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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 501 out of 8,753

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VAERS ID: 1719406 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nodule, Rash, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Big hard knot on top of shoulder. Itchy rash on arm and neck.


VAERS ID: 1719459 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Heart rate increased, Hypertension, Muscle spasms, Paraesthesia, Tinnitus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Hearing impairment (narrow), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rapid heart rate, ringing in ears, dizziness, tightness in chest, high blood pressure, cramping in toes, occasional tingling in fingers


VAERS ID: 1719465 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cardiac function test normal, Chest X-ray normal, Chest pain, Dysphagia, Dyspnoea, Electrocardiogram normal, Fibrin D dimer, Head discomfort, Headache, Loss of personal independence in daily activities, Musculoskeletal discomfort, Nausea, Pain in extremity, Tension headache, Troponin normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (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), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Penicillin, oxycodone
Diagnostic Lab Data: Chest x-ray (Sunday, Sept. 19, 2021) - everything was clear D-dimer (Friday, Sept. 17, 2021) - also clear EKG ( Friday, Sept. 17, 2021 & Sunday, Sept. 19) - also normal heart function Troponin blood test (Sunday, Sept. 19, 2021) - levels were clear
CDC Split Type:

Write-up: Mild chest pain started the day after the vaccine along with some shortness of breath and sore arm. The second day after the vaccine my chest pain got worse along with more shortness of breath and a minor headache and nausea. The third day after the vaccine chest pain and shortness of breath increased. Went to an urgent care clinic, EKG and several blood tests were deemed as normal. Vital signs were also okay. Chest pain and shortness of breath, headache and nausea continued and got worse. On the fifth day after the vaccine I went to the ER, chest pain was at its worse along with the shortness of breath and a tension headache. Had an X-ray done and some more blood test to rule out myocarditis. All came back with okay levels and chest x-ray was clear. Chest pain did not subside, I was told to just drink fluids and take motrin. Chest pain, headache and shortness of breath did not subside, headache got worse on sixth day. Felt like pressure on my entire head and forehead. Day 7, today, chest pain is less and shortness of breath is also less. Headache is constantly there and at times gets worse. My neck feels like it has some pressure and at times it is hard to swallow but there is no pain in my neck or throat. Every day I have taken ibuprofen. Days 6 & 7 I took low dose asprin and tylenol. On days 4,6 and 7 I did not go to work, instead I stayed home and rested. The days that I did go to work were the days I had stronger symptoms.


VAERS ID: 1719554 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-22
Onset:2021-09-15
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Blood glucose increased, Blood lactic acid increased, Blood pH decreased, Blood pressure decreased, Brain natriuretic peptide increased, COVID-19, Cardiac arrest, Cardioversion, Coma scale abnormal, Dyspnoea, Endotracheal intubation complication, Hypoxia, Intensive care, Lactic acidosis, Mechanical ventilation, Oxygen saturation decreased, PCO2 increased, PO2 normal, Positive airway pressure therapy, Pulseless electrical activity, Respiratory distress, SARS-CoV-2 test positive, Septic shock, Troponin, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMHx of morbid obesity, COPD, pickwickian syndrome, HFpEF, OSA, tobacco abuse, diabetes,
Allergies:
Diagnostic Lab Data: COVID PCR+9/15
CDC Split Type:

Write-up: a 44 yo F with a PMHx of morbid obesity, COPD, pickwickian syndrome, HFpEF, OSA, tobacco abuse, diabetes, who was admitted to MICU on 9/16 as a transfer for cardiac arrest in the setting of COVID-19. Patient started having have respiratory distress on 9/12 and called 911. Outside records note that she has chronic shortness of breath. EMS arrived and patient was on her CPAP and sats were 78-80. Patient was placed on a nonrebreather and she started to show improvement. Initial labs at the ED revealed glucose 239, BNP 2771, lactate 23, troponin negative. pH 7.250, pC)2 72, pO2 92. While in the ED, patient''s blood pressure continued to drop. Levophed was started and patient was admitted. Vanc and meropenem was started on 9/13. Patient only had peripheral access. On 9/14 1327, patient had PEA. 2 rounds of Epi and 2 amps of bicarb were given. Rhythm went to VT and underwent defib twice and rhythm converted to ST. Intubation failed during the code, so NIPPV was continued. Patient was transferred to UH MICU for further care. Course: Patient presents with post cardiac arrest. GCS of 6 on arrival. Will obtain CT Head. Arrest likely due from acute on chronic hypoxic respiratory failure from COVID-19. Given prolonged course of hypoxia while not being on mechanical ventilation, severe lactic acidosis and septic shock, prognosis is poor. Will continue broad spectrum antibiotics and COVID -19 labs and management.


VAERS ID: 1719561 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Cough, Headache, Hypoaesthesia, Myalgia, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Severe headaches, coughing, fever chills, arm pain , hip pain, abdominal pains, muscle pain, numbness on right side of face.


VAERS ID: 1719588 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Interchange of vaccine products
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (broad)

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

Write-up: Pt came for second shot of Moderna Covid-19 vaccine. Rph accidently gave the pt Pfizer vaccine instead of Moderna for her second dose Pharmacist found the error when documented the CDC vaccination card. Rph immediately informed the pt about the mistake. The patient was monitored at the store as usual. Rph followed up with the pt few days after her Pfizer shot; the pt experienced the pain at injection site, and feeling the same when she got her Moderna ( first dose) No major side effects found


VAERS ID: 1719609 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-28
Onset:2021-09-15
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flexeril, omeprazole, Xanax
Current Illness: none
Preexisting Conditions: GERD
Allergies: none
Diagnostic Lab Data: CTA chest
CDC Split Type:

Write-up: Pulmonary Embolism


VAERS ID: 1719630 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alopecia, Dizziness, Fatigue, Hypersomnia, Lymph node pain, Lymphadenopathy, Muscle strain, Myalgia, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (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:
Other Medications: Vitamin D3 5000IU Fish oil
Current Illness: None
Preexisting Conditions: PCOS, PTSD, OCD
Allergies: None
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: I got the second shot at 6:30 PM on Tuesday 9/14. Around 2:30 PM on Wednesday 9/15, severe muscle aches began. The severity of the muscle aches cannot be understated -- it was worse than when I had H1N1 and was the worst illness I have had in eight years. I also got a low-grade fever (I have not had a fever since 2014) and dizziness that evening. The muscle aches, fever, and dizziness were gone by the next day after sleeping for 11 hours. However, the lymph node in my armpit was swollen and painful for a few days after that. The lymph node symptom now appears to be gone. I also was very tired until Monday 9/20 and had trouble getting out of bed and was sleeping more than usual. My hair has also been falling out in clumps since around Thursday 9/16. Also, I have been having recurring problems with my muscles since Thursday 9/16. My muscles now keep getting injured. Since getting the vaccine I have gotten significant muscle strains in my right calf, right foot, left abdominal area, and left back area. I walk every day and today I had to get my husband to drive and pick me up in the middle of my walk due to severe pain in my right foot. Another walk that I did on Saturday 9/18 had to be cut short due to pain in my right calf. This has not happened before getting the vaccine, let alone twice in one week.


