became worse all over her body. She stated her face had been changing constantly everyday it was different. One side of her face is bigger than the other. (left side). Heart palpitations, weakness and headaches. Elevated blood pressure


VAERS ID: 1779044 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-10-02
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / UNK RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6138 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 19


VAERS ID: 1779070 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ747AB / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Dyspnoea, Hypertensive urgency, Intensive care
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin 20mg qhs, Carvedilol 25mg bid, ferosul 325mg tid, chlorthalidone 25mg, lisinopril-hydrochlorothiazide 20-25mg, nifedipine 30mg
Current Illness:
Preexisting Conditions: Hypertension, chronic kidney disease - stage 4
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per discharge summery, he experienced shortness of breath approximately 2 hours after vaccination while resting at home. He stood up and paced and felt better but worsened when he sat back down. In the ED he was found to be in hypertensive urgency and started on labetolol 20mg and coreg 25mg, and admitted to the ICU for cardene drip for pressure of 232/110. He was weaned off the drip and remained stable with a new hypertension medication regimen and discharged home. He has a known history of hypertension.


VAERS ID: 1779145 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-22
Onset:2021-10-02
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: effexor, motrin, lotrel
Current Illness:
Preexisting Conditions: depression, hypertension
Allergies: no known allergies
Diagnostic Lab Data: SARS-COV-2 positive on 10/02/21
CDC Split Type:

Write-up: Pt received Moderna vaccines on 03/22/21 and 04/19/21. Pt presented to the ED on 10/02/21 with complaints of a cough, fever, headache, and body aches. Pt was found to be COVID positive


VAERS ID: 1779307 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Neuropathy peripheral
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN. NOT A REGULAR PATIENT OF OUR PHARMACY.
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT REPORTS THAT UPON RETURNING HOME AFTER HER THIRD DOSE OF THE PFIZER COVID VACCINE, SHE BEGAN EXPERIENCING A BURNING SENSATION/NEUROPATHY IN HER RIGHT GLUTEUS MAXIMUS. PATIENT REPORTS THAT THE SENSATION HAS BEEN CONSISTENT SINCE THEN AND HASN''T BECOME CONSIDERABLY WORSE OR BETTER.


VAERS ID: 1779310 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-28
Onset:2021-10-02
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1779318 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-10-02
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK - / -

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

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

Write-up: Covid positive work contact


VAERS ID: 1779321 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Daydreaming, Gingival bleeding, Headache, Hot flush, Memory impairment, Menstruation irregular, Migraine, Night sweats, Pain in jaw
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Gingival disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Osteonecrosis (broad), Fertility disorders (broad)

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

Write-up: headache which lead to migraine. then severe night sweats and chills with hot flashes. bleeding gums with soreness in lower jaw and irregular periods. absent mindedness/ cloudy mind. forgetfulness.


VAERS ID: 1779390 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-27
Onset:2021-10-02
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Chills, Decreased appetite, Exposure to SARS-CoV-2, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient with a history of COPD, chronic back pain, cardiac stents, GERD, and mycobacterium avium. (Patient''s second dose of Pfizer-BioNTech COVID-19 vaccine on 4/17/2021, Lot # EN6201. Both doses were given
Allergies: Codeine, Papaver
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presents to the ED and admitted to the hospital for evaluation of fever, chills, body aches, abdominal pain, nausea, and decreased appetite. Symptoms ongoing for the past few days. Patient states her mother tested positive for COVID-19 one week ago, and her mother currently lives with her.


VAERS ID: 1779449 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-23
Onset:2021-10-02
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / UNK - / -

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

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

Write-up: Covid positive work contact


VAERS ID: 1779629 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-02
Onset:2021-10-02
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Cold sweat, Hyperhidrosis, Lymphadenopathy, Mobility decreased, Muscle spasms, Pain, Pain in extremity, Pelvic pain, Pyrexia, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: I received the 1st pfizer vaccine on 9/2/21. A day later I felt tired and weak, nothing too serious. I got the 2nd dose on October 3rd and a day layer I felt like my whole body was in a cast, I could barely move. My left arm was so painful & under my armpit was very swollen. Back pains and body aches all over & feverish with hot & cold sweats on and off for 12 hours. I took 3 tylenol and seemed to feel better afterwards. Major pelvic area pain bad cramping without me even being on my period. Finished my period and huge blood clots came out (that I never experienced before). Mild blurred vision in my eyesight.


VAERS ID: 1779905 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Arthralgia, Axillary pain, Blood test, Breast pain, Condition aggravated, Ecchymosis, International normalised ratio, Oedema peripheral, Pain, Pain in extremity, Prothrombin time
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid-19 Pfizer, 57 years old, 12/30/2020 ;01/18/2021 (Painful neck and collarbone, swollen, painful axilla)
Other Medications: Synthroid Verapamil Maxide B 100 Complex Vitamins D3 Vitamins
Current Illness:
Preexisting Conditions: Graves Disease Supraventricular Tachycardia
Allergies: Doxycycline
Diagnostic Lab Data: PT; PTT; INR ;Factor5 blood tests
CDC Split Type:

Write-up: Pain and swelling in the Right axilla and right breast with radiating paint o the right elbow, right wrist and thumb from 10/2/2021-10/10/2021. Ecchymosis in the Right axilla and right lateral breast area from 10/3/2021- 10/8/2021.


VAERS ID: 1780145 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pravastatin,hydrochlorothiazide,coq10,aspirin,glucosamine, vitamins c,garlic, turmeric, vitamin d,b complex vitamin,
Current Illness: None
Preexisting Conditions: Moderately high blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Large 3"?3" bruise appeared around the injection site with muscle pain and aching and 12 days later there''s not much change in the bruising and pain


VAERS ID: 1780463 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-30
Onset:2021-10-02
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 AR / IM

Administered by: Military       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood creatine phosphokinase increased, Chest discomfort, Chest pain, Chills, Echocardiogram, Ejection fraction normal, Electrocardiogram ST segment elevation, Fatigue, Myalgia, Myocarditis, Right atrial dilatation, Right ventricular dilatation, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None. He did have COVID symptoms starting August18th 2021 and tested positive for COVID on August 20th.
Preexisting Conditions: None.
Allergies: NKDA
Diagnostic Lab Data: Transthoracic echocardiogram 03October with ejection fraction 64%, mildly dilated right atrium and ventricle, and no pericardial effusion. Maximum troponin 1046 (upper limit of normal is 20), maximum CKP 359, ECG with diffuse ST elevation
CDC Split Type:

Write-up: Pt received dose #2 on 30September. On 02October had sudden onset chest pain/tightness, fatigue, myalgias, chills. Admitted to local Hospital and treated for myopericarditis. Received Toradol and morphine for pain, heparin infusion for anticoagulation. Discharged 05October with 10 days of Indocin, nitroglycerin as needed and docusate as needed.


