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

Found 1,031,637 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 490 out of 10,317

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VAERS ID: 1897357 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3306BD / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site warmth
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: Sertraline - Prozac Claritin
Current Illness: no known
Preexisting Conditions: none
Allergies: no known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: soreness at injection site, golf ball size hard spot, redness, itching and hot to the touch. symptoms started in 1-3 days


VAERS ID: 1897371 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Condition aggravated, Fall, Gait disturbance, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AM: Methylphenidate, Citalopram, Januvia, Loratadine, Exetimibe, Metoprolol; PM: Montelukast, Esomeprazole, Diphenhydramine, Alprazolam.
Current Illness: None
Preexisting Conditions: Diabetes, COPD, High Cholesterol, High Blood Pressure, Depression/Anxiety, Multiple Allergies, ADHD
Allergies: Codeine, Amoxicillin, Atomoxetine, Azithromycin, Celecoxib, Ciprofloxacin, Invokana, Metformin, Sulfa, Milk, Avocado, Nickel, possibly Bananas, Animal Dander, Dust Mites
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Started with sore arm in early afternoon, as expected and as experienced with the first and second doses of the vaccine. By early evening I started experiencing moderate aches in my ankle joints and it was very painful to walk. By the time I went to bed @ 9:30 pm the pain had progressed to many more joints and I began to feel extremely chilled. At 10:30 pm I turned on my heated mattress pad, which helped the chills, but the pain in my joints kept waking me up repeatedly. By 1:30 am 11-23-2021 I could not stand the pain any longer and got out of bed to find some pain relief medication, falling once in the attempt. I took 1 tablet of Naproxen and about 30 minutes later the pain had dimmed enough that I was able to get back to sleep. The joint pain continued Tuesday, 11-23-2021, and I have continued to take one Naproxen tablet- 225 mg every 8 hours to keep the pain bearable. As of today, Wednesday, 11-24-2021, the joint pain is still present, but is gradually lessening.


VAERS ID: 1897375 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / IM

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

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

Write-up: Patient was given an adult dose of Pfizer that was diluted using 1.3mL of sodium chloride and drawn up to administer a 0.2mL dose. Patient was observed for 15 minutes with no signs of allergic reactions. Patient''s parents were contacted by Dr. but they stated they would call the clinic for follow up information.


VAERS ID: 1897384 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hot flush, Nausea, SARS-CoV-2 test negative, Seasonal allergy
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conjunctival disorders (narrow), Hypersensitivity (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: COVID test- Negative 11/24/21
CDC Split Type:

Write-up: Patient came in to pharmacy MC stating that she feels she had a reaction to COVID vaccine that she received on 11/21/21. She began to experience "hot flashes" and nausea. She stated she had "chills" but is afebrile and not experiencing diaphoresis at this moment. She stated that symptoms began on 11/22/21. She was not ill at the time nor taking any medications as per patient. Today she is not experiencing any distress, fever, nor SOB. Currently, experiencing seasonal allergy symptoms.


VAERS ID: 1897404 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Cardiac flutter, Chest X-ray normal, Chest pain, Cough, Dyspnoea, Electrocardiogram normal
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (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: elderberry
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Chest x-ray- normal EKG-normal Blood work to check for clots came out negative
CDC Split Type:

Write-up: Shortness of Breath, chest pain, heart fluttering, started Monday after vaccine. When she breathes she feels like coughing.


VAERS ID: 1897417 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, 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: Flovent HFA inhaler and Proair HFA inhaler
Current Illness: suspected COVID 19
Preexisting Conditions: iron deficiency anemia
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was given an adult dose of Pfizer that was diluted using 1.3mL of sodium chloride and drawn up to administer a 0.2mL dose. Patient was observed for 15 minutes with no signs of allergic reactions.


VAERS ID: 1897442 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Interchange of vaccine products, Product administration error
SMQs:, Medication errors (narrow)

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

Write-up: vaccine administration error: Vaccine recipient had primary series of Moderna. Vaccine recipient requested Moderna booster. Pt received Pfizer covid 19 booster. Vaccine recipient was made aware and given phone number to call if concerns.


VAERS ID: 1897489 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, 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: Loratadine 10mg and promethazine DM
Current Illness: suspected covid 19
Preexisting Conditions: hyperlipidemia, childhood obesity
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

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


VAERS ID: 1897509 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Pain, Pyrexia, Vertigo
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (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: Valtrex as needed for cold sores
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: 12 hours after injection started with chills, aches and fever. Then dizziness started soon after. Fever and chills resolved in about 24 hours. Dizziness has gotten worse as the days progressed. 4 days out now and I?m still having significant dizziness that feels like vertigo.


VAERS ID: 1897512 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, 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: none
Current Illness: NONE
Preexisting Conditions: childhood obesity, hyperlipemia
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

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


VAERS ID: 1897540 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-15
Onset:2021-11-22
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF884 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaginal haemorrhage
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: B12, Natrua-Mune 2, Bergamot BPF, Lipitrol OX, Microbiome Cleanse, D3, Omega 3 -- I have taken these for years
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: none yet -- trying to make appointments now.
CDC Split Type:

Write-up: After menopause for 4 years I am bleeding again.


VAERS ID: 1897544 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-23
Onset:2021-11-22
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 11/22/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1897549 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient was 13 years old at the time of vaccination with pediatric Pfizer vaccine formulation. This was his first dose of the 2-dose series.


VAERS ID: 1897611 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Children''s Saline Nasal Spray 0.65% aerosol
Current Illness: overweight in childhood
Preexisting Conditions: overweight in childhood
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was given an adult dose of Pfizer that was diluted using 1.3mL of sodium chloride and drawn up to administer a 0.2mL dose. Patient was observed for 15 minutes with no signs of allergic reactions.


VAERS ID: 1897650 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Lymph node pain, Lymphadenitis, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen, Calcium supplement, Fish Oil, Centrum Silver, Allegra, Metoprolol, Premarin
Current Illness:
Preexisting Conditions: Atrial Tachycardia, Spondylolisthesis, Prediabetes,
Allergies: Sulfa drugs, Oxycodone, Eurythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lymphadenitis, left collarbone area. Swollen, red and painful to the touch. Symptoms occurred overnight with pain waking me up around 5:30 am on Monday, Nov 22.


VAERS ID: 1897681 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-26
Onset:2021-11-22
   Days after vaccination:331
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 RA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897688 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram normal, Hypoaesthesia, Magnetic resonance imaging normal
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: PT received the J and J covid vaccine on 11/19 without any incident during administration or observation period. Patient called later that afternoon stating both arms were numb. Patient was advised to call her pcp for additional direction. PCP sent pt to ER for further medical evaluation- according to pt, blood work, MRI and CT scan were negative. Pharmacist f/u with patient on 11/24 who reported numbness in legs/feet but symptoms in arms and hands had resolved. Patient reported that ER doctor excepted symptoms to resolve with time.


VAERS ID: 1897707 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Bone pain, Feeling cold, Headache, Injection site erythema, Nausea, Pain in extremity, Skin warm
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ziac as my prescription and over-the-counter Advil
Current Illness: No
Preexisting Conditions: Asthma, arthritis, high blood pressure
Allergies: Mobic
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Started off by massive headache sick to my stomach every bone in my body hurt every joint fingers bris elbows and then I thought I was freezing. Now today 11/24 I have a Bullseye at the shot site and my arm is still very hot


VAERS ID: 1897715 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Pain
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Body aches, stomach upset


VAERS ID: 1897746 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 RA / IM

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

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

Write-up: Patient''s mother requested and consented to Moderna vaccine booster dose for her children as she was receiving her own Moderna Booster. An incorrect booster dose of 0.25 ml of Moderna was administered to her teenage children. A separate VAERs form has been filed for the other teenage recipient. The booster dose was administered outside of dosage guidance for the discussed age group.


VAERS ID: 1897764 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cardiac monitoring, Computerised tomogram, Diarrhoea, Facial paralysis, Injection site rash, Urine analysis
SMQs:, Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (broad), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pol.CL Micro tab generic for K-Dur Lisinipril Simvastatin Acdiophilas Propanolol
Current Illness: no
Preexisting Conditions: no
Allergies: uncertain
Diagnostic Lab Data: Ct scan to rule out stroke urine sample heart monitor blood work
CDC Split Type:

Write-up: right eye and right side of mouth drooping rash at injection site diarrhea


VAERS ID: 1897773 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: Rash that started at injection site and spread to arms, legs and body


VAERS ID: 1897777 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-19
Onset:2021-11-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Diarrhoea, Disorientation, Joint stiffness, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: The over-the-counter medication she started taking after becoming symptomatic is Tylenol.
Current Illness: No other illnesses at time of vaccine
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced joint stiffness, pain, covid arm, disorientation, chills, diarrhea, and vomiting.