VAERS ID: 1719748 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-01
Onset:2021-09-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: Vitamin D Birth Control Allergy medications
Current Illness:
Preexisting Conditions:
Allergies: Flonase
Diagnostic Lab Data:
CDC Split Type:

Write-up: About three weeks after the shot, small bruises began to appear on patient''s left arm. More popped up each day without explanation.


VAERS ID: 1719764 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Nervousness, Pruritus, Pyrexia, Rash, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: Not known
Preexisting Conditions: None reported
Allergies: No known allergy
Diagnostic Lab Data: Not known
CDC Split Type:

Write-up: Patient experienced itching at her scalp about 3 hours after her vaccine administration. Patient took Benadryl as her doctor suggested but did not help. She also experienced vomiting, diarrhea, and reported fever of 105 F. Skin rash/hives spread throughout her body, and she was admitted to the hospital. Patient was discharged either 9/19/21 or 9/20/21. Her symptoms resolved but still felt a bit shaky.


VAERS ID: 1719792 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

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

Write-up: Patient administered the Pfizer Covid19 vaccine at age 11 years 6 months. Physician from contacted for guidance Dr., she advised that this patient receive his second dose after his 12th birthday and this will complete his series.


VAERS ID: 1719794 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-10
Onset:2021-09-15
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chills, Cough, Dyspnoea, Exposure to SARS-CoV-2, Lymphadenopathy, Pyrexia, Rhinorrhoea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol Sulfate 108 (90 Base) MCG/ACT PRN Aspirin 80 mg Oral Daily Baclofen 10 MG TAKE ONE TABLET BY MOUTH DAILY AS NEEDED FOR MUSCLE SPASMS Budesonide-Formoterol Fumarate 160-4.5 MCG/ACT 2 puffs 2 times daily Cetirizine HCl 10 mg Ora
Current Illness: Hypertension, moderate persistent asthma without complication, hyperlipidemia, cervico-occipital neuralgia
Preexisting Conditions: Same as above
Allergies: Dulera, Levaquin, Lipitor, Sulfa antibiotics
Diagnostic Lab Data: 9/16/21-Rec''d Regeneron infusion
CDC Split Type:

Write-up: 9/15/21-Patient here for runny nose, cough, chills, and vomiting. Covid exposure 4 days ago. Received covid vaccine in Feb & March of 2021. Upper respiratory symptoms Runny nose, cough, and chills started 2 days ago. Yesterday patient began experiencing chest tightness, difficulty breathing on expiration, and low grade fever. Continuing to take asthma medication: Symbicort, and allergy medications: Zyrtec and Singulair. Patient denies loss of taste and smell. Patient is unable to keep food down, but is drinking water. Right Ear: Tympanic membrane and external ear normal. Left Ear: Tympanic membrane and external ear normal. Nose: Rhinorrhea present. Mouth/Throat: Posterior oropharyngeal erythema present. Eyes: Pupils are equal, round, and reactive to light. Conjunctivae and lids are normal. Cardiovascular: Normal rate, regular rhythm and normal heart sounds. No murmur heard. Pulmonary/Chest: Effort normal. She has decreased breath sounds in the right lower field and the left lower field. She has no wheezes. She has no rales. She exhibits no tenderness. Lymphadenopathy: Head (right side): Submandibular adenopathy present. No submental, no tonsillar, no preauricular, no posterior auricular and no occipital adenopathy present. Head (left side): Submandibular adenopathy present. No submental, no tonsillar, no preauricular, no posterior auricular and no occipital adenopathy present. She has no cervical adenopathy. Right cervical: No superficial cervical, no deep cervical and no posterior cervical adenopathy present. Left cervical: No superficial cervical, no deep cervical and no posterior cervical adenopathy present. Right: No supraclavicular adenopathy present. Left: No supraclavicular adenopathy present. Neurological: She is alert and oriented to person, place, and time. Skin: Skin is warm. No rash noted.


VAERS ID: 1720059 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-09
Onset:2021-09-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Dizziness, Dyspnoea, Fatigue, Joint swelling, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fatigue, 18 years of age, unknown vaccine, June 1991
Other Medications: Oxycodone, Naproxen, Elavil, Lansoprazole
Current Illness: none
Preexisting Conditions: exercise induced asthma
Allergies: Vancomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortness of breath, chest pain causing patient to awaken from sleep, fatigue, dizziness, joint pain and swelling


VAERS ID: 1720104 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #FF2588 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site mass, Injection site pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Sore arm, lump and sore under the injection site.


VAERS ID: 1720307 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NDC:59267-1000- / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Corneal reflex decreased, Dry eye, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Corneal disorders (narrow), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: On 09/15/2021 at or about 9:30 am, I felt numbness on the left side of my face. The next day I had difficulty drinking from a cup or bottle. Later on during the day I couldn''t blink my left eye. I noticed because my left eye was extremely dry.


VAERS ID: 1720672 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014521A / 2 RA / SYR

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

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

Write-up: Achy body, fever, chills.