VAERS ID: 1780616 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cough, Oropharyngeal pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test, Streptococcus test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Compound fracture of my L2. July 25.2021
Preexisting Conditions: Heterozygous factor 5/ with a abnormal prothrombin c. Lupus, Sjogerns disease ,
Allergies: React/ codeine, Flonase, Sulfa Based A Bx,Levoxyl, Cymbalta,Prozac,Plaquenil Sulfate, Clindamycin,Synthroid. Hospitalization/Major Diagnostic Procedure. 2 Pregnancies.
Diagnostic Lab Data: Strep test & Covid19 test 10/02/2021. Still sick 2 nd Covid19 test 10/12/2021.
CDC Split Type:

Write-up: Woke up w/ raw sore throat , fever, stuffy head, deep cough in cheats, bad congestion. Felt like cotton in my lungs. Couldn?t lay down. Sounds like a harmonica when I breath. Still congested. Had another Covid19 test yesterday 10/12/2021@ Hospital offsite.


VAERS ID: 1782270 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-05
Onset:2021-10-02
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest discomfort, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Lisinopril
Diagnostic Lab Data: 10/2/2021 Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: CHIEF COMPLAINT/REASON FOR VISIT Chest Pain HISTORY OF PRESENT ILLNESS Pt is a COVID positive 83-year-old male with an extensive past medical history significant for CAD status post PCI of, heart failure with reduced ejection fraction most recent EF on 10/4 was 31%, atrial fibrillation status post pacemaker placement (not on anticoagulation due to recent history of GI bleed), mantle cell lymphoma on chemotherapy (recent history of tumor lysis syndrome during hospitalization from 09/21-9/30), who presents today with generalized weakness and mild central chest discomfort. Of note, he was recently hospitalized from October 2nd through October 7th on the Cardiology Service for COVID-19 infection with acute o


VAERS ID: 1782298 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-19
Onset:2021-10-02
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anal stenosis, Asthenia, Blood bicarbonate normal, Blood calcium normal, Blood creatinine increased, Blood lactic acid, Blood urea increased, Blood urine, COVID-19, Chest X-ray normal, Chills, Condition aggravated, Culture urine positive, Diarrhoea, Drug trough level, Enteritis, Fatigue, Frequent bowel movements, Full blood count, Gastritis erosive, Hypophagia, Immunosuppression, Inflammatory marker test, Lipase normal, Metabolic function test, Myalgia, Nausea, Neutrophil count increased, Oxygen saturation decreased, Pouchitis, Protein urine present, SARS-CoV-2 test positive, Tremor, Ultrasound liver normal, Urine analysis abnormal, Urine ketone body present, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal obstruction (narrow), Gastrointestinal ulceration (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Nervous Tumor Brain Pain Unspecified Circulatory Insufficiency Venous Digestive Complication Liver Transplant Rejection Liver Transplant Pouchitis Ileal Cholangitis Lesion Hepatic Benign Polyp Colon Adenomatous Primary Sclerosing Cholangitis Genitourinary Chronic Kidney Disease (CKD), Stage 3 Unspecified Musculoskeletal Pyoderma Gangrenosum Strain Of Muscle Fascia And Tendon At Neck Level Sequela Dermatitis Contact Endocrine/Metabolic Hypercholesterolemia Hematologic Anemia Iron Deficiency Leukocytosis Infectious/Inflammatory COVID-19 Infection Immune Immunodeficiency Due To Drugs Rejection Graft Other Transplant Liver Dysfunction Ileal Pouch Body Mass Index 19.9 Or Less Adult Awaiting Organ Transplant Depressive Disorder Elevated Creatinine Fatigue Fever Of Unknown Origin Medication Therapy Long Term Not Anticoagulant Splenectomy Total Status Post
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: REASON FOR ADMISSION COVID-19 Infection HOSPITAL COURSE Patient is a 62 y.o. female who presented to the Emergency Department (ED) on 10/08/2021 for worsening diarrhea in the setting of a COVID-19 infection. Patient has significant medical comorbidities chronic pouchitis on rotating flagyl and cipro 2/2 total proctocolectomy w/ ileal pouch-anal anastomosis (2014) d/t ulcerative colitis, PSC s/p liver transplant (11/2017), pyoderma gangrenosum, and CKD III (baseline creatinine unclear, but has ranged from 1.4-2.3 in the last year). Per chart review, patient has been in town for her four year posttransplant follow-up appointments. She underwent a pouchoscopy for for surveillance on 10/06/2021 that was uncomplicated. She then contacted the on-call liver transplant pager around 2300 on 10/07/2021 with complaints of chills, shakes, nausea without vomiting, decreased oral intake, and increased bowel output. On arrival to the ED patient was hemodynamically stable and in no acute distress. She was found to have an SpO2 of 89% and was placed on 2 L supplemental oxygen via NC with subsequent improvement. Laboratory studies were obtained. CBC revealed WBC 16.9 with neutrophils 13.82. CMP was notable for a bicarbonate of 21, BUN of 31, creatinine of 2.38, and a total calcium of 10.5. Lipase was 46. Lactate was 1.2. Urinalysis was notable for trace ketones, trace blood, and 30 protein. COVID testing was positive. Recent imaging including CXR and liver ultrasound were unremarkable/stable from previous examinations. Pouchoscopy on 10/06/2021 revealed anal canal stenosis and a single erosion in the neoterminal ileum with known inflammation and the ileoanal pouch 2/2 pouchitis. Patient was given 1 L NS in the ED and is being admitted for ongoing evaluation and management. On arrival to the medical floor patient was hemodynamically stable. Regarding her current COVID infection, patient was vaccinated against COVID-19 with the Pfizer series on 03/19/2021 and 04/13/2021. She states that she had not attended any large social gatherings or public events in the last several weeks. She noted that she consistently wears a mask when out in public. However, patient noted that her daughter and son-in-law do not "believe in COVID" and so they are not vaccinated and do not take safety precautions while in public. Patient visited with her daughter and son-in-law on 09/29/2021 who were feeling ill with symptoms of headache and upper respiratory congestion at the time of their visit. Patient then began to feel fatigued, weak and noted muscle aches on 10/02/2021. Given her transplant status, Infectious Diseases was consulted and recommended remdesivir, and dexamethasone if indicated. Respiratory status, inflammatory markers and labs were monitored closely. Collateral workup was obtained and excluded other acute COVID-related complications. Fortunately, her respiratory status improved. Weaning from O2 was successful. Home oxygen evaluation was performed by RT on 10/11. She was found to NOT quality for homegoing oxygen therapy. Overall, her hospital course was uncomplicated. Medical staff was consulted to assist with her immunosuppression medications. Her Tacrolimus trough was elevated at 9.2. Her Tacrolimus dose was decreased and a repeat trough is trending. Of note, her urine cultures were checked due to a high WBC. They came back positive but because she was asymptomatic, no antibiotics were administered. She remained hemodynamically stable throughout her stay on the medical unit. She completed a 5 day course of Remdesivir. She demonstrated progressive improvement on the aforementioned therapies. Care Management consulted and assisted with discharge planning. Discharge to hotel with friend who will drive back to home with her was arranged on 10/12. She was assessed for Monitoring Program for which she is a candidate. Isolation precautions and criteria for discontinuation are outlined below. Additional ambulatory follow-up with PCP, dermatology, transplant, and GIH was arranged prior to dismissal.