VAERS ID: 1897803 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Pyrexia, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd covid dose was the same
Other Medications: metroprolol lisinopril atrovastatin chlorthalidone aspirin 81 Vitamin D
Current Illness:
Preexisting Conditions:
Allergies: demerol
Diagnostic Lab Data:
CDC Split Type:

Write-up: chills, fever of 101, total loss of energy lasted for 36 hours


VAERS ID: 1897851 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-19
Onset:2021-11-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Fatigue, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (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: No known OTC are known
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: The delayed adverse events that the patient experienced are nausea, vomiting, diarrhea, weakness, and fatigue.


VAERS ID: 1897887 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Pain, Vaccine positive rechallenge
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same reactions after first and second shots
Other Medications: Iisinopril for blood pressure 2.5 mg
Current Illness: None
Preexisting Conditions: Slightly high blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Aches, low energy, chills


VAERS ID: 1897895 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-11-22
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Dyspnoea, Fatigue, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ascorbic Acid (VITAMIN C WITH ROSE HIPS) 500 MG tablet B Complex Vitamins (VITAMIN B COMPLEX PO) BABY ASPIRIN PO benzonatate (TESSALON) 100 MG capsule BIOTIN PO Cholecalciferol (VITAMIN D-3) 5000 UNITS TABS dexamethasone (DECADRON) 6 MG tab
Current Illness:
Preexisting Conditions: OSA (obstructive sleep apnea) Coronary artery disease involving native heart without angina pectoris, unspecified vessel or lesion type Essential hypertension with goal blood pressure less than 140/90 Other hyperlipidemia Inability to maintain erection Hepatic steatosis
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 11/22/2021; COVID-19 positive 11/22/2021; fully vaccinated BRIEF OVERVIEW: Admission Date: 11/22/2021 Discharge Date: 11/24/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient is a 62-year-old male who presented to the emergency department with shortness of breath and fatigue. Patient with known COVID-19. In the emergency department, patient was found to be hypoxemic on room air and placed on supplemental oxygen. Chest x-ray was performed and concerning for COVID-19 pneumonia. He was admitted and started on Decadron and remdesivir. Patient did improve during his stay and felt well on the day of discharge. Pulmonary rehab was consulted and patient was set up with home oxygen. He is to wear 3 L nasal cannula at all times. He was also enrolled in the COVID at home program. He was recommended to follow up with his primary care physician. He was discharged home in stable condition.


VAERS ID: 1897898 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Feeling cold, Feeling hot, Hyperhidrosis, Hypersomnia, Injection site reaction, Migraine, Mobility decreased, Pain, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 5/3/21, second dose of Pfizer in right arm at 24 years old; high fever, chills, and exhaustion for about 18 hours following the
Other Medications: Birth control, Vienva
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11/22/21: Sore arm began that evening at around 8pm but laid down for bed at 9pm. From 10pm-2am, I experienced a fiery burning in every joint in my body for the course of four hours. It was some of the most severe pain I have felt in my life. I can only explain it as a hot poker being jabbed into every joint, even my ribs. I could not move either. At around 2am, the pain almost instantly stopped, and I immediately got cold. My teeth were chattering, and I could not warm up. I did not take my temperature but assume it had to be high. To warm up, I took a half hour shower. When I got out, I had a migraine and started throwing up. By 3am or so, I got into bed, sweating and feeling extremely hot rather than freezing. I woke up again in the morning, feeling rundown. After waking up at 8am, I also slept from 10am-11:30am, 1:30pm-3:00pm, and 4:30pm-10:30pm. I did not have an appetite all day. Throughout the course of this, I took Tylenol at 650mg dosage, but it only affected the injection site, which I thought was odd. I do not normally swallow pills, so my tolerance is extremely low, and I am usually able to get away with a dose of children''s Tylenol, even as a 25 year old. By 11/24, I am not exhausted, but I still have lingering pain that comes and goes. At the time of writing this at 5pm on 11/24 most of the pain is gone, though some joints still throb if they''re bent for too long.


VAERS ID: 1897906 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-11-22
   Days after vaccination:314
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 later had second vaccine, and later tested positive for covid 19


VAERS ID: 1897927 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Joint range of motion decreased, Pain, Sleep disorder
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: Losartan, pro-biotics, vit D
Current Illness: none
Preexisting Conditions: none
Allergies: Allergic to ACE Inhibitors
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme pain in entire left shoulder area. So much so that couldn''t sleep for 2 nights. Very limited range of motion and use of left arm due to extreme pain all around shoulder. Felt like arm had been ripped from shoulder and left to hang. Dead arm. Not tender or sore to touch at injection site. Pain felt more internal.


VAERS ID: 1897930 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Fatigue, Feeling abnormal, Headache, Insomnia, Pain, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (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: Same adverse effects. Maybe worse this time with the booster.
Other Medications: FibreCon pills Stool Softener Centrum Men?s Senior Multi Rosuvistatin, 10mg, 1/day Citalipram, 10mg, 1/day Fluticasone Nasal Spray for Allergies Azelistine Rx Nasal Spray
Current Illness: None
Preexisting Conditions: Complex Sleep Apnea (uses a BiPap matching on ASV) Mild Aortic Valve Insufficiency IBS w/constipation
Allergies: Allergic to many fruits with a stone. Peaches are the worst. Anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: By 8pm of the day I received the Covid-19 booster (Moderna), I became chilly and achy. My temperature was 100�F. I felt very tired and had a headache at the bae of my head. I didn?t sleep well. I felt poorly the next day, as well. My temperature spiked to 100.5�F later that afternoon. I slept well?9.8 hours. I felt better upon awakening, but I am still a bit tired today. No fever and no headache.


VAERS ID: 1897937 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-20
Onset:2021-11-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 OT / IM

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Influenza, Pain, Pyrexia, Rash, Rash pruritic, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: 6 y/o female presents flu symptoms. Symptoms started 3 days ago (sunday) Low grad fever has been on and off. Vomited x 1 on Monday night. Diarrhea since Monday. Bodyaches. Developed a rash last night to bilateral hands- itching and hurting. No appetite. Received 1st COVID vaccine Saturday. Been using tylenol/ibuprofen and benadryl last night for rash.
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: supportive care advised to use otc for rash on hands.
CDC Split Type:

Write-up: 6 y/o female presents flu symptoms. Symptoms started 3 days ago. Low grad fever has been on and off. Vomited x 1 on Monday night. Diarrhea since Monday. Bodyaches. Developed a rash last night to bilateral hands- itching and hurting. No appetite. Received 1st COVID vaccine Saturday. Been using tylenol/ibuprofen and benadryl last night for rash.


VAERS ID: 1897955 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered
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: None
Current Illness: Overweight
Preexisting Conditions: Overweight
Allergies: NKDA
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient given an adult dose of Pfizer diluted using 1.3mL of sodium chloride and drawn up to administer 0.2mL dose. Patient observed for 15 minutes with no signs of allergic reaction.


VAERS ID: 1897956 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / N/A RA / IM

Administered by: Other       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: denied
Current Illness: denied
Preexisting Conditions: denied
Allergies: denied
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received J&J on 11/22/2021, he had Pfizer first dose on 10/18/2021.


VAERS ID: 1897963 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Myalgia, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: High fever (101.0 F). Bad aches in bones, muscles, and intestines for two days. Rash on deltoid of my left arm. Took until mid-day Wednesday for the effects to clear up.


VAERS ID: 1897967 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Immediate post-injection reaction, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Injection site pain was immediate and continued for 12 hours at a very strong level, from 12 to 20 hours, the pain gradually subsided. General fatigue began within about 30 minutes of the injection and continued for approximately 30 hours.


VAERS ID: 1897983 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 and Flu A/B negative 11/24/2021
CDC Split Type:

Write-up: Fever, chills, HA, fatigue, bodyache started 1 day after vaccination. Persists but waxes and wanes.