VAERS ID: 1720689 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Myalgia, Nausea, Oropharyngeal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu midst - upper respiratory infection, approx 26 years of age
Other Medications: Was told by Primary Care Physician Nurse to take Tylenol every 4 hours and drink lots of fluids
Current Illness: None
Preexisting Conditions: Long-standing health conditions since 2013 - female anatomy (menstrual)
Allergies: latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: muscles aches, chills, severe headache, dizziness, nauseous, sore throat


VAERS ID: 1721511 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-09-15
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210938492

Write-up: DIZZINESS; RINGING IN EARS; TIREDNESS; This spontaneous report received from a patient concerned a 60 year old female. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1821286, and expiry: 21-OCT-2021) dose was not reported, administered on 14-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-SEP-2021, the patient experienced dizziness. On 15-SEP-2021, the patient experienced ringing in ears. On 15-SEP-2021, the patient experienced tiredness. The action taken with covid-19 vaccine was not applicable. The patient was recovering from dizziness, tiredness, and ringing in ears. This report was non-serious.


VAERS ID: 1721517 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Colorado  
Vaccinated:0000-00-00
Onset:2021-09-15
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Fatigue, Headache, Nausea, Pain in extremity, Pregnancy test, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had takes a combination birth control pill.
Allergies:
Diagnostic Lab Data: Test Name: Pregnancy test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210938531

Write-up: SHARP ABDOMINAL PAINS; NAUSEA; THREW UP; SORE ARM; FEVERISH; HEADACHE; TIRED/FATIGUE; This spontaneous report received from a patient concerned a 27 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient had takes a combination birth control pill. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, and batch number: 1808880, and expiry: UNKNOWN) dose was not reported, administered on 14-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-SEP-2021, the patient experienced sore arm. On 15-SEP-2021, the patient experienced feverish. On 15-SEP-2021, the patient experienced headache. On 15-SEP-2021, the patient experienced tired/fatigue. On 20-SEP-2021, the patient experienced sharp abdominal pains. On 20-SEP-2021, the patient experienced nausea. On 20-SEP-2021, the patient experienced threw up. Laboratory data (dates unspecified) included: Pregnancy test (NR: not provided) Negative. The action taken with covid-19 vaccine was not applicable. The patient recovered from sore arm, feverish, headache, and tired/fatigue on 17-SEP-2021, and had not recovered from nausea, threw up, and sharp abdominal pains. This report was non-serious.


VAERS ID: 1721933 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Military       Purchased by: ?
Symptoms: Extra dose administered, Off label use, Pain in extremity, Vaccination site pain, Vaccination site swelling, Vaccination site warmth
SMQs:, Tendinopathies and ligament disorders (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:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Staphylococcal infection (Verbatim: staph infection)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101212576

Write-up: left shoulder is warm at the injection site; left shoulder is a little sore at the injection site; left arm swollen; if she picks up her left arm it''s sore; received booster dose; received booster dose; This is a spontaneous report from a contactable consumer or other non hcp (patient). A 99-years-old female patient received third dose of the BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot number was not reported) via an unspecified route of administration, administered in arm left on 15 Sep2021 11:00 (at the age of 99 years-old) as dose 3, single for COVID-19 immunization. Medical history included staph infection from 2005 to an unknown date. When probing medical history, she states she had never had anything serious happen to her except one time she had a staph infection that was pretty serious. She had taken a trip and 2-3 weeks after returning home she developed the staph infection. She was really sick. patient had not received any other vaccine within 4 weeks. Patient was not pregnant at time of vaccination. The patient''s concomitant medications were not reported. When probing concomitant medications, she states she didn''t think her medications are relevant. The patient previously received dose (first and second) of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot number was not reported) in right arm on an unknown date in Jan2021 as single dose for COVID-19 immunization. The patient stated that first doses were given in her right arm, and she had no reaction at all from the first 2 doses. She didn''t even believe she had the first 2 doses because she felt nothing. Clarified she had no reaction to the first 2 doses. She was calling about the booster shot. She just got her booster dose on Friday 10Sep2021. She reported that today is 15Sep2021, her shoulder is warm and a little sore and it had been sore but today it got very warm at the injection site. It''s warm and sore, it''s not terrible but she thought she should call. She states she woke up today and her left arm is warm and swollen and if she picks up her left arm it''s sore. On 15Sep2021, the patient experienced left shoulder is warm at the injection site, left shoulder is a little sore at the injection site, left arm swollen, if she picks up her left arm it''s sore, received booster dose. Patient had not been diagnosed with COVID-19 prior to vaccination and had not been tested since the vaccination. The outcome of the events was not recovered. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1721936 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Fatigue, Headache, Nervousness, Pain
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: TYLENOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Blood pressure high (High blood pressure)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101218382

Write-up: Had two headaches, front and back; Stomach ache; Loose stools; Hurt all over; Eyes would not stay open, very very tired; Very scary; This is a spontaneous report from a contactable consumer, the patient. A 64-year-old non-pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 15Sep2021 at 00:00 (at the age of 64-years-old) as a single dose for COVID-19 immunisation. Medical history included anxiety and high blood pressure. Prior to the vaccination, the patient was not diagnosed with COVID-19. Concomitant medication included paracetamol (TYLENOL) for an unknown indication from an unknown date and unknown if ongoing. The patient previously received acetylsalicylic acid (ASPIRIN) and experienced drug allergy. On 15Sep2021 at 00:00, the patient felt that the reactions were a lot worse than they should be. On the same day, the patient had two headaches front and back, stomach ache, loose stools, hurt all over, her eyes would not stay open, and was very very tired. She almost went to the emergency room (ER). She would not take the second one. She was very scary. The events did not result in doctor or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events had two headaches, front and back, stomach ache, loose stools, hurt all over, eyes would not stay open, very very tired and very scary were resolving at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1722462 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse event, Dysgeusia
SMQs:, Taste and smell disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No medication taken at the time of the vaccination.
Current Illness: No illnesses at the time of vaccination.
Preexisting Conditions: I have endometriosis.
Allergies: No allergies to medication, food, or other products.
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have a metallic taste in my mouth since the 2nd dose of the Pfizer vaccine. The adverse event happened the night I received the dose. I received the shot at 5:00 p.m. and woke up at 2:00 a.m. to the strong taste of metal in my mouth. It has been 8 days since the vaccine, and I still have the strong taste of metal in my mouth.


VAERS ID: 1722478 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / UNK - / IM

Administered by: School       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: This vaccine was given before the nurse realized that the refrigerator thermometer was broken. The vaccine''s temperature had been out of range. Pfizer was contacted and the remaining vaccine needed to be wasted. The patient had to be notified that the dose he received was not valid and has to be repeated. No side effects noted.


