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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 50 out of 8,753

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VAERS ID: 1842390 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Headaches and extreme fatigue.


VAERS ID: 1842549 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-31
Onset:2021-11-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Swollen lymph nodes (throat) - most apparent on day 3 after vaccine. Fatigue, unable to fall asleep.


VAERS ID: 1842661 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Incorrect route of product administration, Injection site pain, Mobility decreased, Pain
SMQs:, Parkinson-like events (broad), Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), 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: Site: Pain at Injection Site-Severe, Systemic: Joint Pain-Severe, Additional Details: patient called to report difficulty lifting and moving arm with lots of pain. patient claims injection was done too high into joint and took pictures. patient said would follow up with doctor tomorrow


VAERS ID: 1842784 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nasopharyngitis, Paralysis, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

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

Write-up: cold, shaking, headache, paralyzed


VAERS ID: 1842785 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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: alprazolam, vyvanse, iron, methadone, pantoprazole, and tizanidine
Current Illness: none
Preexisting Conditions: heart burn, insomnia, anxiety and anemia. History of drug abuse.
Allergies: cashews and environmental
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received Jansen and Jansen at a local pharmacy in April. Patient then received first dose of covid pfizer in the beginning of October. Patient presented to the clinic and received the 2nd pfizer injection 3 weeks after his first injection as instructed. Upon documenting I asked Clinic Admin what number I should list the vaccine given as in the series, and was informed that patient should not have been given the second dose of pfizer.


VAERS ID: 1842792 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chills, Immunodeficiency, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (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: Topiramate, unison, levothyroxine
Current Illness: None
Preexisting Conditions: Hashimotos, migraines
Allergies: Gluten, lactose intolerance
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, muscle pain in large muscle groups, tightness in chest


VAERS ID: 1842803 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-31
Onset:2021-11-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Dysstasia, Extra dose administered, Injection site pain, Interchange of vaccine products, Somnolence, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Patient reported that he had severe pain in his arm at the injections site...this was his booster shot... first 2 shots were Phizer... he also had chills and shakes and felt dizzy... unable to stand, felt very sleepy...


VAERS ID: 1842804 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-22
Onset:2021-11-01
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Intra-abdominal haematoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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: Stelara
Current Illness: Skin condition and Rheumatologist
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Went to medical
CDC Split Type:

Write-up: Presents with a hematoma abdominal area under the navel, went to medical and it was indicated might be an effect of the vaccine.


VAERS ID: 1842812 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Impaired work ability, Injection site warmth, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna 2nd dose
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, nausea, sore arm, increased fatigue, warmth to injection site; swelling Missed 1 full day of work and left early on one day


VAERS ID: 1842820 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-13
Onset:2021-11-01
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, COVID-19, Cerebrovascular accident, Diarrhoea, Dysarthria, Frustration tolerance decreased, Malaise, SARS-CoV-2 test positive
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: finasteride, omeprazole, omeprazole, sertraline, tamsulosin
Current Illness:
Preexisting Conditions:
Allergies: Zomepirac, Azithromycin, Metformin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 82 y.o. left-handed male with hx of Afib on Eliquis, DM, HLD, HTN admitted after being found to be COVID positive and recent symptoms of diarrhea, malaise. Stroke activated due to aphasia, dysarthria of onset approximately 1415; patient was reportedly fluent in speech in the ED and noted on initial assessment after transfer to floor to be acutely aphasic. Patient reports taking Eliquis this morning. Acknowledges word finding difficulty, expresses frustration over this. Denies this ever happening before. Denies vision changes, facial weakness or sensory deficit, extremity weakness or sensory deficit.


VAERS ID: 1842833 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-29
Onset:2021-11-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18228811 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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: Zoloft100mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever the first night. Really bad rash of hivey welts all over my body


VAERS ID: 1842834 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-31
Onset:2021-11-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Headache, Injection site induration, Injection site nodule, Injection site rash, Injection site reaction, Nausea, Pain, Pyrexia, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Fever, fatigue, just did not feel good.
Other Medications: Omega 3, Vit D3, Vit C, Rutin, Probiotics, Pravastatin, Aspirin, Vesicare, Biotin, Magnesium, Zinc. Medical Marijuana, Indica at bedtime for sleep.
Current Illness: Shingles
Preexisting Conditions: Nausea, Anxiety
Allergies: Codeine, Phenergran, and Benadryl.
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: DULL THROBBING HEADACHE FEVER CHILLS ACHES AND PAIN ALL OVR BAD NAUSEA FATIGUE HALF DOLLAR SIZE HARD KNOT ON THE TOP OF MY LEFT ARM, THE COLOR OF PINKISH RED RASH THAT ITCHES.


VAERS ID: 1842848 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-25
Onset:2021-11-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 1 LA / SYR

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

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

Write-up: Large raised spot at spot of injection. Has become very itchy, and should pain developing in both shoulders.


VAERS ID: 1842992 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-25
Onset:2021-11-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest pain, Costochondritis, Electrocardiogram 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 only take a once daily multivitamin and I have a Marnea IED
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: 11/01/2021 I had a blood panel-normal 11/01/2021 EKG-normal
CDC Split Type: vsafe

Write-up: 11/01/2021 I began walking to the bus at 7:45am I felt a bad pain in my chest, it lasted thru out the day. I went into my doctor the same day. I have Costo Chondrointis and it is still ongoing to this day.


VAERS ID: 1842995 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-11
Onset:2021-11-01
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

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

Write-up: Fully vaccinated, Vaccine breakthrough, inpatient hospital admit


VAERS ID: 1843026 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Diarrhoea, Fatigue
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: diarrhea started within 3 hours of receiving vaccine and has continued for 3 days. he started having moderate-severe fatigue 1 day after and has lasted since.


VAERS ID: 1843046 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-05
Onset:2021-11-01
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthma, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Dyspnoea exertional, Electrocardiogram normal, Hypoglycaemia, Infection, Oxygen saturation decreased, Peripheral swelling, Pulmonary oedema, SARS-CoV-2 test positive, Tachypnoea
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, fluticasone furoate-vilanteroL, furosemide, insulin detemir, metoprolol-XL, SITagliptin , tamsulosin
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted as observation on 11/1 due to pneumonia due to COVID-19 virus. Patient was tested for COVID-19 and was positive on 11/1. Symptoms started about a week ago. Also endorses cough. Was covid positive in ER today. Notes some leg swelling which is not a new issue for him. Denies chest pain. In the ER bnp elevated, CXR c/w pulmonary edema vs atypical infection. EKG without acute ischemic changes. Mild hypoglycemia. Afebrile. Not hypoxic but was tachypneic and reportedly some desaturation w/ activity. He is on warfarin. Prior hx of what cardiology is calling likely nonischemic cardiomyopathy thought to be tachycardia induced. Per notes prior cath showed LAD lesion but no intervention done at that time. See ulm for asthma, on breo at home.