VAERS ID: 1782394 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-11
Onset:2021-10-02
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest discomfort, Cough, Exposure to SARS-CoV-2, Pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ascorbic acid (VITAMIN C) 250 MG tablet benazepril-hctz (LOTENSIN HCT) 10-12.5 MG tablet Cholecalciferol (VITAMIN D3) 2000 UNIT TABS magnesium oxide (MAG OX) 250 MG tablet multivitamin/beta carotene (TAB-A-VITE/BETA CAROTENE) tab TABS table
Current Illness: None known
Preexisting Conditions: DDD (degenerative disc disease), lumbar Vitamin D deficiency Essential hypertension Obstructive sleep apnea on CPAP History of endometrial cancer
Allergies: Lisinopril (muscle cramps), losartan (muscle cramps), simvastatin (cramps)
Diagnostic Lab Data: COVID-19 positive on 10/2/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 10/2/2021 with cough, chest discomfort, and body aches. She had a COVID-19 exposure a week prior. Shew as found to be COVID-19 positive and was admitted for further management. She was treated with remdesivir, decadron, and supplemental oxygen. She was discharged home on 10/6/2021.


VAERS ID: 1782513 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-22
Onset:2021-10-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Type 2 DM, no insulin use. Umbilical hernia
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received one dose of the Pfizer COVID-19 vaccine series on 9/22/2021. Pt tested positive for COVID on 10/2/2021 during an ER visit. Pt returned to hospital 10/6/2021 and was admitted with a primary diagnosis of COVID.


VAERS ID: 1782515 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray abnormal, Chest pain, Dizziness, Dyspnoea, Electrocardiogram abnormal, Heart rate irregular, Lip blister, Mouth swelling, Nasal mucosal blistering, Swollen tongue, X-ray abnormal
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D Excedrin Migraine
Current Illness: Migraine
Preexisting Conditions: Migraine
Allergies: None known
Diagnostic Lab Data: 10/4/2021: Dexamethasone and Epinephrine 10/5/2021: Prednisone and Epinephrine injection 10/6/2021: Meclizine 10/11/2021: X-ray and ekg irregular heartbeat 10/12/2021: chest X-ray and ekg: irregular heartbeat
CDC Split Type:

Write-up: Dizziness Swollen tongue Difficulty breathing Swollen inner mouth Blisters all over lips Chest pains Blisters in right nostril


VAERS ID: 1782543 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Heavy menstrual bleeding, Loss of consciousness, Pain in extremity, Postmenopausal haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi Vitamin
Current Illness: Not applicable
Preexisting Conditions: Non applicable
Allergies: Not Applicable
Diagnostic Lab Data:
CDC Split Type:

Write-up: I was vaccinated on 10-1-21 with the Janssen 1822809. Since then I have blacked out twice and I am menstruating after seven years of no periods I am now! - heavy. and pain on top right foot which lasted two days Regarding black outs-My brother had called 911 the first time on 10-2-21 - responders came my sugar level was 90 and BP 126/72 We bought a monitor and my blood sugar has been in a normal range Second time I blacked out was 10-12-21. No changes in eating habits- still juicing in the am and high protein all day. Same diet as the last five years. Pain on right foot roughly two inches in circumphrence - no bruising Blood test ordered for 10-13-21


VAERS ID: 1782803 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling cold, Feeling hot, Injection site pain, Joint range of motion decreased, Nausea, Neuropathy peripheral, Oral mucosal blistering, Pain, Pyrexia, Rash, Rash papular, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: -Linear blisters in mouth bilateral cheeks on day 2, resolved 3 or 4 days after - Day 2 through Day 3 left arm ache, felt feverish and chills - throbbing pain and neuropathy which felt worse after day 4 to day 5 -Nausea and vomiting on day 5 -$g patient took tylenol and motrin on day 5 and on for 8 days - starting day 5 patient could not move arm - on 10/9 patient started Medrol Dose pack had 10% improvement Ice resolved pain a little bit still reports pain and neuropathy and feels hot - on 10/1 pt reported papularrash in fingers with fluid on left 2,3,4 on day 4-5 patients reported rash on right hand and on fingers day 5-6 rash looked like bug bites left hand resolved, reports rash has spread no report of cardio/respiratory symptoms


VAERS ID: 1782805 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alprazolam 1mg, Tylenol (took at 9:15pm evening of vaccination)
Current Illness: No
Preexisting Conditions: No
Allergies: Uribel, Flagyl
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer Covid Vaccine given in left deltoid IM. Starting at 9pm on 10/2/21 (the day of vaccination) patient experienced arm redness, swelling, and hot to touch at injection site. On 10/13/21 patient came into pharmacy to show arm to pharmacist. Injection site still looks dry and discolored. Patient is concerned about possible scarring.


VAERS ID: 1782850 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-09
Onset:2021-10-02
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, COVID-19, Chills, Dyspnoea, Headache, Hypersomnia, Mobility decreased, Nausea, Neck pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg od vit B-12 od vit B-complex od Biotin od
Current Illness: no
Preexisting Conditions: high blood pressure prediabetic GERD
Allergies: flagyl peanuts some dairy products depending on how much real diary they have in them.
Diagnostic Lab Data: COVID-19 - Rapid Test- positive
CDC Split Type: vsafe

Write-up: On 10/02/2021, I was doing normal routine things and I was fine through out the day, Then at 4:30 pm it felt like someone kicked me in my back, I had severe headache, neck ache and sour stomach, and no energy. I got shivers, chills, and fever (the highest was 101, I had low grade fever for a couple of days. I took Tylenol and 4 hours later I tried Motrin, and Tylenol arthritis and nothing helped relieve the symptoms. I slept for 3 days straight. I could not get out of bed. My headache was torture. I had nausea, I kept down fluid, I never threw up. On Monday I was very weak, I could not catch my breath. On 10/05/2021, Tuesday, I was tested for COVID-19 test-positive. On Wednesday, Dr. scheduled me to get antibodies and prescribed me an inhaler, Brio. Today is my 12 day since I started having symptoms, but I feel a whole lot better and I am on my way to feeling better. I think I contracted COVID-19 at work, I''m a healthcare worker, about 2 or 3 weeks prior I had 3 or 4 patients who had COVID-19 and we did not know. I have been real careful. Thank goodness no one in my house contracted COVID-19.


