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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 491 out of 8,753

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VAERS ID: 1772311 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1772327 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1772346 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1772392 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-15
Onset:2021-09-16
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dehydration, Diarrhoea, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Dehydration (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:
Current Illness:
Preexisting Conditions: Diabetes, Renal Disease, Autoimmune Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PUI tested positive on 9/16 after experiencing diarrhea and dehydration. PUI was admitted to Hospital from 9/17-9/19 for an IV as she was dehydrated. PUI has no other symptoms. PUI is fully vaccinated with Pfizer vaccine that she got on 2/25 and 3/15. PUI has an autoimmune condition, kidney disease and diabetes that she is not experiencing any difficulties with during this time.


VAERS ID: 1772401 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1772573 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-04
Onset:2021-09-16
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fibrin D dimer, Thrombosis, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (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: aripiprazole 5mg, hydroxyzine 50mg, citalopram 40mg, alprazolam 0.5 mg
Current Illness:
Preexisting Conditions:
Allergies: penicillins
Diagnostic Lab Data: d-dimer 0.75, ultrasound showed clot
CDC Split Type:

Write-up: Developed clot in lower leg (shin), 60 mg Lovenox at ER, 81 mg aspirin daily, cephalexin 500 mg three times a day for 10 days, smz/tmp 800mg/160mg twice daily for 3 days


VAERS ID: 1773610 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Alabama  
Vaccinated:2021-07-15
Onset:2021-09-16
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Herpes zoster, Oral herpes, Rash
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101275109

Write-up: cold sore break out; shingles; rash; severe pain in back; This is a spontaneous report from a contactable consumer (patient) via Regulatory Authority. A patient of an unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number and expiration date were not reported), via an unspecified route of administration on 15Jul2021, dose 2, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. It was reported that about two weeks afterwards the vaccination, the patient had a cold sore break out. Then on 16Sep2021, the patient started having severe pain in back. On 18Sep2021, a rash was forming, and the patient went to the emergency room on 20Sep2021 to be told the patient have shingles. The patient filed a report to notify of this and asked any studies on the effect the mRNA was having on these other viruses. Information on the lot/batch number has been requested.


VAERS ID: 1773631 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Dizziness, Dyspnoea, Fatigue, Heart rate, Heart rate irregular, Pain in extremity, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: OMEPRAZOLE; CARVEDILOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high (Heart Decease, High Blood Pressure); Heart disease, unspecified (Heart Decease, High Blood Pressure)
Allergies:
Diagnostic Lab Data: Test Date: 20210916; Test Name: irregular heartbeat; Result Unstructured Data: Test Result:irregular; Test Date: 20210928; Test Name: BinaxNOW/Abbott; Test Result: Negative ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101282906

Write-up: dizziness; irregular heartbeat; aches: legs/shoulders; aches: legs/shoulders; tiredness/weakness when moving about; tiredness/weakness when moving about; Breathing at times tight; This is a spontaneous report received from a contactable consumer (patient) reported for himself. An 82-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot number: EW0175, Expiration date was not reported), via an unspecified route of administration in arm left on 13Sep2021 at 14:00 (at the age of 82-year-old) as a dose 1, single for COVID-19 immunization. The patient''s medical history included heart decease and high blood pressure from an unspecified date and unknown if ongoing. Known allergies were reported as none. The patient''s concomitant medications in two weeks included omeprazole dr, 20 mg and carvedilol 25 mg and other, all were taken for an unspecified indication. The patient did not receive any other vaccines within four weeks. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had been tested for COVID-19. On 16Sep2021 at 12:00 am, three-four days following, the patient experienced dizziness, irregular heartbeat, aches: legs/shoulders, tiredness/weakness when moving about, breathing at times tight but never serious - able to take deep breathes easily. The adverse events resulted in doctor or other healthcare professional office/clinic visit. Treatment was received for the events that included heart monitor by cardiologist. On 16Sep2021, the patient underwent lab tests and procedures which included irregular heartbeat (heart rate), resulted as irregular and BinaxNOW/Abbott (SARS-CoV-2 test), resulted as negative, nasal swab on 28Sep2021. The outcome of the events was unknown. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1774913 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Chest discomfort, Chest pain, Condition aggravated, Electrocardiogram, Peak expiratory flow rate
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: light asthma
Allergies: penicillin; certain pollen
Diagnostic Lab Data: Peak flow 09/23/2021 EKG 09/27/2021
CDC Split Type:

Write-up: Since the third day, every night I felt a hint of chest pain/distress, which becomes more clear during a deep breath, for around 1.5 weeks. It dispear during the day and after 10 days, but reappears indefinitely later. I went to see a cardiologist, and the doctor listened to my heart and lung and said that may be asthma. My asthma was asymptomatic before the vaccination and only appears during extremely hard exercise. After the vaccination I also found my asthma got worse (noticable during long fast walking/slow running, and sometimes at rest).


VAERS ID: 1774946 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-06-29
Onset:2021-09-16
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07BC21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Back pain, Neck pain, X-ray
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Had no energy, was lightheaded all the time, almost passed out a lot, felt nauseas all the time and had to send long periods res
Other Medications: DHEA
Current Illness:
Preexisting Conditions: Diving accident 7 years prior
Allergies: Dog and Cat hair
Diagnostic Lab Data: X-rays 09/27/2021
CDC Split Type:

Write-up: Bad pain in my neck, shoulder, and spine. Currently undergoing 12-18 weeks of physical therapy. So far has done some good, but also hasn''t really done to much to alleviate the pain.


VAERS ID: 1775159 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaccine positive rechallenge
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: Prozac, ambien, gabepentine. Vitamins C,D and zinc.
Current Illness: Covid 19
Preexisting Conditions: No
Allergies: Moraphen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: All lymph nodes on the side I received the vaccine in, my left size, were sore and swollen. There was pain, throbbing, severe soreness and knots you could feel. The largest knot burst and I received some relief. There is still soreness deep in my left breast. I received my second dose today, 10/9/21, and it is beginning to feel like before only quicker.


VAERS ID: 1775453 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Insomnia, Palpitations, Pruritus
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 40hrs insomnia 40hrs of my heart booming (feeling of beating out of my chest) 4 days of itching skin on my back of my hands, forearms, back of my knees, and around my neck.


VAERS ID: 1775660 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-11
Onset:2021-09-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oral disorder
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Turmeric, Dandelion Root, Probiotic, Magnesium, Potassium, Biotin, Zinc, Ginkgo Biloba, Hair,Skin & Nails supplement, D3, K2, C, Eaters Digest(Ox Bile Extract, Pancreatin, Pepsin, Diastase, Betaine Hydrochloride, Papain)
Current Illness: None
Preexisting Conditions: None
Allergies: I react to heavy metals, especially Mercury.
Diagnostic Lab Data: None were done.
CDC Split Type:

Write-up: I began getting small mouth lesions on my lips about 5 days after my 2nd vaccine. I eventually also got a couple on my tongue. As I generally use homeopathic remedies I used 3 doses of Arsenicum Album pellets and the lesions cleared up in about 5 days.


VAERS ID: 1775735 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: Pt seeing md tomorrow 10/11/2021 to see the cause of this
CDC Split Type:

Write-up: PT REPORTED RADIATING PAIN THAT''S BEEN GETTING WORSE FOR 3 WEEKS, migrated to other arm and neck


VAERS ID: 1775810 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Echocardiogram, Electrocardiogram ambulatory, Electrocardiogram normal, Laboratory test, Palpitations, Sinus arrhythmia, Sinus rhythm, Supraventricular extrasystoles
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypokalaemia (broad)

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

Write-up: - 2 days after the injection he started to with chest pressure or tightness with intermittent sharp chest pain that is occasionally on the left and occasionally on the right. Sometimes feels short of breath with the sharp pain. - Submitted to ER 11 days after receiving vaccine - with chest pain and pounding palpitations. - EKG detecgted occasional premature atrial contractions (PAC). - Referred to cardiologist for additional evaluation. Cardiologist prescribed a 3 day heart monitor, which detected SINUS RHYTHM WITH SINUS ARRHYTHMIA, WITH OCCASIONAL PREMATURE ATRIAL COMPLEXES and OCCASIONAL PREMATURE VENTRICULAR CONTRACTIONS; OTHERWISE NORMAL ECG. - Care plan includes heart monitor, labs for inflammation, and echocardiogram.


VAERS ID: 1776311 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-10
Onset:2021-09-16
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 RA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1776357 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-09
Onset:2021-09-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gingival erythema, Lip dry, Lip erythema, Lip swelling, Noninfective gingivitis, Skin fissures, Skin weeping
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Gingival disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Vitamin D3, Zinc, and Combo Magnesium and Calcium
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: First gums were red and inflamed. Was prescribed antifungal lozenge''s and dexamethasone mouth rinse. As it progressed my lips were extremely swollen red and dry. The corners of my mouth were cracked and oozing. Using Vaseline only made it worse. . Now a month later I am finally getting some relief from an antibiotic cream given to me and coconut oil. I did my own research and came up with Angular Cheilitis.


VAERS ID: 1776887 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

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

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

Write-up: Lightheaded without syncope


VAERS ID: 1776982 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-09-16
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Dizziness, Gait disturbance, Headache, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: fever, loss of taste and smell headache, trouble walking, dizzy


VAERS ID: 1778017 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER 310358A / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Chest pain, Chills, Dysgeusia, Fatigue, Headache, Lip swelling, Nausea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Taste and smell disorders (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: head aches, chest pain, left back pain and feeling shaky, felt like my lips was swollen, nausea and metallic taste in my mouth. chills, stomach pain, leg pain, feeling fatigued


VAERS ID: 1778995 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-03
Onset:2021-09-16
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, COVID-19 pneumonia, Fatigue, Pulmonary embolism, Respiratory symptom, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (broad), Embolic and thrombotic events, venous (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: desogestreL-ethinyl estradioL (Apri) 0.15-0.03 mg per tablet - Take 1 tablet by mouth daily for menstrual cycle regulation
Current Illness: Vaccine given 9/3/2021. Covid-19 positive diagnosis made on 9/10/2021. Symptom onset including severe fatigue on 9/6/2021 with respiratory symptoms to follow. Diagnosed with Covid-19 pneumonia, ARDS, and pulmonary embolism on 9/16/2021. It is unclear if the administration of the Covid-19 vaccine contributed to development of pulmonary emboli or if this was related to Covid-19 illness itself, and/or if oral contraceptive pill was contributing factor.
Preexisting Conditions: None known other than foot pain which she was seeing podiatry for. Patient is otherwise very healthy.
Allergies: No known allergies
Diagnostic Lab Data: As above.
CDC Split Type:

Write-up: Saw PCP for annual physical on 9/3/2021. Felt generally well at that appointment other than some mild ongoing fatigue, nothing specific. Administered first dose of Pfizer Covid-19 vaccine that day and tolerated it well. Patient reported significant increase in fatigue on 9/6/2021. Came in to be tested for Covid-19 on 9/10/2021 and tested positive. Insidious onset of respiratory symptoms which progressively got worse around this time. Came in to Emergency Department on 9/16/2021 and was found to have Covid-19 pneumonia, acute respiratory distress and pulmonary embolism but main factor for admission to hospital was the pulmonary embolism.