VAERS ID: 1843073 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dizziness, Dyspnoea, Headache, Injection site rash, Vision blurred
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: 1st injection had major chest pain and feeling of squeezing tightly in my chest, hard time breathing 2nd injection have chronic debilitating headache for 3 days, extreme dizziness and cloudy focus, rash developed at injection site.


VAERS ID: 1843138 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Erythema, Headache, Hyperhidrosis, Injection site erythema, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient called workplace clinic and request provider callback. He states on 11/1 he received J&J COVID 19 vaccine and felt ok immediately after vaccination. Later that evening on 11/1 noted fever 102, headache and chills. Next AM on 11/2, he felt better but by days end noted fever 100-101, chills and return of headache (although headache now less intense than 11/1). On 11/3 AM, he woke up feeling better than prior 2 days but by bedtime noted fever 100-101, return of headache (headache continues to lessen from what it was the prior evening). On 11/4 woke up sweating and no headache. Took temperature during our call and it was 99.6. Took Ibuprofen 400mg this AM. Also noted redness on right arm at injection site and appeared to be "tracking down" arm. He states he also received Pneumovax on 11/1 at same time as J&J. This patient did not received either vaccine from this workplace clinic.


VAERS ID: 1843153 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 RA / IM

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

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

Write-up: NONE


VAERS ID: 1843173 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: NONE


VAERS ID: 1843215 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-14
Onset:2021-11-01
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient was swabbed at our offsite testing location and no primary care provider listed. Please contact patient for further questions.
Current Illness: Patient was swabbed at our offsite testing location and no primary care provider listed. Please contact patient for further questions.
Preexisting Conditions: Patient was swabbed at our offsite testing location and no primary care provider listed. Please contact patient for further questions.
Allergies: Patient was swabbed at our offsite testing location and no primary care provider listed. Please contact patient for further questions.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated for and then tested positive for COVID-19


VAERS ID: 1843266 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Hives appeared on left arm 30 minutes after administration. The evening of the vaccination patient experienced 104 F fever. 3 days later she experienced pain at the site of the injection with a raised bump with a diameter of 2 to 2 and 1/2 inches in the diameter


VAERS ID: 1843302 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-01
Onset:2021-11-01
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD,hypertension
Allergies:
Diagnostic Lab Data: COVID-19 PCR nasal swab
CDC Split Type:

Write-up: Patient presented with generalized weakness and feeling "unwell". Patient ended up testing positive for COVID and are fully vaccinated


VAERS ID: 1843362 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-01
Onset:2021-11-01
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, type 2 diabetes
Allergies:
Diagnostic Lab Data: COVID-19 PCR nasal
CDC Split Type:

Write-up: Patient presented with SOB, nausea, and vomit. Patient was positive for COVID and fully vaccinated.


VAERS ID: 1843388 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF25960 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angioedema, Eye swelling, Incomplete course of vaccination, Lip swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nothing prior to vaccine received
Current Illness: possibly a slight cold leading up to vaccine administration
Preexisting Conditions: n/a
Allergies:
Diagnostic Lab Data: Benadryl and prednisone 60 mg administered at the onset of reaction. Patient has required Benadryl the next two nights as well. Was given depomedrol 80 mg IM in office with an rx for an oral steroid to have on hand. Advised patient to NEVER received COVID vaccine again d/t severity of symptoms.
CDC Split Type:

Write-up: Delayed onset angioedema. Swelling of the lips and eyes with itching systemically.


VAERS ID: 1843405 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Fall
SMQs:, Accidents and injuries (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Flax Seed Oil
Diagnostic Lab Data: EMS was called and checked patient at the scene. Patient did not go to the hospital.
CDC Split Type:

Write-up: Patient received her Booster dose at Pharmacy on 11/1/21. When she was leaving the clinic, she fell outside. Her daughter was with her at the time, and expressed that she does not feel the fall is vaccine related since her mom did not feel dizzy; she feels her mom simply lost her balance. A staff member helper her up, and EMS was called. Patient was checked out at the scene. She did not go to the hospital. nurse called the patient on 11/2/21, and patient reported that she was fine.


VAERS ID: 1843470 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-30
Onset:2021-11-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Inflammation, Muscle tightness, Nerve compression, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Accidents and injuries (broad), 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: Pfizer dose 2- 02/20/2021- When I would lay down, my heart would race. I thought I was having a panic attack so I took my anxiet
Other Medications: Turmeric supplement; ginger supplement; multivitamin; probiotic; fish oil
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: I have chronic muscular tension in my left shoulder that was feeling better until 2 days after I got my booster. There is a lot of inflammation down my left shoulder, a pinched nerve down my back, face tingling on the left side and tingling in my left hand. I have an appointment upcoming with a chiropractor. I have been using heat and and having my sister help me who is a physical therapist. Nothing has provided prolonged relief.


VAERS ID: 1843504 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Eye swelling, Fatigue, Ocular hyperaemia, Pain in extremity, Palpitations, Paraesthesia, Paraesthesia oral, Periorbital swelling, Pyrexia, Rash macular, Scab, Skin burning sensation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: TDAP Boostrix at pharmacy in 2016, age 61. Palpitations, dizzy Blurry vision Neck and left shoulder tingled. After 1 hour, mou
Other Medications: NP Thyroid, Wellbutrin 300XL, Vitamin B complex, Vitamin D, Vitamin C, Selenium, Zinc
Current Illness: None
Preexisting Conditions: Mild asthma but under control for a long time
Allergies: Penicillin, Levaquin, Keflex, Gabapentin, grapefruit, milk, cod fish, nickel, formaldehyde, toluene, benzalkonium chloride, also had a reaction to the TDAP vaccine
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: My appt was at 7:40 PM but they were running late so I think the reaction started about 20-30 minutes after the injection. My lips, mouth and nose tingled for about 10 minutes. I felt my heart race a few times. The 2nd day, my skin felt like it was on fire and my hands and feet hurt. I also had a low fever and exhaustion. The 3rd day I just felt exhausted. The 4th day I am feeling tired and a bit faint. I also noticed a couple of red blotches with crust on my face and chest, and below my left inner eye was red, puffy and swollen.