VAERS ID: 1782900 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-01-12
Onset:2021-10-02
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 UN / IM

Administered by: Senior Living       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: Hx lacunar cerebrovascular accident, right sided; Recurring UTI; personal history of other infectious and parasitic diseases; Persistent Atrial Fibrillation; Unspecified Dementia without behavioral disturbance; CAD; HTN; Cardiac Pacemaker Device, OP
Allergies: Zoloft; Clonazepam; lyrica; gabapentin
Diagnostic Lab Data: BinaxNow Rapid Test
CDC Split Type:

Write-up: Tested positive for Covid-19 on 10/2/2021


VAERS ID: 1782922 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-01-12
Onset:2021-10-02
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Ageusia, Fatigue, Nasal congestion, Nasopharyngitis, SARS-CoV-2 test
SMQs:, Taste and smell disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Iron deficiency anemia secondary to blood loss, chronic; Essential HTN; Weakness; Gastric Ulcer, unspecified as acute or chronic, without hemorrhage or perforation; personal history of other specified conditions, decreased mobility, acute posthemorrhagic anemia
Allergies: ACE inhibitors; Clindamycin; Lisinopril; Losartan; Magnesium; PCN; Magnesium Containing Compounds; Erythromycin
Diagnostic Lab Data: BinaxNow Rapid Test
CDC Split Type:

Write-up: fatigue, loss of taste, congestion, head cold symptoms


VAERS ID: 1783019 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN-GIVEN A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 20 mg, Losartan 25 mg, Crestor 5 mg, Albuterol inhaler, Refresh eye drops
Current Illness: none
Preexisting Conditions: HTN, nonrheumatic aortic valve stenosis, nonrheumatic mitral valve regurgitation, hyperlipidemia, hypertropia, mass of parotid gland, depression, mild intermittent asthma, sleep apnea
Allergies: House dust mite
Diagnostic Lab Data: none. He was seen by Chiropractor twice
CDC Split Type:

Write-up: Patient reports that on 10/2/21 his right hand and fingers lost feeling and function and had no strength.


VAERS ID: 1783033 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Eye discharge, Feeling cold, Headache, Migraine, Pain in extremity, 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), 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: None
Current Illness: none
Preexisting Conditions: none
Allergies: Kiwi, nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: My left arms started hurting the same day and started swelling the following day. I had a headache and fever and my eyes were running and I got cold and I got migraines


VAERS ID: 1784608 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-27
Onset:2021-10-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neck pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin, losartsn, jardiance, metfromin, synthroid
Current Illness: none
Preexisting Conditions: diabetes
Allergies: lisinopril, demerol, seasonal allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: local arm soreness for 4 days then the neck pain started it would come and go in severity, lasted over 10 days no relief from tylenol or motrin at times very painful


VAERS ID: 1784635 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / SYR
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312862 / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Hyperhidrosis, Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 25 Mg Rosuvastatin 5 mg Ultimate Probiotic 14 Cranberry 4200 mg Magnesium 400mg AlgaeCal Plus
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I was vaccinated at 4pm. At 2am I work up feeling nauseous. I walked into the bathroom and was standing at the sink when I suddenly passed out. When I came me to, I was sweating profusely and extremely chilled. I went back to bed. The next day I felt wiped out most of the day. I slept from noon till 4pm and then felt much better


VAERS ID: 1784902 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-27
Onset:2021-10-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartin 60 mg Tranxene 7.5 mg Pioglitazone 15 mg Doxycycline 50 mg
Current Illness: None
Preexisting Conditions: Pace maker in January 2021 Has one kidney
Allergies: Codene
Diagnostic Lab Data: Blood test to check the blood count which was fine.
CDC Split Type:

Write-up: Started on 10/2/21 with a nose bleed. We were able to get the bleeding stopped at home. Started bleeding again on 10/3/21, it took longer but we got it stopped and it did start bleeding again later in the day just not as bad. Monday, 10/4/21 could not get the nose to stop bleeding. It was pouring out of his nose. Called 911 and went to Hospital. They were unable to stop the bleed and ended up packing. Were told to follow up with primary care dr in 48 hours. Wednesday 10/6/21 - went to primary care dr and he took out the packing. About 1:00 pm on Thursday 10/7/21 it started to bleed again. We contacted his ENT and made an appointment for Friday. They were able to clean the nose and cauterize the bleed and it has been fine since. Don''t know that this was related to vaccine but he has never had an issue with nose bleeds in the past.


VAERS ID: 1784917 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Condition aggravated, Discomfort, Dyspnoea, Fatigue, Head discomfort, Headache, Hypoaesthesia, Malaise, Muscle fatigue, Musculoskeletal stiffness, Pain, Pain in extremity, Pallor, Peripheral coldness, Rash, Sluggishness, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Two pneumonia vaccines and had symptoms, not severe, but had a lot of fatigue 10-12 hours later, but did feel warm and lethargic
Other Medications: Uloric and Prednisone.
Current Illness: None.
Preexisting Conditions: Arthritis, gout, back pain (3 surgeries), multiple surgeries, A-fib, toxoplasmosis.
Allergies: Celebrex and Vioxx.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: He received his vaccine, had arm pain the first day and felt fine. He was in the produce department and his hand started getting cold and white. He does have Raynaud''s disease and has a heart condition and was worried that it may be affecting that. It has occurred a few times but has not happened that often, and this was about 1 1/2 hours after the vaccine. With the heart related conditions about noon on Saturday he had taken a few quick steps and his vision started going dark on both eyes, had labored breathing. He checked his temp and everything was fine, 97.4. He rested for a while and felt better, but he was sluggish all day, had fatigue. He went to the CDC website and had a lot of the symptoms listed. He had headache, some fatigue, malaise and arthralgia. He did not feel well, he has low energy but as the day went on he ate something and felt better, but the headache stayed with him, pressure type in nature/numbness. The more activity he did the worse it got. After Tuesday the headache started coming and going. Yesterday he started developing a rash on his back and on the left side of his chest/side and looks similar to shingles, but has no open sore or discharge. He does not have real pain but does have discomfort. He was feeling that the myocarditis was affecting his heart. He saw pictures on the website and the pictures are similar to what he has and also has muscle fatigue/stiffness and soreness. He has discomfort due to the symptoms. He has not called his doctor regarding these symptoms. He had his wellness check but was not able to address his issues he''s have due to time restraints. He did have aortic stenosis and surgery for that in the past, 7/23/2019 and now has a pacemaker. He does have a history of toxoplasmosis and it looks like shingles. He has had a Reclast infusion, but has had reactions to that of uncomfortable. He had the 2nd a year later and then a 3rd dose a year after that, felt like he had been hit by a truck, multiple symptoms, but he tuft it out. His Rheumatologist told him that he gets a fracture that he would be on medicine for the rest of his year. His mother was in the hospital for a while after giving birth to him, and he was in the hospital as well after birth and had rheumatic fever as a child.


VAERS ID: 1785048 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-20
Onset:2021-10-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray, Computerised tomogram, Dizziness, Fall, Gait inability, Headache, Hyperhidrosis, Muscular weakness, Scan
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: blood pressure medication and Prilosec
Current Illness: none
Preexisting Conditions: acid reflux , low B/P, has had double knee replacements
Allergies: none known
Diagnostic Lab Data: was taken by ambulance to Hospital was admitted to R/O Aneurysm had CT scans, chest x-ray, abdominal scans
CDC Split Type:

Write-up: in the night awoke very diaphoretic states clothes wet, attempted to get up and got very lightheaded and fell back in the bed , legs very weak unable to walk and headache


VAERS ID: 1785084 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-01
Onset:2021-10-02
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Adult failure to thrive, Encephalopathy, Nausea
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Parkinson''s, dementia.
Allergies: Penicillin
Diagnostic Lab Data: Unknown. The patient does not know when she had her COVID vaccinations. The Health Dept. contacted the patient''s son and he confirmed that they are fully vaccinated but does not know what happened to their cards (his mom and dad''s cards).
CDC Split Type:

Write-up: Failure to thrive. Nausea, encephalopathic.


