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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 492 out of 8,753

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VAERS ID: 1820436 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 RA / IM

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

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

Write-up: Within 24 hours I got tinnitus. It is gradually getting worse. Some nights I get <3 hours of sleep because it''s so loud. Some days it''s difficult to think clearly or concentrate because it''s so loud. Some days/nights are better/worse than others. Contacted my PCP who said she never heard of that as being related to the vaccine. Told to contact my employer''s employee health. Contacted them and they also said they never heard of that as being related to the vaccine and to contact my PCP. Contacted my PCP again and she wrote for an ENT referral, which I still haven''t heard from.


VAERS ID: 1820456 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / OT

Administered by: Unknown       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: KEPPRA [LEVETIRACETAM DIHYDROCHLORIDE]; MAGNESIUM OXIDE; RETIN-A
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Gave 14 years old 1st dose; This spontaneous case was reported by a health care professional and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Gave 14 years old 1st dose) in a 14-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 005C21A and 005C21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included LEVETIRACETAM DIHYDROCHLORIDE (KEPPRA [LEVETIRACETAM DIHYDROCHLORIDE]) from 16-Sep-2021 to an unknown date, MAGNESIUM OXIDE from 16-Sep-2021 to an unknown date and TRETINOIN (RETIN-A) for an unknown indication. On 16-Sep-2021 at 5:00 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Oct-2021 at 4:30 AM, 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 PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Gave 14 years old 1st dose). On 16-Sep-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Gave 14 years old 1st dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No treatment drug details was received. Most recent FOLLOW-UP information incorporated above includes: On 21-Oct-2021: Follow-up document received on 21-Oct-21 : patient height, weight ,race, ethinicity, second dose information, concomitant medications were updated.


VAERS ID: 1820597 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hypersensitivity, Immunisation, Off label use, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101327827

Write-up: Hives; Rash; Itching; Allergic reaction; I received the 3rd shot for the Pfizer, the booster; I received the 3rd shot for the Pfizer, the booster; This is a spontaneous report from a contactable consumer (patient). A male patient of an unspecified age received booster dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot number was not reported, Expiration date: unknown), via an unspecified route of administration on 16Sep2021 as dose 3 (booster), single for COVID-19 immunization. The patient medical history and concomitant medications were not reported. Patient previously received first dose of bnt162b2 (Lot number and expiration date not reported) as dose 1, single and second dose of bnt162b2 (Lot number and expiration date not reported) as dose 2, single, both via an unspecified route of administration on an unknown date for COVID-19 immunization. On 05Oct2021, the patient got an allergic reaction, a rash, hives, and itching. Patient wanted to know if that was possible that after three weeks, he gets a reaction. The outcome of events was unknown. QR comment: Reporter type was not available over the call, hence reporter type was captured as consumer or non-healthcare professional by default. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1821258 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-03-24
Onset:2021-09-16
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 UN / IM

Administered by: Public       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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient diagnosed and hospitalized with COVID-19 while fully vaccinated.


VAERS ID: 1821427 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamins
Current Illness: None
Preexisting Conditions: Neuroma on left foot, psoriasis on elbows, low iron
Allergies: Pennicillian, yeast, dairy
Diagnostic Lab Data: None yet. I called the doctor and they couldn''t get me right in, but said I should report it to the CDC. I''m still working on getting an appointment. Hopefully I can get in by the end of the week.
CDC Split Type:

Write-up: The day after the injection I got sick- nausea, headache, fever, rash on my cheeks and eyelids and nervous jitters. I thought it would pass, and all of it did except the rash on my face that has gone down a lot, but is still present. I called the doctor today and they said that I should report it to the CDC.


VAERS ID: 1821777 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Tinnitus
SMQs:, Hearing impairment (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec but I hadn''t taken it in a few days around that time; multivitamin; fish oil; calcium
Current Illness: None
Preexisting Conditions: No
Allergies: Sulfa drugs
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: Woke up with ringing in my ears. It was pretty intense ringing. It has gone down over the last several weeks. But it still quite noticeable. I never had an tinnitus before and it is most noticeable at night so it interferes with my sleep. I am scheduled to see an audiologist/ENT, but not until November 3, 2021.


VAERS ID: 1823555 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-01
Onset:2021-09-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Heart rate, Heart rate increased, Painful respiration
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Other ischaemic heart disease (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma
Allergies:
Diagnostic Lab Data: Test Date: 20210916; Test Name: Heart rate; Result Unstructured Data: Test Result:Elevated
CDC Split Type: USPFIZER INC202101359920

Write-up: Pain in chest, around the heart; Sharp and sudden pains, may happen while breathing occasionally.; Elevated heart rate for the first couple of days after shot; This is a spontaneous report from a non-contactable consumer (patient). A 22-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration, administered in the left arm in Sep2021 (Batch/Lot Number: FC3180) as DOSE 1, SINGLE for COVID-19 immunisation. Medical history included asthma from an unknown date and unknown if ongoing. There were no concomitant medications. The patient previously took amoxicillin and experienced allergies. Vaccine was received in a pharmacy/ drug store. There were no other vaccine received in four weeks and no other medications received in two weeks. The patient did not have COVID-19 prior to vaccination and was not tested for COVID-19 post vaccination. On 16Sep2021, the patient experienced pain in chest, around the heart (medically significant), sharp and sudden pains, may happen while breathing occasionally, and elevated heart rate for the first couple of days after shot. The pain persisted up until the date of the report. The events resulted in doctor or other healthcare professional office/clinic visit. The events did not require treatment. The outcome of the events was not recovered. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1827430 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chills, Dyspnoea, Feeling hot, Off label use, Product use issue
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: No
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101222322