VAERS ID: 1843531 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-29
Onset:2021-11-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Epistaxis, Erythema, Nasal inflammation, Nasal vestibulitis, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Chicken pox, at age 12, unsure of vaccination date, type or brand.
Other Medications: Birth control, Omeprazole, Famotidine
Current Illness:
Preexisting Conditions: Migraines, anxiety, GERD
Allergies: Sulfa medications, Ceclor, Thimerosal
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nasal redness, swelling, bleeding and pus on inside of both nostrils. Phone call with ENT specialist diagnosed as nasal vestibulitis.


VAERS ID: 1843597 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Feeling cold, Illness, Injection site pain, Lethargy, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Saw Palmento Vitamin D3 4000IU Lisinopril
Current Illness: None
Preexisting Conditions: Coronary Heart Disease High Blood Pressure
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Tachicardia which lasted about 15. Overall sickness; upset stomach, lethargic, sore arm from injection site,chills and feeling cold.


VAERS ID: 1843619 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 4 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Derealisation, Flat affect, Hyperhidrosis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient did report passing out in the past with previous vaccines and blood draws
Allergies: None
Diagnostic Lab Data: Blood pressure was checked
CDC Split Type:

Write-up: Patient received the moderna booster and reported no issues or allergies to the first to moderna vaccines . Patient was advised to pull up and wait 15 minutes. Husband was driving the vehicle and pulled up and stopped. As soon as the husband stopped the car he got out and started screaming . Patient has flat affect with eyes open not responding to any type of stimulation . Patient continue to be in daze would not verbally responded to questions for over 10 minutes . Patient was laid back in car seat and then began to sweat and started responding slight at that time .


VAERS ID: 1843620 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-23
Onset:2021-11-01
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025021A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Breast pain, Fatigue, Myalgia, Pain in extremity, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Lipodystrophy (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: Synthroid, Protonix
Current Illness: None
Preexisting Conditions: Heart arrhythmia, ulcerative colitis, thyroid disease, malignant hyperthermia, arthritis.
Allergies: Latex, eggs, PCN, sulfa, raglan
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle pain severe, extreme fatigue, left arm pain, swelling, left breast pain., joint aches


VAERS ID: 1843623 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Erythema, Extra dose administered, Nausea, Pain in extremity, Peripheral swelling, Pruritus, Sleep disorder
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: mild reactions to first two moderna shots
Other Medications: rytary 5 times daily, lirica, lovasttin,
Current Illness: none
Preexisting Conditions: Gerd,
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: After getting the booster shot at about 30 pm and 4 to 5 hours later I started feeling nauseous and chills. And I couldn''t sleep that night because of very bad chills. I had chills the next day also. And the night of the shot my arm started getting sore and swelling and has turned bright pink and started itching. i still have the chills and the issues with the arm.


VAERS ID: 1843651 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-01-21
Onset:2021-11-01
   Days after vaccination:284
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL5318 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol Sulfate, Atorvastatin Calcium, Boniva, Calcium Ergocalciferol, Multi Vit, Lumigan, Lutein, Melatonin, Pantoprazole Sodium, prednisolone, Spirnolactone-HCTZ, Timoloo Maleate, Wixela Inhub, Advair Diskus, Combigan, Dupixent, Wixela
Current Illness: None
Preexisting Conditions: Asthma, COPD, Hypercholesterolemia, Recurrent Pneumonia, Osteoperosis, Glaucoma
Allergies: Azithromycin, Bee Stings, Codeine, Fosomax, Iodine, Lobster, Omeprazole.
Diagnostic Lab Data: PCR test. Positive Result Resident remains in her residence in Assisted Living
CDC Split Type:

Write-up: Resident was on quarantine from spouse testing positive. Felt ill the next day and a test was conducted that day and sent to lab.


VAERS ID: 1843660 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-08-10
Onset:2021-11-01
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: patent presented for a clinic visit, per ND Vaccine certificate states patient recived COVID Vaccine from a white drug #39 pharmacy prior to the age of 12 and before pediatric was approved. received on 08/10/2021 08/31/2021 Per clinic visit today father voiced they lied about age for child to get vaccinated before the approved age


VAERS ID: 1843701 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
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: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Discomfort, Dizziness, Electrocardiogram
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular 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: Known medications include Fosamax and statin
Current Illness:
Preexisting Conditions: PMH significant for Osteopenia, HLD, Lumbar spondylosis, and thrombosed external hemorrhoids.
Allergies: Pt w/ hx of sulfa allergy (trouble breathing/anaphylaxis) and acetazolamide allergy.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/ hx of sulfa allergy (trouble breathing/anaphylaxis) and acetazolamide allergy. PMH significant for Osteopenia, HLD, Lumbar spondylosis, and thrombosed external hemorrhoids. Known medications include fosamax and statin 25mins post vaccination, pt reported mild chest tightness. MAR announced approximately 9:14 am. Airway: patent Breathing: WNL, RR 24/min, 02 sats 97 to 99%RA. MD auscultated lung fields Circulation: normal skin color, warm and dry, pulses palpable with regular rate and rhythm Pt cc started discomfort, left side neck pressure, chest tightness, light headed, 12 LEAD EKG completed, NSR HR 60s. Pt denies resp distress. Pt AX0 x4, responds to verbal commands Vitals: 9:20 am R side arm, lying down BP 139/74, HR 77 9:22 am R side arm, lying down BP 146/75, HR 68 9:35 am R side arm, lying down BP 140/68, HR 62, RR 24/min MD counseled pt, ER precautions given, follow up w/PCP, and to inquire in future, if more boosters/vaccine future for COVID-19, discuss w/ PCP if alternative then Pt assisted ambulation, pt no distress. Pt refused to go ER/further evaluation. Pt assisted to car, will drive self home.