VAERS ID: 1897995 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-11-22
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Menstrual disorder
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Menstrual Cycle started 10 days early


VAERS ID: 1897998 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product administration error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UN KNOWN ADMINISTRATION ERROR: PHARMACIST ADMINISTERED PFIZER COVID -19 FOR 12 AND ABOVE INSTEAD OF PFIZER COVID-19 (5-11 YEARS) VACCINE
Current Illness: UN KNOWN ADMINISTRATION ERROR: PHARMACIST ADMINISTERED PFIZER COVID -19 FOR 12 AND ABOVE INSTEAD OF PFIZER COVID-19 (5-11 YEARS) VACCINE
Preexisting Conditions: UN KNOWN ADMINISTRATION ERROR: PHARMACIST ADMINISTERED PFIZER COVID -19 FOR 12 AND ABOVE INSTEAD OF PFIZER COVID-19 (5-11 YEARS) VACCINE
Allergies: UN KNOWN ADMINISTRATION ERROR: PHARMACIST ADMINISTERED PFIZER COVID -19 FOR 12 AND ABOVE INSTEAD OF PFIZER COVID-19 (5-11 YEARS) VACCINE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: ADMINISTRATION ERROR: PHARMACIST ADMINISTERED PFIZER COVID -19 FOR 12 AND ABOVE INSTEAD OF PFIZER COVID-19 (5-11 YEARS) VACCINE SO FAR PATIENT DID NOT REPORT ANY ADVERSE EVENT.


VAERS ID: 1898035 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UN KNOWN ADMINISTRATION ERROR: PHARMACIST ADMINISTERED PFIZER COVID-19 VACCINE FOR 12 YEARS AND ABOVE INSTEAD OF PFIZER COVID-19 VACCINE (5 TO 11 YEARS)
Current Illness: UN KNOWN ADMINISTRATION ERROR: PHARMACIST ADMINISTERED PFIZER COVID-19 VACCINE FOR 12 YEARS AND ABOVE INSTEAD OF PFIZER COVID-19 VACCINE (5 TO 11 YEARS)
Preexisting Conditions: UN KNOWN ADMINISTRATION ERROR: PHARMACIST ADMINISTERED PFIZER COVID-19 VACCINE FOR 12 YEARS AND ABOVE INSTEAD OF PFIZER COVID-19 VACCINE (5 TO 11 YEARS)
Allergies: UN KNOWN ADMINISTRATION ERROR: PHARMACIST ADMINISTERED PFIZER COVID-19 VACCINE FOR 12 YEARS AND ABOVE INSTEAD OF PFIZER COVID-19 VACCINE (5 TO 11 YEARS)
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: ADMINISTRATION ERROR: PHARMACIST ADMINISTERED PFIZER COVID-19 VACCINE FOR 12 YEARS AND ABOVE INSTEAD OF PFIZER COVID-19 VACCINE (5 TO 11 YEARS)


VAERS ID: 1898204 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OU7F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Electrocardiogram, Headache, Injection site pain, Pain, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: First 2 doses of Covid Moderna
Other Medications: Metformin; Ozimpic, Atorvastatin, Levothyoxine
Current Illness: None
Preexisting Conditions: Diabetic
Allergies: none
Diagnostic Lab Data: Covid test 11/23/21 at hospital Chest scan EKG
CDC Split Type:

Write-up: Debilitating headache; vomit; diarrhea; severe body aches; injection spot arm pain


VAERS ID: 1898463 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 - / IM
FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION QFAA2116 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Inappropriate schedule of product administration, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

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

Write-up: Pt stated her vaccination was administered lower than normal. She received both immunizations in the same arm as per her request. She reported headache, swelling and body aches.


VAERS ID: 1898467 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Injection site pain, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid vaccine, moderna. First 2 shots were in April 2021. Same adverse reactions as with the booster shot. All 3 shots induce
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm at injection site, body/joint aches, extreme headache, fever, chills, nausea


VAERS ID: 1898479 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-19
Onset:2021-11-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oral herpes
SMQs:, Oropharyngeal infections (narrow), Opportunistic infections (broad)

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

Write-up: PRECIPITATED A SEVERE OUTBREAK OF COLD SORES


VAERS ID: 1899511 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: On 11/22/21 we (the pharmacy) gave a 17 year old a Pfizer booster, which is only approved for 18+. After getting ahold of the mother on 11/24, she explained that she thought her daughter was immunocompromised. Based on her conditions/meds,
Current Illness: NO
Preexisting Conditions: Asthma
Allergies: NO
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: On 11/22/21 we gave a 17 year old a Pfizer booster, which is only approved for 18+. After getting ahold of the mother on 11/24, she explained that she thought her daughter was immunocompromised. Based on her conditions/meds, the dose should not have been given.


VAERS ID: 1899515 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Immobile, Musculoskeletal stiffness, Pain, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Anaphylaxis, 15, 12/13/2017, HPV Vaccine:Gardisil
Other Medications: Cymbalta 60 mg Multivitamin
Current Illness:
Preexisting Conditions:
Allergies: Gardisil HPV Vaccine Hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID arm Swelling in arm, itching, intense pain, tight shoulder muscle, immobility


VAERS ID: 1899517 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-11-20
Onset:2021-11-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dizziness, Fatigue, Heart rate irregular
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad)

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

Write-up: 2 days after receiving my booster Pfizer vaccine I had mild chest pain that lasted 3 days (I''m currently on day 3 and symptom has improved but still noticeable). Also had fatigue and the exact sensation is hard to explain but felt lightheaded at times and like my heart wasn''t beating normally. Like a slowed heartbeat or less effective that corresponded to a throbbing sensation in my heart and head and fatigue. It was somewhat mild pain but concerning since it affected what seemed like my heart. I haven''t seen a medical professional about it, though I did think it was concerning enough to report here


VAERS ID: 1899698 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Chills, Cold sweat, Feeling cold, Grip strength decreased, Headache, Hypoaesthesia, Immediate post-injection reaction, Injection site pain, Lethargy, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (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:
Other Medications: Women?s multi-vitamin
Current Illness: None
Preexisting Conditions: RSD in left ankle post ankle fracture
Allergies: Fluoroquinolones; penicillin
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Immediate onset: Tingling and numbness in left arm down to 3 fingers on left hand with accompanying weakness of grip; sharp, deep pain at injection site. 4 hours after the injection: headache, chills, freezing cold, lethargy, cold sweats, throbbing and sharp shooting pains in left ankle. As of 11/24, chest pain on left side behind breast.


VAERS ID: 1899723 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Injection site erythema, Injection site pain, Injection site swelling, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Diarrhea-Medium, Systemic: Vomiting-Medium, Systemic: Weakness-Medium, Additional Details: LEFT ARM SIZE OF SOFTBALL


VAERS ID: 1899958 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-17
Onset:2021-11-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Neck pain
SMQs:, Arthritis (broad)

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

Write-up: Extreme upper neck pain at base of head with headache.


VAERS ID: 1899995 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Chills, Diarrhoea, Fatigue, Headache, Injection site pain, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), 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: vitamins, atorvastatin 10 mg, enalapril 10 mg
Current Illness: head cold
Preexisting Conditions: high blood pressure
Allergies: iodine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore injection site, headache, extreme fatigue, weakness, muscle aches, chills, 100 d fever, vomiting, nausea & diarrhea. Lasted 2 1/2 days.


VAERS ID: 1900033 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Exposure during pregnancy
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Hyperemesis/Morning Sickness
Preexisting Conditions:
Allergies: Penicillin, Red Dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: 20 Weeks Pregnant. Felt constant cramping and aching on right side of lower stomach (felt like period cramps on right side ovary). Cramping and aching lasted 24 hours. Pain was moderate, never got severe, but definitely not something I was expecting.