VAERS ID: 1722545 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-07-21
Onset:2021-09-15
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Urethral caruncle
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Loss of caruncel functionality. Later caruncel fell off


VAERS ID: 1722600 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Muscle spasms
SMQs:, Dystonia (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: DON''T KNOW
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NO KNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: MAJOR FATIGUE,BAD HEADACHE, MUSCLE CRAMPS, EVEN UP UNTIL 9-22. SHE STATES IT TOOK HER 2 & 1/2 WEEKS TO HAVE RELIEF FROM THE 1ST DOSE AS WELL


VAERS ID: 1722688 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-09-15
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: COVID positive


VAERS ID: 1722690 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Chest pain, Disorientation, Fatigue, Feeling cold, Headache, Hypoaesthesia, Muscle spasms, Musculoskeletal stiffness, Pain, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: High blood pressure
Preexisting Conditions: Chronic pains. Dr prescribes me with Naproxen
Allergies: None
Diagnostic Lab Data: None. The nurse at my job stated that these were normal reactions that everyone at the hospital experienced after the jab and couldn''t help me with any adverse report or anything else. I still can''t get an appointment with my PCP to conduct a firm check-up in determining what is wrong with me.
CDC Split Type:

Write-up: Less than 24 hours after injection, I experienced e - Extreme headache, chest pains, high fever and frigid coldness; fainting and disorientation. My son carried me to bed and massaged Vicks on my chest. He covered me with a warm blanket and prayed for the intervention into my plight. Now I have ongoing headaches, great pressure on my chest, weakness, spasm and extreme fatigue. Pain, numbness and stiffness throughout whole body.


VAERS ID: 1722692 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Pain in extremity, Product administered to patient of inappropriate age
SMQs:, Tendinopathies and ligament disorders (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: administered to 16 year old -sore arm reported


VAERS ID: 1722750 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-04-06
Onset:2021-09-15
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitoza 1.2mg daily levimere Amplodiphine Hydrochlori lisinopril 10mg daily
Current Illness: No
Preexisting Conditions: Diabetes High Blood pressure
Allergies: No
Diagnostic Lab Data: Positive Covid test
CDC Split Type:

Write-up: Contracted Covid after vaccination


VAERS ID: 1722822 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-12
Onset:2021-09-15
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Blood culture negative, Blood sodium decreased, COVID-19, COVID-19 pneumonia, Clinical trial participant, Diarrhoea, Dyspnoea, Hypovolaemia, Legionella test, Lung disorder, Prone position, SARS-CoV-2 test positive, Sputum culture, Streptococcus test negative
SMQs:, Anaphylactic reaction (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), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Infective pneumonia (narrow), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL) 500 MG tablet Brimonidine Tartrate (LUMIFY) 0.025 % SOLN dexamethasone (DECADRON) 6 MG tablet olmesartan (BENICAR) 5 MG tablet simvastatin (ZOCOR) 5 MG tablet
Current Illness: COVID-19 positive 9.14.21
Preexisting Conditions: Problem List 7 items Diverticulitis of colon (without mention of hemorrhage) Hernia, incisional Strangulated ventral incisional hernia Hyponatremia Essential hypertension Hyperlipidemia Hypertension
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.16.21); COVID-19 positive (9.14.21); fully vaccinated Discharge Provider: MD Primary Care Provider: MD Admission Date: 9/16/2021 Discharge Date: Sep 21, 2021 PRESENTING PROBLEM: Acute respiratory failure with hypoxia (HCC) [J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] HOSPITAL COURSE: Patient is a 67 year old male with a past medical history of HTN, HLD who presented with worsening shortness of breath x 2 weeks, found to be positive for COVID-19 (9/15). He has been vaccinated against COVID 19 (Pfizer x 2). CTA thorax negative for PE, but showing extensive bilateral airspace disease consistent with Covid pneumonia. Blood cultures, Legionella antigen, Strep pneumonia antigen negative. Sputum cultures with normal respiratory flora. Patient was not a candidate for monoclonal antibody or Remdesivir. He did complete a 5 day course of antibiotics for CAP coverage. Ten day dose of dexamethasone was also initiated and he was placed on HFNC and weaned steadily each day as tolerated. Patient worked with pulmonary rehabilitation and prone positioning during his hospitalization. He was able to wean to 3L nasal cannula 9/20 and to room air 9/21. Patient had also been experiencing diarrhea prior to admission. This symptom was improved during hospital stay without need for medication. Sodium of 129 on admission, likely due to hypovolemia. This improved with improved appetite. However, on last day of hospitalization it dropped back to 131. His primary care provider was notified and a follow up CBC within 1 week recommended to ensure that his sodium remains stable. Of note, Patient agreed to participate in two trials during his hospitalization. For this reason he was provided Cyclosporine as part of the trial. He was provided with the information of the trial coordinator for any further follow up questions he may have and he is aware that he may opt out at any time. Pulmonary therapy met with patient 9/21 to evaluate and prepare him with his home oxygenation needs. Having completed his testing without any oxygen requirements, he will be returning home on room air. He is provided with pulse oximeter and instructed to follow up with PCP if he sees his saturation below 91%. Upon evaluation, his vitals were stable and he was oxygenating well on room air. He is instructed to restart his statin upon return home and finish out his course of dexamethasone with 4 more tablets provided. He had no further questions or concerns at discharge and felt comfortable returning home in stable condition to his family. Discharge Disposition: home health care Active Issues Requiring Follow-up: Low Sodium - follow up outpatient and further discussion with PCP Low Oxygenation - continue to monitor this with your pulse oximetry and follow up if dropping below 91%


VAERS ID: 1722868 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea, Lip swelling, Periorbital swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Our Health Dept secretary expressed she bumped into the pt''s mom over the weekend and the mom proceeded to tell our secretary that her child had a reaction from the Pfizer vaccine that was taken 4 days ago. It was reported to me Monday am, 9/20/2021. I reached out to the mom but got no response, I left a message on her cell''s voice mail to call me back. Mom called back on 9/21/21 @ 9:08 am. I asked the mom to explain to me what happened to her daughter and stated " my daughter lips swelled up and her eyes were puffy". When asked at what time this occurred, mom replied "she woke up the next morning like that, I gave her some Benadryl and Tylenol and she lay back down, when she got up later in the day, she was alright". I asked the mom did the pt experience any trouble breathing, mom replied, "oh yeah, she did a little bit, her asthma was trying to act up, so I gave her her Albuterol Inh and like I said, when she woke up later in the afternoon , she was fine". I asked mom did she take the pt to the ER, mom stated "no I didn''t". I advised the mom on pt had having what seemed to be and Anaphylaxis reaction to the Pfizer vaccine and she is not to receive it ever again unless under the care of her PCP. I advised mom that we wouldn''t be able to complete that series of Pfizer d/t her reaction. I advised mom to seek any medical attention from ER or the Pediatrician''s office of any other problems were to occur.