VAERS ID: 1843702 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Decreased appetite, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ozempic; Jardiance; Novolog 70/30; Simvastatin; Levothyroxin; Losartan; 50 mg aspirin; CQ-10; Krill Oil; Vit. D; Senior Multivatiamin all had been used longterm).
Current Illness: None
Preexisting Conditions: Type 2 Diabetes; Arthritis with TLNR in 2008; Cardiac stents in 2007.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: BY 4 PM, I HAD TEMPERATURE OF 100,7 DEGREES SINCE THEN, I HAVE ALTERNATED BETWEEN CHILLS (SHAKING) AND FEVER TEMPERATURE WAS 99.7 TODAY AT 4 PM. HAVE ONLY BEEN ABE TO EAT SMALL PANCAKE AND DRINK WATER AND JUICE.


VAERS ID: 1843721 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-28
Onset:2021-11-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Intermenstrual bleeding, Pregnancy test negative
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Avianne, atenolol, buspirone, citalopram, famodidine
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin/penicillin, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spotting in replace of a heavy period, pregnancy test was negative


VAERS ID: 1843737 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-29
Onset:2021-11-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 3 RA / IM

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

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

Write-up: Patient''s right arm started feeling warm on Monday (11/1/2021) evening. By Tuesday morning she had also developed a red itchy rash.


VAERS ID: 1843756 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-22
Onset:2021-11-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

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

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

Write-up: Rapid heart rate (130-160) consistently even at rest. Shortness of breath.


VAERS ID: 1843834 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-30
Onset:2021-11-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Ear infection, Ear pain, Feeling hot, Lethargy, Oropharyngeal pain, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Diabetic - insulin; Synthroid; Benicar - high blood pressure med
Current Illness: Concurrently at time of vaccination my best guess is yes - might have had a cold coming on or allergies
Preexisting Conditions: diabetic
Allergies: no
Diagnostic Lab Data: Yesterday: COVID test - and that was negative; this was at an Physicians Urgent Care for the test
CDC Split Type: vsafe

Write-up: Symptoms that I''ve had - lethargy for the first Sunday and part of Monday; and also some fever and chills but nothing registered on Thermometer (that was Sunday and Monday); Earache and sore throat (started a little bit on Saturday but I got the vaccine anyways. Earache started Monday and continues still today. I went to the doctor (Urgent Care) yesterday and he has given me antibiotics for the ear infection/sore throat/cough. I''m on the mend. I got a flu shot - within a month from this vaccine - that was at a different. - don''t know the brand name.


VAERS ID: 1843878 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-28
Onset:2021-11-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 10mg 1/2 tablet daily Spironolactone hydrochlorothiazide (he thinks the strengths are 50 and 25) two daily Aspirin 81mg daily A medication to help with urination--he does not know the name of it
Current Illness: hypertriglyceridemia
Preexisting Conditions: hypertriglyceridemia
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Delayed hypersensitivity reaction to Moderna Covid-19 vaccine booster (?Covid arm?)


VAERS ID: 1843901 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache
SMQs:

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

Write-up: Severe fatigue and constant headaches since receiving first shot


VAERS ID: 1844329 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 3 RA / IM

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

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

Write-up: Pt called on 11/4/2021 to report swelling the size of a golf ball, that site is red, swollen and painful. She reported that symptoms seemed to get better and today has come back.


VAERS ID: 1844335 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Pain in extremity, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Vitamin B-12, Fenofibrate, Fluoxetine, Gabapentin, Rosuvastatin, Losartin, Levothyroxine, Fiber
Current Illness:
Preexisting Conditions:
Allergies: Coconut & codeine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pain in arm, rash, fatigue & headache: began 8 PM date of injection and all that is left as of today is the slight rash and fatigue.


VAERS ID: 1844336 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-11-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Contusion, Full blood count abnormal, Petechiae, Platelet count decreased, Thrombocytopenia
SMQs:, Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, Alprazolam, Ibuprofen
Current Illness: GERD
Preexisting Conditions: SLE
Allergies: PCN, Bactrim
Diagnostic Lab Data: CBC.
CDC Split Type:

Write-up: Thrombocytopenia- PLT level 9 on CBC - petechial bruising.


VAERS ID: 1844553 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Extra dose administered, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (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: TIOTROPIUM 2.5MCG/ACTUAT 60D ORAL INHL MAGNESIUM OXIDE 400MG TAB FUROSEMIDE 40MG TAB SODIUM CHLORIDE 0.65% SOLN NASAL SPRAY ARIPIPRAZOLE 20MG TAB FLUTICASONE PROP 50MCG 120D NASAL INHL LOSARTAN 25MG TAB OMEPRAZOLE 20MG EC CAP ASPIRIN 81MG E
Current Illness:
Preexisting Conditions: Migraines COPD CHF Degenerative Disk Disease Obesity
Allergies: Chloral Hydrate Etodolac Aciphex Horses
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills Hive (3 inch long 1 inch wide) on right arm at injection site Diarrhea


VAERS ID: 1844559 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Dizziness, Electrocardiogram, Gait disturbance, Loss of personal independence in daily activities, Pyrexia, Sinusitis, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin amoxicillin tylenol
Current Illness: sinus infection
Preexisting Conditions: diabetic type 2 atrial fibrillation
Allergies: morphine
Diagnostic Lab Data: 4 lead, blood pressure, spo2, temperature check (temp was 104)
CDC Split Type:

Write-up: Patient received the Pfizer booster shot on Monday. Afterwards he began to have a fever, sinus infection, and could not walk without assistance due to an unsteady gate, dizziness, light-headedness, and weakness. Patient also developed slight tremors in his arms.


VAERS ID: 1844710 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin,500 mg daily Hydrocortisone 10 mg daily Thyroxine 0.1 mg daily Glucosamine/Chondroitin Vitamin D 50,000 units weekly
Current Illness:
Preexisting Conditions: Pre-diabetes Obesity S/P Pituitary adenoectomy
Allergies: ? Aspirin Tape Allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itching and redness for 4 inches around injection site starting about an hour after injection. Nausea 1 day after injection. Still have mild nausea.