VAERS ID: 1900043 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: pericarditis


VAERS ID: 1900050 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-20
Onset:2021-11-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

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

Write-up: Tender and swollen lymph node in armpit near injection site


VAERS ID: 1900057 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-21
Onset:2021-11-22
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abnormal behaviour, Amnesia, Angiogram abnormal, Angiogram cerebral abnormal, Base excess increased, Blood glucose normal, Cerebral small vessel ischaemic disease, Chest X-ray normal, Confusional state, Facial paralysis, Fall, Feeling abnormal, Haemoglobin decreased, Headache, Hemiparesis, Loss of consciousness, Neurological symptom, PCO2 increased, Scan with contrast abnormal, Subarachnoid haemorrhage, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (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), Hostility/aggression (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Medications: tylenol, fosamax, arimidex, ecotrin, lipitor, betamethasone dipropionate, vitamin b12, cymbalta DR, lexapro, feratab, flonase, zestoretic, mag-ox, glucophage XR, Toprol-XL, prilosec, ozempic, tresiba flextouch, aristocort cream
Current Illness:
Preexisting Conditions: Past Medical History: b12 deficiency, right breast CA, diabetes mellitus type 2, GAD, GERD, HTN, hyperlipidemia, macular degeneration, magnesium deficiency, mass of upper lobe of right lung, major depressive disorder, osteoarthritis of both hands, renal cyst, vitreous hemorrhage of right eye Past Surgical History: De quervain?s release, fixation kyphoplasty, Hx back surgery, Hx breast biopsy, Hx breast lumpectomy, Hx cataract removal, Hx knee arthroscopy, Hx tonsillectomy, Hx dental extraction
Allergies: Allergies: Band-Aid Plus Antibiotic, Actos
Diagnostic Lab Data: CT angio intra-extra cranial w IV contrast (head-neck): Impression: no large vessel occlusion, small amount of subarachnoid hemorrhage noted in the right parietal region. Extensive small vessel ischemic changes without evidence of acute territorial infarct. CXR: Impression: normal appearance of lungs. Vital Signs: BP- 148/74, HR- 82, RR- 17, Temp 98.1 F, SpO2- 94% on room air Labs: PCO2 (venous)- 61mm/Hg, Base excess- 6.1mmol/L, HGB- 11g/dL, glucose- 96
CDC Split Type:

Write-up: Dr. note- H&P: chief complaint: syncopy & stroke-like symptoms HPI: femail with medical history of hypertension, hyperlipidemia, frequent falls who presents with syncopal event. Patient was at her usual health state as of this morning. She left home to go shopping with her daughter. Her daughter was still at home and when she came out patient was found on the grass, unconscious. EMS was called, patient woke up and had 2 episodes of emesis. According to EMS report it was reported that patient had left-sided facial droop and left-sided weakness. Upon arrival to the ED patient did not have any focal weakness or facial droop. Patient does not remember what happened or how she fell. At the CTA head and neck, she was found to have 2 mm subarachnoid hemorrhage on the right parietal lobe. There is no external signs of head trauma after her fall. Patient does not remember how she was transferred to the hospital. At the time of my exam she is complaining about slight headache. She denies any shortness of breath, chest pain, abdominal pain, focal weakness, numbness, speech abnormality. Husband at the bedside, reports that patient had 2-3 falls within last couple of weeks. However when she fell previously, she did not pass out. Her other falls were related to imbalance and they were mostly mechanical falls. Patient denies any incontinence after today?s event, denies any seizure-like activity. She was confused after the event but got back to her baseline quickly. Will admit for further workup and treatment related to subarachnoid hemorrhage and syncopy. Diagnoses: subarachnoid hemorrhage, hyperlipidemia, major depressive disorder, diabetes mellitus type 2 Dr. note- ED: chief complaint: stroke symptoms HPI: 71 y.o. femail who presents to the ED for stroke symptoms. Patient was getting ready to go shopping with a family member earlier today 11/22/21 and was found on the ground by the car. Per EMS patient?s daughter said that shortly after lunch patient ?wasn?t acting right,? had left sided weakness, and a left facial droop. She had two episodes of emesis while being lifted onto stretcher. Patient says that she is no is any pain but ?feels out of it.? She has had no recent illness but is diabetic and had back surgery in July, 2021. Family member states that she is alert and oriented at baseline. Patient denies chest pain, shortness of breath, abdominal pain, fever, chills, or any other symptoms.


VAERS ID: 1900062 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-11-17
Onset:2021-11-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adrenal mass, Arteriosclerosis, Back pain, Bacterial test, Blood lactic acid normal, C-reactive protein increased, Chest X-ray abnormal, Cholelithiasis, Computerised tomogram abdomen normal, Computerised tomogram spine, Fatigue, Flank pain, Haematocrit decreased, Haemoglobin decreased, Intervertebral disc degeneration, Lipase normal, Lung consolidation, Lung infiltration, Metabolic function test normal, Movement disorder, Muscle spasms, Musculoskeletal discomfort, Pain, Pain in extremity, Pleural effusion, Pollakiuria, Pyrexia, Red blood cell count decreased, Red blood cells urine positive, Respiratory viral panel, Scan with contrast normal, Spondylolisthesis, Urinary hesitation, Urinary incontinence, Urine analysis abnormal, Urine analysis normal, White blood cell count increased, White blood cells urine positive
SMQs:, Rhabdomyolysis/myopathy (broad), Haematopoietic erythropenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Medications: norvasc, ecotrin, lipitor, vitamin d3, coenzyme Q10, flexeril, feosol, lasix, glucophage, women?s multivitamin, inderal
Current Illness:
Preexisting Conditions: Past Medical History: anemia, anxiety, CHF, CAD, diabetes type 2, GERD, hyperlipidemia, HTN, mitral valve disorder, non-rheumatic aortic stenosis, panic attack, problems with swallowing, pulmonary HTN, undiagnosed cardiac murmurs, former smoker Past Surgical History: aortic valve surgery, colonoscopy, gastroscopy with biopsy, history carotid endarterectomy, cataract removal
Allergies: Allergies: cephalexin, penicillins, lipitor (myalgia high doses)
Diagnostic Lab Data: Vital signs: BP ? 136/48, HR ? 86, RR ? 20, Temp ? 98.2 F, SpO2 92% on room air Labs: RBC 2.82, HGB 9.2, HCT 28.8, UA w/moderate bacteria and slight WBCs & RBCs, CRP 135.5 mg/L, Respiratory Virus Panel negative CT lumbar spine wo IV contrast: vertebrae- degenerative changes, no acute fracture, 5mm anterolisthesis at L4-L5. Vasculature- calcified atherosclerosis, no aneurysm. Soft tissues- effusions with basal consolidation left greater than right, 10mm right adrenal nodule, calcified gallstones. Findings- effusions with basal consolidation left greater than right, 10mm right adrenal nodule which may be benign or malignant, calcified gallstones. CXR: infiltrate versus effusion at left lung base.
CDC Split Type:

Write-up: Dr. note- H&P: chief complaint: back pain HPI: White female who presents with low back pain. Patient states that she did have a ground level fall several weeks ago and landed on her left side and had bruising to the left side of her chest wall but states this resolved and is unsure the low back pain is because of the fall. Patient went to a local urgent care because of a fever T-max 102 F on 11/20/2021 and was also complaining of right flank pain with some mild radiation down her legs at that time. She also was complaining of urinary hesitancy and frequency some incontinence throughout the day. The patient was seen and evaluated in the ED and had essentially normal CMP, UA, lactic acid, noted to have a slightly elevated WBC at 14.7 and did have a normal lipase. Patient underwent a CT of the abdomen and pelvis with IV contrast which demonstrated no acute findings. The patient was discharged with musculoskeletal low back pain and prescribed Flexeril 5mg which she states she is taking least 3 doses with no improvement of her discomfort. She has taking Tylenol with minimal improvement of her discomfort. She notices increased discomfort of her lower back with range of motion. She currently denies any pain radiating into the legs. Patient relates that she has had significant worsening of her pain with any movement, muscle spasms and fatigue since receiving her COVID-19 vaccination booster. Denies fever, chills, cough, sob, chest pain, nausea, vomiting, abdominal pain, diarrhea, urinary symptoms, other bowel or bladder complaints, saddle paresthesia or weakness of the lower extremities. ED evaluation including CT of the lumbar spine was unremarkable for acute pathology. However, patient continues to have significant ambulatory dysfunction and pain with movement. She will be admitted for further evaluation and treatment and rehab services consultation. Diagnoses: ambulatory dysfunction, back pain, falls, diabetes mellitus type 2, CAD PA-C note- ED: chief complaint: lower back pain HPI: 90 y.o. female who presents to the ED complaining of continued low back pain. Patient states that she did have a ground level fall several weeks ago and landed on her left side and had bruising to the left side of her chest wall but states this resolved and is unsure the low back pain is because of the fall. Patient went to a local urgent care because of a fever T-max 102 F on 11/20/2021 and was also complaining of right flank pain with some mild radiation down her legs at that time. She also was complaining of urinary hesitancy and frequency some incontinence throughout the day. The patient was seen and evaluated in the ED and had essentially normal CMP, UA, lactic acid, noted to have a slightly elevated WBC at 14.7 and did have a normal lipase. Patient underwent a CT of the abdomen and pelvis with IV contrast which demonstrated no acute findings. The patient was discharged with musculoskeletal low back pain and prescribed Flexeril 5mg which she states she is taking least 3 doses with no improvement of her discomfort. She has taking Tylenol with minimal improvement of her discomfort. She notices increased discomfort of her lower back with range of motion. She currently denies any pain radiating into the legs. She has not yet followed up with her primary care physician. There are notes in the computer apparently from a nurse at the patient?s PCP?s office which demonstrates that the patient?s daughter is concerned because the patient continued have a fever today of 101 F and also continues low back pain. Is initially thought that the fever that she presented with a couple days ago was likely due to her recently receiving COVID booster on 11/17/2021. They were apparently advised to return to the ED if there is any new or worsening symptoms and the daughter was concerned about possibility of a UTI or still due to receiving the COVID booster. RN note: EMS time out complete. Pt had a fall approx 4 weeks ago. Started with lower back pain on the 17th. States the pain is bilateral but shoots down her left leg. No other known injury noted.