Write-up: Two minutes after getting it I got a major heat wave; Pressure in my chest; difficult to breath; Really bad chill; Pfizer vaccine and Influenza vaccine administered on 16Sep2021; Pfizer vaccine and Influenza vaccine administered on 16Sep2021; This is a spontaneous report from a contactable consumer (patient). A 22-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot Number: FC3183) via an unspecified route of administration, administered in left arm on 16Sep2021 at 4''O clock(at the age of 22-year-old) as dose 1, single for covid-19 immunisation and Influenza vaccine via an unspecified route of administration on 16Sep2021 4''O clock (Batch/Lot number was not reported) as dose number unknown for immunization. No relevant medical history reported. There were no concomitant medications. Patient reported, on 16Sep2021, two minutes after getting her first shot she got a major heat wave and like pressure in her chest like it was kind of difficult to breath and then right after that it was really bad chill and she just have not a heard of anybody that she know that has had a reaction so quickly after getting it. So, she was kind of concern and scared her. Patient took Influenza vaccine at the same time of Pfizer vaccine on 16Sep2021. Outcome of the events was unknown at the time of reporting. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1828902 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Feeling hot, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine about 12 years ago caused her to be sick for about 3 days with flu like symptoms.
Other Medications: aleve
Current Illness:
Preexisting Conditions: Breast Cancer survivor
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt stated she started feeling very hot and had trouble breathing. She was gasping for air and had rapid heart beat. She felt like she was going to pass out. She was gasping for air so she laid down. This entire episode lasted about 10-15 minutes. She was able to get up and was back to normal but still scared about the episode that happened and worried it would happen again. Pt states she has not had any further episodes like this.


VAERS ID: 1829107 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Hypoaesthesia, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Sexual dysfunction (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium


VAERS ID: 1829271 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-09-02
Onset:2021-09-16
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized after testing positive for COVID.


VAERS ID: 1829376 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-16
Onset:2021-09-16
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blood test normal, Cardiac stress test, Chest pain, Dizziness, Electrocardiogram normal, X-ray normal
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: EKG, chest x-ray, blood tests administered on date of event (September 18). Results normal. Additional stress test administered October 19. Results normal.
CDC Split Type:

Write-up: Chest pain and dizziness during exercise. Lasted about 10 seconds.


VAERS ID: 1830792 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Balance disorder, Dizziness, Dysphagia, Eye pain, Fall, Fatigue, Feeling abnormal, Flank pain, Malaise, Muscle twitching, Myalgia, Neck pain, Neurological symptom, Pain, Palpitations, Sleep disorder, Throat tightness, Ultrasound scan, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOSARTAN/HCTZ; CLARITINE; MOTRIN [IBUPROFEN]; VITAMIN B [VITAMIN B NOS]; VITAMIN C CITRUS; MULTIVITAMINS;MINERALS
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Ultrasound on throat; Result Unstructured Data: Normal
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Occipital neurology symptoms; Left plank pain; Fell due to unbalance; Pain the back of the neck; Blurred vision while watching tv; Sleep disturbance; Significant dizziness; Brain fog; Balance issues; Left ocular pain; Right side pain; Labor swallowing; Malaise; Fatigue; Soreness in the arm; Arm twitching right after injection/twitching throughout the body/buttock was twitching; Abdominal pain/pain in lower side of abdominal/lower pain in the abdominal/lower pain in the abdominal; 7 hours afterward throat started to feel tightness/throat felt like constricted; Palpitation; This spontaneous case was reported by a consumer and describes the occurrence of MUSCLE TWITCHING (Arm twitching right after injection/twitching throughout the body/buttock was twitching), ABDOMINAL PAIN (Abdominal pain/pain in lower side of abdominal/lower pain in the abdominal/lower pain in the abdominal), THROAT TIGHTNESS (7 hours afterward throat started to feel tightness/throat felt like constricted), PALPITATIONS (Palpitation) and SLEEP DISORDER (Sleep disturbance) in a 60-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included HYDROCHLOROTHIAZIDE, LOSARTAN POTASSIUM (LOSARTAN/HCTZ), LORATADINE (CLARITINE), IBUPROFEN (MOTRIN [IBUPROFEN]), VITAMIN B [VITAMIN B NOS], ASCORBIC ACID (VITAMIN C CITRUS) and MULTIVITAMINS;MINERALS for an unknown indication. On 16-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced MUSCLE TWITCHING (Arm twitching right after injection/twitching throughout the body/buttock was twitching), ABDOMINAL PAIN (Abdominal pain/pain in lower side of abdominal/lower pain in the abdominal/lower pain in the abdominal), THROAT TIGHTNESS (7 hours afterward throat started to feel tightness/throat felt like constricted), PALPITATIONS (Palpitation) and MYALGIA (Soreness in the arm). On 17-Sep-2021, the patient experienced SLEEP DISORDER (Sleep disturbance), DIZZINESS (Significant dizziness), FEELING ABNORMAL (Brain fog), BALANCE DISORDER (Balance issues), EYE PAIN (Left ocular pain), PAIN (Right side pain), DYSPHAGIA (Labor swallowing), MALAISE (Malaise) and FATIGUE (Fatigue). On 18-Sep-2021, the patient experienced FLANK PAIN (Left plank pain), FALL (Fell due to unbalance), NECK PAIN (Pain the back of the neck) and VISION BLURRED (Blurred vision while watching tv). On 02-Oct-2021, the patient experienced NEUROLOGICAL SYMPTOM (Occipital neurology symptoms). At the time of the report, MUSCLE TWITCHING (Arm twitching right after injection/twitching throughout the body/buttock was twitching), ABDOMINAL PAIN (Abdominal pain/pain in lower side of abdominal/lower pain in the abdominal/lower pain in the abdominal), THROAT TIGHTNESS (7 hours afterward throat started to feel tightness/throat felt like constricted), PALPITATIONS (Palpitation), SLEEP DISORDER (Sleep disturbance), DIZZINESS (Significant dizziness), FEELING ABNORMAL (Brain fog), BALANCE DISORDER (Balance issues), EYE PAIN (Left ocular pain), PAIN (Right side pain), DYSPHAGIA (Labor swallowing), MALAISE (Malaise), FLANK PAIN (Left plank pain), FALL (Fell due to unbalance), NECK PAIN (Pain the back of the neck), VISION BLURRED (Blurred vision while watching tv), NEUROLOGICAL SYMPTOM (Occipital neurology symptoms), MYALGIA (Soreness in the arm) and FATIGUE (Fatigue) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Ultrasound scan: normal (normal) Normal. It was reported that patient experienced arm twitching right after injection, twitching throughout the body on day 2 and buttock was twitching on day 3. Abdominal pain, pain in lower side of abdominal was experienced day 1 and lower pain in the abdominal on day 2 and day 3. It was also reported that patient saw an Ear Nose Throat (ENT) just to have a check. No treatment medication was provided. This case was linked to MOD-2021-361927 (Patient Link).