VAERS ID: 1785126 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / UNK 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis Gabapentin (night) 50 mg. zoloft
Current Illness: none
Preexisting Conditions: stress-related dry cough
Allergies: no
Diagnostic Lab Data: Have not visited doctor yet.
CDC Split Type:

Write-up: Constant pain in left arm from site of injection to wrist. Used cold pack for several days and then when pain persisted, heating pad. To date, pain is constant.


VAERS ID: 1785372 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Migraine
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 called pharmacy on 10/14/21 to report that she has been experiencing at least two migraines daily since she received the Johnson and Johnson vaccination. Patient states she has not had prior history of migraines previous to receiving this shot. To remedy migraine, patient has been taking Aleve and/or Tylenol as directed on box. She will also schedule a doctor''s appointment if migraines continue.


VAERS ID: 1785379 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELT284 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 RL / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Amnesia, Blood electrolytes normal, Chills, Computerised tomogram normal, Dehydration, Dizziness, Electrocardiogram normal, Extra dose administered, Headache, Hyperhidrosis, Neurological examination normal, Red blood cell count normal, White blood cell count normal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Medication errors (narrow), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT brain(Normal) Electrocardiogram (Normal) Electrolytes (Normal) White Cell (Normal) Red Cell (Normal) Neurological Exam (Normal)
CDC Split Type:

Write-up: I received the Covid booster shot at 9/30/2021. , After that, I experienced headaches the next 2 weeks. On Saturday 8, a week after Covid booster, I had a very bad day. I was sweating a lot and I got dehydrated. I am almost pass out. I had short memory lost. After that day, it has been very difficult to feel completely recovered. I ended up in the emergency room on Sunday 9. I was with headaches , dizziness and chills. Today, I am doing better but not totally recovered. I am still having headaches.


VAERS ID: 1785471 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Chills, Paraesthesia, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot approximately 8 years ago. Made me sick for three weeks. Dr. Insisted it wasn?t the vaccine but that I was just sick.
Other Medications: Benazapril 29mg daily
Current Illness: Seasonal cold 4 weeks prior.
Preexisting Conditions: High blood pressure. Treated with benazapril.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the initial fever, chills and vomiting for two day after shot, I now have weird tingling under my skin across my entire back. Almost like their is something crawling around under my skin. Sometimes that feeling extends to shoulders and hips. I feel weak most of the day. My blood pressure is more elevated than normal. It has been 14 days since the shot.


VAERS ID: 1785628 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-08
Onset:2021-10-02
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Diarrhoea, Headache, Influenza like illness, Injection site pain, Oropharyngeal pain, Pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: Morphine and pain medications
Diagnostic Lab Data: 2 COVID-19 tests: negative.
CDC Split Type: vsafe

Write-up: The next day after having the vaccine my arm was sore at the injection site and I felt a little achy. Like flu symptoms but they were very slight. My arm was sore after a week. On 10/02/2021 I started getting a sore throat. I thought it was allergies because of the weather. It did not go away. I started getting a runny nose, cough, headache, flu like symptoms, diarrhea, low grade fever. It went down to my chest. I never lost my sense of smell or taste. It felt like the normal flu. On Monday I called the doctor to make sure I did not have COVID-19. I took an antigen test that I got from Walgreens and the doctor ordered a PCR test and both were negative. She prescribed a steroid and an inhaler. I also took some over the counter medication.


VAERS ID: 1785665 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-06
Onset:2021-10-02
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cough, Oropharyngeal pain, Productive cough, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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? No
Previous Vaccinations:
Other Medications: Levothyroxine; Doxycycline Mono; Hydrochlorothiazide - for blood pressure; Trazadone at night; Vit D; Potassium
Current Illness: no
Preexisting Conditions: Undetermined interconnective tissue disease; high blood pressure
Allergies: Injected gold therapy; Micardis - whole class of drugs that Micardis falls under
Diagnostic Lab Data: COVID tests - two home tests - one negative and one positive and one from the hospital - positive.
CDC Split Type: vsafe

Write-up: I started experiencing a sore throat; scratchy throat and then a kind of build up of phlegm in the throat. By Monday, I started having a runny nose. I did take a home test on Sunday night and it was negative. My husband was sick and much sicker than I was at this point. I took another home test on Tuesday night and it tested positive. On Wednesday, I went to Hospital - drive though site - they told me it was positive. Then they called me for the Monoclonal Infusion. Thursday morning, I had the antibody infusion. I have had more coughing and lack of energy - essentially a bad head cold. We started for home on Saturday - it took three days to get home because we were both sick. I was feeling better by Saturday and I''m feeling even better today. I am not 100% yet. My energy is better. The symptoms seem to be a lot better since the infusion on the 7th.


VAERS ID: 1785728 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA J04E21A / 2 LA / SYR

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

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

Write-up: 17 hours after vaccination, tiredness, body aches, fever, chills lasted for approximately 36 hours. 5 days after vaccination, rash on both arms, chest, and legs. Lasted for approximately 12 hours.


VAERS ID: 1785939 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 RA / IM

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

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

Write-up: Covid vaccine was given beyond use of date. Last day to use vaccine was 9/30/2021, vaccine given on 10/2/2021. Patient notified. No adverse events or outcome.


VAERS ID: 1757063 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG1657 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Genital rash, Rash erythematous, Testicular pain, Testicular swelling
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Swollen, painful left testicle with red rash.


VAERS ID: 1780595 (history)  
Form: Version 2.0  
Age: 2.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure via breast milk, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Neonatal exposures via breast milk (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: Comments: Patient has not had symptoms associated with COVID-19 Not had a COVID-19 test
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: vomiting; Vomited; Vaccine exposure via breast milk; This case was received via regulatory authority (Reference number: GB-MHRA-ADR 26028546) on 04-Oct-2021 and was forwarded to Moderna on 04-Oct-2021. This regulatory authority case was reported by a consumer and describes the occurrence of VOMITING (vomiting) and VOMITING (Vomited) in a 2-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. MEDICAL HISTORY (Parent): Concurrent medical conditions included Maternal exposure during breast feeding since 02-Oct-2021. MEDICAL HISTORY (Patient): Patient has not had symptoms associated with COVID-19 Not had a COVID-19 test. On 02-Oct-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (Transmammary) 1 dosage form. On 02-Oct-2021, the patient experienced VOMITING (Vomited) (seriousness criterion medically significant) and EXPOSURE VIA BREAST MILK (Vaccine exposure via breast milk). On an unknown date, the patient experienced VOMITING (vomiting) (seriousness criterion medically significant). On 02-Oct-2021, EXPOSURE VIA BREAST MILK (Vaccine exposure via breast milk) had resolved. At the time of the report, VOMITING (vomiting) outcome was unknown and VOMITING (Vomited) had not resolved. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Transmammary) was unknown. concomitant medications list was not provided. Treatment information was not provided. Patient has not tested positive for COVID-19 since having the vaccine. Company Comment: This case concerns a 2-year-old, female patient with a medical history maternal exposure during breastfeeding, who experienced the unexpected events of vomiting and exposure during breastfeeding. The events occurred the same day after the second dose of Moderna Covid-19 vaccine. The rechallenge is not applicable in this case since no report about the first dose was mentioned. The benefit-risk relationship of the vaccine is not affected by this report. Event seriousness assessed as per Regulatory Authority reporting, however there was no information in the source document supporting that the events resulted in a persistent or permanent incapacity; Sender''s Comments: This case concerns a 2-year-old, female patient with a medical history maternal exposure during breastfeeding, who experienced the unexpected events of vomiting and exposure during breastfeeding. The events occurred the same day after the second dose of Moderna Covid-19 vaccine. The rechallenge is not applicable in this case since no report about the first dose was mentioned. The benefit-risk relationship of the vaccine is not affected by this report. Event seriousness assessed as per Regulatory Authority reporting, however there was no information in the source document supporting that the events resulted in a persistent or permanent incapacity