VAERS ID: 1900064 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-01
Onset:2021-11-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Breast swelling, Chills, Headache, Lymphadenopathy, Migraine, Pyrexia
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sulfasalizine, prednisone, plaquenil
Current Illness: rheumatoid Arthritis
Preexisting Conditions: Rheumatoid arthritis
Allergies: Rosemary, evergreen trees
Diagnostic Lab Data:
CDC Split Type:

Write-up: Similar to second by worse- fever, chills, headache and eventual migraine for three days, swolling on l collarbone and pain in arm pit. Now, swelling enlargement of left breast and side of chest


VAERS ID: 1900074 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-19
Onset:2021-11-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Chest pain, Electrocardiogram, Malaise
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (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: Buprenorphine/Nalaxone (x2 8mg/2mg strips per day) Aspirin (81mg per day) Escitalopram (5mg per day)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Ran an ECG from my watch. It said it was normal. But I?m reading reports online of many others with similar reactions whose ECG measure fine. So Idk.
CDC Split Type:

Write-up: Pains in chest near heart. It?s not extreme pain, but it?s enough to notice quick, sharp stabs that are freaking me out. They come and go. Day after vax felt kinda sick. Next day felt great, thought it was over. But the following day (day 3 after) I started noticing quick pains around heart. It?s continued until now, which is why I started researching it and saw I should report it.


VAERS ID: 1900363 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-27
Onset:2021-11-22
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: s/p removal of cancerous tumor on liver with no chemo or radiation follow up needed
Allergies: none known
Diagnostic Lab Data: Rapid test for Covid positive 11/25/2021
CDC Split Type:

Write-up: vaccinated with Moderna on 2/27 and 3/27/2021. Symptoms developed on 11/22 - chills, nasal congestion Reported as case of breakthrough Covid in previously vaccinated person.


VAERS ID: 1901078 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-11-22
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse drug reaction, Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211152802

Write-up: ALMOST DIED AT MIDNIGHT; ALMOST KILL HER; This spontaneous report received from a consumer via a company representative concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 22-NOV-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 22-NOV-2021, the patient experienced almost died at midnight. On 22-NOV-2021, the patient experienced almost kill her. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the almost died at midnight and almost kill her was not reported. This report was non-serious.


VAERS ID: 1901421 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Cold sweat, Costochondritis, Dyspepsia, Electrocardiogram, Nausea, Pyrexia, Troponin
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin, Losartan, Metformin, Cetirizine
Current Illness: N/A
Preexisting Conditions: Diabetic, High blood pressure
Allergies: N/A
Diagnostic Lab Data: Troponin, chest x-ray, EKG
CDC Split Type:

Write-up: Cold sweats, fever, indigestion, nausea [T+24 hours] costochondritis (T+48hours) After being diagnosed with costochondritis, patient began regimen of 600mg ibuprofen q8h. Symptoms started to subside after for dose.


VAERS ID: 1901717 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-26
Onset:2021-11-22
   Days after vaccination:269
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthenia, Bacterial test, Bacterial test positive, Bladder catheterisation, Blood culture negative, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Cough, Culture urine negative, Dyspnoea, Dysuria, Fall, Fatigue, Granuloma, Hilar lymphadenopathy, Hip fracture, Hypoxia, Lung opacity, Open reduction of fracture, Pneumonia, Procalcitonin increased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet apixaban starter pack (ELIQUIS) 5 MG TBPK tablet azithromycin (ZITHROMAX) 500 MG tablet benzonatate (TESSALON) 100 MG capsule calcium carbonate (TUMS) 500 MG chewable tablet cefuroxime (CEFTIN) 500
Current Illness:
Preexisting Conditions: Respiratory Pneumonia due to COVID-19 virus Circulatory Coronary artery disease Hypertension Pulmonary embolism on right (HCC) Genitourinary Stage 3a chronic kidney disease (HCC) Indwelling Foley catheter present Endocrine/Metabolic Hyperlipidemia Other Osteoarthritis of one hip, right Periprosthetic fracture around internal prosthetic hip joint, initial encounter
Allergies: No Known Allergies
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time DR CHEST SINGLE VIEW Resulted: 11/23/21 0244 Order Status: Completed Updated: 11/23/21 0246 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/23/2021 2:31 AM TECHNIQUE: Portable upright AP INDICATION: Dyspnea cough COMPARISON: 10/19/2021 and older exams. ENCOUNTER: Not applicable _________________________ FINDINGS: No change in mild cardiomegaly. Stable tortuosity of the descending thoracic aorta. Normal pulmonary vasculature. Old calcified granulomatous disease with a large calcified granuloma in the left lower lobe and calcified mediastinal and hilar lymph nodes. Mild to moderate bilateral pneumonia with alveolar opacification in the right mid lung and left midlung laterally. No pleural effusions or pneumothorax. _________________________ Impression: Mild to moderate bilateral pneumonia. Procedure Component Value Ref Range Date/Time Peripheral Blood Culture Collected: 11/23/21 0130 Order Status: Completed Specimen: Blood, Venous Updated: 11/26/21 0200 Cult Blood Peripheral No Growth 3 Days Peripheral Blood Culture Collected: 11/23/21 0130 Order Status: Completed Specimen: Blood, Venous Updated: 11/26/21 0200 Cult Blood Peripheral No Growth 3 Days Urine Culture Collected: 11/23/21 1009 Order Status: Completed Specimen: Urine, catheter Updated: 11/25/21 1347 Bacterial culture, urine 10,000-50,000 CFU/mL Mixed Flora Comment: Multiple organisms $g10,000 CFU/ml present suggesting probable contamination. Legionella Antigen, Urine (Normal) Collected: 11/23/21 1009 Order Status: Completed Specimen: Urine, clean catch Updated: 11/23/21 1820 Legionella Ag Urine Negative Negative Streptococcus Pneumoniae Antigen, Urine (Normal) Collected: 11/23/21 1009 Order Status: Completed Specimen: Urine, Voided Updated: 11/23/21 1820 STREPTOCOCCUS PNEUMONIAE ANTIGEN Negative Negative, Invalid COVID-19 PCR - Rapid (Abnormal) Collected: 11/23/21 1001 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 11/23/21 1032 COVID-19 PCR Detected Abnormal
CDC Split Type:

Write-up: Patient discharged after ( 2) day inpatient stay. 11/22-11/24/2021 The patient is a 92 y.o. male who presents today with shortness of breath and fatigue. The patient has a pertinent medical history for coronary artery disease, hypertension, hyperlipidemia, and PE in August and currently on Eliquis until 11/24 (plan to continue while inpatient). Additionally the patient sustained a fall in July with a right hip fracture and subsequently underwent an ORIF with cable fixation and currently has persistent inability to void since the fall. He has had a urinary catheter since this fall. History has been obtained from the patient and his daughter. The patient tested positive for COVID-19 on 11/18. He reports symptoms started on 11/16 at include fatigue, weakness, cough in these have progressed over the following days which led him to seek the ER. While in the ER he was found to be mildly hypoxic at 88-90% on room air and was placed on 1 L nasal cannula. He was given dexamethasone remdesivir for treatment of COVID -19. While in the ER his CRP was quite elevated at 134.3 and a procalcitonin was elevated at 0.45. He was given Rocephin and azithromycin for possible bacterial pneumonia The patient''s daughter met with hospice this am, and requests that patient be discharged from hospital back to his home. She will sign him onto hospice this afternoon. Per her wishes, patient will be discharged on oxygen and given prescriptions for dexamethasone and antibiotics.