VAERS ID: 1845420 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-01
Onset:2021-11-01
   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 FF8841 / 3 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Immunisation, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101495492

Write-up: Sore arm; Chills; Joint pain; Headache; Booster; This is a spontaneous report from a non-contactable consumer, the patient. A 29-year-old male patient received third (booster) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FF8841) via an unspecified route of administration in the left arm on 01Nov2021, (at the age of 29-years-old) as a single dose for COVID-19 immunisation. Medical history included penicillin allergy. Prior to the vaccination, the patient was not diagnosed with COVID-19. Concomitant medications were not reported. It was unknown whether, the patient received any other vaccines within four weeks prior to the vaccination. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EL3247) via an unspecified route of administration on 22Jan2021 (at the age of 28-years-old) as a single dose for COVID-19 immunisation and the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EL3247) via an unspecified route of administration on 12Feb2021 (at the age of 28-years-old) as a single dose for COVID-19 immunisation. On 02Nov2021, the patient experienced sore arm, chills, joint pain and headache. The events did not result in doctor or other healthcare professional office/clinic visit, and 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 events. The clinical outcome of the events sore arm, chills, joint pain and headache were resolving at the time of this report. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1845801 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-01
Onset:2021-11-01
   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 FH8028 / 2 RA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Cough, Nausea, Pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Pfizer Covid first dose. Oct 11, 2021. Eyelid swelling, nausea, vomting, headache, soreness/body aches, chest tightness, cough.
Other Medications: Benadryl
Current Illness: Reaction to first Pfizer Covid Injection - Adverse reaction report was also filed for that.
Preexisting Conditions: Tetrology of Fallot Repair
Allergies: Latex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Took benadryl as suggested by primary provider prior to injection; 30-40 minutes after injection nausea and vomiting last about 3 hours. Soreness/aches started about 3 hours after injection lasting 2 days. Chest tightness, cough started about 3 hours after injection and are ongoing.


VAERS ID: 1845902 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2020-12-01
Onset:2021-11-01
   Days after vaccination:335
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Hypotension, Malaise, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes, cardiac disease
Allergies:
Diagnostic Lab Data: COVID-19 nasal swab PCR
CDC Split Type:

Write-up: Patient present from dialysis where they became extremely hypotensive and feeling unwell. Ended testing positive for COVID-19. Patient was fully vaccinated


VAERS ID: 1845917 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-01
Onset:2021-11-01
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: cardiac disease, kidney disease
Allergies:
Diagnostic Lab Data: COVID-19 PCR nasal swab
CDC Split Type:

Write-up: Patient presented with a cough, fevers, and weakness. Patient is fully vaccinated and resulted positive for COVID-19.


VAERS ID: 1845925 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-18
Onset:2021-11-01
   Days after vaccination:287
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 - / -

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

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

Write-up: Tested PCR positive for COVID 11/1/21 after being fully vaccinated.


VAERS ID: 1845942 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

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

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

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


VAERS ID: 1845947 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Migraine, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Slight to the 2nd dose
Other Medications: Ibuprofen, acetaminophen
Current Illness: NONE
Preexisting Conditions: Migraines
Allergies: Demerol, penicillin, vitamin water ingredients, Macrodantin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever, chills and fatigue the first 3 days, N/Muscle pain the 4th day. Migraine the 5th day.


VAERS ID: 1845951 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-01
Onset:2021-11-01
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac disorder, Cough, Oxygen saturation decreased, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, melanoma
Allergies:
Diagnostic Lab Data: COVVID-19 PCR nasal swab
CDC Split Type:

Write-up: Patient presented with a cardiac event. Patient had decreases O2 and congestion, cough. Patient has beeen vaccinated and resulted positive for COVID.


VAERS ID: 1845971 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-01
Onset:2021-11-01
   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 FF2593 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Modafinil; vitamin D; B-12; folate; fish oil
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Blood work
CDC Split Type: vsafe

Write-up: Heavy menstrual bleeding with blood clots.


VAERS ID: 1845986 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Fatigue, Headache, Hypoaesthesia, Injected limb mobility decreased, Lethargy, Muscle spasms, Myalgia, Nausea, Pain, Pain in extremity, Paraesthesia, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: severe pain in left arm, inability to move arm 12 hrs after injection. Severe headache, fever, nausea, lethargy, body ache within 24 hrs. 72+ hrs later- tiredness, feeling of breathlessness, sudden dizziness (sitting or standing) followed by severe headache. muscle aches/cramps throughout body. Arms/legs randomly tingle and go numb. My left arm/hand has a constant tremor.


VAERS ID: 1846042 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Dysphagia, Dyspnoea, Fatigue, Hyperhidrosis, Hypertension, Hypoaesthesia oral, Nausea, Pruritus, Skin warm, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness:
Preexisting Conditions: Hypothyroidism
Allergies: I am allergic to aspirin, thimerosal
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I experienced my left arm becoming hot and sweaty, difficulty breathing, itchiness, dizziness, difficulty swallowing, lips became numb and my blood pressure became high. I also experienced fatigue, nausea, vomiting and joint aches.


VAERS ID: 1846051 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 RA / SYR
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. UNKNOWN / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Dizziness, Headache, Hyperhidrosis, Myalgia, Pyrexia, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Both Moderna COVID Injections
Other Medications: Prednisone 5mg Pantoprazole 50mg Atenolol 100mg LoDose Aspirin Vision Vitamin Hydrocodone 10mg 3/day Calcium D3 1000mg Potassium Chloride 10meq Morphine Sulfate ER 15mg 2/day Atrovastatin 40 mg Melatonin 10mg Tylenol PM 2/day
Current Illness: None
Preexisting Conditions: Rheumatoid Arthritis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Uncontrolled Diarrhea Heavy Sweating Shaking Fever of 101 Weakness Dizziness Muscle Pain Throughout Body Headache Fainting


VAERS ID: 1846131 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-24
Onset:2021-11-01
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-PCR test ran on 11/4/21 and was positive.
CDC Split Type:

Write-up: Patient presented to facility with shortness of breath for past 11 days. Patient reported being COVID positive at previous facility, Urgent Care.


VAERS ID: 1846159 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 RA / IM

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

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

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


VAERS ID: 1846174 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-25
Onset:2021-11-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angioedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, metoprolol, losartan, Nexium, simvastatin
Current Illness:
Preexisting Conditions: RA, hypertension, hypothyroid
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Angioedema


VAERS ID: 1846180 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 LA / IM

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

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

Write-up: patient had itching at injection site, and itching on face starting 10 minutes after injection. itching lasted for several hours even after a dose of 25mg of benadryl was given.