VAERS ID: 1779185 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Blepharospasm
SMQs:, Dystonia (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (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: Left eye twitching


VAERS ID: 1779386 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-18
Onset:2021-09-16
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Atrial fibrillation, Blood test, Cardiac stress test normal, Cardioversion, Echocardiogram normal, Fatigue
SMQs:, Supraventricular tachyarrhythmias (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Telmisartan 40mg, 1xday Atorvastatin 40mg, 1xday Multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Nuclear stress test- no clogged arteries Blood work Echocardiogram- no blood clots Thoracic echocardiogram- didn''t have any blood clots
CDC Split Type: vsafe

Write-up: I had no reaction from vaccine, but roughly 2 or 3 weeks later I developed atrial fibrillation. I have never had heart issues before, and no one in my family history has had it as well. I was in the hospital for 3 days. They did the cardioversion to get my heart back on a normal rhythm. After that I left the hospital and I was just on medications. About two weeks later the atrial fibrillation came back. Today I went into the hospital for nuclear stress test to make sure I don''t have any clogged arteries. I am now in the process of getting a cardiac ablation. I am usually active, but now I am more exhausted and tired since being diagnosed with atrial fibrillation.


VAERS ID: 1779457 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Full blood count, Headache, Hypoaesthesia, Laboratory test normal, Magnetic resonance imaging head, Magnetic resonance imaging neck, Tinnitus
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: trellegy inhaler, albuterol inhaler, vit a, vit d, vit c, vit b complex, reservatrol, quercetin
Current Illness: none
Preexisting Conditions: asthma, neck and back pain
Allergies: nka
Diagnostic Lab Data: MRI of brain with and without contrast. 10/6/21. MRI cervical spine 10/6/21. CBC 10/6/21. Test for stroke ....results no stroke suspected. 10/5/21.
CDC Split Type:

Write-up: Initial reaction was a headache. 2 days later felt numbness on the left side. eft ear ringing. patient said he felt like he "had a concussion".


VAERS ID: 1779558 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-09-16
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK LA / IM

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

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

Write-up: COVID 19


VAERS ID: 1780443 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Scrotal pain
SMQs:

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

Write-up: Patient reports constant scrotal pain that began 24 hours after his immunization and has persisted for 4 weeks.


VAERS ID: 1780807 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Site: Itching at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium.


VAERS ID: 1782363 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH IC 3180 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Palpitations, Troponin
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Troponin 0.10, high . Normal EKG and ECHO
CDC Split Type:

Write-up: Chest pain, palpitatations, shortness of breath. Resolved with Advil.


VAERS ID: 1782425 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-09-16
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / UNK - / -

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

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

Write-up: COVID 19


VAERS ID: 1783179 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-12
Onset:2021-09-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Anticoagulant therapy, Blood creatinine increased, Burning sensation, Computerised tomogram head abnormal, Computerised tomogram neck, Condition aggravated, Feeling hot, Full blood count, Globulins increased, Glomerular filtration rate decreased, Haematocrit decreased, Hypoaesthesia, Jugular vein thrombosis, Lymphoedema, Mean cell volume normal, Mean platelet volume decreased, Metabolic function test, Neck pain, Paraesthesia, Platelet count normal, Protein total increased, SARS-CoV-2 test negative, Swelling, Throat tightness, Ultrasound Doppler abnormal, White matter lesion
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Last chemo dose listed from outside records as 9/1 and next dose delayed due to events. Was on Paclitaxel/Trastuzumab but appears per chart review paclitaxel discontinued 12/2020 and continues on trastuzumab- but not clear. Amlodipine 1
Current Illness:
Preexisting Conditions: Breast Cancer Stage I, ER+/PR+/Her2+, premenopausal, hx of post-operative cellulitis, benign essential HTN, history of papillary thyroid cancer status post surgery, post thyroidectomy, recurrent sinusitis, obesity, cyst of left ovary, tobacco user, S/P bilateral salpingo-oophorectomy, anemia due to neuoplastic disease
Allergies: listed: hydrocodone/APAP- nausea
Diagnostic Lab Data: Upon hospital admission 9/20/21 CBC including platelets WNL with exception of Hct 34.4, MCV 80, MPV 6.8, CMP WNL with exception SCr 1.19, protein 8.5, globulin 3.9, eGFR 49, PTT WNL, COVID 19 nasopharnygeal negative CT head: IMPRESSION: Small subcortical white matter lesions with no associated enhancement or mass effect. The etiology is uncertain. These can be seen with chronic small vessel ischemic change, chronic migraines, vasculitis, demyelinating processes, the sequela of old trauma, and infectious etiologies such as Lyme disease. Follow-up MRI may be helpful CT neck: IMPRESSION: 1. Thrombosed RIGHT internal jugular vein with clot surrounding tubing of right-sided Port-A-Cath device within the upper superior vena cava. 2. Normal appearance otherwise to neck. 3. No evidence for acute cardiopulmonary disease within chest.. US VENOUS UPPER EXTREMITY RIGHT DUPLEX: Acute deep venous thrombosis involving the right internal jugular vein remaining arm veins are open and in normal limits. Cursory evaluation of the left lower extremity, subclavian veins are negative. 10/11/21 US VENOUS UPPER EXTREMITY RIGHT DUPLEX Impressions * Acute occlusive DVT identified in the right internal jugular vein. * The remainder of the right upper extremity venous system appears patent. * Cursory check of the left was negative. * No signficant change from prior study 9/20/21
CDC Split Type:

Write-up: Received Pfizer COVID vaccine 1 of 2 on 9/12/21. Has office visit with PCP 9/16/21 chief compliant "R lateral neck pain and swelling, started 2 days ago, not improving. Did receive 1st COVID vaccine 4-5 days ago, was advised by lymphedema coach that her immune system would "flare". Also has a port in her R upper chest wall, last accessed 3 weeks ago. Has tried nothing for her pain." Referral placed for CT scan of the area, instructions to apply heat and tizanidine prescribed. 9/20/21 hematology office outpatient visit note on 9/20/21, "Pt mentions received Covid vaccine 9/12. States she felt "hot and burny" for two days thereafter, with some tightness to throat. Felt fine Tuesday 9/14. Wed 9/15, swelling began" referred her to the emergency room where she was then admitted with diagnosis of right occlusive DVT in the internal jugular. Spent 3 days in the hospital and discharged on apixaban and pain medications. 10/1/21 heme/onc outpatient follow-up visit "?. She is currently doing better compared to last week, has less pain, denies any shortness of breath or chest pain. ECOG 1. Swelling has also improved Lately however she is also having swelling of the left side of her body, worsening of previous lymphedema, going to physical therapy for this already." 10/11/21 Heme/onc follow-up call patient c/o "1) Constant "irritation" and tingling under her right jaw that started one hour ago. Pt reports HX of right jugular vein blood clot. 2) Pt denies jaw pain, dyspnea, chest tightness, chest palpitation, nausea, diaphoresis, HA, vision changes. Pt states she has experienced this jaw numbness when she has significant allergies. Pt states she has missed 2 of her Eliquis doses within the last 5 days.A) Pt asking if she can have a neck ultrasound ordered. B) RN concerned that pt should be seen by an Urgent Care or ED." 10/11/21 ER visit for Paresthesia (Primary Dx); Thrombosis of internal jugular vein, unspecified laterality"? with neck tingling. She did receive an ultrasound from triage and results are already available: "No change in the right proximal, mid and distal internal jugular vein thrombus noted since last exam dated 9/20/21.". She has normal voice and swallow and there is no evidence of airway compromise. She has no evidence of ear infection requiring antibiotics. She has set an alarm to help her remember her anticoagulation. She is relieved that there is no progression of the clot. I see no evidence of other emergent medical condition or further testing at this time, and she is stable for discharge to follow up with oncology as needed. To continue anticoagulation as prescribed."


VAERS ID: 1784781 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Hepatic enzyme increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: None
Current Illness: None
Preexisting Conditions: Allergic Rhinitis
Allergies: none
Diagnostic Lab Data: Elevated liver enzymes on 9/21/21, 10/6/21, 10/9/21
CDC Split Type:

Write-up: Chest Pain, now resolved


VAERS ID: 1784786 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-09-16
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Adnexa uteri pain, Intermenstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: 46 year old woman who hasn''t had a period in a year and a half (due to having an IUD in place) developed feminine bleeding akin to a monthly cycle (period). This occurred 2 weeks after her Janssen vaccine. She also developed what she called "ovarian pain" that preceded the bleeding. Since that occurrence, she has had multiple rounds of spotting. She finds this very strange and concerning considering she still has the IUD in. The pain has resolved, but the spotting/bleeding has not.


VAERS ID: 1784877 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dizziness, Fatigue, Gait disturbance, Headache, Muscle tightness, Nausea, Oligomenorrhoea, Pain in extremity, Paraesthesia, Presyncope
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Fertility disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Balziva (birth control) - prescribed for continuous use.
Current Illness: N/A.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: J&J Covid Vaccine received 9/16 @ 2:35pm. Heavy waves nausea & dizziness began within 5 min and through night. 9/17 - extreme leg pains, difficulty walking, dizziness, intense headaches 9/18 - random bouts of dizziness, general fatigue. 9/19 - chest pains & tightness in neck periodically through day, sporadic dizziness (to the point of near fainting a couple times) 9/20 - lighter chest pains & some tightness in neck periodically through day. 9/21 - sporadic lighter chest tightness, but still feeling tightness in neck periodically followed by intense tingling on the top of my head while walking for exercise. 9/22 through 9/25 - most symptoms seem to have eased up over a few days, but still have sporadic moments of dizziness, chest pains, and neck tightness. Note: doctor prescribed continuous Balziva (birth control pill) - no breaks for periods for multiple months. Stopped taking 9/19 for fear of complications with vaccine especially after extreme leg pains and chest pains. Waited to submit this report until 4 weeks out in hopes that I am mostly out of the window of developing the blood clot disorder, but will submit an additional report should anything else develop as I know most issues with vaccines happen within 42 days which would be another couple weeks from now.


VAERS ID: 1785082 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-16
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Polymenorrhoea
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: i have had 3 menstruation cycles in the month following my vaccination. I had my first one from 09-16-21 to 09-21-21. I stopped bleeding and then began a second period from the 10-02-21 through 10-09-21. Unusually long and dark almost black in color and painful. Then I stopped again on the 9th only to start another cycle 5 days later on the 10/13/21. This is so frustrating, wrong, and terrifying. I dont know why I am bleeding every other week. i am not on birth control, contraceptives, and it''s impossible that I am pregnant. I have no STDs/STis. I had a pap swear and ultrasound done last year and there were no abnormalities in my reproductive organs. I have never experienced anything like this. I have not received medical care for this due to the fact no doctors have any research on this issue and everyone claims the vaccine is safe.


VAERS ID: 1785263 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-09-16
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020E721A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Herpes zoster, Lacrimation increased, Lymphadenopathy, Mouth ulceration, Ocular hyperaemia, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Eliquis
Current Illness: None
Preexisting Conditions: Atrial fibrillation
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: It started with my right eye getting red and swollen and started tearing. I had a lesion in my mouth. I went to an eye doctor and to the dentist. I had the second dose and that night my eye continued to swell. I had a rash on the side of my face. On Friday it was so bad I went to the doctor and I was diagnosed with shingles. They just gave me a medication. I still have some lesions in my mouth and swollen glands behind my right ear.