VAERS ID: 1782067 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-02
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Eye movement disorder, Hospitalisation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Coronary artery disorder (Deposits in heart vessels); Hyperlipidaemia (Hyperlipidemia)
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATJNJFOC20211021145

Write-up: UNRESPONSIVE TO VERBAL STIMULI; ABNORMAL EYE MOVEMENTS NOS; HOSPITALISATION; COLD SWEAT; This spontaneous report received from a physician by a Regulatory authority (regulatory authority, AT-BASGAGES-2021-049761) on 12-OCT-2021 and concerned a 50 year old male. The patient''s weight was 100 kilograms, and height was 180 centimeters. The patient''s concurrent conditions included: coronary artery disorder, and hyperlipidaemia. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: AB25320 expiry: UNKNOWN) 1 dosage forms, 1 total, administered on 02-OCT-2021 for covid-19 immunisation. No concomitant medications were reported. On 02-OCT-2021, the patient experienced unresponsive to verbal stimuli, abnormal eye movements nos, cold sweat and was hospitalized. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from unresponsive to verbal stimuli, abnormal eye movements nos, and cold sweat, and the outcome of hospitalisation was not reported. This report was serious (Hospitalization Caused / Prolonged, and Other Medically Important Condition).


VAERS ID: 1784445 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3005706 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Fall, Feeling abnormal, Headache, Loss of consciousness, Pallor, Peripheral coldness, Presyncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Poorly feeling; Vomiting; Facial pallor; Peripheral coldness; Mild weakness; Mild pain in the back of head; Loss of consciousness; Fall; Vagal reflex; This case was received via regulatory authority (Reference number: JP-TAKEDA-2021TJP103463) on 05-Oct-2021 and was forwarded to Moderna on 10-Oct-2021. This case, initially reported to the regulatory authority by a physician, was received via the regulatory authority (Ref, v21128580). Loss of consciousness was assessed as serious by the MAH. On an unknown date, body temperature before the vaccination: 36.4 degrees Celsius. On 02-Oct-2021, at 09:12, the patient received the 1st dose of the vaccine. At 09:22, while under observation, the patient fell out of a chair to the floor due to dizziness and was transferred to a first-aid room in a stretcher. The patient complained of dizziness and poorly feeling. BP: 125/58, HR: 52, Sp02: 100%, and BT: 36.1. Peripheral coldness was noted while no cutaneous flush or itching was noted. Although the patient was unconscious for a few seconds before being placed on a stretcher, the consciousness soon returned normal. The patient was placed on a follow-up in a spine position with leg elevation. At 09:28, dizziness and poorly feeling disappeared. The patient had peripheral coldness. A diagnosis of vagal reflex was made. BP: 110/63, HR: 58, and Sp02: 99%. At 09:37, leg elevation was discontinued, and the patient was followed up. There was no complaint of poorly feeling. BP: 103/64, HR: 56, and Sp02: 100%. At 09:40, the patient took oral rehydration in a sitting position. There was no complaint of poorly feeling. BP: 104/70 and HR: 70. At 09:43, a physician explained about vagal reflex. At 09:44, the patient stood upright. There was no complaint of poorly feeling. At 09:45, the symptom resolved, and the patient returned home. At 09:55, poorly feeling developed again. At 09:56, when retuning to the first-aid room in a wheelchair, the patient experienced slight amount of gastric fluid-like vomiting. The patient had facial pallor and peripheral coldness. BP: 97/35, HR: 91, and Sp02: 99%. The consciousness level was normal. Mild weakness developed. The patient was placed on leg elevation. At 10:05, the patient had mild pain in the back of head after vomiting. The patient complained of a persisting pain. The patient was given explanation while lying on a bed with leg elevation. Securing the route in the right side (22G), and drip infusion of saline 100 mL was performed. At 10:24, drip infusion of the 2nd vial of saline 100 mL was performed. While lying on a bed, queasy was mild, and pain in the back of head was also alleviated. At 10:31, vital signs were BT: 36.1, HR: 52, BP: 94/58, and Sp02: 99%. Leg elevation was discontinued. While the patient continued lying in a supine position, resolution of queasy and pain in the back of head was noted. At 10:35, change to acetate Ringers solution was made. At 10:42, although the patient had no symptoms in a supine position, an ambulance was called at the direction of the physician to confirm that allergy did not develop when the patient took a sitting position. At 10:48, vital signs were BT: 36.5, HR: 52, BP: 101/62, and Sp02: 100%. At 10:54, the patient was transferred on the ambulance and was transported. Drip infusion was performed. The patient returned home. It was confirmed that the patient recovered in the early evening. On 03-Oct-2021, resolution of the symptom was confirmed. The outcome of loss of consciousness, fall, vagal reflex, poorly feeling, vomiting, facial pallor, peripheral coldness, mild weakness, and mild pain in the back of head was reported as resolved. Follow-up investigation will be made. Company Comment: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Reporter''s Comments: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Sender''s Comments: This case concerns a 17 year-old male patient with no reported medical history who experienced the unexpected events of feeling abnormal, peripheral coldness, loss of consciousness, vomiting, pallor, asthenia, and headache The events occurred on the same day after the first dose of mRNA-1273. The rechallenge was unknown as only the first dose was administered. The benefit-risk relationship of mRNA-1273 is not affected by this report.


VAERS ID: 1787266 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-02
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ROJNJFOC20211021395

Write-up: Allergy; This spontaneous report received from a consumer via Regulatory Authority (RO-NMA-2021-SPCOV12783) on 12-OCT-2021 concerned a 45 year old male of an unspecified race and ethnic origin. The patient''s weight was 63 kilograms, and height was 174 centimeters. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: XE423 expiry: unknown) 1 dosage forms, 1 total administered on 01-OCT-2021 for covid-19 immunisation. No concomitant medications were reported. On 02-OCT-2021, the patient experienced allergy. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from allergy. This report was serious (Life Threatening).