VAERS ID: 1846188 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-27
Onset:2021-11-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Head discomfort, Nausea, Ocular discomfort, Visual impairment
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (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: I may have taken my vitamins I do have a Estrogen patch
Current Illness: seasonal allergies
Preexisting Conditions: I have MS but have been stable for years. Been off medications for 2.5 years
Allergies: I am allergic to Pomegranates
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: On 11/01/2021 I was working, and I was trying to look up some information and saw some squiggly lines and some blind spots in my vison, that lasted for 15 mins. After about an hour I had some pressure on the right side of my head, and also nausea, but it didn''t last long. 11/02/2021 it repeated itself again, but with pressure around my right eye. 11/03/2021 symptoms also repeated, it lasted longer this day for half an hour. I saw my optometrist on 11/03/2021-nothing was abnormal. I have a visual field test scheduled for the end of November. 11/04/2021 just last night I had the symptoms returned again just in the left eye at this time, and lasted 35 mins. The lines this time got brighter in the left eye.


VAERS ID: 1846190 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SC

Administered by: Other       Purchased by: ?
Symptoms: Cellulitis, Erythema, Extra dose administered, Incorrect dose administered, Incorrect route of product administration, Injection site extravasation, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna Covid vaccine 1 and 2
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: VACCINE ADMINISTRATION ERROR: The vaccine was given subcutaneously causing cellulitis. (redness, heat, swelling) In addition, several drops of the vaccine were seen and felt running down the patient''s arm, therefore the full dose was not administered. I did not experience any of the adverse symptoms as I had with the first two vaccines and based on an article by agency, I do not feel this dose will be effective.


VAERS ID: 1846203 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 UN / IM

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

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

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


VAERS ID: 1846220 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-10-26
Onset:2021-11-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Extra dose administered, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer COVID Vaccine # 2
Other Medications: Xeralto Sivastatin Prednisone Wixela Sertraline Calcium with D
Current Illness: Polymyositis Pulmonary fibrosis diagnosed after 2nd Pfizer Covid shot in January 2021
Preexisting Conditions: Polymyositis Pulmonary Emboli
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Following both my second COVID vaccine in January 2021 and my booster in October 2021 I developed severe congestion, cough and shortness of breath. It appears to have exacerbated my auto immune both times. The first episode required a trip to the ER for shortness of breath.


VAERS ID: 1846223 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-03
Onset:2021-11-01
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Nut Allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient Aged 5-11 was given and adult dose of the Pfizer COVID-19 12 year+ vaccine. Doctor informed mother of vaccination with the adult version of the COVID-19 vaccine. Mom stated patient currently afebrile,active and playful.


VAERS ID: 1846234 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-30
Onset:2021-11-01
   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 - / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Breast pain, Burning sensation, Herpes zoster, Pain
SMQs:, Peripheral neuropathy (broad), Lipodystrophy (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID AND VALSARTAN
Current Illness: NONE
Preexisting Conditions: HYPOTHYROIDISM, HISTORY OF BREAST CANCER,
Allergies: SHRIMP
Diagnostic Lab Data: DOCTORS VISIT 11/3
CDC Split Type:

Write-up: SEVERE, SHOOTING, BURNING PAIN UNDER ON RIGT RIB THAT TRAVELS TO BREAST AND TRAVELS TO MID-SPINE. DOCTOR SAYS IT MAY BE SHINGLES BUT RASH HAS NOT YET APPEARED.


VAERS ID: 1846265 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-03
Onset:2021-11-01
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Nut Allergy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient Received an adult dose of the Pfizer COVID-19. Mom has been informed and states child is afebrile, active and playful.


VAERS ID: 1846304 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-29
Onset:2021-11-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE WAS ASSURED IT WAS A SIDE EFFECT AND WOULD GO AWAY
CDC Split Type:

Write-up: LARGE SWOLLEN LEFT LYMPH NODE UNDER ARMPIT


VAERS ID: 1846341 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-26
Onset:2021-11-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Extra dose administered, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: rash and blood pressure rise


VAERS ID: 1846343 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-01
Onset:2021-11-01
   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 FFPFER3203087 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, Vaccination 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: No adverse ever but would like this to be noted as an administration error
CDC Split Type:

Write-up: Patient was administered Pfizer booster instead of Modern as requested . Technician did not inform patient of name of vaccine before injecting. She admitted she should have checked first. Of note, upon scheduling, patient was told to stick to same vaccine that he received on Shot 1 and 2.


VAERS ID: 1846352 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-23
Onset:2021-11-01
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Extra dose administered, Pain, Pruritus, Sensitive skin
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Previously reported same symptoms in VAERS after 2nd Covid-19 vaccination.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Brazil nut allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Skin sensitivity, burning/itching pain, mildly affecting chest for 1 day (then resolved), and more significantly affecting lower arms, and lower legs for 4 days (improving over time), and severely affecting hands/palms, and feet/soles for 5 days (very slowly resolving). These symptoms started 7-8 days after dosing, and were previously experienced (though then much more severely) starting 6-7 days after 2nd dose (and which was previously reported to VAERS). Pain/burning somewhat responsive to neurontin/gabapentin.


VAERS ID: 1846381 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-23
Onset:2021-11-01
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025D21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid arm with one of the first two shots. Cannot recall which
Other Medications: Multivitamin, CBD oil, medical marijuana (THC)
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives and rash outbreak all over the body lasting more than 4 days now


VAERS ID: 1846389 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-06
Onset:2021-11-01
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Floxmax, Norvasc, Lipitor, ASA 81 mg, Atarax, Roxicodone, Ultram, Lasix, Colace, Prilosec, Humulin N (25 units AM), Metformin 500 mg daily, Vit. D3, Proscar.
Current Illness: N/A
Preexisting Conditions: BPH, CKD, CVA, cervical fusion, TURP
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization


VAERS ID: 1846390 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-25
Onset:2021-11-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nausea, Parosmia
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Phantom smell. Smell is similar to old flowers or smoke. This smell gives me a slight headache/nausea.