VAERS ID: 1785288 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hypersensitivity, Memory impairment, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: She got her 3rd vaccine, an hour after she came home she felt light headed. She drank something and felt OK. After that she had an allergic reaction, she started itching, and felt flushing of her face. She took Tylenol and went to sleep. She gets the normal reaction to all vaccines, and after 2-3 days she''s fine. She got it one day and then she was Friday. After that she has noticed that her memory is getting foggy, her long term memory is not very good. She figured out that she a book that she has memorized and recite it and she cannot remember the words, but that still continues and can''t recall things and she is concerned about that. She wants to know if there is anything that she can do and if it''s going to be long-lasting. She does has an appointment with her doctor and also with a neurologist next week.


VAERS ID: 1785500 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-01
Onset:2021-09-16
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Cough, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (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: ? Sumatriptan ? 10mg as needed ? Rizatriptan ? 10mg as needed ? Alprazolam ? 0.5mg as needed
Current Illness: N/A
Preexisting Conditions: Migraines
Allergies: red dye food coloring
Diagnostic Lab Data: 10/8/2021 - xrays - inconclusive
CDC Split Type: vsafe

Write-up: Presented with a cough for the last 4 weeks. Went to the doctor for xrays, etc. covid testing came back negative. And prescribed z pack, cough has basically gone away now.


VAERS ID: 1785610 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? 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:
CDC Split Type:

Write-up: Presented with chest pain and weakness 2 days after Moderna vaccination for COVID. Diagnosed with pericarditis


VAERS ID: 1785983 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-09-16
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03TC2W4 / 1 LA / IM

Administered by: Private       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: Albuterol inhaler, enoxaparin , Furosemide 20 mg, Hydroxychloroquine,opsumit,Tadalafil, Remodulin IV
Current Illness: Pulmonary Hypertension
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. received Moderna vaccine as an inpatient in the hospital. She is 14 years old and when discharged she could not obtain a second vaccine due to being under 18


VAERS ID: 1787977 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-25
Onset:2021-09-16
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to the hospital with COVID pneumonia and hypoxia. He was hospitalized for 12 days and discharge to home on oxygen.


VAERS ID: 1787992 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-12
Onset:2021-09-16
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Diarrhoea, Fatigue, Hypomagnesaemia, Mineral supplementation, Nausea, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow)

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

Write-up: Patient presents to the ED with fever, chills, fatigue, body aches, sore throat, cough, diarrhea and nausea. She was found to have hypomagnesemia and was admitted for magnesium repletion. She was discharged in stable condition 6 days later.


VAERS ID: 1788032 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, 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: none
Current Illness: none
Preexisting Conditions: seizure disorder
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given 1st Moderna vaccine and he was under 18 (17 yr and 9 mo) Patient and step-father deny and adverse reactions


VAERS ID: 1788211 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-07-01
Onset:2021-09-16
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: COVID hospitalization after full vaccination.


VAERS ID: 1788680 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine increased, Computerised tomogram head abnormal, Congestive cardiomyopathy, Echocardiogram, Ejection fraction decreased, Haemoglobin decreased, Immunoglobulin therapy, Intensive care, International normalised ratio normal, Laboratory test normal, Mental status changes, Platelet count decreased, Renal failure, Systolic dysfunction, Thrombocytopenia, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: right common peroneal neuropathy
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: plts of 83k on 9/16/2021, plts of 22k, (hgb 8 down from baseline 16.7) on 10/14/21. normal INR. DIC labs negative. troponin 2.45 ng/mL on 10/14/21. Creatinine of 2.69 on 10/15/21 (baseline 0.94) pending vascular u/s. TTE demonstrating reduced systolic function, LVEF 30-35%.
CDC Split Type:

Write-up: concern for TTP/ITP given array of symptoms and thrombocytopenia started around the time of vaccination. he is currently admitted to the ICU for high concern for TTP (awaiting HIT panel, ADAMTS13, etc). admitted yesterday with AMS, kidney failure, sever thrombocytopenia (17k), new dilated cardiomyopathy (troponin increased to $g2) and CT head findings concerning (waiting on stability of renal function to get MR for cavernous sinus thrombosis). he is undergoing PLEX, IVIG, receiving caplacizumab and decadron.


VAERS ID: 1790120 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-27
Onset:2021-09-16
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / OT

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

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

Write-up: Receiving Moderna COVID-19 vaccine as a second dose but already received Pfizer COVID-19 vaccine as a 1st dose; This spontaneous case was reported by a nurse and describes the occurrence of INTERCHANGE OF VACCINE PRODUCTS (Receiving Moderna COVID-19 vaccine as a second dose but already received Pfizer COVID-19 vaccine as a 1st dose) in a 30-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014F21A) for COVID-19 vaccination. Co-suspect product included non-company product TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) for an unknown indication. Concurrent medical conditions included Anxiety. Concomitant products included TRAZODONE, PAROXETINE and BUSPIRONE for an unknown indication. On 27-Jul-2021, the patient started TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) 1 dosage form. On 16-Sep-2021 at 3:45 PM, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced INTERCHANGE OF VACCINE PRODUCTS (Receiving Moderna COVID-19 vaccine as a second dose but already received Pfizer COVID-19 vaccine as a 1st dose). On 16-Sep-2021, INTERCHANGE OF VACCINE PRODUCTS (Receiving Moderna COVID-19 vaccine as a second dose but already received Pfizer COVID-19 vaccine as a 1st dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Treatment information was provided. Most recent FOLLOW-UP information incorporated above includes: On 20-Sep-2021: Follow-up was received on 20-SEP-2021 and Patient''s demographics added, race and ethnicity added, medical history added, concomitant medication dosage details and frequency added


VAERS ID: 1790269 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-12
Onset:2021-09-16
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Skin ulcer
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ATENOLOL; DILTIAZEM; DULOXETINE; FAMOTIDINE; FOLIC ACID; METHOTREXATE; MINOXIDIL; MOMETASONE FUROATE CIPLA; MONTELUKAST SODIUM; NIACIN; OLMESARTAN MEDOXOMIL; POTASSIUM CHLORIDE; TORSEMIDE; ZOLPIDEM TARTRATE ACTAVIS; ACETAMINOPHEN; GLUCOSAMI
Current Illness: Adhesive tape allergy; Hypertensive heart disease (controlled via medication); Obesity (losing weight); Osteoarthritis (increased dosage of methotrexate); Seronegative rheumatoid arthritis (increased dosage of methotrexate); Sleep apnea (controlled by Bi-PAP)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Venous stasis ulcer; This spontaneous case was reported by a consumer and describes the occurrence of SKIN ULCER (Venous stasis ulcer) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002A21A and 031M20A) for COVID-19 vaccination. Previously administered products included for an unreported indication: FLUZONE HIGH DOSE QUADRIVALENT (route Intramuscular,Body site left deltoid and dose 1) on 09-Sep-2021. Concurrent medical conditions included Hypertensive heart disease (controlled via medication) since 11-Jul-2008, Sleep apnea (controlled by Bi-PAP) since 20-Aug-2009, Obesity (losing weight) since 15-Jul-2004, Seronegative rheumatoid arthritis (increased dosage of methotrexate) since 07-Feb-2019, Osteoarthritis (increased dosage of methotrexate) since 07-Feb-2019 and Adhesive tape allergy. Concomitant products included FOLIC ACID for Anaemia, DULOXETINE, ACETAMINOPHEN, GLUCOSAMINE and CHONDROITIN for Arthritis, POTASSIUM CHLORIDE for Electrolyte substitution therapy, NIACIN for High cholesterol, FAMOTIDINE for Hyperchlorhydria, ATENOLOL, DILTIAZEM, MINOXIDIL, OLMESARTAN MEDOXOMIL and TORSEMIDE for Hypertension, ZOLPIDEM TARTRATE (ZOLPIDEM TARTRATE ACTAVIS) for Insomnia, MOMETASONE FUROATE (MOMETASONE FUROATE CIPLA) for Nasal congestion, METHOTREXATE for Rheumatoid arthritis, MONTELUKAST SODIUM for Rhinitis allergic, MULTIVITAMIN & MINERAL, VITAMIN D3 and VITAMIN C [ASCORBIC ACID] for an unknown indication. On 12-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 16-Sep-2021, the patient experienced SKIN ULCER (Venous stasis ulcer). The patient was treated with CARMELLOSE SODIUM (DUODERM CGF [CARMELLOSE SODIUM]) for Venous stasis ulcer, at an unspecified dose and frequency. At the time of the report, SKIN ULCER (Venous stasis ulcer) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. This case was linked to MOD-2021-338635 (Patient Link).


VAERS ID: 1790283 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Adnexa uteri pain, Chest discomfort, Chest pain, Chills, Cough, Headache, Hyperhidrosis, Lymph node pain, Lymphadenopathy, Myalgia, Palpitations, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (She tested positive for COVID-19 disease two weeks prior to vaccination with COVID-19 symptoms, Night sweats and muscle pain)
Allergies:
Diagnostic Lab Data: Test Date: 20210822; Test Name: COVID-19 virus test; Test Result: Positive ; Result Unstructured Data: She tested positive for COVID-19 disease
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: she still feels heavy in her chest; She was coughing while talking; Chest hurt; Ovaries area Hurting; Sweats; Heart palpitation; Swollen Lymph nodes in the neck; Hurting Lymph nodes in the neck; Headache; She started heving Chills; Body aches; This spontaneous case was reported by a patient and describes the occurrence of CHEST DISCOMFORT (she still feels heavy in her chest), COUGH (She was coughing while talking), CHEST PAIN (Chest hurt), ADNEXA UTERI PAIN (Ovaries area Hurting) and HYPERHIDROSIS (Sweats) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 (She tested positive for COVID-19 disease two weeks prior to vaccination with COVID-19 symptoms, Night sweats and muscle pain) from 22-Aug-2021 to 01-Sep-2021. On 15-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced COUGH (She was coughing while talking), CHEST PAIN (Chest hurt), ADNEXA UTERI PAIN (Ovaries area Hurting), HYPERHIDROSIS (Sweats), PALPITATIONS (Heart palpitation), LYMPHADENOPATHY (Swollen Lymph nodes in the neck), LYMPH NODE PAIN (Hurting Lymph nodes in the neck), HEADACHE (Headache), CHILLS (She started heving Chills) and MYALGIA (Body aches). On an unknown date, the patient experienced CHEST DISCOMFORT (she still feels heavy in her chest). At the time of the report, CHEST DISCOMFORT (she still feels heavy in her chest) had not resolved, COUGH (She was coughing while talking), CHEST PAIN (Chest hurt), ADNEXA UTERI PAIN (Ovaries area Hurting), HYPERHIDROSIS (Sweats), LYMPHADENOPATHY (Swollen Lymph nodes in the neck), LYMPH NODE PAIN (Hurting Lymph nodes in the neck), HEADACHE (Headache), CHILLS (She started heving Chills) and MYALGIA (Body aches) outcome was unknown and PALPITATIONS (Heart palpitation) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 22-Aug-2021, SARS-CoV-2 test: positive (Positive) She tested positive for COVID-19 disease. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. No treatment details were reported. Patient reported that her doctor (Urgent care) told her that she got her COVID-19 vaccine too early after COVID-19 disease. She does not have a medical history of heart disease.