VAERS ID: 1722887 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-21
Onset:2021-09-15
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR COVID-19 test with a positive result
CDC Split Type:

Write-up: Patient received the Janssen vaccine on 7/21/21 so was fully vaccinated when they tested positive for COVID-19 on 9/15/21


VAERS ID: 1722911 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Angina pectoris, Cardiac flutter, Fatigue, Injection site hypoaesthesia, Pain, Painful ejaculation, Spermatozoa abnormal
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Tachyarrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (narrow), Fertility disorders (narrow), Sexual dysfunction (narrow)

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

Write-up: 2021/09/15 Time:1800 approximately(seen at medical clinic on base on 2021/09/20) -severe body aches -fatigue 2021/09/17 Time:0800 approximately(seen at medical clinic on base on 2021/09/20) -left arm numb 2021/09/19 Time:1100 approximately(seen at medical clinic on base on 2021/09/20, referred to urologist off base/appointment scheduled 2021/10/22) -painful ejaculation and hard gelatin like substances in sperm -left arm numb Time:2200 approximately 2021/09/21 Time:1630 approximately(ER visit off base, referred to cardiologist/no appointment made at this time) -fluttering heart/sharp pain felt in heart 2021/09/22 Time:0700 approximately -sharp pain felt in heart


VAERS ID: 1722957 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-03
Onset:2021-09-15
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK RA / -

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

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

Write-up: COVID-19


VAERS ID: 1723008 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Immediate post-injection reaction
SMQs:, Neuroleptic malignant syndrome (broad), Hypersensitivity (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Injection was given @4:29PM & immediately broke out in a sweat. Patient was given water & taken to a room to lay down. EMSA was called & arrived at 5:40PM. They assessed him & determined he was fine. His girlfriend took him home. The next day the pharmacist who administered the shot called and he was feeling good.


VAERS ID: 1723088 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: PATIENT HAD FIRST DOSE OF MODERNA VACCINE ON 9/15/21, AND DEVELOPED CHEST PAINS AND DIFFICULTY BREATHING. PATIENT WENT TO CAMBRIDGE MEDICAL CENTER DUE TO HER SYMPTOMS.


VAERS ID: 1723091 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 - / -

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

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

Write-up: Breakthrough COVID 19 infection not requiring hospitalization. Patient had recently received 3rd dose of COVID 19 vaccine


VAERS ID: 1723170 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder, Vaccine positive rechallenge
SMQs:

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

Write-up: change in menstrual cycle. Have had 3 IUD''s for the last 15 years or so. Last one inserted a year ago. With my IUD I am lucky enough to not get a menstrual period. After the first Pfizer shot 8.24.21 (FC3182) I started a period that lasted for 4 days. 3 weeks later I had my second shot 9.14.21 (FF2588) and the next day started a period that is till going now for 8 days. I feel it important to report this affecting hormones and menstrual cycle after not having one for 15 years. Obviously this vaccine made my body react hormonally. Not only did I get a period but I got it both times next day after the shot.


VAERS ID: 1723177 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-09-15
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 021B21A / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Cough, Diarrhoea, Pyrexia, Rhinorrhoea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, Runny Nose, Cough, Vomiting, and Diarrhea


VAERS ID: 1723182 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 - / IM

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

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

Write-up: Client in office with mother, who''s language is limited. Child said he and his sister need COVID vaccine. After the nurse gave the vaccine and observation were over she gave presented the CDC vaccine card to the parent. The mom goes in her purse and pull out a CDC vaccine card, which shows the children had already been fully vaccinated.


VAERS ID: 1723208 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 - / IM

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

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

Write-up: Children in clinic with mother who''s language is limited. The 17 year old child said they needed covid vaccine. Their records were pulled and no Covid vaccine had been given. After the nurse gave the vaccine and presented the CDC vaccine card to the mom. She reached into her purse and pulled out a CDC vaccine card for both kids. Both of the children had been fully vaccinated.


VAERS ID: 1723238 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Covid -19 Immunization given outside the 6 hour window after diluent added, vaccine stored in refrigerator. Vaccine mixed at 09:30 Health Director notified immunization coordinator. Health Director notified RN dose acceptable within manufacture guidelines. Recommended to submit VAERS.


VAERS ID: 1723270 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Covid vaccine given outside 6 hour after diluent added. Health Director notified per RN. Health Director f/u and notified RN "vaccines within manufacture guidelines which make doses viable"


VAERS ID: 1723283 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / UNK LA / IM

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

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

Write-up: Dose given from vial opened/punctured on 09/09/2021. Vial not discarded after the recommended 12 hours after puncture. Dose given on 09/15 from previously punctured vial. Vial kept in refrigerator at appropriate temperature with no temperature excursions. Reported to Moderna.


VAERS ID: 1723286 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / UNK LA / IM

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

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

Write-up: Dose given from vial opened/punctured on 09/09/2021. Vial not discarded after the recommended 12 hours after puncture. Dose given on 09/15 from previously punctured vial. Vial kept in refrigerator at appropriate temperature with no temperature excursions. Reported to Moderna.


VAERS ID: 1723293 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / UNK RA / IM

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

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

Write-up: Dose given from vial opened/punctured on 09/09/2021. Vial not discarded after the recommended 12 hours after puncture. Dose given on 09/15 from previously punctured vial. Vial kept in refrigerator at appropriate temperature with no temperature excursions. Reported to Moderna.


VAERS ID: 1723299 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / UNK LA / IM

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

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

Write-up: Dose given from vial opened/punctured on 09/09/2021. Vial not discarded after the recommended 12 hours after puncture. Dose given on 09/15 from previously punctured vial. Vial kept in refrigerator at appropriate temperature with no temperature excursions. Reported to Moderna.