VAERS ID: 1846408 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-25
Onset:2021-11-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site pruritus, Vaccination site reaction
SMQs:

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

Write-up: allergic reaction at vaccination site. large reaction approx 8x8 cm in size red, itchy area started about 1 week after receiving covid vaccine


VAERS ID: 1846417 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clotrimazole 1% cream Mupirocin 2% external ointment Epi Pen as needed
Current Illness: None
Preexisting Conditions: allergies
Allergies: Insect bites, stings, mango, pollen
Diagnostic Lab Data: transported via ambulance to the emergency room Patient has a follow-up apt on 11-15-21
CDC Split Type:

Write-up: Patient received their first dose of Moderna and was being observed for 30 minutes as patient know to have severe allergies requiring an Epi pen as needed. Shortly after receiving the injection, patient complained of shortness of breath, urticaria, O2 sats of 93%. Benadryl 50mg and Solumedrol 40mg given IM and transported to the emergency room via 911. Patient has a follow-up apt on 11-15-21


VAERS ID: 1846471 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-29
Onset:2021-11-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D121A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medication Sig ? omeprazole 20 mg capsule,delayed release(DR/EC) Take 1 capsule by mouth twice daily take first capsule 30 minutes before first meal of day ? BALZIVA, 28, 0.4-35 mg-mcg tablet TAKE 1 TABLET DAILY WITHOUT PLACEBO. ? azelaic a
Current Illness: None
Preexisting Conditions: Depression
Allergies: Gabapentin - urinary retention
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed multiple cherry angiomas scattered across torso and face - blanching micro red papules.


VAERS ID: 1846548 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-30
Onset:2021-11-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypersensitivity, Injection site erythema, Injection site pruritus, Injection site swelling
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Pneumonia vaccine, Tetanus vaccine, I had a similar reaction to this vaccine. I do not remember the year that happened.
Other Medications: Levothyroxine; acebutolol; flecainide; amlodipine; stool softener
Current Illness: None
Preexisting Conditions: None
Allergies: Pneumonia vaccine; CIPRO; BACTRIM; tetanus shot
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: 2 days later I started having swelling, redness, and itching at vaccination site. I went to the same pharmacy but not the same location where I got the shot and they told me I was having an allergic reaction and suggested me to take Zyrtec. I am almost recovered, I do not see much swelling now but it still itches.


VAERS ID: 1846555 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: multivitamins
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: fatigue and lightheadedness shortly after injection. a few hours later, arm pain and slight nausea. minor side effects for first 24 hours, except that arm pain was becoming severe. after 24 hours, body aches and severe pain, headache, fatigue, nausea. disappeared in sleep probably around 36 hours. still a lot of fatigue.


VAERS ID: 1846616 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-04-23
Onset:2021-11-01
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Dehydration, Hypotension, Malaise, Pneumonia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient vaccinated with Covid vaccinations and admitted to hospital with covid symptoms. Patient admitted with acute kidney injury, dehydration, hypotension, and pneumonia due to covid.


VAERS ID: 1846645 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-31
Onset:2021-11-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 2 LA / IM

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

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

Write-up: Unexplained fever of 104.8 within 12 hours in injection


VAERS ID: 1846649 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-22
Onset:2021-11-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chest pain, Malaise, SARS-CoV-2 test positive
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cordarone (amiodarone) 200mg tablet; Norvasc (amlodipine) 5mg tablet; Eliquis (apixaban) 5mg tablet; Halfprin (aspirin) 81mg tablet; Lipitor (atorvastatin) 20mg tablet; Lipitor (atorvastatin) 40mg tablet; Feosol (ferrous sulfate) 325/65mg F
Current Illness: None known
Preexisting Conditions: Coronary artery disease involving native coronary artery of native heart with angina pectoris; DM (diabetes mellitus); hyperlipidemia; post coronary artery bypass graft status; essential hypertension; intermittent claudication; PAF (paroxysmal atrial fibrillation); carotid stenosis; degenerative arthritis of left knee; acute flank pain; atrial fibrillation; encounter for long-term (current) use of other medications; spasm of thoracolumbar muscle; DM (diabetes mellitus); obesity; Stage 3A chronic kidney disease; DJD (degenerative joint disease) of knee; history of coronary artery bypass graft; CAD (multiple vessel); insulin-requiring or dependent type II diabetes mellitus; type 2 diabetes mellitus without complication; unspecified long term insulin use status; coronary artery disease with angina pectoris; unspecified vessel or lesion type; unspecified whether native or transplanted heart; diabetic nephropathy associated with type 2 diabetes mellitus; weight loss subtherapeutic anticoagulation; congestive heart failure, unspecified HF chronicity, unspecified heart failure type; anemia, unspecified type; SIRS (systemic inflammatory response syndrome); former smoker; unstable angina; acute on chronic combined systolic and diastolic CHF (congestive heart failure); recurrent pleural effusion on left; dyspnea on exertion; left atrial thrombus; OSA (obstructive sleep apnea); dyslipidemia; cervical DDD (degenerative disc disease); skin lesion of cheek; CAD in native artery; recurrent left pleural effusion; symptomatic sinus bradycardia; depression, recurrent
Allergies: CT dye (hives); sulfa drugs
Diagnostic Lab Data: COVID-19 test positive on 11/1/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 11/3/2021 with complaints of chest pain. He reported feeling unwell for the past week and tested positive for COVID-19 on 11/1/2021. Patient did not require any symptomatic treatment for his COVID-19 infection during admission. He was discharged home on 11/5/2021. Patient completed his primary COVID-19 vaccine series with Pfizer on 1/26/2021 and 2/16/2021.


VAERS ID: 1846818 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-10-26
Onset:2021-11-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Computerised tomogram, Electrocardiogram, Extra dose administered, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C Vitamin D3 Align probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: A week after receiving my third shot I spiked a blood pressure of 200/104. After being seen at the ER and giving my history and having a CT, EKG, blood tests and a UA it was determined I had a transient high blood pressure and I was released with blood pressure 162/77 without having had medication. The following day my BP was back to normal. I am only reporting this in case there have been other reports of similar occurrences.