VAERS ID: 1790419 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-01-29
Onset:2021-09-16
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HYDROCHLOROTHIAZIDE; LISINOPRIL; METOPROLOL; LEVOTHYROXINE; PAROXETINE
Current Illness: Allergy to animals (dust animals); Allergy to antibiotic (Macrobid); Anxiety; Blood pressure high; Pollen allergy; Thyroid disorder NOS
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: did not have second dose of Moderna until 9 months later after the first dose; This spontaneous case was reported by a consumer and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (did not have second dose of Moderna until 9 months later after the first dose) in a 64-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 053E21A and 028L20A) for COVID-19 vaccination. Concurrent medical conditions included Allergy to antibiotic (Macrobid), Allergy to animals (dust animals), Pollen allergy, Blood pressure high, Thyroid disorder NOS and Anxiety. Concomitant products included PAROXETINE from 01-Apr-2015 to an unknown date for Anxiety, HYDROCHLOROTHIAZIDE from 01-Jan-2000 to an unknown date, LISINOPRIL from 01-Jan-2000 to an unknown date and METOPROLOL from 01-Jan-2000 to an unknown date for Blood pressure high, LEVOTHYROXINE from 01-Jan-1995 to an unknown date for Thyroid disorder. On 29-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 16-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (did not have second dose of Moderna until 9 months later after the first dose). On 16-Sep-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (did not have second dose of Moderna until 9 months later after the first dose) had resolved. Not Provided No treatment medication was reported. This case was linked to MOD-2021-287478 (Patient Link).


VAERS ID: 1790896 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Unknown  
Location: Pennsylvania  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ankylosing spondylitis, Inappropriate schedule of product administration, SARS-CoV-2 antibody test
SMQs:, Arthritis (narrow), Medication errors (narrow), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; ALEVE; TYLENOL; MIRALAX
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Bipolar affective disorder; Chondritis; Hypothyroidism; Psychotic episode; Rheumatoid arthritis; Scoliosis
Allergies:
Diagnostic Lab Data: Test Date: 20210606; Test Name: Covid antibodies; Result Unstructured Data: Test Result:No antibodies found
CDC Split Type: USPFIZER INC202101288234

Write-up: Aankylosing spondylitis; second vaccine dose on 06May2021 and third booster dose on 16Sep2021; This is a spontaneous report from a contactable consumer. A 51-year-old patient of unknown gender received third dose booster of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Lot number EW0179), intramuscular into the Right Arm on 16Sep2021 at 18:30 (at the age of 51-years-old) at single dose for COVID-19 immunization. The patient had received the first dose of BNT162B2 (lot EP7533) in the Right Arm on 15Apr2021 and the second dose of BNT162B2 (lot ER8735) in the Right Arm on 06May2021. No Prior Vaccinations Within 4 Weeks. Medical history included Underactive thyroid, Bi-Polar with Psychotic Episodes, Osteo/ Rheumatoid arthritis and Chondritis, Scoliosis. Concomitant Drugs included Synthroid 15 mg oral daily for Thyroid, Aleve oral for Joint pain/ Arthritis, Tylenol oral for Pain and Miralax oral. On 17Sep2021 the patient was newly diagnosed with ankylosing spondylitis following ongoing symptoms and requested a lab test to check antibodies to rule out any concern that she was also suffering from COVID. The patient was concerned that she has been vaccinated and on 06Jun2021 the antibodies were not found. The outcome of the event was unknown. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1791137 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow), 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:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: Patient''s Medical History (including illness at time of vaccination): None
Allergies:
Diagnostic Lab Data: Test Date: 20210902; Test Name: COVID-19 Test; Test Result: Negative ; Test Date: 20210913; Test Name: COVID-19 Test; Test Result: Negative
CDC Split Type: USPFIZER INC202101311402

Write-up: Facial numbness; This is a spontaneous report received from a contactable consumer(patient). A 39-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; lot number: FF8839 and expiry were reported) via an intramuscular, at the age of 39-year-old, on 16Sep2021 10:30, at the left arm, at dose 2, single for covid-19 immunisation in a Pharmacy/drug store. The patient didn''t have any medical history. Historical vaccine included BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; lot numbers: FA6780 and expiry dates: 30Sep2021) via an intramuscular on 07Aug2021 11:00 at age of 39 years old dose 1, single for covid-19 immunisation and experienced nerve Pain on 08Aug2021 and swollen lymph nodes on 09Aug2021. The patient tested COVID-19 on 02Sep2021 and 13Sep2021 and had negative results. On 16Sep2021 17:00, the patient experienced facial numbness. The outcome of the event was unknown at the time of report. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1791261 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Body temperature, Cough, Diarrhoea, Headache, Nausea, Pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IBUPROFEN; TYLENOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Food allergy (Known allergies: Flu vaccine, Eggs, Coconut, Seafood and Lyrica)
Allergies:
Diagnostic Lab Data: Test Date: 20210916; Test Name: fever; Result Unstructured Data: Test Result:100.3; Comments: low grade fever of 100.3 for 2 days; Test Date: 20210927; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: USPFIZER INC202101335103

Write-up: I ran a low grade fever of 100.3 for 2 days; had a severe headache; joint pain; nausea; diarrhea; body aches; runny nose; dry cough; This is a spontaneous report from a contactable other hcp (patient herself). A 45-years-old female patient received bnt162b2 (BNT162B2, formulation: solution for injection , lot number: 301308A, expiration date: not reported), via an unspecified route of administration, administered in Arm Left on 15Sep2021 19:30 (at the age of 45 years) as dose 1, single for COVID-19 immunization. Medical history included Known allergies from Flu vaccine, Eggs, Coconut, Seafood and Lyrica. Patient had no COVID prior vaccination. Concomitant medication(s) included ibuprofen (IBUPROFEN) taken for an unspecified indication, start and stop date were not reported; paracetamol (TYLENOL) taken for an unspecified indication, start and stop date were not reported. On 16Sep2021 at 06:00, the patient ran a low grade fever of 100.3 for 2 days, had a severe headache, joint pain, nausea, diarrhea, body aches, runny nose, dry cough. Patient had Covid test type post vaccination: Nasal swab on 27Sep2021 and results were Negative. Patient did not receive any treatment. Clinical outcome of the event was reported as recovered in Sep-2021. Follow-Up (14Oct2021): Follow-up attempts are completed. No further information is expected.


VAERS ID: 1793860 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

Write-up: Patient complained of sharp, shooting pains, almost like little bites all throughout her body for 24 hours after the shot.


VAERS ID: 1794211 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-09
Onset:2021-09-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site rash, Pruritus
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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7 or 8 days after vaccine administration patient said a small rash developed around the injection site. It spread to bigger area. No blisters. It itched. It went away about a week later.


VAERS ID: 1794463 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-31
Onset:2021-09-16
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: I had 2 weeks of heavy menstruation (Sep 16-30) and passing big blood clots from my menstruation period. I am pre menopausal so my period is lighter and lesser days now, so I''m shocked this suddenly happened after my 1st dose of vaccine. Other friends and many women per reading experienced the same and yet you are not mentioning this as side effect.


VAERS ID: 1794549 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Site: Pain at Injection Site-Severe.


VAERS ID: 1795573 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-19
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaemia, Angiopathy, Autoimmune disorder, Cardiac disorder, Dyspnoea, Eosinophil count increased, Haemoglobin decreased, Laboratory test abnormal, Mean cell volume decreased, Monocyte count increased, Rheumatoid factor positive, Serum ferritin decreased, Vitamin D decreased
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: Allergies
Preexisting Conditions: Asthma , arythmia , endimetriosis
Allergies: Levaquin ,selfish
Diagnostic Lab Data: Ferritin low, vitamin D low, hemoglobin low MCV low , eosinofills high , MCBC low,Mono high , factor rheumatoid positive.
CDC Split Type:

Write-up: One week later I had heart and breathing problems. My vascular health got worst . I have a inmune desease that the havent diagnose yet. Id became anemic


VAERS ID: 1797861 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-09
Onset:2021-09-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Breast swelling, Extra dose administered, Menstrual disorder
SMQs:, Angioedema (broad), Medication errors (narrow)

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

Write-up: Patient reports having unexpected menstruation one week after the second and third dose of the COVID-19 vaccine. Additionally c/o breast swelling beyond one bra cup size.


VAERS ID: 1797980 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

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

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

Write-up: RECEIVED TOO EARLY 1ST DOSE 9/2, 2ND DOSE 9/16


VAERS ID: 1798019 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse 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:

Write-up: No adverse effects reported


VAERS ID: 1798530 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-09
Onset:2021-09-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient with fever, diarrhea and left hip pain beginning 7 days after vaccination and ongoing x 5 weeks. Patient with extensive evaluation without clear etiology of fever of unknown origin and diarrhea.


VAERS ID: 1800319 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant drugs were not reported. Treatment medications were not provided. It was reported that vial did not undergo any temperature excursions. This case was linked to MOD21-152032 (Patient Link).


VAERS ID: 1800320 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. It was unknown if the doses are first, second or third doses for the patient. The vials were stored in the freezer and taken out of the freezer and placed in the refrigerator on the date of administration. The vials was did not undergone any temperature excursions. Concomitant medications were not reported. Treatment information was not reported.


VAERS ID: 1800321 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in an 83-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. No treatment information was provided.


VAERS ID: 1800322 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in an 81-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication information provided by the reporter. No treatment information provided.


VAERS ID: 1800324 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in a 39-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant information was not provided. It was reported that the vials were stored in the freezer and taken out of the freezer and placed in the refrigerator on the date of administration. The vials did not undergo any temperature excursions. Treatment information was not provided.


VAERS ID: 1800325 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. no concomitant medications were reported. no treatment medications were reported.


VAERS ID: 1800513 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in an 83-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications were not provided. Treatment information was not provided. The vials were stored in the freezer and taken out of the freezer and placed in the refrigerator on the date of administration. The vials did not undergo any temperature excursions


VAERS ID: 1800514 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in an 84-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was mentioned. No treatment medication was mentioned.


VAERS ID: 1800515 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in an 81-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided. The vials were stored in the freezer and taken out of the freezer and placed on the date of administration. The vials did not undergo any temperature excursions. No treatment medications were provided.


VAERS ID: 1800516 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (doses administered past the published expiry) in a 79-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant and treatment medications are provided by the reporter. The vials were stored in the freezer and taken out of the freezer and placed in the refrigerator on the date of administration. The vials did not undergo any temperature excursions.


VAERS ID: 1800518 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported. The vials were stored in the freezer and taken out of the freezer and placed in the refrigerator on the date of administration. The vials did not undergo any temperature excursions.


VAERS ID: 1800519 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in a 69-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). At the time of the report, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications reported. No treatment reported.


VAERS ID: 1801320 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-08
Onset:2021-09-16
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: I have had an IUD for several years and have not had a period (bleeding). Ever since the vaccine, I am bleeding HUGE amounts during my period.


VAERS ID: 1803619 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. The vials were stored in the freezer and taken out of the freezer and placed in the refrigerator on the date of administration. The vials did not undergo any temperature excursions. No concomitant medications were reported No treatment information was provided This case was linked to MOD-2021-351209 (Patient Link).