VAERS ID: 1723304 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-08
Onset:2021-09-15
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / -

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

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

Write-up: Breakthrough COVID-19 infection not requiring hospialization


VAERS ID: 1723311 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-06
Onset:2021-09-15
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Breakthrough COVID 19 infection not requiring hospitalization


VAERS ID: 1723335 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-14
Onset:2021-09-15
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: actemra, zocor, prednisone, xanax, aldactone, vit c, breo ellipta, imdur, bumex, potassium, cozaar, trazodone, calcium with vit d, multivitamin, toprol, boniva, plavix, albuterol, fish oil, eliquis and coq10
Current Illness:
Preexisting Conditions:
Allergies: erythromycin, indocin, lexapro, augmentin , dust mites and mold
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID-19 after being fully vaccinated


VAERS ID: 1723346 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C@1A / 1 LA / IM

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

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

Write-up: Patient is under 18 years of age and was given Moderna.


VAERS ID: 1723395 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-20
Onset:2021-09-15
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Blood bicarbonate decreased, Blood creatinine increased, Blood pH decreased, Blood potassium increased, Brain natriuretic peptide increased, COVID-19, Cardiomegaly, Chest X-ray abnormal, Cough, Dyspnoea, End stage renal disease, Fatigue, Haemoglobin decreased, Headache, Hypervolaemia, Interstitial lung disease, PCO2 decreased, PO2 decreased, Pleural thickening, Pneumonia, Pulmonary oedema, SARS-CoV-2 test positive, Troponin, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, allopurinol, amitriptyline, amlodipine, aspirin, atorvastatin, calcitriol, clopidogrel, hydralazine, novolog, levemir, omeprazole,
Current Illness:
Preexisting Conditions: Alcohol abuse, CKD, diabetes type 2, diabetic nephropathy, Diabetic ulcer of left foot, gout, history of DVT and PE, hypertension, MRSA in past, PVD, retinopathy, smoking
Allergies: None
Diagnostic Lab Data: 9/16/21 chest xray: Cardiomegaly with bilateral interstitial and airspace disease and fissural thickening. This does appear worse on the left compared to the right. Findings likely at least partially related to edema but are concerning for underlying pneumonia.
CDC Split Type:

Write-up: Presented to ED on 9/16/21 with complaints of wheezing and headache, SOB since last night along with cough, feeling more weak and fatigued. no phlegm production, no fever chills, no dysphagia, no body aches or sore throat. he took the COVID vaccine back in April and in May. He does have a fistula in place in Jan 2021. In ED, BP 145/81, pulse of 88, T 98.7?, oxygenating on 6 L at 96% on 2 L nasal cannula. chest x-ray performed that showed cardiomegaly with bilateral interstitial thickening, evidence of edema and pneumonia. Regarding labs, troponin at 0.079, creatinine 8.0, COVID was positive, BNP 709. ABG PO2 of 59.4, pCO2 of 24.5, pH of 7.333, bicarbonate of 13.0. Hb 10.5, K 5.3, Interventions in ED include DuoNeb treatment at 3 mL nebulizer x1 dose. Rocephin 1 g IV, Doxycycline 100 mg IV. COVID protocol was initiated in the emergency room. Patient''s diagnosed and admitted on 9/16/21 as acute respiratory failure with hypoxia secondary to community-acquired pneumonia,fluid overload due to underlying ESRD and COVID-19 infection. Patient was treated with Rocephin, doxycycline, Decadron, and Remdesivir. His shortness of breath improved. Pt weaned off of oxygen and has been doing fine without it over the last 2 days. Discharged on 9/22/21


VAERS ID: 1723807 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-13
Onset:2021-09-15
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal weight gain, Fatigue, Testicular swelling
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Enlarged Testicles, Fatigue, unexplained weight gain


VAERS ID: 1723852 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-09-15
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: had a breakthrough COVID-19 infection despite full vaccination. Mild-to-moderate disease right now and she is doing well on room air, although she does have significant comorbidities that put her at risk for severe disease. Will treat her with remdesivir


VAERS ID: 1724283 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Auscultation, Confusional state, Fear, Heart rate irregular, Hyperhidrosis, Pallor, Pulse abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (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: Adderall 30mg was taken the morning of event
Current Illness: None
Preexisting Conditions: ADD
Allergies: No allergies to report
Diagnostic Lab Data: No tests or lab results have been done.
CDC Split Type:

Write-up: Pt received COVID-19 vaccination, when he began to stand, vaccination nurse noticed that he became very pale. Nurse sat him on chair with back against the wall. Pt asked nurse for water and juice. Pt became very anxious and extremely diaphoretic (dripping), given ice pack and towels - Clinical Lead RN called. 1631 - Clinical Lead RN called to room and observed pt to be very pale and extremely diaphoretic. Attempted to take radial pulse from left arm, pulse too thready, irregular and weak to read. Apical pulse was irregular and weak in 30''s. B/P 60/32 Left arm. RN grabbed emergency kit to get Epinephrine. 1632 - Epinephrine given in Right Thigh. Pt appears confused and states he is scared and "doesn''t know what is happening". 911 called and Paramedics dispatched. 1636 - While Vaccination nurse continues to dry and talk to the patient, Lead RN continues to auscultate apical pulse, which slowly begins to get stronger, up to 70 bpm. (pt states that he is worried and asks if we are being honest with him, will he be alright). Pt states that the only med that he takes is Adderall and that he has no history of this happening before with other injections. 1640 - Color is slowly returning to patient. Apical pulse is now up to 90 bpm and is strong and regular. B/P in left arm is 112/62. Paramedics have just arrived and will be taking pt to Emergency. Pt able to stand and is much more alert but seems a little in shock over what has just happened. Pt able to stand and walk to gurney for transport.


VAERS ID: 1724458 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site vesicles
SMQs:

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

Write-up: Inches away from injection site I developed a yellow bubbly blister.