VAERS ID: 1846856 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-27
Onset:2021-11-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Audiogram abnormal, Deafness unilateral
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: Phenytoin Sodium Rosuvatin Lisinopril Montelukast Cholecalcif Aspirin (lo-dose) Glucosamine / Chondroitin Cyclosporine Bimatoprost Estradiol
Current Illness: None
Preexisting Conditions: Type 2 Diabetes
Allergies: Tegritol Sensitivity
Diagnostic Lab Data: Audiology test administered. Left ear severely impaired
CDC Split Type:

Write-up: Suddenly lost all hearing in left ear


VAERS ID: 1846862 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-05
Onset:2021-11-01
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anosmia, Chills, Cough, Diarrhoea, Eye pruritus, Headache, Sinus congestion, Sneezing, Taste disorder, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (narrow), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Nexplanon 68 MG Implant as directed Subcutaneous ?Methocarbamol 750 MG Tablet 1 tablet Orally every 6 hours as needed ?Lithium Carbonate ER 300 MG Tablet Extended Release 3 tablets Orally Once a day ?Allegra 60 MG Tablet 1 tablet
Current Illness: none
Preexisting Conditions: Obesity. Restless legs syndrome. Bipolar disorder. Depression/anxiety since age 12. Hx tramadol/benzodiazepine abuse. Hx of biliary dyskinesia. chronic right DeQuervain''s tenosynovitis s/p tendon release. vitamin D deficiency. Iron deficiency anemia. Menometrorrhagia.
Allergies: novicaine
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, nonproductive cough, chills, altered taste, loss of smell, diarrhea, sinus congestion, post nasal drainage, sneezing, itchy eyes. starting on 11/1/21


VAERS ID: 1846869 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-28
Onset:2021-11-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Periorbital swelling, Pruritus, Swelling of eyelid, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot-2 times- sever 2 flu like symptoms. 3rd time- I could not lift my arm over my head for 2 months. I was pretty wiped out
Other Medications: Vitamin D; calcium
Current Illness: No
Preexisting Conditions: No
Allergies: Opioids my stomach doesn''t like it, but not allergic
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: I was tired and exhausted for a day and a half, post vaccine. On Monday, 4 days after the vaccine, on the 11/01/2021 I woke up with the hives all over my arms and legs and part of my body. Hives every where. I took some lysime and 1 -200 mg Ibuprofen It kind a of was ok for a few hours and then it came back in full force. About 5pm I took a baby Benadryl 12.5 mg. At that point it was all over my body and everywhere. It itched like crazy. At 10 pm I took a Claritin. The Claritin helped. I fell asleep. I woke up the next morning, 11/02/2021-eyes were half swollen shut, itched like crazy, I took some more Benadryl and that helped some but did not solve it. Then in the evening the hives got worse. I was concerned because I felt like my throat might close up. Then took 50 mg Benadryl, that helped some. The next morning, 11/03/2021- left eye was half swollen shut and was extremely exhausted. I do not have as many welts on my body. I was not totally covered in them. I called my doctor, I had a telehealth call at 2:00 PM on Wednesday. She said to take Claritin and Benadryl at night in addition to. I fell asleep Wednesday night and on Thursday, 11/04/2021-I still had welts under my eyes, but it wasn''t closing my eyes. My eyes were not swollen shut. I had a little bit of puffiness underneath my eyes. And 11/05/2021, I am fine.


VAERS ID: 1846919 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-31
Onset:2021-11-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Influenza, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

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

Write-up: Tiredness.. flue symptoms..body aches,headaches.. Dizziness..fever chills


VAERS ID: 1846940 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-11-01
Onset:2021-11-01
   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 FF2590 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Chills, Dizziness, Extra dose administered, Lymph node pain, Lymphadenopathy, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On day 1-day of vaccine patient had chills, fever of 102, and elevated B/P of 200/160. Day 2-Lymph nodes became swollen, tender and sore-especially under both arms, patient had dizziness and nausea. Day 3-Lymph nodes remain swollen, tender and sore under both arms, and nausea.


VAERS ID: 1846955 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-01
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: No known illnesses
Preexisting Conditions: Unknown
Allergies: No known allergies listed
Diagnostic Lab Data: None-just monitoring patient for any possible ADE
CDC Split Type:

Write-up: The staff at a Senior Living told pharmacist that the patient was due for her Moderna booster vaccine--thus, at least 6 months had past since the patient''s last covid vaccine. Then, consent was given by the patient, and the pharmacist injected 0.25 mL of Pfizer vaccine into the patient''s deltoid. Several hours later, the staff at center informed the pharmacist that the patient had actually just had her second pfizer vaccine only 2 weeks prior. The staff consulted a physician, and has monitored for side effects all day. As of 5:15pm on 11/5/2021 patient is feeling well and has not had any adverse reaction to the recent vaccine.


VAERS ID: 1846971 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-28
Onset:2021-11-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Blood pressure measurement
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin ACV gummie
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: Allergy to Motrin
Diagnostic Lab Data: November 1, 2021 November 2, 2021
CDC Split Type:

Write-up: My blood pressure is elevated. I went to the dentist to have my tooth filled and could not due to my elevated blood pressure. I then went to the urgent care.


VAERS ID: 1848212 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Large lump/swelling at injection site still persists and has not decreased as of day 5


VAERS ID: 1848588 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-01
Onset:2021-11-01
   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 320380 / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Injected limb mobility decreased, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101507105

Write-up: Arm is so sore; Can barely move the arm; This is a spontaneous report from a contactable healthcare professional. A 57-year-old male patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: 320380) via intramuscular route of administration in the left arm on 01Nov2021 at 16:00 (at the age of 57-years-old) as a single dose for COVID-19 immunisation. It was unknown if the patient had any medical history and 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. Concomitant medications were not reported. On 01Nov2021 at 18:00, the patient''s arm was so sore and on 03Nov2021, the patient had to stay home from work. The patient could barely move the arm. The patient was using a heating pad for soreness. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were taken as a result of the events and included treatment with heating pad. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events arm is so sore and can barely move the arm was not resolved at the time of this report.


VAERS ID: 1848709 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-28
Onset:2021-11-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 RA / IM

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

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

Write-up: Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: PATIENT MENTIONED SHE HAS REDNESS AROUND THE BAND-AID AREA AFTER TAKING THE BAND-AID OFF. REDNESS WAS NOT AROUND THE INJECTION SITE, BUT FROM THE BAND-AID BEING ON THE SKIN FOR TOO LONG. PATIENT WAS ADVISED TO TAKE BENADRYL TO REDUCE THE REDNESS.


VAERS ID: 1848782 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-27
Onset:2021-11-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Apri oral contraceptive pill
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: None known
Diagnostic Lab Data: ECG 11/6/21 normal.
CDC Split Type:

Write-up: Onset 5 days after vaccination of midsternal chest pain worse with lying down and eating, better with hunching forward. Symptoms lasted 3 dyas.


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