VAERS ID: 1803620 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Moderna COVID-19 vaccine was administered to patients past the published expiry date; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Moderna COVID-19 vaccine was administered to patients past the published expiry date) in an 85-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Moderna COVID-19 vaccine was administered to patients past the published expiry date). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Moderna COVID-19 vaccine was administered to patients past the published expiry date) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided. No treatment medications were reported.


VAERS ID: 1803621 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications was reported. No treatment drug details was reported. It was unknown if the doses are first, second or third doses for the patients. The vials were stored in the freezer and taken out of the freezer and placed in the refrigerator on the date of administration. The vials did not undergo any temperature excursions


VAERS ID: 1803625 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / -

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

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

Write-up: This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in a 53-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. The vials were stored in the freezer and placed in the refrigerator on the date of administration. The vials did not undergo any temperature excursions. This case was linked to MOD-2021-350918, MOD-2021-350921, MOD-2021-350925, MOD-2021-350929, MOD-2021-350930, MOD-2021-350935, MOD-2021-350936, MOD-2021-350939, MOD-2021-350941, MOD-2021-350944, MOD-2021-350947, MOD-2021-350959, MOD-2021-350972, MOD-2021-350996, MOD-2021-350998, MOD-2021-351000, MOD-2021-351002, MOD-2021-351003, MOD-2021-351018, MOD-2021-351020, MOD-2021-351021, MOD-2021-351025, MOD-2021-351030, MOD-2021-351035, MOD-2021-351038, MOD-2021-351040, MOD-2021-351042, MOD-2021-351048, MOD-2021-351049, MOD-2021-351050, MOD-2021-351053, MOD-2021-351062, MOD-2021-351071, MOD-2021-351076, MOD-2021-351094, MOD-2021-351111, MOD-2021-351123, MOD-2021-351144, MOD-2021-351146, MOD-2021-351153, MOD-2021-351155, MOD-2021-351180, MOD-2021-351190, MOD-2021-351194, MOD-2021-351198, MOD-2021-351201, MOD-2021-351209, MOD-2021-351213, MOD-2021-351214, MOD-2021-351220, MOD-2021-351222, MOD-2021-351224, MOD-2021-351544, MOD-2021-351623, MOD-2021-351627, MOD-2021-351642, MOD-2021-351643, MOD-2021-351646, MOD-2021-351651, MOD-2021-351652, MOD-2021-351653, MOD-2021-351658, MOD-2021-351663, MOD-2021-351665, MOD-2021-351696, MOD-2021-351699, MOD-2021-351713, MOD-2021-351718, MOD-2021-351724, MOD-2021-351732, MOD-2021-351733, MOD-2021-351747, MOD-2021-351753, MOD-2021-351761, MOD-2021-351768, MOD-2021-351774, MOD-2021-351776, MOD-2021-351790, MOD-2021-351794, MOD-2021-351797, MOD-2021-351828, MOD-2021-351833, MOD-2021-351838, MOD-2021-351848, MOD-2021-351861, MOD-2021-351867, MOD-2021-351877, MOD-2021-351890, MOD-2021-351905, MOD-2021-351914, MOD-2021-351936 (Patient Link).


VAERS ID: 1803627 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / -

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in an 83-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). On 16-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment medication use was reported.


VAERS ID: 1803634 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / OT

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

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

Write-up: Doses administered past the published expiry; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) in a 60-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry). At the time of the report, EXPIRED PRODUCT ADMINISTERED (Doses administered past the published expiry) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications was provided by the reporter. No treatment medications was provided by the reporter.


VAERS ID: 1804437 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Libido decreased, Premature ejaculation
SMQs:, Sexual dysfunction (narrow)

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

Write-up: After receiving the vaccine there was very little change to my normal health and bodily functions. I noticed late that night that I began having low libido. No ED noticed. However I did experience premature ejaculation. PE and low libido have continue after receiving the vaccine despite no other changes in health, diet or lifestyle.


VAERS ID: 1804519 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram abnormal, Anticoagulant therapy, Artery dissection, Blood test, Cardiac arrest, Cardiac dysfunction, Cardiac monitoring, Cardioversion, Chest discomfort, Chest pain, Computerised tomogram normal, Confusional state, Discomfort, Dyspnoea, Echocardiogram abnormal, Electrocardiogram QT prolonged, Feeling abnormal, Hypotension, Muscle spasms, Muscle tightness, Stress cardiomyopathy, Syncope
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fluoxetine, vit D-2, Multivitamin, Phentermine, Contrave (previous week taking Wellbutrin then stopped for 2 days and started Contrave)
Current Illness: None
Preexisting Conditions: PCOS, Cervical disc arthritis, Tarsal tunnel/Morton?s Neuroma treatment but now believed to be Neuropathy. Anxiety, Herniated lumbar discs.
Allergies: Sulfa antibiotics, Hydrocodone, Grass, Dust
Diagnostic Lab Data: Listed above ECG ECHOCARDIOGRAM ANGIOGRAM BLOOD LABS CT SCAN ZIO PATCH
CDC Split Type:

Write-up: For 4 days after vaccine I had trouble breathing with what felt like muscle spasms in my right side, rib cage, back side. On day 6 I had strange pains again but extended up my chest and neck tightening. Heaviness on my chest. Confusion, couldn?t get comfortable or catch my breath. Overwhelming feeling something was wrong. After 911 responders started monitoring heart I collapsed, heart stopped, they shocked me 3 times, took me to Hosp where cardiologist did angiogram and believes he saw 2 arterial dissections. Other cardiologist said he disagreed and it was Tokotsubo syndrome, broken heart syndrome, did Echo cardio grams and ECG?s. Put me on aspirin, Plavix, metropolol succinate, lisinopril. Gave me heparin shots to abdomen multiple times throughout the day. Stayed for 3 days. ECG?s all showed prolonged Q-T interval, Echo showed 40% heart function. My usual BP is 100-110/60-70. It was continuously very low, 60-80/25-45. Angiogram showed zero blockages, no plaque, later CT showed 0 Calcium score, no calcification in all the areas checked. I?ve always had great cholesterol levels (lol LDL, high HDL) low triglycerides, low healthy heart rate (in Hosp approx 45-55.) Two weeks after first Hosp Stay I went back in for another 3 days because of abnormal heart rhythms.


VAERS ID: 1804835 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site urticaria, Oral mucosal eruption, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: benedryl, ibuprofen, albuterol,
Current Illness: asthma, allergies, migraines
Preexisting Conditions: asthma
Allergies: latex, seasonal allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt described hives of Right upper arm near injection site. Full body pruritis, and rash around mouth within 12 hours of vaccine. Other side effects included body aches, fatigue, and HA lasting up to two weeks


VAERS ID: 1807390 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Contusion, Gingival bleeding, Haematuria, Haemoglobin, Platelet count, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gingival disorders (narrow), Accidents and injuries (narrow), Tubulointerstitial diseases (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? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dental implantation; Hysterectomy; Thyroid disorder; Thyroidectomy
Allergies:
Diagnostic Lab Data: Test Date: 202110; Test Name: Blood test; Result Unstructured Data: Not reported; Test Date: 202110; Test Name: Haemoglobin; Result Unstructured Data: Little low; Test Date: 202110; Test Name: Platelet count; Result Unstructured Data: Low
CDC Split Type: USJNJFOC20211032981

Write-up: BLEEDING GUMS/SEVER BLEEDING IN THE MOUTH; BRUISES TO ARMS; PLATELET COUNT LOW; HEMATURIA; This spontaneous report received from a patient (retired nurse) concerned a 70 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included: hysterectomy in 1992, removed thyroid gland in 2019, dental implant in 25-SEP-2021, and thyroid problems. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: unknown) dose was not reported, 1 total administered on 09-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 16-SEP-2021, the patient started to had hematuria, had blood in the urine. The color of the urine was like a cranberry color, then in the night there was some real blood clots observed in the urine. She spent a whole day in emergency room (ER). On 01-OCT-2021, 02-OCT-2021 and 03-OCT-2021, the patient started to had severe bleeding in the mouth/bleeding gums. She was very worried and she admitted to the hospital on 05-OCT-2021. On 17-OCT-2021 (last night), she started to bleed again from her mouth during her shower but she used some peroxide and put some sterile gauze and pressed on that area in her mouth and it stopped bleeding. Her dentist told her that there is no problem in the bones and the bleeding can be either from the soft tissue or due to the vaccine. On 18-OCT-2021 in the morning, she was doing some blood work. On an unspecified date in OCT-2021, the patient experienced bruises to her arms from many intravenous (IV''s) while she was hospitalized for hematuria and severe bleeding in the mouth/bleeding gums. They did a several blood tests and didn''t find out any reason for bleeding. During hospitalization, her platelets count was low as she was still bleeding and her hemoglobin was a little low. Two bags of plasma were received as a treatment. Patient discharged on 12-OCT-2021 and was hospitalized for 8 days. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from bleeding gums/sever bleeding in the mouth, and the outcome of hematuria, bruises to arms and platelet count low was not reported. This report was serious (Hospitalization Caused / Prolonged). This case, from the same reporter is linked to 20211034387.; Sender''s Comments: V0: 20211032981-Covid-19 vaccine ad26.cov2.s-Hematuria, Bleeding gums/sever bleeding in the mouth, Bruises to arms, Platelet count low. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1807493 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-13
Onset:2021-09-16
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Depression; Low blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101281254

Write-up: Severe vertigo; This is a spontaneous report from a contactable other hcp (patient herself). A 60-years-old non pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection; Lot Number: FA7485), via an unspecified route of administration, administered in left deltoid on 13Aug2021 (age at vaccination: 60 years) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient''s medical history included hypotension and depression. The patient''s concomitant medications were not reported. The patient was administered the vaccine in a pharmacy. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient previously took metronidazole (FLAGYL) and scopolamine aminoxide and experienced drug hypersensitivity. On 16Sep2021, the patient experienced severe vertigo lasting over 1 and 1/2 weeks. The adverse event resulted in emergency room visit. The patient received Meclizine as treatment for the adverse event. The patient was not diagnosed with covid-19 prior to vaccination nor was tested since the vaccination. The outcome of the event was not recovered. The device date was 28Sep2021. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1807933 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-07
Onset:2021-09-16
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrioventricular block second degree, Chest pain, Discomfort, Echocardiogram, Electrocardiogram, Electrocardiogram ambulatory abnormal, Exercise electrocardiogram, Hyperhidrosis, Impaired work ability, Laboratory test, Malaise, Pallor, Paraesthesia, Pericardial effusion, SARS-CoV-2 test, Tachycardia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), COVID-19 (broad)