VAERS ID: 1830898 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMAN PAPILLOMA VACCINE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210916; Test Name: Body temperature; Result Unstructured Data: Test Result:104; Comments: Multiple events of high fever 104 highest (4 in total)
CDC Split Type: USPFIZER INC202101219589

Write-up: Multiple events of high fever 104 highest (4 in total); This is a spontaneous report from a non-contactable consumer. A 13-year-old male patient received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on 15Sep2021 (at the age of 13-years-old) as a single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient received other vaccines within four weeks prior to the vaccination which included HPV9 (HUMAN PAPILLOMA VACCINE), taken on an unknown date for an unknown indication. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on an unknown date as a single dose for COVID-19 immunisation. On 16Sep2021, the patient experienced multiple events of high fever 104 highest (4 in total). The event did not result in doctor or other healthcare professional office/clinic visit, and emergency room/department or urgent care. It was unknown whether any therapeutic measures were taken as a result of the event. On 16Sep2021, the patient underwent body temperature test and the result was 104 (unspecified units). Since the vaccination, it was unknown whether the patient had been tested for COVID-19. The clinical outcome of the event multiple events of high fever 104 highest (4 in total) was not resolved at the time of this report. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1831014 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Fatigue, Headache, Neurological examination, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Prior to vaccination, was the patient diagnosed with COVID-19?:Yes)
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Blood test; Result Unstructured Data: Test Result:UNKNOWN RESULTS; Comments: Treatment AE: Blood work; Test Date: 2021; Test Name: Neurological examination; Result Unstructured Data: Test Result:UNKNOWN RESULTS; Comments: Treatment AE: neur eval; Test Date: 20210930; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: USPFIZER INC202101318712

Write-up: Severe headaches; Fatigue; This is a spontaneous report from a contactable healthcare professional, the patient. A 37-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0191) via an unspecified route of administration in the left arm on 16Sep2021 (at the age of 37-years-old) as a single dose for COVID-19 immunisation. Medical history included COVID-19. The patient had no known allergies. Prior to vaccination, the patient was diagnosed with COVID-19. Concomitant medications were not reported. The patient did not receive any other vaccines within four weeks prior to the vaccination. On 16Sep2021, the patient experienced severe headaches and fatigue. The events resulted in doctor or other healthcare professional office/clinic visit. Therapeutic measures were taken as a result of the events and included treatment with unspecified medications, neurological evaluation and blood work. Since the vaccination, the patient had been tested for COVID-19. On 30Sep2021, the patient underwent SARS-COV-2 test (nasal swab) and the result was negative. On an unknown date in 2021, the patient underwent neurological examination and blood test and the results were unknown. The clinical outcome of the events severe headache and fatigue was not resolved at the time of this report. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1831626 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Blood test, Chest discomfort, Dyspnoea, Electrocardiogram, Fatigue, Influenza like illness, Muscle contractions involuntary, Myalgia, Sleep disorder, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amblobiden losartin lamitrogine colondine potassium ambien
Current Illness: None
Preexisting Conditions: High blood pressure From the vaccine I have had the following symptoms Intense muscle pain contractions wakes me up at night Acute Shortness of breath fatigue flu symptoms all getting progressively worse
Allergies:
Diagnostic Lab Data: X-ray Blood test EKG
CDC Split Type:

Write-up: From the vaccine I have had the following symptoms Intense muscle pain contractions Acute Shortness of breath fatigue flu symptoms all getting progressively worse. Feel like there is a heavy weight o.n my chest pressing down all the time.


VAERS ID: 1833097 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Biopsy, Condition aggravated, Goitre, Neck pain, Pain in extremity, Tenderness, Thyroid gland scan abnormal
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Hypothyroidism (broad), Hyperthyroidism (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D 2000 IU/day, eliquis 2.5 mg 2x per day, culturelle probiotic
Current Illness:
Preexisting Conditions: Previous Deep Vein Thrombosis, Temporal Mandibular Joint Syndrome (TMJ), unexplained belching
Allergies: Allergic to tizanidine and multiple pollen allergies
Diagnostic Lab Data: I had previous history of a thyroid goiter on my left side that had remained the same size since discovery two years ago in 2019 (TI- RAD 2-3 rating) however on Oct 11, 2021 I had an ultrasound and the goiter had grown 50 percent in size and was rated (TI-RAD 5 by radiologist). The growth triggered a biopsy conducted on Oct 28, 2021 and I''m still waiting the results. I''m only reporting because the area that I thought was just a swollen lymph node after vaccination ended up being the thyroid goiter enlarging.
CDC Split Type:

Write-up: Following the vaccine I had a lot of pain in my left arm as expected. I had pain in my left shoulder and all along the left side of my neck and the back of my neck. There was tenderness along the left side which I assumed were swollen lymph nodes, which I expected. Eventually intense arm, shoulder and neck pain along the back of my neck subsided. The neck pain has come and gone. I realized what I thought was the swollen lymph node was the goiter enlarging.


VAERS ID: 1833671 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Shortness of breath for a week


VAERS ID: 1834453 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-10
Onset:2021-09-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Contusion, Immune thrombocytopenia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Bloodwork 9/16/21
CDC Split Type:

Write-up: Almost one week post vaccination, I noticed unexplained bruising on the backs of my legs consistent with ITP. I was seen I two urgent cares and was sent for follow up bloodwork. By the time bloodwork came back, all levels were within normal range.


VAERS ID: 1835303 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-01
Onset:2021-09-16
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101253351

Write-up: Numb finger tips on left hand.; This is a spontaneous report from a contactable consumer, the patient. A 39-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on an unknown date in Aug2021 at 12:00 (at the age of 39-years-old) as a single dose for COVID-19 immunisation and the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the right arm on an unknown date in Sep2021 at 14:00 (at the age of 39-years-old) as a single dose for COVID-19 immunisation. The patient did not have any relevant medical history. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any concomitant medications. The patient did not receive any other vaccines within 4 weeks prior to the COVID-19 vaccine. On 16Sep2021 at 14:00, the patient experienced numb finger tips on left hand. The event did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the event. The clinical outcome of the event numb finger tips on left hand was not resolved at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1835504 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, 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: ESCITALOPRAM
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101369791

Write-up: started menstruating 4 days early after the first dose of vaccine; This is a spontaneous report from a contactable consumer, the patient. A 38-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 13Sep2021 at 19:00 (at the age of 38-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history. Prior to vaccination, the patient was not diagnosed with COVID-19. Concomitant medications included escitalopram (MANUFACTURER UNKNOWN) for an unknown indication from an unknown dates and unknown if ongoing. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient previously received ciprofloxacin (CIPRO) for an unknown indication on an unknown date and experienced drug allergy. On 16Sep2021 at 12:00, after the first dose of vaccine. the patient started menstruating 4 days early. The event did not result in doctor or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the event. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event started menstruating 4 days early was resolved with sequelae on an unknown date in 2021. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1836734 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-21
Onset:2021-09-16
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, Zoloft, irbesartan, ezetimibe, hydroxychloroquine, gabapentin, tramadol
Current Illness:
Preexisting Conditions: Lupus, hypertension
Allergies: Bees
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme Vertigo, nausea started three weeks after booster Taking antivert as needed.