VAERS ID: 1752857 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chills, Condition aggravated, Hyperaesthesia, Injection site pain, Insomnia, Pain, Pyrexia, Restlessness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (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: Arm soreness and restlessness
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Kiwi, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever of 101.2, body aches, skin sensitivity, inability to sleep,arm, where bad was given was very sore, restlessness started the night received the third booster shot


VAERS ID: 1753046 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / SYR

Administered by: Pharmacy       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: On 9/30/2021, 8:30 AM I took 2x Physicians Care extra strength pain reliever and again on 9/30/2021 at 2:00 PM for muscle aches in my legs.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 10/1/2021 5:30 AM very intense nose bleed out of left nostril, lasted for about 30 minutes. Nose bleed started back 10/1/2021 10:00 AM, not as intense, lasted about 20 minutes. Never had a nose bleed before in my life and does not run in the family.


VAERS ID: 1753224 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 20 mg Atorvastatin 10 mg
Current Illness: 0
Preexisting Conditions: Hypertension
Allergies: 0
Diagnostic Lab Data: 0
CDC Split Type:

Write-up: Fever, chills, nausea, body and joint aches, headache, fatigue


VAERS ID: 1753225 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atrovastatin lisinopril aspirin zetia pantoprolizol calcium d3 b12 magnesium zinc biotin callogen
Current Illness: None
Preexisting Conditions: Heart
Allergies: Egg dairy corn soy
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Redness at injection site


VAERS ID: 1753226 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye symptom, Hypoaesthesia, Paraesthesia oral, Tongue disorder
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Patient''s tongue was hot then began to tingle. Patient notice right eye drooping and right check began to feel numb. This began about 30-45minutes after injection.


VAERS ID: 1753236 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA09 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Axillary pain, Lymphadenitis, Tenderness
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On 10/1/21 at 0230, I woke up with sharp, stabbing pains in my left axilla. The pain was intensified while laying flat. Upon palpitation, lymph node were inflamed in left axilla and left clavicle region. They were extremely sore to touch and the pain intensified anytime my left arm of relaxing to my side. I took 1300mg of Tylenol. Symptoms are still present as of this report at 0832.


VAERS ID: 1753242 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 31045BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Headache, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Patient Called on this morning After getting Pfizer Booster 3rd dose on yesterday is having headaches body-aches diarrhea nausea and vomiting


VAERS ID: 1753244 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling cold, Pain in extremity, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Flu shots, felt sick
Other Medications: Rovistatin, 10mg 1x/day
Current Illness:
Preexisting Conditions:
Allergies: mycin derivitives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shakes, very cold..... sore arm


VAERS ID: 1753283 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 3 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 50mg Wellbutrin 75mg Iron supplement Multivitamin Vitamin C Vitamin D3
Current Illness: Strep throat one month ago
Preexisting Conditions: None
Allergies: Seveee Penicillin allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sustained fever of 99.5-101 beginning at 1am, around 17 hours after my shot. I began taking 1 Tylenol and 1 ibuprofen beginning at 8pm last night every 3 hours. My fever persists through the meds. I?m pouring in sweat sitting by a fan and eating ice chips after taking a cold shower. I can?t control the fever. I feel nauseous and like I?m going to pass out


VAERS ID: 1753305 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 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? 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: N/A.
CDC Split Type:

Write-up: Patient states that after receiving the 3rd dose Booster Pfizer 09/29/2021, started experiencing symptoms 10/01/2021 of rash across the back and abdominal area. Primary communications 10/01/2021 suggested self-treating with Benadryl. No other symptoms noted.


VAERS ID: 1753309 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Dysmenorrhoea, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None at this time, will be calling provider if pain persists.
CDC Split Type:

Write-up: Severe menstrual like pain. The pain started shortly after the injection, but severe pain this morning (10 days into menstrual cycle).


VAERS ID: 1753316 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 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: Unknown
Current Illness: No
Preexisting Conditions: No
Allergies: NKA
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Client received first dose of Pfizer on 8/20/21 Lot # FD8448. Today client received a dose of Moderna Lot # 033C21A. No symptoms observed while waiting the 15 minutes. The patient''s father was present with son. The patient''s father was informed of incident and was advised to contact us with any changes in symptoms or other concerns.


VAERS ID: 1753323 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dry throat, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC; CIPRO; and ALLEGRA
Current Illness: N/a
Preexisting Conditions: Cancer, currently in remission per patient
Allergies: SULFA and PENCILLIN
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Within 2 minutes of administering Pfizer covid vaccination patient expressed that his throat felt very dry and he feels like his throat is closing a little. Patient was given Allegra 60 mg 1 tablet per standing orders. Patient was talking to nursing staff the entire time. After administration of Allegra patient expressed that he felt better. He was talking the entire time of his observation with nursing staff.


VAERS ID: 1753336 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Bone pain, Fatigue, Migraine, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Osteonecrosis (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: Aderrall CBD topical cream Ibuprofin
Current Illness: None
Preexisting Conditions: ADHD
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Migraine headache in the evening- same day as the shot Bone & joint aches, moderate fatigue, mild muscle weakness - the day after getting the shot


VAERS ID: 1753351 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypothermia
SMQs:, Accidents and injuries (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: Eliquis, Labatelol, Atorvastatin
Current Illness: None
Preexisting Conditions: A-Fib, Hypertension, High Cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hypothermia- body temperature 94.8


VAERS ID: 1753358 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-25
Onset:2021-10-01
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21-2A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Exposure during pregnancy, SARS-CoV-2 test positive, Uterine contractions during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (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: currently at 38w5d presents with c/o uterine contractions, , intermittent, radiates to back, rates 7/10, denies associated bleeding or SROM. Preoperative screening for COVID-19 resulted positive. Appears to be incidental finding at this time.


VAERS ID: 1753414 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013589 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Headache, Oral pain, Oropharyngeal pain, Paraesthesia, Trismus
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

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: See details of adverse reaction after first vaccine shot.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: It''s been less than 24 hours since the shot but the reaction is shaping up to be the same. Sore throat, trouble swallowing this morning, left cheek feels tingly, headache. All reactions that I had after the first dose that eventually led to extreme pain when trying to open my mouth on the left side. It felt like my jaw was locked at a certain point, preventing me from opening it wide enough to yawn without being in terrible pain.


VAERS ID: 1753427 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Extra dose administered, Pharyngeal paraesthesia
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: adalimumab (HUMIRA,CF, PEN) 40 mg/0.4 mL pen, cetirizine-pseudoephedrine (ZYRTEC-D) 5-120 mg per tablet, cholecalciferol, vitamin D3, (VITAMIN D3 ORAL), and PROAIR HFA 90 mcg/actuation inhaler
Current Illness: N/A
Preexisting Conditions: Crohn''s Disease
Allergies: Nut and Latex
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was in office and receive his 3rd dose of Pfizer vaccine. patient started having tingling in his throat and lightheaded 3 to 4 minutes after the vaccine was given. Patient was give 1 tablet of Allegra 60 mg . Patient started feeling better after he took the Allegra. Patient was kept in observation for additional 30 min.