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

Write-up: 9/16/21 (9 days after 2nd vaccination) Chest Pain started while I was driving my children to school, I arrived at work not feeling well with continued chest pain. I had one of my co-workers check my BP and pulse, I was pale and sweaty. I checked in as a patient and saw an NP. They performed an EKG and ran some labs all of which are available in a database. NP referred me to PCP. I was able to a PCP appointment on the same day. I was referred to same day cardiology. I saw a specialist also on 9/16/21. I had another EKG, echo, and a treadmill stress test, and was sent home to await results. I was notified the next day that I had a small pericardial effusion, Specialist wanted me to have a repeat echo in 2 weeks and said he would call me with the results. I went for the repeat echo on 9/30/21, after the echo was complete the tech asked if I was scheduled to see the doctor that day, I told her No. She wanted to call up to the office before I left to make sure he didn?t want to see me. It was decided that I should see the doctor, so I saw specialist again. He said the pericardial effusion was still there no worse but no better. Will at the visit I reported some of the symptoms I had been feeling during the time between the 2 visits (cool tingling sensation on the left side of my chest up to my left clavicle, continued feeling of pressure, and an episode of tachycardia that occurred while I was at work on 9/24/21 were my heart rate was 120-130. He decided to order a 3-day Holter and start me on anti-inflammatory medication (Colchicine and Ibuprofen). Specialist wanted to see me again in 2 weeks for another echo and appointment. I began wearing the Holter that afternoon 9/30/21- 10/3/21. The monitor was dropped off on 10/4/21. I received the Holter report on Monday 10/11/21 around 7:00pm) It did show brief episodes of Wenckebach. I sent specialist because he did not call to discuss these results like he had before. One of his mid-levels called me back and stated that I shouldn?t be concerned. I explained to him that I am still having episodes of palpitations and intermittent chest discomfort, I inquired about the brief episodes of Wenckebach. He told me that I should be able to feel that and Wenckebach wouldn?t be that cause of palpitations. He told me to keep taking the anti-inflammatory medication and to keep the scheduled follow up appointment with specialist on 10/21/21 for a repeat echo and visit. 1st vaccine was received on 8/3/21 Covid symptoms started on 8/12/21 (I was tested on 8/12/21. I was in quarantine for 10 days, and returned to work on 8/23/21) 2nd Vaccine was received on 9/7/21


VAERS ID: 1808581 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Breast pain, Condition aggravated, Fatigue, Grip strength decreased, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Lipodystrophy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta, Flexeril
Current Illness: Fibromyalgia, sinus infection.
Preexisting Conditions: Fibromyalgia
Allergies: Aspirin, Anti-inflammatories, Amoxicillin with Clavulanate Potassium, Duloxetine, Diphenhydramine Hydrochloride, Erythomycin Base, Metoclopramide Hydrochloride, Hydrocodone Acetaminophen, Atenolol, Hydromorphone Hydrochloride, Prochlorperazine, Carbamazepine.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: began having extreme fatigue, body aches/pain at about 8pm, by midnight was running a fever, body pain and joint pain was horrific, a little after midnight began have extreme shooting pain in left Axilla. Pain then began to shoot to left breast, then to left shoulder and then to left elbow. This would not go away for 5 days. By 6th day began to feel relief. To this day, the pain is not gone, still having shooting pain and suddenly will drop things because of the pain in left Axilla. My joint pain became worse, especially hands and feet. This time around left knee pain became horrific as well at about midnight day of injection. I had massive left knee pain for about 2 weeks. I had left knee surgery 2018 for meniscus repair and at that time also developed sepsis-followed by second surgery. Until now, I still am having all these symptoms. Knee pain is very painful but not as horrific as it was before.


VAERS ID: 1809824 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Chest X-ray abnormal, Chest pain, Computerised tomogram thorax abnormal, Pulmonary embolism, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 150mg trazadone 100mg lamotrigine
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Bloodwork, X-ray, ultrasound and CT scan.
CDC Split Type:

Write-up: I received my second vaccine on 9-14-21 and started having chest pains two days later, on 9-16-21. I went into Hospital and was diagnosed with a pulmonary embolism. Bloodwork, X-ray, ultrasound and a CT scan was used to confirm the diagnosis.


VAERS ID: 1810462 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Diarrhoea, Fatigue, Headache, Influenza like illness, Musculoskeletal stiffness, Neck pain, Pyrexia, Somnolence, Vaccination complication, West Nile virus test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: West Nile viral infection (She already had antibodies)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: 99 ?F; Test Name: West Nile virus; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Diarrhea; Flu like symptoms; Neck stiffness; Neck pain; Sleepy; Cloggy; Temperature of 99?; Headache; Tired; This spontaneous case was reported by a nurse and describes the occurrence of DIARRHOEA (Diarrhea), INFLUENZA LIKE ILLNESS (Flu like symptoms), MUSCULOSKELETAL STIFFNESS (Neck stiffness), NECK PAIN (Neck pain) and SOMNOLENCE (Sleepy) in a 75-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included West Nile viral infection (She already had antibodies). On 15-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Sep-2021, the patient experienced DIARRHOEA (Diarrhea), INFLUENZA LIKE ILLNESS (Flu like symptoms), MUSCULOSKELETAL STIFFNESS (Neck stiffness), NECK PAIN (Neck pain), SOMNOLENCE (Sleepy), VACCINATION COMPLICATION (Cloggy), PYREXIA (Temperature of 99?), HEADACHE (Headache) and FATIGUE (Tired). At the time of the report, DIARRHOEA (Diarrhea), INFLUENZA LIKE ILLNESS (Flu like symptoms), MUSCULOSKELETAL STIFFNESS (Neck stiffness), NECK PAIN (Neck pain), SOMNOLENCE (Sleepy), VACCINATION COMPLICATION (Cloggy), PYREXIA (Temperature of 99?), HEADACHE (Headache) and FATIGUE (Tired) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 99 ?f (High) 99 ?F. On an unknown date, West Nile virus test: positive (Positive) Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No Concomitant product use was reported. No treatment information was provided.


VAERS ID: 1813387 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Ear pain, Musculoskeletal stiffness, Neck pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, lopressor, trokendi xr, benadryl, claritin
Current Illness: None
Preexisting Conditions: Migraines, hypothyroidism
Allergies: Nkda
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe neck pain and stiffness, constant. Bilateral ear pain, intermittent. Taking high doses of motrin daily and using heat packs to deal with this.


VAERS ID: 1813690 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Arthropathy, Back pain, Blood pressure increased, Blood test, Cardiac monitoring, Electrocardiogram, Heart rate increased, Hypoaesthesia, Left ventricular hypertrophy, X-ray normal
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Arthritis (broad), Dehydration (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: Men''s multi vitamin. Omega 3 Fish oil.
Current Illness: N/A
Preexisting Conditions: High cholesterol, Hypothyroidism, Testicular Cancer 5 years cancer free
Allergies: lactose intolerant
Diagnostic Lab Data: At medical said what symptoms I had, and my blood pressure was in the 130''s Sys and in the upper 80''s DIA (normally I am 120 over 72) Discussed pain in my shoulder above my heart and pain in my back somewhat behind my heart. At which time given two EKG''s (good Dr.) which both had probable left ventricle hypertrophy. As I was still having pain Dr. ordered an Xray and blood work, then highly recommended me to go the ER. Did the blood work on site. Xray machine down on site went to the ER around 1100. Did more blood work hooked to heart monitoring machine. Blood pressure was 150 over 108 in the ER. Had an Xray which came out normal and blood work resulted in no active heart attack. Currently on Blood pressure monitoring as it is elevated.
CDC Split Type:

Write-up: 14 Sep21 8pm constantly feeling my heart beating rapidly took nyquil to go to sleep. 15Sep21 11am left work had numbness in hands and drove slowly home. Joint pain had left knee go out 3:50pm (previous injury but that has not happened since physical therapy 2008 time frame). Left shoulder pain near heart 7:17pm. Contacted medical and came in for an appointment on 22 Sept2021


VAERS ID: 1813730 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-22
Onset:2021-09-16
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 2 LA / SYR
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Blood potassium decreased, Blood test, Chest X-ray normal, Electrocardiogram
SMQs:, Supraventricular tachyarrhythmias (narrow), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 112 mcg, Lipitor 10 mg, Fosomax 70 mg, Baby Aspirin, Vitamin D3, Calcium 600 1200 mg, Vitamin C, Mature Multi Vitamin, Probiotics, Biotin with Collagen, Zinc,
Current Illness: None
Preexisting Conditions: Hypothyroidism, Osteoporosis, high cholesterol. Event was A-Fib, bought to hospital emergency room by ambulance. Was put on Eloquis and Bystolic, following up with Cardiologist. Off of Eloquis now, will continue on beta blocker.
Allergies: Allergic to Parafon Forte and possibly Cipro
Diagnostic Lab Data: Blood work which showed my potassium levels were slightly low. Chest x-ray was clear.
CDC Split Type:

Write-up: On September 16, at approximately 12:00 pm I went into Atrial Fibulation. I was wearing an I-watch and it confirmed I was in A-Fib, so I called my cardiologist''s office and spoke to a nurse. She told me to call an ambulance, which I did. Paramedics arrived four minutes later, hooked me up to an EKG to confirm A-Fib, which is was, was taken to hospital via ambulance. Shortly after arriving, my heart went back into normal sinus rhythm on its own. No medication was needed or other treatment. Resident Doctor spoke to my cardiologist via telephone and they decided on a course of treatment which was Eloquis and Bystolic. Followed up with doctor a week later. I am a 60 year old female who exercises 5-6 days a week for the last 40 years. Cardio, yoga, weight training. Not over weight, eat fairly healthy. Never had any heart issues my entire life until this.


VAERS ID: 1814107 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Vaccine administered days after BUD established by manufacturer in refridgerator


VAERS ID: 1815454 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, COVID-19, Eye pain, Headache, Hyperhidrosis, Nausea, Pain, Pain in extremity, Pharyngeal swelling, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Total Knee Replacement Ankle worked - took a tumor out my ankle in 06/2021 Chronic Pain
Allergies: Pensullin tricyclic
Diagnostic Lab Data: 3day-Covid Test - Tested positive to Covid-19
CDC Split Type: vsafe

Write-up: 4hours after vaccination I began to experience a headache Arm hurt General body pains-loss energy Swollen Throat Sweating a lot Joints hurt Eyes hurt Nausea after during and eating


VAERS ID: 1817258 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Agitation, Myalgia, Palpitations, Pyrexia, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Very agitated; Body ache; Arm pain; Fever; Palpitations; This spontaneous case was reported by a consumer and describes the occurrence of PALPITATIONS (Palpitations), AGITATION (Very agitated), MYALGIA (Body ache), VACCINATION SITE PAIN (Arm pain) and PYREXIA (Fever) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) for COVID-19 vaccination. Concurrent medical conditions included Dizziness. Concomitant products included MECLIZINE [MECLOZINE] for Dizziness. On 15-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced PALPITATIONS (Palpitations), MYALGIA (Body ache), VACCINATION SITE PAIN (Arm pain) and PYREXIA (Fever). On an unknown date, the patient experienced AGITATION (Very agitated). On 19-Sep-2021, MYALGIA (Body ache), VACCINATION SITE PAIN (Arm pain) and PYREXIA (Fever) had resolved. At the time of the report, PALPITATIONS (Palpitations) and AGITATION (Very agitated) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medications include Meclizine for Dizziness. This case was linked to MOD-2021-355813 (Patient Link).


VAERS ID: 1817864 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Ear swelling, Lip swelling, Pruritus, Rash, Tachycardia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 1st Moderna vaccine--low grade fever and myalgias x 2 days
Other Medications: none documented
Current Illness: Negative for any disease
Preexisting Conditions: None documented
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experiences hives and pruritis and a feeling of lips and ears swelling. She describes the rash as burning. She is tachycardic (128 bpm) BP = 148/88.. All other vitals are within normal limits. Patient initially saw her PCP, who administered a steroid injection. She took diphenhydramine and cetirizine at home with no improvement. In the ER, she is treated with diphenhydramine, famotidine, methylprednisolone x 2, epinephrine x 2. She improved and was d/c home with prescriptions for Epi pen, steroid dosepak and famotidine.