VAERS ID: 1836792 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-12
Onset:2021-09-16
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Amenorrhoea
SMQs:, 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: Zyrtec Flonaze
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NSAIDS Penicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: She has not had her period since Aug 16, 2021 - nearly 90 days since her last cycle


VAERS ID: 1836881 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E01A / 1 LA / -

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? 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: 12 year old patient received moderna shot instead of pfizer


VAERS ID: 1837030 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O48F / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphonia
SMQs:, Parkinson-like events (broad)

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

Write-up: Systemic: Hoarseness-Medium, Additional Details: Hoarseness but nothing beyond that


VAERS ID: 1840678 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840741 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840746 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840756 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 RA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840773 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840778 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: No adverse event, 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: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840787 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840791 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 RA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840798 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840802 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840813 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: No adverse event, 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: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840816 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840817 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840820 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840823 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 RA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840825 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 RA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840952 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840954 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 LA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840957 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: No adverse event, 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: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840958 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: No adverse event, 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: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840960 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 RA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1840964 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 RA / IM

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

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

Write-up: PT RECIEVED VACCINE THAT WAS PAST THE BEYOND USE DATE. NO ADVERSE EFFECTS REPORTED.


VAERS ID: 1841390 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: beginning 3 days after 2nd dose, the patient began experiencing fevers. Fevers occurred almost every day, often accompanied with headache and/or nausea. This continued for 6 weeks, at which point patient saw their primary care physician who prescribed a course of Prednisone for 9 days. Patient fully recovered following this treatment.


VAERS ID: 1842571 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 - / OT

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

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

Write-up: Body aches after first shot; This spontaneous case was reported by a nurse and describes the occurrence of MYALGIA (Body aches after first shot) in a 52-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048F21A) for COVID-19 vaccination. No Medical History information was reported. On 16-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Sep-2021, the patient experienced MYALGIA (Body aches after first shot). On 18-Sep-2021, MYALGIA (Body aches after first shot) 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 information was reported. No treatment medications were provided. This case was linked to MOD-2021-366238 (Patient Link).


VAERS ID: 1842592 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-22
Onset:2021-09-16
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: first dose greater than 25 days/my second shot was 16Sep2021, five months later/2nd dose $g36 days; tired/fatigued; This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (tired/fatigued) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (first dose greater than 25 days/my second shot was 16Sep2021, five months later/2nd dose $g36 days) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 004F21A) for COVID-19 vaccination. No Medical History information was reported. On 22-Apr-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. In 2021, the patient experienced FATIGUE (tired/fatigued). On 16-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (first dose greater than 25 days/my second shot was 16Sep2021, five months later/2nd dose $g36 days). On 16-Sep-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (first dose greater than 25 days/my second shot was 16Sep2021, five months later/2nd dose $g36 days) had resolved. At the time of the report, FATIGUE (tired/fatigued) outcome was unknown. No concomitant medications were provided. No treatment medications were provided It was reported that the patient felt fine after the second dose, except tired/fatigued. Most recent FOLLOW-UP information incorporated above includes: On 28-Oct-2021: Follow up received: New event (fatigue) was added. Vaccine administration site updated.


VAERS ID: 1842836 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product administration error, 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: Patient inadvertently received vaccine after published expiration date. Moderna Company analyzed lot 007B21A and advised vaccine maintained activity needed to protect against covid 19 at time vaccine was administered. Patient did not call in to complain of any adverse events. This is administrative error without adverse event.


VAERS ID: 1842854 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product administration error, 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: Patient inadvertently received vaccine after published expiration date. Moderna company analyzed lot 007B21A and advised this lot maintained activity necessary to protect against covid 19 at time vaccine was administered. Patient also did not call in and complain of any adverse event. This is administrative error without adverse event.


VAERS ID: 1842869 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

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

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

Write-up: Patient inadvertently received vaccine after published expiration date. Moderna Company analyzed lot 007B21A and advised vaccine maintained activity necessary to protect against covid 19 at time of vaccine administration. Also patient did not call in to complain of adverse event. This is administration error without adverse event.


VAERS ID: 1842882 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

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

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

Write-up: Patient inadvertently received vaccine after published expiration date. Moderna Company analyzed lot 007B21A and advised vaccine maintained activity necessary to protect against covid 19 at time of administration. Patient also did not call in to complain of adverse event. This is administration error without adverse event.


VAERS ID: 1842890 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, 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: Patient inadvertently received vaccine after published expiration date. Moderna company analyzed lot 007B21A and advised vaccine maintained activity necessary to protect against covid 19 at time of administration. Patient also did not call into complain of adverse event.


VAERS ID: 1842901 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product administration error, 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: Patient inadvertently received vaccine after published expiration date. Moderna company analyzed lot 007B21A and advised vaccine maintained activity necessary to protect against covid 19 at time of administration. Patient also did not call in to complain of adverse event. This is administrative error without adverse event.


VAERS ID: 1842913 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product administration error, 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: Patient inadvertently received vaccine after published expiration date. Moderna Company analyzed lot 007B221A and advised vaccine maintained activity necessary to protect against covid 19 at time of administration. Also patient did not call in to report adverse event. This is administrative error without adverse event.


VAERS ID: 1842927 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

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

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

Write-up: Patient inadvertently received vaccine after published expiration date. Moderna Company analyzed lot 007B21A and advise d vaccine maintained activity necessary to protect against covid 19 at time of administration. Also patient did not call in to complain of adverse event. This is administrative error without adverse event.