VAERS ID: 1725553 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-25
Onset:2021-09-15
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 - / OT

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210912; Test Name: Covid 19; Test Result: Positive
CDC Split Type: USPFIZER INC202101218853

Write-up: Colleague is now COVID positive and ill with cold symptoms, fever, aches, cough, headache; Colleague is now COVID positive and ill with cold symptoms, fever, aches, cough, headache; This is a spontaneous report from a contactable Other Health Professional. A 30-year-old female patient received bnt162b2 (Pfizer-BioNTech COVID-19 Vaccine, solution for injection), dose 1 intramuscular on 04Feb2021 (at the age of 29-year-old) (Batch/Lot Number: EL3247) as DOSE 1, SINGLE, dose 2 intramuscular on 25Feb2021 (Batch/Lot Number: EL3247) as DOSE 2, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. It was unknown if the patient was pregnant. It was unknown if the patient was pregnant at time of vaccination. The patient underwent lab tests and procedures which included COVID 19 test: positive on 12Sep2021. The patient was covid positive and ill with cold symptoms, fever, aches, cough, headache (vaccination failure and covid-19) (medically significant) on 15Sep2021. It was unknown if patient received treatment for events. Outcome of events were not recovered. The lot number for the vaccine BNT162B2 was not provided and will be requested during follow up.; Sender''s Comments: The efficacy of a drug varies from patient to patient and can be affected by different factors; however, a contributory role of the suspect product bnt162b2 to the reported vaccination failure / COVID-19 cannot be ruled out.


VAERS ID: 1725554 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-02
Onset:2021-09-15
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ROSUVASTATIN
Current Illness: High cholesterol (from ten years)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210915; Test Name: COVID 19 instant test; Test Result: Positive ; Test Date: 20210916; Test Name: COVID 19 instant test; Test Result: Positive
CDC Split Type: USPFIZER INC202101218869

Write-up: Yesterday the patient tested positive using a rapid/"instant" test for COVID-19 as well as again today using an "instant" test resulting as positive.; Yesterday the patient tested positive using a rapid/"instant" test for COVID-19 as well as again today using an "instant" test resulting as positive.; This is a spontaneous report from a Pfizer sponsored program. A contactable consumer(patient) reported that a 69-year-old male patient received bnt162b2 (PFIZER-BIONTECH covid-19 vaccine, formulation: solution for injection) via an unspecified route of administration (batch number/lot number: FC3182), in left arm on 30Aug2021 12:00 PM (at the age of 69-years-old) as dose 3, single, via an unspecified route of administration (batch number/lot number: EL9262), in left arm on 02Feb2021 12:00 PM (at the age of 68-years-old) as dose 2, single and via an unspecified route of administration (batch number/lot number: EH9859), in left arm on 12Jan2021 12:00 PM (at the age of 68-years-old) as dose 1, single and all for covid-19 immunization . Medical history included ongoing high cholesterol from ten years. Ongoing concomitant medication included rosuvastatin for high cholesterol from ten years. The patient received his 1st dose of the Pfizer COVID vaccine on 12Jan2021, 2nd dose 02Feb2021, & 3rd dose received on 30Aug2021. On 15Sep2021 the patient tested positive using a rapid/"instant" test for COVID-19 as well as again on 16Sep2021 using an "instant" test resulting as positive. The patient was waiting on the PCR testing results. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 15Sep2021 and sars-cov-2 test: positive on 16Sep2021. The outcome of the events was unknown.


VAERS ID: 1725562 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-10
Onset:2021-09-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dehydration, Dizziness, Gastritis, Headache, Hot flush, Pain, Pyrexia, SARS-CoV-2 test
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific inflammation (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOLOFT
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210916; Test Name: Respiratory panel; Test Result: Negative ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101224210

Write-up: Got really really dizzy; Severe headache; Whole body was hurting; Severely dehydrated; Some gastro information (gastric inflammation); Severe cold chills and hot flashes when not running a fever; Severe cold chills and hot flashes when not running a fever; Ran a fever; This is a spontaneous report from a contactable consumer, the patient. A 28-year-old non-pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 10Sep2021 at 10:00 (at the age of 28-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported. Prior to the vaccination, it was unknown if the patient was diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medication included sertraline hydrochloride (ZOLOFT) for an unknown indication from an unknown date and unknown if ongoing. The patient previously received hydrocodone bitartrate/ paracetamol (LORTAB) and experienced drug allergy. On 15Sep2021, the patient got really really dizzy, had severe headache, her whole body was hurting and she was dehydrated, severely dehydrated. The patient also had some gastro information (gastric inflammation). The patient experienced severe cold chills and hot flashes when not running a fever, and then she also ran a fever that she was still fighting. The patient did not have issues with cold chills while running a fever. The events resulted in emergency room/department or urgent care visit. Since the vaccination, the patient had been tested for COVID-19. On 16Sep2021, the patient underwent respiratory panel test via nasal swab and the test result was negative. Therapeutic measures were taken as a result of the events and the patient was prescribed with a muscle relaxer (unspecified). The clinical outcome of the events got really really dizzy, severe headache, whole body was hurting, severely dehydrated, some gastro information (gastric inflammation), severe cold chills and hot flashes when not running a fever and ran a fever was not recovered at the time of the report. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1725610 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Cough, Fatigue, Nasal congestion
SMQs:, Anaphylactic reaction (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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101228748

Write-up: "I" developed a dry cough /fatigue/congestion within 12 hrs of getting this vaccine; "I" developed a dry cough /fatigue/congestion within 12 hrs of getting this vaccine; "I" developed a dry cough /fatigue/congestion within 12 hrs of getting this vaccine; This is a spontaneous report from a non-contactable healthcare professional, the patient. A 25-year-old female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: 30135BA) via intramuscular route of administration in the right arm on 15Sep2021 at 11:00 (at the age of 25-years-old) as a single dose for COVID-19 immunisation. It was unknown if the patient was pregnant at the time of vaccination. The patient had no medical history reported. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications were not reported. On 15Sep2021, at 20:00, the patient developed dry cough, fatigue and congestion within 12 hours of getting this vaccine. It was also reported that these symptoms were still going on and it had been 4 days after receiving it. The event resulted in doctor or other healthcare professional office/clinic visit. Therapeutic measures included treatment with benzonatate (MANUFACTURER UNKNOWN) 200MG capsule to help relieve the cough. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events developed a dry cough, fatigue and congestion within 12 hours of getting this vaccine was not recovered at the time of this report. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1725628 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OCREVUS; LUVOX [FLUVOXAMINE MALEATE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Multiple sclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101233995