VAERS ID: 1901874 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-06
Onset:2021-11-22
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL969 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID+ 11/22/21
CDC Split Type:

Write-up: COVID BREAKTHROUGH CASE


VAERS ID: 1901875 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product administration error
SMQs:, Medication errors (narrow)

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

Write-up: Reporting is for a vaccine medication administration error where an adult patient was administered the Pfizer-BioTech Vaccine 5-11 years formulation(orange cap), resulting in a lower than authorized dose for a booster. There is currently no symptoms or adverse event. Patient has been called and correct age appropriate dose of vaccine has been administered as per CDC and vaccine manufacturer guidelines.


VAERS ID: 1901882 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-30
Onset:2021-11-22
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Blood glucose increased, Brain natriuretic peptide normal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax, Dyspnoea, Echocardiogram normal, Ejection fraction normal, Hyperglycaemia, Hypoxia, Interstitial lung disease, Myelosuppression, Platelet count decreased, Pulmonary oedema, Pyrexia, SARS-CoV-2 test positive, Sputum culture positive, Thrombocytopenia
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Agranulocytosis (narrow), Asthma/bronchospasm (broad), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler amLODIPine (NORVASC) 10 MG tablet azithromycin (ZITHROMAX) 250 MG tablet bisacodyl (DULCOLAX) 5 MG enteric coated tablet budesonide/formoterol (SYMBIC
Current Illness:
Preexisting Conditions: Respiratory COPD (chronic obstructive pulmonary disease) (HCC) Centrilobular emphysema (HCC) Pneumonia due to COVID-19 virus Circulatory Accelerated hypertension Nervous Tobacco dependence Genitourinary OAB (overactive bladder) Other Tobacco use Current chronic use of systemic steroids Steroid-induced osteoporosis Family history of abdominal aortic aneurysm (AAA)
Allergies: No Known Allergies
Diagnostic Lab Data: Results Procedure Component Value Ref Range Date/Time DR CHEST SINGLE VIEW [339030613] Resulted: 11/22/21 1229 Order Status: Completed Updated: 11/22/21 1231 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/22/2021 12:01 PM TECHNIQUE: Single view chest INDICATION: covid, dyspnea COMPARISON: CT chest 8/27/2021 and chest radiograph 8/11/2021 ENCOUNTER: Not applicable _________________________ Impression: Known severe emphysema. There is mild interstitial prominence which can be seen with pulmonary edema. Underlying infection is a consideration particularly in the setting of recent history of COVID 19. No evidence of pneumothorax or large pleural effusion. The cardiac silhouette is normal in size. I have personally viewed the images, discussed the findings with D.O., reviewed the interpretation, and agree. Procedure Component Value Ref Range Date/Time COVID-19 PCR [339030620] (Abnormal) Collected: 11/22/21 1652 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 11/22/21 1829 COVID-19 PCR Detected Abnormal
CDC Split Type:

Write-up: Patient discharged after (2) day inpatient admission 11/22-11/24/2021. Patient is a 62 year male past medical history of severe chronic obstructive pulmonary disease on chronic prednisone and azithromycin (follows with Dr.), history of left upper lobe resection 2015, hypertension, prediabetes who presents today with worsening fevers shortness of breath since 11/15/2021. Patient tested himself at home with an over-the-counter test on 11/19/2021 which was positive for COVID-19. He is vaccinated and had his 2nd Pfizer dose 03/30/2021. He did not yet receive the booster vaccine. Patient''s symptoms initially started with fever overall 102 F at home. In the emergency department he was noted to be hypoxic requiring 3 L nasal cannula, worsening shortness of breath found to have acute on chronic hypoxic respiratory failure in the setting of COVID-19 pneumonia. Initial lab work notable for thrombocytopenia with platelets of 88, likely myelosuppressive manifestation of COVID-19. Chest x-ray demonstrated evidence of pneumonia with mild interstitial prominence. He was febrile upon arrival as well to 39.4 it was given Toradol and dexamethasone. He was admitted to Medicine no 11/22/2021 for further workup and management. He had normal echocardiogram with EF 57% and normal BNP. He was also noted to have sputum culture from August 2021 positive for Rhizopus and was evaluated by ID outpatient, thought to be contaminant versus colonization. He was treated with dexamethasone and remdesivir. During his admission his oxygen requirements continued between 2 and 3 L nasal cannula. Platelets eventually improved. His blood glucose was mildly elevated on dexamethasone, secondary to steroid induced hyperglycemia, without need for at home insulin on discharge. Pulmonary rehab was consulted, recommended 3 liters/minute at rest and 6 liters/minute with activity, of supplemental oxygen. Patient instructed to complete steroid course for outpatient management of COVID-19. Patient was discharged in stable condition, afebrile, in no acute distress, and with arranged home oxygen medical equipment and instruction of home use medical equipment.


VAERS ID: 1901893 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (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: Prilosec, Flonase
Current Illness: None
Preexisting Conditions: None
Allergies: Morphine, iodine
Diagnostic Lab Data: No e
CDC Split Type:

Write-up: Numbness in both legs, moderate pain in hip joints, tingling is both feet.


VAERS ID: 1901894 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product administration error
SMQs:, Medication errors (narrow)

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

Write-up: Reporting is for a vaccine administration error where an adult patient was administered the Pfizer-BioTech vaccine 5-11 years formulation(Orange cap),resulting in a lower than authorized dose for a booster. There is currently no symptoms or adverse event. Patient has been called and correct age appropriate dose of Pfizer-Biotech vaccine has been given as per CDC and vaccine manufacturers


VAERS ID: 1901896 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS 58160-0823-11 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Fatigue, Headache, Injection site pain, Pain
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Shingles vaccination (dose 1) provided at same time. No other medications or supplements.
Current Illness: None
Preexisting Conditions: None
Allergies: gluten (i.e. wheat, rye, barley, sorghum, etc.) dairy (all) soy (minor) amaranth quinoa hemp (and related) chocolate
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache (significant) Joint aches (significant) Body aches Fatigue Dizziness Fairly normal injection site soreness in both arms (Left-COVID Moderna Booster; Right-Shingles (1st dose)). One fairly tough day with ramp up and quick recovery afterwards. - Used ibuprofen fours times in total. - Chicken soup and lots of sleep.


VAERS ID: 1901900 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-15
Onset:2021-11-22
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein increased, COVID-19, Chills, Cough, Diarrhoea, Dyspnoea, Fibrin D dimer increased, Hypoxia, Imaging procedure abnormal, Laboratory test abnormal, Lung opacity, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), 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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL) 0.5% (5 mg/mL) nebulizer solution albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler aspirin 325 MG tablet Cholecalciferol (VITAMIN D-3) 1000 UNITS CAPS diclofenac sodium 1 % gel
Current Illness: 6/8/2021- Bronchitis with wheezing; atypical chest pain; productive cough
Preexisting Conditions: Non-Hospital Unspecified essential hypertension DM (diabetes mellitus), type 2 Chronic low back pain Chronic kidney disease, stage V requiring chronic dialysis Senile nuclear cataract Myopia Knee pain, left Rupture quadriceps tendon Pericardial effusion Hypertension
Allergies: CodeineNausea Only
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time DR CHEST SINGLE VIEW [353942480] Resulted: 11/22/21 0918 Order Status: Completed Updated: 11/22/21 0920 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/22/2021 9:00 AM TECHNIQUE: Single view chest INDICATION: COVID positive, hypoxemia COMPARISON: 11/19/2021 and 2/19/2016 ENCOUNTER: Not applicable _________________________ Impression: Moderate low lung volumes. There are patchy peripheral and mid to lower lung predominant opacities as well as interstitial prominence. These findings can be seen with pulmonary edema and/or atypical infection. No evidence of pneumothorax or large pleural effusion. The cardiac silhouette appears similarly enlarged. I have personally viewed the images, discussed the findings with doctor., reviewed the interpretation, and agree.
CDC Split Type:

Write-up: Patient currently admitted at (40 days inpatient starting on 11/22/2021. Patient is a 64 y.o. female fully vaccinated against COVID 19 (Pfizer, 2nd dose in June) now presents with COVID-19 infection and SOB. PMHx significant for ESRD s/p DDRT, immunosuppression with (prograf, myfortic, prednisone), chronic pericardial effusion, IDDM-II, GERD, HTN. Patient tested positive for COVID-19 on 11/17. 1 week of cough, diarrhea, fevers, chills. Seen in ED on the 19th, discharged with albuterol inh. This morning feeling more short of breath so returned to the ED. In the ED hemodynamics were stable. She was hypoxic on RA in the 80s, required 2 L NC. Labs with elevated CRP otherwise fairly unremarkable. D-dimer elevated at 940.