VAERS ID: 1842945 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

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

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

Write-up: Patient inadvertently received vaccine after published expiration date. Moderna Company analyzed lot 007B21A and advised vaccine maintained activity necessary to protect against covid 19 at time of administration. Also patient did not call in to complain of adverse event. This is administrative error without adverse event.


VAERS ID: 1842970 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

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

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

Write-up: Patient inadvertently received vaccine after published expiration date. Moderna analyzed lot 007B21A and advised vaccine maintained activity necessary to protect against covid 19 at time of administration. Also patient did not call in to complain of adverse event. This is an administration error without adverse event.


VAERS ID: 1842989 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, 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: Patient inadvertently received vaccine after published expiration date. Moderna analyzed vaccine and advised lot 007B21A maintained activity necessary to protect against covid 19 on date vaccine was administered. Also patient did not call in to complain of adverse eveent.


VAERS ID: 1843027 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product administration error, 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: Patient received vaccine after published expiration date. Moderna Company analyzed lot 007B21A and advised vaccine maintained activity necessary to protect against covid 19 at date of administration. Also patient did not call in to report adverse event. This is administration error without adverse event.


VAERS ID: 1843094 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product administration error, 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: Patient received vaccine after published expiration date. Moderna Company analyzed lot 007B21A and advised vaccine maintained activity necessary to protect against covid 19 on date vaccine was administered. Also patient did not call to complain of adverse event. This is administration error without adverse event.


VAERS ID: 1843120 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

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

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

Write-up: Patient received vaccine after published expiration date. Moderna Company analyzed vacccine and advised lot 007B21A maintained activity necessary to protect against Covid 19 on date of administration. Also patient did not call in to complain of adverse event. This is an administrative error without adverse event.


VAERS ID: 1843147 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

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

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

Write-up: Patient received vaccine after published expiration date. Moderna Company analyzed lot 007B21A and advised vaccine maintained activity necessary to protect against covid 19 at time of administration. Also patient did not call in and complain of any adverse event. This is administrative error without adverse event.


VAERS ID: 1843156 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, X-ray normal
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I was taking Levothyroxine Sodium, Duloxetine, Centrum Multivitamin, Oxycodone Acetaminophen and Equitrim.
Current Illness: I was not experiencing any illness.
Preexisting Conditions: I had bladder cancer, but I am in remission. I do have a history of pericarditis from dental work I had a long time ago.
Allergies: I do not have any allergies.
Diagnostic Lab Data: I had and EKG and x-rays. All tests came back normal.
CDC Split Type: vsafe

Write-up: The day after receiving my third dose, I started to have frequent chest pains. I would take the Equitrim and it would go away. It would come back within a day or two. I told my Oncologist and he wanted me to have an EKG and X-ray''s. All tests came back normal. I still have the pains every couple of days, but I take my medication and it helps.


VAERS ID: 1843174 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-27
Onset:2021-09-16
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular, Ovarian cyst, Ultrasound scan vagina, Ultrasound uterus, Uterine leiomyoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine, Bupripion
Current Illness: None
Preexisting Conditions: Recurrent Major Depression (in remission)
Allergies: Bactrim
Diagnostic Lab Data: Urterine and Vaginal ultrasound (10/29/2021) ultrasound result was uterine fundal fibroid and simple left overian cyst.
CDC Split Type:

Write-up: Starting on 09/16/2021, had irregular bleeding outside of regular menstrual cycle, lasting for 3 weeks. Went to PC on 10/05/2021. Was referred to urogynocologist. Saw her on 10/27/2021.


VAERS ID: 1843177 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

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

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

Write-up: Patient received vaccine after published expiration date. Moderna analyzed lot 007B21A and indicated vaccine maintained activity necessary to protect against covid 19 on date vaccine was administered. Also patient did not call in to complain of adverse event. This was administration error with no adverse event.


VAERS ID: 1843187 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

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:

Write-up: Patient received vaccine after published expiration date. Moderna Company analyzed lot 007B21A and advised vaccine maintained activity required to protect against covid on date vaccine was administered. Also patient did not call in to complain of side effects.


VAERS ID: 1843193 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK RA / IM

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

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

Write-up: Patient received vaccine after published expiration date. Moderna company analyzed vaccine and advised batch/lot# 007B21A maintained activity necessary to protect against COVID-19 at date of administration. Also patient did not call in to complain of adverse event.


VAERS ID: 1843207 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product administration error, 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: Patient received vaccine after published expiration date. Moderna Company analyzed vaccine and advised lot 007B21A maintained activity necessary to protect against covid 19 on date vaccine was administered. Also patient did not call in to complain of adverse events. This is administrative error without adverse event.


VAERS ID: 1843218 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 7+ RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product administration error, 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: Patient inadvertently received vaccine after published expiration date. Moderna Company analyzed lot 007B21A and advised vaccine maintained activity necessary to protect against covid 19 on date of administration.Also patient did not call in to complain of adverse event. This is administration error without adverse event.


VAERS ID: 1843633 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-10
Onset:2021-09-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol
Current Illness: none
Preexisting Conditions: asthma
Allergies: dogs, dust mites, grass pollen, tree pollen, soybean
Diagnostic Lab Data: none
CDC Split Type:

Write-up: chest pain


VAERS ID: 1846287 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK - / IM

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

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

Write-up: Vaccine Error: 2nd dose of pfizer administered on day 14 instead of 17-21. Agency contacted and advised to repeat 2nd dose at least 21 days after last dose.


VAERS ID: 1846758 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / UNK RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Electric shock sensation, Rheumatoid arthritis
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (narrow), Immune-mediated/autoimmune 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: Plaquenil; Arava; Cymbalta; Remicade infusion; Synthroid.
Current Illness: Hashimoto''s disease; Rheumatoid Arthritis
Preexisting Conditions: Rheumatoid Arthritis and Hashimoto''s disease.
Allergies: flagyl and sulfa drugs.
Diagnostic Lab Data: No other tests or labs other than the regular ones at my Rheumatologist. They administered IV steroid in Remicade infusion.
CDC Split Type:

Write-up: Severe Rheumatoid Arthritis Flare with only 1st dose. Reaction on day 3. joint pain and electricity type shocks felt at joints. (this has never been felt before even before RA was treated.)