VAERS ID: 1753448 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Headache, Pain
SMQs:, Guillain-Barre syndrome (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: Aleve
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Weakness, body/joint pain, chills, headache


VAERS ID: 1753454 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Paraesthesia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Light headed, dizzy, tingling in hands and feet, blurry vision


VAERS ID: 1753478 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Urinary incontinence
SMQs:

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

Write-up: Urinary incontinence; headache; unusual fatigue


VAERS ID: 1753518 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

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

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

Write-up: Patient was administered Pfizer on 9/10 as first dose and on 10/1 was administered Janssen as second dose in error. No adverse reaction at this time


VAERS ID: 1753553 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-01
Onset:2021-10-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspepsia, Gastrointestinal disorder, Gastrooesophageal reflux disease, Hypertension, Paraesthesia, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol lorazepam Prozac zolpidem Zyrtec Flonase
Current Illness: Post nasal drip and seasonal allergies
Preexisting Conditions: Depression anxiety and hipertensi?n
Allergies: None
Diagnostic Lab Data: Spoke to the doctor they will be a series of test conducted that I haven?t done yet.In the meantime I was prescribed Pepcid
CDC Split Type:

Write-up: Three hours after the shot I felt pins and needles on my right side of the face, six hours later I experience extremely high blood pressure 200/100, a couple days after I started having gastrointestinal problemsIndigestion acid reflex felt like a lump in my throat.


VAERS ID: 1753573 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

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

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

Write-up: Patient received .3 ml Janssen dose instead of Pfizer dose 2, patient notified, no adverse reactions at this time.


VAERS ID: 1753637 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 LA / IM

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

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

Write-up: Vaccine expired 9/21/21 and was administered to patient prior to knowledge of expiration date. No adverse reaction noted. Moderna notified and will call back with any needed follow up.


VAERS ID: 1753643 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-04
Onset:2021-10-01
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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: breakthrough covid case. Positive PCR test on 10/1/2021


VAERS ID: 1753645 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphonia, Pharyngeal swelling, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same reaction with 1st dose on 9/10/21
Other Medications:
Current Illness:
Preexisting Conditions: ESSENTIAL HTN DM 2 Other SEVERE OBESITY EQUIVALENT, BMI 38-38.9, ADULT W CO-MORBIDITY MAJOR DEPRESSIVE DISORDER, RECURRENT EPISODE, IN FULL REMISSION CARPAL TUNNEL SYNDROME. LACTOSE INTOLERANCE GASTRITIS OSTEOARTHRITIS OF BILAT KNEES PANIC DISORDER ULCERATIVE COLITIS OF UNSPECIFIED SITE INTERMITTENT ASTHMA SCREENING COLONOSCOPY HX OF TOTAL HYSTERECTOMY, NO VAGINAL PAP SMEAR REQUIRED
Allergies: Ceftin [Cefuroxime Axetil] Ceftin [Cefuroxime Axetil]Asthma Flagyl [Metronidazole] Flagyl [Metronidazole]Nausea and/or Peanut - Dietary Peanut - Reason: Sulfa (Sulfonamide Antibiotics) Sulfa (Sulfonamide Antibiotics) Augmentin [Amoxicillin With Clavulanate Potassium] Augmentin [Amoxicillin With Clavulanate Potassium]: Iodine And Iodine Containing Compounds Iodine And Iodine Containing CompoundsSibutramine Hcl Monohydrate Sibutramine Hcl Monohydrate Adverse Reactions/Drug Intolerances Aspirin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Throat swelling, Itchy throat, hoarse voice after 7 minutes of 2nd dose of vaccine Benadryl 50mg PO given 10minutes after reaction started Patient symptoms revolving after 15 minutes of giving Benadryl. Hoarseness , swelling and itchiness resolving


VAERS ID: 1753648 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

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

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

Write-up: Pt came to clinic for office visit and requested booster shot of Covid vaccine. Pt initially received Moderna vaccine and was given Pfizer for booster dose in office. Pt was notified.


VAERS ID: 1753675 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Virgin Islands  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

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

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

Write-up: Patient was given Moderna COVID-19 vaccination as first dose and was given Pfizer Biotech as the second dose erroneously. Patient showed no adverse reaction. He was monitored per protocol and went home after 15 minutes.


VAERS ID: 1753689 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Intermittent over-the-counter gummy multivitamin and biotin.
Current Illness: None
Preexisting Conditions: Spina bifida
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Enlarged right arm pit lymph node.


VAERS ID: 1753690 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Condition aggravated, Dyspnoea, Electrocardiogram normal, Pallor
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: none, vitamins
Current Illness: none
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: @0906 Pulse ox read saturation of 98% HR 112. Site lead called 911. @0908 BP 147/93 HR 93 @0910 NP assessing lung sounds. Lung sounds clear. Oxygen saturation 100% BP 147/93 HR 111. @0913 EKG shows normal sinus rhythm. BP 147/93 HR 111 @0914 BP 163/93 hr 109. Blood pressure repeated with result of 148/89 Hr 104.
CDC Split Type:

Write-up: @0906 Pt alerted nurse of SOB with chest discomfort. Nurse approached patient and alerted NP and EMS for further assistance. Pt was seated and assisted to lay down on mat. Pulse ox read saturation of 98% HR 112. Site lead called 911. @0908 NP assessed client. No diaphoresis, mild pallor, denies nausea, no fever, no chills, denies blurry vision, denies dizziness, denies swelling of the throat. No hx of medical issues, no prescribed medications, Hx of surgery for appendix, denies drinking energy drinks only coffee. BP 147/93 HR 93 @0910 NP assessing lung sounds. Lung sounds clear. Oxygen saturation 100% BP 147/93 HR 111. Wife states husband was feeling very anxious prior to vaccine. Patient reports that he has had this happen before and reports that he feels his blood pressure go down. Reports seeing clearly with no dizziness. @0913 Pt reports same situation happened 3 months ago and happens about 1 time year when he is running. EKG shows normal sinus rhythm. BP 147/93 HR 111 @0914 Pt states feeling better. Pt says has not gone to doctor when this happened in past. Pt reports still feeling anxious. BP 163/93 hr 109. Blood pressure repeated with result of 148/89 Hr 104. Patient does not know what his baseline blood pressure is. @0917 NP endorsed care to paramedic. PT refused to be taken to hospital. PT left ambulatory with AMA signed with fire department.


VAERS ID: 1753710 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (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 reported trouble swallowing and felt like her throat was closing up a few minutes after receiving the vaccine. I had someone call the paramedics and I gave her a dose of epinephrine (Epi-pen) 0.3mg. After a few minutes she was breathing easier. The paramedics came and checked her out and she spoke to her physician by text, who advised her to take a benadryl and famotidine. After about 45 minutes, the patient was comfortable enough for someone to drive her home.


VAERS ID: 1753723 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 3 RA / IM

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

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

Write-up: patient previously got 2 doses of Moderna covid 19 vaccines back in February and March but mistakenly got Pfizer for 3rd dose


VAERS ID: 1753725 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-10-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pruritus, Sinus pain
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderal XR, LoEstrin
Current Illness: no
Preexisting Conditions: no
Allergies: PCN, Sulfa
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Severe left sinus pain. Tylenol Sinus PE. Pain subsided after medication. Also has itchy skin around elbows on both arms and on the face around the lips - started 9/25, negative SOB or difficulty breathing/swallowing. Zyrtec 10mg twice daily and Benadryl at night help relieve itchiness.


VAERS ID: 1753748 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3015T8A / UNK - / SYR

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

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

Write-up: Eye swollen shut


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