VAERS ID: 1818207 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-01
Onset:2021-09-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, amlodipine, aspirin, budesonide/formoterol, iron, insulin, ipratropium/albuterol, isosorbide mononitrate, lactobacillus acidophilus, loratadine, metoprolol, Montelukast, mupirocin, prednisone, KCl, simvastatin, torsemide, warfari
Current Illness:
Preexisting Conditions: coagulation disorder, A fib, CHF, DM, COPD, hyperlipidemia
Allergies: Bactrim, Pradaxa, ciprofloxacin, levofloxacin, doxycycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/16/21 presents to the ED with SOB and testes positive for COVID 19, despite being vaccinated (3 doses of Pfizer) 9/22/21 pt discharged, "Completion of 5 days of remdesivir, Rocephin, and Zithromax To continue Decadron until 9/25"


VAERS ID: 1818427 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Fatigue, Feeling abnormal, Musculoskeletal pain, Musculoskeletal stiffness, Nausea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Verapamil Benicar Spiriva Symbicort
Current Illness: None
Preexisting Conditions: COPD, HTN, O.A.
Allergies: PCN - shortness of breath, rash Cipro - rash Cephalosporins - anaphylaxis Environmental - black mold, leaf mold, pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported that she received Covid 19 vaccine 2 weeks after receiving a steroid injection for O.A. of the spine and hips. She woke up during the night following the vaccination w/ terrible burning pain in her hips and buttocks. The pain subsided after 1 day. She also reported intermittent nausea w/ one episode of vomiting over the few days following the vaccination. Patient reports that she continues to feel tired and "very stiff" since the vaccine, commenting that she is "worse off" now than she was before receiving the vaccine.


VAERS ID: 1818452 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-21
Onset:2021-09-16
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood alcohol increased, Computerised tomogram head abnormal, Concussion, Dizziness, Dyspnoea exertional, Fall, Glucose tolerance test, Head injury, Loss of consciousness, Magnetic resonance imaging normal, Ophthalmological examination abnormal, Sinusitis, Vertigo, Vision blurred, Visual field defect, Visual field tests, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine 20+ years ago (age 17)
Other Medications: Celexa, Hydrochlorothiazide, Lisinopril, Claritin, Co-Q10
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Amoxacillin, Ceclor, Codeine, Demerol, Erythromycin, Percocet, General Anesthesia
Diagnostic Lab Data: CT scan 10/6/21 right sinus infection otherwise unremarkable, blood alcohol level 10/10/21 256 mg/dL, 24 hour glucose tolerance test 10/12/21 all levels <10 mg/dL except 4pm draw was 18 mg/dL, eye exam 10/19/2021 with new prescription given and noted deficits in the right eye, visual field study 10/19/21 unaware of results at this time, MRI 10/19/21 unremarkable, E-consult with neuro 10/21/21 recommended in person neuro consult, cardiology work-up, sleep study, EEG and MRA of head and neck all yet to be scheduled, GI consult scheduled for 10/27/21
CDC Split Type:

Write-up: Severe vertigo (9/16/21) resulting in fall with head injury/concussion (10/2/21), continuous black outs with elevated blood alcohol levels without ingestion of alcohol (10/10/21) as well as possible stoke/seizure activity not evaluated by the ER physician, visual changes including blurriness, and loss of peripheral vision (9/16/21), dizziness, lightheadedness and shortness of breath with exertion (9/16/21)


VAERS ID: 1819218 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Blood test, Cardiac disorder, Chest X-ray abnormal, Dyspnoea, Electrocardiogram, Headache, Laboratory test, Pulmonary thrombosis, Thrombosis, Ultrasound Doppler abnormal, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: synthroid
Current Illness: none
Preexisting Conditions: hypothyroidism
Allergies: none
Diagnostic Lab Data: 4 ekg?s , ultra sound, chest x-ray, blood work/labs
CDC Split Type:

Write-up: shortness of breath, heart issues, severe headache, severe blood clots in leg and lungs


VAERS ID: 1820395 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-09-16
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Agitation, Alanine aminotransferase, Alanine aminotransferase increased, Angiogram, Angiogram pulmonary, Angiogram pulmonary abnormal, Anticoagulant therapy, Aspartate aminotransferase, Aspartate aminotransferase increased, Asthenia, Atrial fibrillation, Atrial flutter, Blood creatine phosphokinase, Blood creatine phosphokinase increased, Blood creatinine, Blood gases, Blood potassium, Blood potassium decreased, Bronchogram, COVID-19, COVID-19 pneumonia, Colonoscopy, Computerised tomogram head, Computerised tomogram head normal, Computerised tomogram spine, Condition aggravated, Coronary artery disease, Creatinine renal clearance, Creatinine renal clearance decreased, Delirium, Disorientation, Disturbance in attention, Dyslipidaemia, Dyspnoea, Dysstasia, Echocardiogram, Echocardiogram abnormal, Electrocardiogram, Electrocardiogram abnormal, Electrolyte substitution therapy, Fall, Fatigue, Fluid balance assessment, Fluid balance positive, Glycosylated haemoglobin, Glycosylated haemoglobin normal, Heart rate, Heart rate increased, Hypertension, Hypokalaemia, Hypomagnesaemia, Hypophagia, Hypoxia, Intensive care, Lung opacity, Malnutrition, Myocardial infarction, Nothing by mouth order, Pleural effusion, Pneumonia bacterial, Renal function test, Rhabdomyolysis, SARS-CoV-2 test, SARS-CoV-2 test negative, Troponin, Troponin increased, Urine analysis, Urine analysis normal, Vaccination failure
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Dyslipidaemia (narrow), Lack of efficacy/effect (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Other ischaemic heart disease (narrow), Lipodystrophy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: METFORMIN; TYLENOL; SALBUTAMOL; PROVENTIL HFA [SALBUTAMOL]; VENTOLIN HFA; PROAIR HFA; ELIQUIS; ASPRIN; AMLODIPINE; LISINOPRIL; SPIRIVA
Current Illness: Abstains from alcohol; Arthritis; Atrial fibrillation; Atrial flutter; Benign prostatic hyperplasia; Cancer; Chronic obstructive pulmonary disease; Coronary artery disease; Depression; Diabetic neuropathy; Dyslipidemia; Emphysema; Heart failure; Hypertension; Non ST segment elevation myocardial infarction; Protein-calorie malnutrition; Tobacco user (everyday smoker. Packs day: 0 25 Years: 46 00 Pack years: 11 50 Types: Cigarettes (3 per day)); Type II diabetes mellitus (Type II or unspecified type diabetes mellitus without mention of complication not stated as uncontrolled)
Preexisting Conditions: Medical History/Concurrent Conditions: Adenoidectomy; Carpal tunnel release (Right); Cataract operation; Colon polypectomy (performed by MD); Colonoscopy (07/JUN/2018); Coronary stent placement; Fatigue; Fusion cervical spine (X 2); Pneumonia; Short of breath; Tonsillectomy; Comments: The patient had no known allergies and is widowed. The patient has 4 children. The patient did not have substance and sexual activity history. The patient had a family history of cancer (mother, cause of death), Colon Polyps (brother at 72 years), transluminal coronary angioplasty, heart failure (father, cause of death).
Allergies:
Diagnostic Lab Data: Test Date: 20180607; Test Name: Colonoscopy; Result Unstructured Data: not reported; Test Date: 2019; Test Name: Computerised tomogram head; Result Unstructured Data: small meningioma; Comments: small meningioma which was stable in appearance; Test Date: 20210303; Test Name: Colonoscopy; Result Unstructured Data: not reported; Test Date: 202109; Test Name: Creatine kinase; Result Unstructured Data: 8094; Test Date: 202109; Test Name: Renal function test; Result Unstructured Data: normal; Test Date: 202109; Test Name: COVID-19 PCR test; Result Unstructured Data: negative; Test Date: 202109; Test Name: Echocardiogram; Result Unstructured Data: stable ejection fraction; Comments: stable ejection fraction and showed inferior infarct normal Right ventricular size and systolic function and no significant valvular dysfunction; Test Date: 20210926; Test Name: Creatinine renal clearance; Result Unstructured Data: decreased; Test Date: 20210926; Test Name: Echocardiogram; Result Unstructured Data: abnormal; Test Date: 20210926; Test Name: Electrocardiogram; Result Unstructured Data: atrial fibrillation; Comments: abnormal; Test Date: 20210926; Test Name: Fluid balance assessment; Result Unstructured Data: positive; Test Date: 20210926; Test Name: Glycosylated haemoglobin; Result Unstructured Data: normal; Test Date: 20210926; Test Name: Heart rate; Result Unstructured Data: increased; Test Date: 20210926; Test Name: SARS-CoV-2 test; Result Unstructured Data: negative; Test Date: 20210926; Test Name: Troponin; Result Unstructured Data: increased; Comments: elevated at 32 and 30; Test Date: 20210926; Test Name: Urine analysis; Result Unstructured Data: normal; Comments: no evidence of any infection; Test Date: 20210926; Test Name: Computerised tomogram spine; Result Unstructured Data: no acute pathology; Test Date: 20210926; Test Name: Computerised tomogram head; Result Unstructured Data: normal; Test Date: 20210926; Test Name: Bronchogram; Result Unstructured Data: not reported; Test Date: 20210926; Test Name: Blood potassium; Result Unstructured Data: decreased; Test Date: 20210926; Test Name: Blood creatine phosphokinase; Result Unstructured Data: increased; Test Date: 20210926; Test Name: Aspartate aminotransferase; Result Unstructured Data: increased; Test Date: 20210926; Test Name: Alanine aminotransferase; Result Unstructured Data: increased; Test Date: 20210926; Test Name: Angiogram pulmonary; Result Unstructured Data: abnormal; Test Name: Serum creatinine; Result Unstructured Data: 67 mg/dL; Test Name: Creatinine clearance; Result Unstructured Data: 89.3 mL/min; Comments: by C-G formula; Test Name: Angiography; Result Unstructured Data: mild positive fluid balance; Comments: 1. No evidence of acute pulmonary embolism noting that the subsegmental branches in the lower lobes are suboptimally opacified due to artifact 2. Right upper lobe-predominant patchy groundglass airspace disease as seen with COVID-19 infection Volume loss in the lower lobes with small right greater than left pleural effusions No consolidative lobar pneumonia 3. Findings suggestive of mild positive fluid balance Question chronic pulmonary arterial hypertension.; Test Name: HbA1C; Result Unstructured Data: 5.4
CDC Split Type: USJNJFOC20211031440