VAERS ID: 1848173 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-17
Onset:2021-09-16
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Antibody test, Chills, Headache, Illness, Neuropathy peripheral, Pain in extremity, Pyrexia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CLL; Drug allergy (Allergic to the medication lisinopril.); Immunocompromised; Peripheral neuropathy (Diagnosed 5 years ago)
Preexisting Conditions: Medical History/Concurrent Conditions: Heart attack (Couple of years ago)
Allergies:
Diagnostic Lab Data: Test Date: 202104; Test Name: Antibody test; Result Unstructured Data: Antibody test after the 2nd dose and had zero antibodies; Test Date: 202109; Test Name: Antibody test; Result Unstructured Data: Antibody test after the 3rd dose and had zero antibodies
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Peripheral neuropathy pain "exploded" in his feet; Feet started "crazy hurting"/ongoing foot pain; Very sick; Fever; Chills; Pounding headache; This spontaneous case was reported by a consumer and describes the occurrence of NEUROPATHY PERIPHERAL (Peripheral neuropathy pain "exploded" in his feet) in a 71-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 040B21A and 044A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Heart attack (Couple of years ago). Concurrent medical conditions included Peripheral neuropathy (Diagnosed 5 years ago), CLL since July 2020, Drug allergy (Allergic to the medication lisinopril.) and Immunocompromised. On 17-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 14-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 16-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 16-Sep-2021, the patient experienced NEUROPATHY PERIPHERAL (Peripheral neuropathy pain "exploded" in his feet) (seriousness criterion medically significant), PAIN IN EXTREMITY (Feet started "crazy hurting"/ongoing foot pain), ILLNESS (Very sick), PYREXIA (Fever), CHILLS (Chills) and HEADACHE (Pounding headache). The patient was treated with GABAPENTIN for Adverse event, at a dose of 1800 mg once a day. On 21-Sep-2021, ILLNESS (Very sick), PYREXIA (Fever), CHILLS (Chills) and HEADACHE (Pounding headache) had resolved. At the time of the report, NEUROPATHY PERIPHERAL (Peripheral neuropathy pain "exploded" in his feet) and PAIN IN EXTREMITY (Feet started "crazy hurting"/ongoing foot pain) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In April 2021, Antibody test: zero (normal) Antibody test after the 2nd dose and had zero antibodies. In September 2021, Antibody test: zero (normal) Antibody test after the 3rd dose and had zero antibodies. Patients concomitant medication included Gabapentin, Chronic Lymphocytic Leukemia medications NOS and heart medications NOS. Patient was treated with increased dose of gabapentin. The patient reported pain was ongoing in feet. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was not applicable. This case concerns a 71 year old male patient, with medical history of chronic lymphocytic leukemia and peripheral neuropathy diagnosed 5 years ago, who experienced non serious unexpected event of neuropathy peripheral after third dose of mRNA-1273. The event occurred the same day after vaccination. The re-challenge is not applicable. Patient?s medical history of neuropathy peripheral could be considered a contributing factor. The benefit-risk relationship of Moderna COVID-19 vaccine is not affected by this report. Event [neuropathy peripheral ] was automatically upgraded as serious as per IME list. However, based on information available and as per medical judgement was assessed as non-serious.; Sender''s Comments: This case concerns a 71 year old male patient, with medical history of chronic lymphocytic leukemia and peripheral neuropathy diagnosed 5 years ago, who experienced non serious unexpected event of neuropathy peripheral after third dose of mRNA-1273. The event occurred the same day after vaccination. The re-challenge is not applicable. Patient?s medical history of neuropathy peripheral could be considered a contributing factor. The benefit-risk relationship of Moderna COVID-19 vaccine is not affected by this report. Event [neuropathy peripheral ] was automatically upgraded as serious as per IME list. However, based on information available and as per medical judgement was assessed as non-serious.


VAERS ID: 1848579 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Burning sensation, Chest pain, Dyspnoea, Electric shock sensation, Exercise tolerance decreased, Feeling cold, Hypoaesthesia, Muscle twitching, Palpitations, Tachycardia, Temperature intolerance
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CELEXA [CITALOPRAM HYDROBROMIDE]
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101499881

Write-up: Palpitaions; Tachycardia/ Episodes of tachycardia during sleep; Chest pain; Body weakness; Left eye twitch; Feet burning; Cold sensation; SOB; Heat and exercise intolerance; Heat and exercise intolerance; Electric feeling throughout body; Numbness in left ring finger and pinky; This is a spontaneous report from a contactable other healthcare professional, the patient. A 42-year-old non-pregnant female patient received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: 30130BA) via an unspecified route of administration in the arm left on 16Sep2021 at 16:00 (at the age of 42-years-old) as a single dose for COVID-19 immunisation. The patient''s medical history was reported as none. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The concomitant medications included citalopram hydrobromide (CELEXA) and multivitamins (unspecified); both for unknown indications from unknown dates and unknown if ongoing. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3182) via an unspecified route of administration in the left arm on 26Aug2021 at 16:00 (at the age of 42-years-old) as a single dose for COVID-19 immunisation. On 16Sep2021 at 16:00, the patient experienced palpitations, tachycardia, chest pain, body weakness, left eye twitch, feet burning and cold sensation, shortness of breath (SOB),episodes of tachycardia during sleep, heat and exercise intolerance, electric feeling through out body, numbness in left ring finger and pinky. The adverse events resulted in doctor or other healthcare professional office/clinic visit. Therapeutic measures were not taken as a result of the reported events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events palpitations, tachycardia, chest pain, body weakness, left eye twitch, feet burning and cold sensation, shortness of breath (SOB), episodes of tachycardia during sleep, heat and exercise intolerance, electric feeling throughout body, numbness in left ring finger and pinky were not resolved at the time of this report.


VAERS ID: 1848634 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Joint swelling, Livedo reticularis, Pain, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 hours after the injection my arm mottled from the right wrist to mid bicep. Mottling resolved after approximately 30 to 45 minutes. Pain and swelling to the right hand and shoulder started approximately 2 hours after the injection and remains today. Best I can explain is joint pain in the right shoulder and joint pain in the right hand with the middle knuckle being swollen. Pain is a dull ache somewhat relieved with position. Pain remains with over the counter medications.


VAERS ID: 1850361 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Headache, Pain in extremity, Pulmonary pain, Toothache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: * My left arm hurt for over a month, I could feel it every time I was at the gym * pain in my upper lungs * Ive had headaches quite often and I rarely get them * Dizzy spells that are on and off (never had that before) * My joints burned when i was working out for a good two months after the shot * the left side of my head hurt... almost like my teeth hurt but not one specific tooth.