VAERS ID: 1901903 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Immunisation, No adverse event, Underdose
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: Reporting is for a vaccine administration error where an adult patient was administered the Pfizer-BioTech vaccine 5-11 years formulation(Orange cap),resulting in a lower than authorized dose for a booster. There is currently no symptoms or adverse event. Patient has been called and correct age appropriate dose of Pfizer-Biotech vaccine has been given as per CDC and vaccine manufacturer guidelines.


VAERS ID: 1901913 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-12
Onset:2021-11-22
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Cough, Decreased appetite, Fatigue, Headache, Hypoxia, Nausea, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: pravastatin 40 mg oral tablet
Current Illness: None listed
Preexisting Conditions: hyperlipidemia
Allergies: NKA
Diagnostic Lab Data: 11/20/2021 COVID 19 PCR positive 11/22/2021 COVID 19 Rapid antigen positive 11/22/2021 CXR shows possible small left-sided pleural effusion which may be new. Bibasilar infiltrates which are slightly improved on the right compared to the previous exam.
CDC Split Type:

Write-up: on November 13 patient came down with symptoms of chills, headache, fatigue, loss of appetite, nausea, cough, and progressively worsening general weakness over the past several days. Patient had an outpatient COVID19 test that was negative on November 18th but then went to see his PCP on November 20th and a chest x-ray at that time demonstrated ?pneumonia that look like COVID19? according to the patient''s wife. Patient is not currently on antibiotics. Patient did not have a repeat COVID19 test on November 20th. EMS noted that the patient was hypoxic with a pulse oximetry of 87% on room air at the home. Admitted to hospital with COVID pneumonia on 11/22/2021, still hospitalized. Currently on 6 L of oxygen via nasal cannula.


VAERS ID: 1901914 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-11-22
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8759 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Nasal congestion, Pain, Productive cough, Pyrexia, Sinus congestion, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Vitamin C 500 MG Capsule as directed Orally ?Vitamin D (Ergocalciferol) 50 MCG (2000 UT) Capsule 1 capsule Orally Once a day ?Remicade 100 MG Solution Reconstituted 150 mg Intravenous Every 8 weeks ?Gabapentin 100 MG Capsule 1 ca
Current Illness: none
Preexisting Conditions: Crohn''s disease dx 1978, was followed by North Memorial GI-now with MNGI. depression -- previously followed with Dr. (psychiatry). Mixed headaches. gastritis noted on EGD sept 2010. G3 P3. h/o anemia (hemoglobin 11/25/12 normal and has been normal $g1 year, checked with every Remicade follow up). Scoliosis. Left arm fracture 4th grade. low back pain (see 11/2015 MRI)--mild lumbar DDD. Chronic neck pain. osteopenia (see 2019 DEXA).
Allergies: Sertraline HCl: decreased libido - Side Effects Effexor XR: not effective - Side Effects Escitalopram Oxalate: dizzy, tinnitus, HA - Side Effects Percocet Nickel: rash - Allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, productive cough, fever (101 F a few days ago), chills, body aches, nasal congestion, sinus congestion, sneezing. starting 11/22/21


VAERS ID: 1901916 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Reporting is for a vaccine administration error where an adult patient was administered the Pfizer-BioTech vaccine 5-11 years formulation(Orange cap),resulting in a lower than authorized dose for a booster. There is currently no symptoms or adverse event. Patient has been called and correct age appropriate dose of Pfizer-Biotech vaccine has been given on 11/23/21, as per CDC and vaccine manufacturer guidelines


VAERS ID: 1901928 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Reporting is for a vaccine administration error where an adult patient was administered the Pfizer-BioTech vaccine 5-11 years formulation(Orange cap),resulting in a lower than authorized dose for a booster. There is currently no symptoms or adverse event. Patient has been called and correct age appropriate dose of Pfizer-Biotech vaccine has been given on 11/24/21, as per CDC and vaccine manufacturer guidelines.


VAERS ID: 1901948 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK2157 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient given vaccine scheduled for 5-11 year old. Pt is 12 year, 1 month old. Patient had no adverse effects and tolerated vaccine well.


VAERS ID: 1901956 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-20
Onset:2021-11-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (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: vitamin D
Current Illness: none
Preexisting Conditions: developmental delay due to CASK deletion
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Two nosebleeds, one was second night after vaccine, sometime in the middle of the night and the second was on day 2 or 3 after the vaccine.


VAERS ID: 1901977 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-09
Onset:2021-11-22
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 - / -

Administered by: Pharmacy       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-19 positive 11/24/21
CDC Split Type:

Write-up: COVID-19 vaccine breakthrough case


VAERS ID: 1901979 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus given in 1988 at age 18. Difficulty breathing
Other Medications: Vitamin D, B complex
Current Illness: None
Preexisting Conditions: None
Allergies: Detergents, moth balls
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, fever, headache, body aches, underarm on L side very swollen and sore, symptoms lasted 48 hours with underarm swelling for 72 hours after injection.


VAERS ID: 1901986 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-02
Onset:2021-11-22
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Laboratory test abnormal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11.22.21 pos on admission
CDC Split Type:

Write-up: SOB


VAERS ID: 1902035 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase nasal spray Miralax
Current Illness: Hand, foot, and mouth 2 weeks prior to vaccination
Preexisting Conditions: Seasonal environmental allergies
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Tinnitus


VAERS ID: 1902062 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F22A / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Myalgia, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

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

Write-up: Musical pain headache chilled nose drainage


VAERS ID: 1902123 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-11-18
Onset:2021-11-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Angiogram, Chest pain, Computerised tomogram, Deep vein thrombosis, Hypotension, Lethargy, Pulmonary embolism, Scan with contrast, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Furosemide, Levothyroxine, Methazolamide, Vitamin D3, Omeprazole, Potassium Chloride, Sertraline.
Current Illness: Fracture of Pubis, Fracture of Fourth Metatarsal Bone, right foot,
Preexisting Conditions: Rheumatoid Arthritis, Hypothyroidism
Allergies: Latex
Diagnostic Lab Data: 11/22/21 Angiogram with IV contrast, CT,
CDC Split Type:

Write-up: Lethargy, low BP & tachycardia, chest pain. Admitted to hospital 11/22 with Dx. of Pulmonary Embolisms & DVT''s in right Peritoneal Veins. Discharged back to facility 11/24.


VAERS ID: 1902167 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-17
Onset:2021-11-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Asthenia, Blood potassium decreased, Chest X-ray, Chronic left ventricular failure, Electrocardiogram, Electrolyte depletion, Full blood count, Hypokalaemia, Injection site hypoaesthesia, Metabolic function test
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypokalaemia (narrow)

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

Write-up: Patient presents to ED after Cardiology called him to come in due to low potassium. Denies muscle aching or chest pains at this time. Does state he is feeling bloated despite having a hard stool about an hour ago. 1. Hypokalemia 2. Electrolyte depletion 3. Weakness 4. Left arm numbness 5. Chronic systolic CHF (congestive heart failure) potassium chloride (KLOR-CON M20) 20 MEQ CR tablet


VAERS ID: 1902204 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Oxygen saturation decreased, Vertigo
SMQs:, Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Vestibular disorders (narrow), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: MECLIZINE, OMEPRAZOLE, AZELASTINE NASAL SPRAY, LEVOTHYROXINE, ESTRADIOL
Current Illness: NONE
Preexisting Conditions: VERTIGO
Allergies: PENICILLIN, CEPHALOSPORINS
Diagnostic Lab Data:
CDC Split Type:

Write-up: ~5 HOURS AFTER RECEIVING VACCINE, PT (WHILE SITTING) EXPERIENCED EXTREME WORSENING OF VERTIGO AND WEAKNESS. TAKEN TO EMERGENCY ROOM, ADMITTED. O2 LEVELS BELOW 80%, GIVEN OXYGEN. RECOVERED FROM WORST OF SYMPTOMS. STILL EXPERIENCING VERTIGO/WEAKNESS


VAERS ID: 1902246 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-27
Onset:2021-11-22
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Dry throat, Headache, Oropharyngeal pain, Pulmonary congestion, Rhinorrhoea, Sinus tachycardia
SMQs:, Cardiac failure (broad), Taste and smell disorders (narrow), Supraventricular tachyarrhythmias (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Dehydration (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: Prenatal + DHA 27-1 & 250 MG Therapy Pack Orally
Current Illness: none
Preexisting Conditions: PCOS, Primary infertility, History of pre-eclampsia in prior pregnancy.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: HA, ST, runny nose, and loss of taste/smell Symptoms began 4 days ago with dry tickly throat. Progressed to rhinorrhea and chest congestion over next few days. Developed sore throat yesterday with loss of smell. No fever or chills. starting 11/22/21


VAERS ID: 1902261 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Gaze palsy, Injection site pain, Lymphadenopathy, Paraesthesia, Pyrexia, Tenderness
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Ocular motility disorders (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: None
Preexisting Conditions: Obese
Allergies: Eurythromyicine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day 1:Left Arm pit became tingly evening of the injection. Sore injection site Day 2: Lymph node started to swell. Skin tender in armpit. Fatigue. Sore injection site. Day 3: fatigue, more swelling and tenderness in armpit. Woke with headache. Day 4: headache woke me during the night. Left armpit still swollen and tender. Fever, tingly feeling in face, slightly dizzy feeling. Fatigue.