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; AGITATION; ATRIAL FLUTTER; CONDITION AGGRAVATED; CORONARY ARTERY DISEASE; DISORIENTATION; DISTURBANCE IN ATTENTION; DYSLIPIDAEMIA; DYSPNOEA; DYSSTASIA; FALL; HYPERTENSION; HYPOMAGNESAEMIA; HYPOPHAGIA; LUNG OPACITY; PLEURAL EFFUSION; NOTHING BY MOUTH ORDER; INTENSIVE CARE; ANTICOAGULANT THERAPY; ELECTROLYTE SUBSTITUTION THERAPY; ALANINE AMINOTRANSFERASE INCREASED; ANGIOGRAM PULMONARY ABNORMAL; ASPARTATE AMINOTRANSFERASE INCREASED; BLOOD CREATINE PHOSPHOKINASE INCREASED; BLOOD POTASSIUM DECREASED; CREATININE RENAL CLEARANCE DECREASED; ECHOCARDIOGRAM ABNORMAL; ELECTROCARDIOGRAM ABNORMAL; FLUID BALANCE POSITIVE; HEART RATE INCREASED; TROPONIN INCREASED; BLOOD GASES; BRONCHOGRAM; COMPUTERISED TOMOGRAM HEAD NORMAL; COMPUTERISED TOMOGRAM SPINE; GLYCOSYLATED HAEMOGLOBIN NORMAL; SARS-COV-2 TEST NEGATIVE; URINE ANALYSIS NORMAL; ASTHENIA; FATIGUE; COVID-19 PNEUMONIA; ACUTE RESPIRATORY FAILURE; PNEUMONIA BACTERIAL; MYOCARDIAL INFARCTION; ATRIAL FIBRILLATION; DELIRIUM; HYPOXIA; HYPOKALAEMIA; COVID-19; MALNUTRITION; RHABDOMYOLYSIS; This spontaneous report received from a health care professional via a Regulatory Authority Vaccine Adverse Event Reporting System [ID 1761883] concerned a 77 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included: fatigue, short of breath, right coronary artery stent/ drug eluting stent (RCA/DES), pneumonia due to organism, endoscopy colon/ colonoscopy, adenoidectomy, carpal tunnel release, cataract removal bilateral, cervical fusion, colonoscopy polypectomy, and tonsillectomy, and concurrent conditions included: tobacco use, atrial fibrillation, atrial flutter, coronary artery disease, dyslipidemia, type 2 diabetes mellitus, hypertension, arthritis, benign prostatic hyperplasia, non-ST-elevation myocardial infarction (NSTEMI), chronic obstructive pulmonary disease, emphysema, depression, diabetic neuropathy, non-alcohol user, systolic and diastolic heart failure, cancer and protein-calorie malnutrition. The patient had no known allergies and is widowed. The patient has four children. The patient had no substance and sexual activity history. The patient had a family history of cancer (mother, cause of death), Colon Polyps (brother at 72 years), transluminal coronary angioplasty, heart failure (father, cause of death). The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805025 and expiry: unknown) dose was not reported, 1 total administered on 09-MAR-2021 for an unspecified indication. The drug start period was 201 days. Concomitant medications included metformin for non insulin dependent diabetes mellitus, acetylsalicylic acid (Aspirin), amlodipine besilate (Norvasc), apixaban (Eliquis), lisinopril, paracetamol (Tylenol), salbutamol (albuterol HFA), spiriva and salbutamol sulfate. On 07-JUN-2018, Laboratory data included: Colonoscopy (NR: not provided) not reported. On 2019, Laboratory data included: Computerised tomogram head (NR: not provided) small meningioma which was stable in appearance. On 03-MAR-2021, Laboratory data included: Colonoscopy (NR: not provided) not reported. On SEP-2021, Laboratory data included: COVID-19 PCR (polymerase chain reaction) test (NR: not provided) negative, Creatine kinase (NR: not provided) 8094, Echocardiogram (NR: not provided) stable ejection fraction and showed inferior infarct normal right ventricular (RV) size, systolic function and no significant valvular dysfunction. Cardiology recommended to continue metoprolol, and up titrate as needed. Amlodipine and lisinopril were held to allow further up titration of metoprolol. Renal function test (NR: not provided) normal. On 16-SEP-2021, the patient experienced rhabdomyolysis. On 17-SEP-2021, the patient experienced mild protein-malnutrition. On 26-SEP-2021, the patient was presented to the emergency department with hypoxia and shortness of breath. Emergency room (ER) workup showed positive for COVID-19 pneumonia and also with atrial fibrillation (AFib), Rapid ventricular rate (RVR). The Intensive care unit was contacted by ER air in agreement with CC2 level bed and would consult on patient. The patient denied having fevers or chills. The resting history was provided by daughter of the patient at bedside given his inattentiveness and disorientation She states that over the last few days he has become more fatigued and short of short of breath since discharge from recent hospitalization. On 26-SEP-2021, the patient experienced acute respiratory failure secondary to severe COVID-19 pneumonia, covid-19, agitation, atrial fibrillation, atrial flutter, condition aggravated, coronary artery disease, creatinine renal clearance decreased, delirium, dyslipidaemia, dysstasia, fall (in his apartment and was unable to get up for about 12 hours), hypertension, hypokalaemia, hypomagnesaemia, hypophagia, lung opacity, myocardial infarction, nothing by mouth order, pleural effusion, pneumonia bacterial, asthenia and fatigue and was hospitalized (dates unspecified). The patient was treated with electrolyte substitution therapy. Laboratory data included: Alanine aminotransferase (NR: not provided) increased, Angiogram pulmonary (NR: not provided) abnormal, Aspartate aminotransferase (NR: not provided) increased, Blood creatine phosphokinase (NR: not provided) increased, Blood potassium (NR: not provided) decreased, Bronchogram (NR: not provided) not reported, Computerised tomogram head (NR: not provided) normal, Computerised tomogram spine (NR: not provided) no acute pathology, Creatinine renal clearance (NR: not provided) decreased, Echocardiogram (NR: not provided) abnormal, Electrocardiogram (NR: not provided) atrial fibrillation, Fluid balance assessment (NR: not provided) positive, Glycosylated haemoglobin (NR: not provided) normal, Heart rate (NR: not provided) increased, SARS-CoV-2 test (NR: not provided) negative, Troponin (NR: not provided) increased (elevated at 32 and 30), and Urine analysis (NR: not provided) normal. On an unspecified date, the patient experienced suspected clinical vaccination failure. Laboratory data (dates unspecified) included: Computed Tomogram Angiography Thorax (NR: not provided) No evidence of acute pulmonary embolism noting that the sub segmental branches in the lower lobes are sub optimally opacified due to artifact, right upper lobe-predominant patchy ground glass airspace disease as seen with COVID-19 infection, volume loss in the lower lobes with small right greater than left pleural effusions, no consolidative lobar pneumonia, findings suggestive of mild positive fluid balance, question chronic pulmonary arterial hypertension, Creatinine clearance (NR: not provided) 89.3 mL/min (milliliter/minute), HbA1C (glycated hemoglobin) (NR: not provided) 5.4, and Serum creatinine (NR: not provided) 67 mg/dL (milligram/deciliter). Treatment medications (dates unspecified) included: diltiazem, metoprolol, remdesivir, dexamethasone, furosemide, vancomycin, cefepime, precedex and enoxaparin sodium. The patient was planned to start with very low dose insulin sliding scale given that he would be on steroids for covid-19 treatment. It was reported that the patient was unable to tolerate oral intake, hence Eliquis was kept on hold for now and started on Lovenox protocol for COVID-19 and transition back to Eliquis was thought of when patient was able to tolerate orally. The patient was at high risk of clinical deterioration and death due to severe COVID pneumonia requiring high amount of oxygen supplementation, wean oxygen as tolerated to maintain saturations greater than 92%, cardizem drip and metoprolol titration was planned to control heart rate to less than 120. The patient was on nil per oral (NPO) diet. He was evaluated by Physical therapist (PT) and Occupational therapist (OT) and recommendation was for home health therapy. He had no other acute issues and was discharged home in stable condition. The duration of hospitalization were 9 days. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from blood creatine phosphokinase increased, and heart rate increased, and the outcome of acute respiratory failure, agitation, alanine aminotransferase increased, angiogram pulmonary abnormal, aspartate aminotransferase increased, asthenia, atrial fibrillation, atrial flutter, blood potassium decreased, covid-19, covid-19 pneumonia, condition aggravated, coronary artery disease, creatinine renal clearance decreased, delirium, disorientation, disturbance in attention, dyslipidaemia, dyspnoea, dysstasia, echocardiogram abnormal, electrocardiogram abnormal, fall, fatigue, fluid balance positive, hypertension, hypokalaemia, hypomagnesaemia, hypophagia, hypoxia, lung opacity, malnutrition, myocardial infarction, nothing by mouth order, pleural effusion, pneumonia bacterial, rhabdomyolysis, troponin increased, suspected clinical vaccination failure, anticoagulant therapy, blood gases, bronchogram, computerised tomogram head normal, computerised tomogram spine, electrolyte substitution therapy, glycosylated haemoglobin normal, intensive care, sars-cov-2 test negative and urine analysis normal was not reported. This report was serious (Hospitalization Caused / Prolonged, and Life Threatening). This case was associated with a Quality Complaint 90000198177. The suspected product quality complaint has been confirmed to be the reported allegation could not be confirmed. A manufacturing related root cause could not be identified based on the Quality Complaint evaluation/investigation performed. Additional information received from Complaint Vigilance department on 22-OCT-2021. The following information was updated and incorporated into the case narrative: quality complaint investigation result was added. Upon review following information was amended: The family history of cause of death of 3 diseases (cancer, heart failure and transluminal coronary angioplasty) was deleted in disease tab and added in pre-existing medical history tab.; Sender''s Comments: V1:F/U-PQC result.This does not alter previous causality. 20211031440-covid-19 vaccine ad26.cov2.s?Rhabdomyolysis,Covid19 Pneumonia,Acute respiratory failure,Pneumonia bacterial,Deliruim,Hypoxia,Hypokalemia,blood creatine phosphokinase increased,Covid19,Agitation,Condition aggravated,Disorientation,Disturbance in attention,Dysstasia, Fall,Hypomagnesaemia,Hypophagia,Lung opacity,Pleural effusion,Nothing by mouth order,Intensive care,Anticoagulant Therapy,electrolyte substitution therapy,angiogram pulmonary abnormal,blood K+ decreased,creatinine renal clearance decreased,fluid balance positive,blood gases,bronchogram,CT head normal,CT spine,glycosylated Hb normal,sars-cov-2 test negative,urine analysis.This event(s) is considered unassessable.The event(s) has a compatible/suggestive temporal relationship,is unlabeled,& has unknown scientific plausibility.There is no information on any other factors potentially associated with the event(s). 20211031440-covid-19 vaccine ad26.cov2.s?Suspected clinical vaccination failure-This event(s) is considered not related.The event(s) has a compatible/suggestive temporal relationship,is unlabeled,& has unknown scientific plausibility.There are other factors more likely to be associated with the event than the drug.Specifically: SPECIAL SITUATIONS 20211031440-covid-19 vaccine ad26.cov2.s-Myocardial infarction,Atrial fibrillation,Atrial flutter,Coronary artery disease,Dyslipidemia,Hypertension,heart rate increased,Dyspnoea,Echocardiogram abnormal,EKG abnormal,Troponin increased,ALT increased,AST increased,Malnutrition.This event(s) is considered not related.The event(s) has a compatible/suggestive temporal relationship, is unlabeled,& has unknown scientific plausibility.There are other factors more likely to be associated with the event(s) than the drug.Specifically:MEDICAL HISTORY,UNDERLYING DISEASE 20211031440-covid-19 vaccine ad26.cov2.s?Fatigue,Asthenia.This event(s) is labeled per Regulatory Authority & therefore considered potentially related


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