VAERS ID: 1850884 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Chest pain, Dizziness, Dyspnoea, Fatigue, Feeling abnormal, Hot flush, Hyperhidrosis, Nausea, Palpitations, Panic attack, Pyrexia, Vaginal haemorrhage
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily Multivitamins (Women''s Multi - Rainbow Light brand, B-Complex - Nature Made, Vitamin D 2000 Mg)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Waiting on appointment with medical doctor for follow up and assistance to balance after vaccination.
CDC Split Type:

Write-up: Difficulty breathing, chest pains, racing heart, panic attack feelings with inability to regulate and pace breathing, extreme hot flashes and sweating, low grade fever or 99-100 degree every other day for 4 weeks, extreme fatigue and "brain fog", dizzy, nauseous for 4 weeks, blood pressure has risen, daily menstrual spotting to this day when there was no previous menstrual activity for nearly 2 years due to IUD placement.


VAERS ID: 1851143 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norlyda Birth Control
Current Illness: none
Preexisting Conditions: Menstrual cramps and migraines.
Allergies: Aleve/Naproxen
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3 Days after the 2nd Covid shot my daughter started her period despite the fact that she is on birth control daily to help with bad menstrual cramps and migraines that seem hormone triggered and she hasn''t had a period for a few months. After the 2nd shot her period came back within days and lasted for two weeks which has never happened in her entire life and is not normal in my experience for any woman. It was heavier than normal bleeding for longer than she has ever experienced. Then again the next month she got a very painful period again despite taking her Norlyda pill as prescribed daily. It really seems like all of this was connected to her receiving the second vaccine. A friend of mine warned us of this as it happened to her too and her periods had been regular her whole life so it really stood out to her too as abnormal. Our greatest concern is for our daughter''s future fertility.


VAERS ID: 1851198 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Balance disorder, Candida infection, Condition aggravated, Decreased appetite, Fall, Fatigue, Magnetic resonance imaging, Migraine, Myalgia, Nausea, Ophthalmological examination normal, Pain, Photophobia, Vertigo, Vomiting, Weight decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (narrow), Tendinopathies and ligament disorders (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? Yes
Hospitalized? No
Previous Vaccinations: 1st dose of Moderna 08/29/2021 (nausea, chronic migraines, muscle aches, Vertigo, chronic pain)
Other Medications: Botox, Popirmate, Amieriprilien, Estrodol, Lexapro, Xanax, Promechazine, Vicodin, Biotin, Zyrtec, Nexium, Excedrin, Mecilizine, Benadryl
Current Illness: N/A
Preexisting Conditions: Chronic Migraines
Allergies: Celebrex, Gabapentin, Topical Iodine
Diagnostic Lab Data: MRI 10/2021
CDC Split Type:

Write-up: Pt. states that after receiving the 2nd dose of Moderna 09/16/2021, started experiencing symptoms of increase in pain due to chronic migraines, light sensitivity, nausea, fatigue, vomiting, Vertigo, Photophobia, frequent falls unbalanced, thrush, weight loss, muscle aches, and back pain. Primary visit 09/2021 prescribed Prednisone with no changes. Emergency Room visit 10/07/2021 (denied Medical Care), Vision examined = Normal (recommendation continue use of previous prescription). Still experiencing symptoms. Extreme loss of appetite, weight loss associated. 11/16/2021 scheduled for Stomach scope/colonoscopy, 11/29/2021 Primary appt. full results.


VAERS ID: 1854005 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

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: Error: Improper Storage (temperature)-


VAERS ID: 1854152 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site pain, Joint range of motion decreased
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Received phone call today from patient reporting ongoing symptoms from Johnson and Johnson COVID-19 Vaccine that she received from Pharmacy on 9/16/2021 in her right deltoid. This is the first time the patient is calling the Vaccine Support Line to report the symptoms. Patient stated she is still having pain in the right arm. Patient states she is not able to sleep on that arm at all, lifting her arm is painful, and even when pulling things it is painful. Patient stated she waited so long to call to report it because she was waiting to see if the symptom would resolve on it''s own but it hasn''t. Patient states that she would like to be seen by a provider for this. Advised Patient that her symptoms would be documented and a worker''s comp case would be opened up for her. Once that is done an Employee Health nurse will contact her letting her know the next steps. Patient voiced understanding and had no other questions at this time.


VAERS ID: 1854290 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

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: Error: Improper Storage (temperature)-


VAERS ID: 1854915 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Hypersomnia, Memory impairment, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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: Unknown
CDC Split Type:

Write-up: Metallic taste in mouth roughly 30 minutes of vaccine, drove home and took Benadryl, Slept/doesn''t remember the next 10 hours. Also experienced muscle weakness. Followed up with physician/hospital, but results unknown.


VAERS ID: 1855058 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Hypoaesthesia, Hypoaesthesia oral, Inflammation, Lymphadenopathy, Neuralgia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: routine flu shot
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: amoxicillin and cefalexin
Diagnostic Lab Data: blood tests and and ct scan.
CDC Split Type:

Write-up: swelling of face and right side of the head as the shot was administered on the right arm. lump under armpit and lymph node swelling along with nerve inflammation and loss of sensation of right side of face tongue and head for over several weeks since the day of 2nd dose of Pfizer vaccine.


VAERS ID: 1857029 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 LA / OT

Administered by: Unknown       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: CETIRIZINE; HYDROXYZINE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 12 year old was administered the first dose of the Moderna Covid19 Vaccine.; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old was administered the first dose of the Moderna Covid19 Vaccine.) in a 12-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 061E21A) for COVID-19 vaccination. Concomitant products included CETIRIZINE and HYDROXYZINE for an unknown indication. On 16-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Sep-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old was administered the first dose of the Moderna Covid19 Vaccine.). On 16-Sep-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old was administered the first dose of the Moderna Covid19 Vaccine.) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No Treatment information was reported. This is a case of Product administered to patient of inappropriate age for this 12-year-old male patient with no relevant medical history reported. The patient received the first dose of mRNA-1273 vaccine on 16-Sep-2021. No adverse events were reported. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This is a case of Product administered to patient of inappropriate age for this 12-year-old male patient with no relevant medical history reported. The patient received the first dose of mRNA-1273 vaccine on 16-Sep-2021. No adverse events were reported. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.