VAERS ID: 1902316 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-15
Onset:2021-11-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GLGH8030 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit D, zinc, multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myocardial infarction 1 week after injection


VAERS ID: 1902343 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Injection site pain, Paraesthesia, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Lipodystrophy (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: Pneumonia vaccine, eliquis, Verapamil, lipitor, fenofibrate, Levothyroxine, Amitriptyline, Clonazapam, Tylenol
Current Illness: Cardiac Arrhythmias, obesity, factor v, Hypothyroid, gastroparesis, hiatal hernia, umbilical hernia, fibromyalgia, anxiety, Osteoporosis, Osteoarthritis, bone spurs, left rotator cuff problems, bursitis in hips
Preexisting Conditions: Same as item 11.
Allergies: Levaquin, Gabapentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: First two vaccines were Pfizer so you know with no problems. Left arm in shot location pain and slight soreness in left axillary by midnight. Woke up several times with axilla pain gradually worsening. Tylenol and ice packs that next day. Pain in axilla worsened thru the next day extending into left breast; continued ice packs and Tylenol and reported to doctor office which just referred me to vaccine pharmacy who referred to cdc who referred me to file this. 11/25/2021 pain decreased to tolerable with only Tylenol. 11/26/2021 left axilla only tender when pressure applied. Around 4pm started having tingling in both hands which gradually extended up both arms then tingling over whole body when standing, so now I''m just sitting.


VAERS ID: 1902496 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Deafness, Ear infection, Ear pain
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Retinol
Current Illness: None
Preexisting Conditions: None
Allergies: Fish
Diagnostic Lab Data: 11/24 doctor visit with dr.
CDC Split Type:

Write-up: Hearing loss, pain in both ears, infection in both ears


VAERS ID: 1902498 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-01
Onset:2021-11-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Had headache and chills. Age 76 at time of second dose, Moderna 03/10/21. Lot #026A21A
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, rash and hives all over the body. Very itchy. Presented several days after booster shot. Went to the Clinic for treatment. Was prescribed Allegra and Benadryl.


VAERS ID: 1902694 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-21
Onset:2021-11-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Oropharyngeal pain, Pain, Pain in extremity, Respiratory tract congestion
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Large welt with itching at vaccination site - left arm
Other Medications: Estrogen, progesterone, baby aspirin, vitamin d, iron
Current Illness: A cold a week prior - congestion
Preexisting Conditions: MTHFR
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, sore throat, fatigue, congestion, sore arm followed by sore body, headache


VAERS ID: 1916159 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Headache, Malaise, Myalgia, Nausea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Headache, Myalgia, Arthralgia, Nausea Vomiting, malaise


VAERS ID: 1943177 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Erythema multiforme, Fatigue, Neck pain, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash, ErythemaMultiform, neck aches, fatigue, chills


VAERS ID: 1943182 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA L032F21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA L032F21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Back pain, Blood pressure increased, Chest pain, Dizziness, Fatigue, Headache, Hypertension, Malaise, Myalgia, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Dizziness, Headache, Myalgia, Arthralgia & HYPERtension Narrative: Patient received Booster Moderna Vaccine on 11/17/2021 and reported adverse side effects on 11/19/2021 when the SE became more severe. Onset of headache on 11/17/2021 neck and back pain on 11/18/2021 and headache worsened on 11/19/2021. SE reported directly to VAERS on 11/19/2021. Patient reported worsening symptoms on 11/20-21/2021 resulting in Emergency Room visit. SE at the time were Headaches, Chest Pain, Elevated Blood Pressure. Symptoms improved but currently as of 11/26/2021 Patient with continued malaise, dizziness and fatigue.


VAERS ID: 1903475 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01214210 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, Chills, Diarrhoea, Fatigue, Headache, Lethargy, Pain, Pyrexia, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Mild side effects, low fever, aches, tired
Other Medications: Tylenol, vancomycin, amiordorone, eliquis,
Current Illness: bowel obstruction, CDiff
Preexisting Conditions: Atril Fib, and heart arrhythmia, cancer in remission
Allergies: lactose intolerant
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Side effects included fever of 100.4. , body aches, vomiting, extreme chills, headache, diarrhea, lethargy, weakness, one bout of Atrill Fib. Side effects lasted about 3 days...leaving me tired and shaky but feeling stronger.


VAERS ID: 1903480 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol, lasix, rosuvastatin, asprin
Current Illness: none
Preexisting Conditions: heart failure, kidney failure, falls, hypothyroidism, hyperlipidemia
Allergies: amoxicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Administered a booster dose of Moderna Vaccine, however resident had already had a booster approx a month earlier


VAERS ID: 1903483 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 4 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sertraline, clonazepam, loratadine, torsemide, xarelto, donepezil, melatonin
Current Illness: none
Preexisting Conditions: alzheimers, anxiety, edema
Allergies: codine, hydrocodone, minocycline, tetracycline, tramadol, pollen
Diagnostic Lab Data: none
CDC Split Type:

Write-up: administered booster of Moderna vaccine, however patient had already received a booster in August 2021


VAERS ID: 1903484 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-08
Onset:2021-11-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 150mg Xanax 25 mg
Current Illness: None
Preexisting Conditions: None
Allergies: Nsaids Sulfa drugs Avocados
Diagnostic Lab Data: None but plan on trying to see a doc for relief
CDC Split Type:

Write-up: Two weeks after the booster I started getting hives on my legs . They started at night and would be gone by morning . However now says later they are coming and going all day and have also shown up on my back and arms . Hydrocortisone doesn''t seem to help much . Allegra helped in the morning for a while .


VAERS ID: 1903781 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / OT

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Hyperhidrosis, Immunisation, Lymphadenopathy, Muscle spasms, Pyrexia, Vaccination site pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; Penicillin allergy (known allergies: penicillin).
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101641646

Write-up: Fever; Chills; Muscle spasms; Joint pain; Profuse sweating; Tiredness; Pain at injection site; Lymphadenopathy; Dose received: 3; This is a spontaneous report from a contactable consumer, the patient. A 22-year-old non-pregnant female patient received third (BOOSTER) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FH8027) via intramuscular route of administration in the left arm on 22Nov2021 at 08:30 (at the age of 22-years-old) as a single dose for COVID-19 immunisation. Medical history included asthma and allergy to penicillin. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. The patient did not take any concomitant medications within two weeks of vaccination. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0170) via intramuscular route of administration in the left arm on 24Apr2021 at 15:00 (at the age of 21-years-old) and the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0176) via intramuscular route of administration in the right arm on 15May2021 at 15:15 (at the age of 21-years-old), both as a single dose for COVID-19 immunisation. On 22Nov2021 at 12:00, the patient experienced fever, chills, muscle spasms, joint pain, profuse sweating, tiredness, pain at injection site and lymphadenopathy. The events did not result in doctor or other health care professional office/clinic visit, and emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events fever, chills, muscle spasms, joint pain, profuse sweating, tiredness, pain at injection site and lymphadenopathy was unknown at the time of this report.


VAERS ID: 1903908 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-22
Onset:2021-11-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injected limb mobility decreased
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: Numbness in left arm from elbow down x 14 days. Denies any other side effects such as pain, redness, swelling, warmth. Pt says he is also unable to fully extend the arm.


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