VAERS ID: 1857796 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 RA / IM

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

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

Write-up: 2 days after the Moderna shot I awoke with medium sized pimples, very itchy, tipped with white, mostly on right upper body, mostly in hollow under clavicle and on midriff below breast. There were also random sites: on right leg, on left arm, on belly. They kept appearing for about a week and even now another will pop out. I had myself checked out at the above clinic, with a triage practitioner. I was concerned that perhaps it was shingles, but she advised that it was not. She thought it could be a reaction to the Moderna shot


VAERS ID: 1858259 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-19
Onset:2021-09-16
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Patient vaccinated with Pfizer vaccine mixed with sterile water instead of 09% Normal Saline, preservative free. Consulted with FDA and CDC to determine next steps for patient after discovery. Re-vaccination advised and outreach team contacting impacted patient and offering to speak with a physician to discuss.


VAERS ID: 1858281 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Patient vaccinated with Pfizer vaccine mixed with sterile water instead of 09% Normal Saline, preservative free. Consulted with FDA and CDC to determine next steps for patient after discovery. Re-vaccination advised and outreach team contacting impacted patient and offering to speak with a physician to discuss.


VAERS ID: 1858361 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 vaccinated with Pfizer vaccine mixed with sterile water instead of 09% Normal Saline, preservative free. Consulted with FDA and CDC to determine next steps for patient after discovery. Re-vaccination advised and outreach team contacting impacted patient and offering to speak with a physician to discuss.


VAERS ID: 1858751 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Patient vaccinated with Pfizer vaccine mixed with sterile water instead of 09% Normal Saline, preservative free. Consulted with FDA and CDC to determine next steps for patient after discovery. Re-vaccination advised and outreach team contacting impacted patient and offering to speak with a physician to discuss.


VAERS ID: 1858755 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Patient vaccinated with Pfizer vaccine mixed with sterile water instead of 09% Normal Saline, preservative free. Consulted with CDC to determine next steps for patient after discovery. Re-vaccination advised and outreach team contacting impacted patient and offering to speak with a physician to discuss.


VAERS ID: 1858769 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Patient vaccinated with Pfizer vaccine mixed with sterile water instead of 09% Normal Saline, preservative free. Consulted with FDA and CDC to determine next steps for patient after discovery. Re-vaccination advised and outreach team contacting impacted patient and offering to speak with a physician to discuss.


VAERS ID: 1858795 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Patient vaccinated with Pfizer vaccine mixed with sterile water instead of 09% Normal Saline, preservative free. Consulted with FDA and CDC to determine next steps for patient after discovery. Re-vaccination advised and outreach team contacting impacted patient and offering to speak with a physician to discuss.


VAERS ID: 1858803 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Patient vaccinated with Pfizer vaccine mixed with sterile water instead of 09% Normal Saline, preservative free. Consulted with FDA and CDC to determine next steps for patient after discovery. Re-vaccination advised and outreach team contacting impacted patient and offering to speak with a physician to discuss.


VAERS ID: 1858975 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Patient vaccinated with Pfizer vaccine mixed with sterile water instead of 09% Normal Saline, preservative free. Consulted with FDA and CDC to determine next steps for patient after discovery. Re-vaccination advised and outreach team contacting impacted patient and offering to speak with a physician to discuss.


VAERS ID: 1860309 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Headache, Hyperhidrosis, Immunisation, Influenza like illness, Nausea, Off label use, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: DEPAKOTE; SEROQUEL; VITAMIN D [COLECALCIFEROL]
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101301889

Write-up: Feverish; Clammy; Sweating; Nauseous; Felt a bit like a mild flu case; Mild headache; Received my booster on 16Sep2021; Received my booster on 16Sep2021; This is a spontaneous report from a contactable consumer (patient) reported for himself that: A 74-years-old male patient received third dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: FC3182) via an unspecified route of administration, administered in Arm Left on 16Sep2021 16:00 (Age at Vaccination 74-years-old) as DOSE 3 (BOOSTER), SINGLE for COVID-19 immunization. Medical history included none. Concomitant medication(s) included valproate semisodium (DEPAKOTE) taken for an unspecified indication, start and stop date were not reported; quetiapine fumarate (SEROQUEL) taken for an unspecified indication, start and stop date were not reported; colecalciferol (VITAMIN D [COLECALCIFEROL]) taken for an unspecified indication, start and stop date were not reported. Past drug included Known allergies: A drug called Avelox. Patient receive did not any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, patient did not diagnose with COVID-19. Since the vaccination, patient did not test for COVID-19. Previously patient received first dose of dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: Gn5318) via an unspecified route of administration, administered in Arm Left on 07-FEB-2021 02:00 PM (Age at Vaccination 74-years-old) as DOSE 1 SINGLE for covid-19 immunization. Patient received second dose of dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Unknown. Obscured by other product labelling) via an unspecified route of administration, administered in Arm Left on 17-JAN-2021 04:00 PM (Age at Vaccination 74-years-old) as DOSE 2 SINGLE for covid-19 immunization. On 16Sep2021 16:00 the patient experienced felt a bit like a mild flu case and mild headache. On 27Sep2021 the patient experienced feverish, clammy, sweating, nauseous. received my booster off label use), received my booster on 16sep2021 (immunisation) on 16Sep2021. It was reported that I received my booster on 16Sep2021, at a nearby withheld. Felt a bit like a mild flu case for about a day and a half. It is now 02Oct2021 and everyday since the booster I have had a nagging but rather mild headache. On 27Sep2021 I was on a day trip, and I suddenly became very feverish, clammy, sweating, pretty bad headache, and felt nauseous. All of that took place over about a two hour period then it went away. However, as I stated earlier this somewhat mild but nagging headache has happened all day every day since I got my booster shot. Patient was did not received treatment. Device Date: 02Oct2021.The outcome of the events Felt a bit like a mild flu case, Feverish, Clammy, Sweating, Nauseous, was recovered in 2021. Mild headache was not recovered. received my booster on 16Sep2021 was unknown. Follow-Up (11Oct2021): Follow-up attempts are completed. No further information is expected.


VAERS ID: 1860952 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E211A / 2 LA / IM

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

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

Write-up: Extreme muscle aches and joint pain


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