Write-up: Nausea; Vomiting; Headache; Fever; Body aches; Chills; Joint pain, hip pain; Spinal pain; Fatigue; This is a spontaneous report from a contactable consumer, the patient. A 39-year-old non-pregnant female patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0183) via an unspecified route of administration in the left arm on 15Sep2021 at 07:00 (at the age of 39-years-old) as a single dose for COVID-19 immunisation. Medical history included multiple sclerosis. 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 included ocrelizumab (OCREVUS) and fluvoxamine maleate (LUVOX); both for an unknown indication from an unknown date and unknown if ongoing. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0183) via an unspecified route of administration in the left arm on an unknown date in Aug2021 at 07:15 (at the age of 39-years-old) as a single dose for COVID-19 immunisation. The patient previously also received azithromycin (ZITHROMAX) and gadolinium (MANUFACTURER UNKNOWN) and experienced drug allergy. On 15Sep2021 at 15:00, the patient experienced nausea, vomiting, headache, fever, body aches, chills, joint pain, hip pain, spinal pain and fatigue. The events resulted in doctor or other healthcare professional office/clinic visit. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events nausea, vomiting, headache, fever, body aches, chills, joint pain, hip pain, spinal pain and fatigue was recovered with sequelae (reported as recovered with lasting effects) on an unknown date in Sep2021.


VAERS ID: 1726008 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-26
Onset:2021-09-15
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Coronary arterial stent insertion, Coronary artery occlusion, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Other ischaemic heart disease (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart attack. Blockage and then 2 stents


VAERS ID: 1726177 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816027 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood test, Chest X-ray, Dyspnoea, Electrocardiogram, Electrocardiogram ambulatory, Impaired work ability, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Arthritis (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: seafood iv contrast
Diagnostic Lab Data: Chest xray, blood work ,ekg, and put on a heart monitor. Been prescribed a inhaler.
CDC Split Type:

Write-up: Been to hospital for asthma like breathing on 09/21/2021. Uncontrolable shackes and alot of joint pain. Have missed couple days of work.


VAERS ID: 1726309 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Patient Too Young for Vaccine Administered-


VAERS ID: 1726319 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Patient Too Young for Vaccine Administered-


VAERS ID: 1726347 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / SYR

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

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

Write-up: Left arm got magnetized right where I got vaccinated


VAERS ID: 1726387 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-09-10
Onset:2021-09-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206AZIA / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Dizziness, Fatigue, Headache, Laboratory test, Limb discomfort, Pyrexia, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Initial symptoms within the first 2 days were severe headache and low-grade fever, fatigue. The symptoms gradually faded, with the exception of the fatigue, which lingered. 5 days after the injection I experienced a sudden heaviness of limbs, a strange sensation in my gums and roof of mouth, and then a wave of faintness in my head. I called 911 because I thought I was going down. The paramedics concluded that I did not have an allergic reaction, and stayed until my vitals returned to close to normal. 6 days after the injection I experienced two more such episodes, each to a lesser degree. I was able to see my physician on the 7th day, who ordered bloodwork.


VAERS ID: 1726544 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-12
Onset:2021-09-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest discomfort, Dizziness, Electrocardiogram normal, Fatigue
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Reactions to chicken pox and flu vaccinations as a child including high fevers and showing symptoms of the virus I was inoculate
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG and bloodwork tests.
CDC Split Type:

Write-up: Dizziness and fatigue began immediately after receiving the dose (lasting about 2 days). On day 3, the dizziness subsided but I began to have mild discomfort in my chest. On day 6 (09/18/2021), I went to the emergency room because the discomfort did not improve or worsen. EKG and bloodwork did not show signs of heart attack, myocarditis, or pericarditis, and the doctor was unable to pinpoint the cause of it (aside from mentioning a delayed reaction to the vaccine). The discomfort subsided on day 9 (09/21/2021).


VAERS ID: 1726652 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A1 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chest pain, Chills, Cognitive disorder, Decreased appetite, Fatigue, Heart rate increased, Pyrexia, Sleep disorder, Tremor, Urinary retention
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu and Tetanus shots ten years ago, chest pain.
Other Medications: LEVOTHROID
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: I went to bed at 08:30pm, which was very unusual for me. I started to shake violently, and my teeth were chattering. Then I woke up in the middle of the night and developed a fever. Every time I took a deep breath, it would hurt. It was hard for me to hold my urine. I took a Tylenol for the fever. My resting heart rate went up to 80. Eventually, my fever went away. However, for several days, I felt very weak and fatigued. I barely had any energy and it''s been hard for me to gather my thoughts or think clearly. Also, my appetite has decreased.


VAERS ID: 1726654 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-05
Onset:2021-09-15
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Chills, Exposure to SARS-CoV-2, Fatigue, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose02/12/21 2nd dose03/05/21 Diagnosed covid positive:09/18/21 Symptom onset:09/15/21 Exposure: Symptoms:fever, fatigue,muscleaches,abdpain,chills


VAERS ID: 1726658 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-08
Onset:2021-09-15
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/11/21 2nd dose02/08/21 Diagnosed covid positive:09/16/21 Symptom onset:09/15/21 Exposure: Symptoms:fever, cough,runnynose


VAERS ID: 1726659 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-07
Onset:2021-09-15
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/10/21 2nd dose02/07/21 Diagnosed covid positive:09/16/21 Symptom onset:09/15/21 Exposure: Symptoms:fatigue,sore throat,Runny nose,HA


VAERS ID: 1726809 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-04
Onset:2021-09-15
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral normal, Anxiety, Arteriogram carotid normal, Ataxia, COVID-19, Cerebrovascular accident, Cluster headache, Computerised tomogram head normal, Impaired work ability, Migraine, Nervous system disorder, SARS-CoV-2 test positive, Speech disorder, Tachycardia, Transient aphasia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol sulfate (PROAIR RESPICLICK) 108 (90 Base) MCG/ACT inhalation powder Take 2 puffs by inhalation every 4 hours as needed for Wheezing. ? amitriptyline (ELAVIL) 10 MG tablet ? amoxicillin-clavulanate (AUGMENTIN) 875-125 MG per tablet
Current Illness:
Preexisting Conditions: Pure hypercholesterolemia 09/19/2021 ? Labyrinthitis ? Irritable bowel syndrome ? Eczema ? Bronchospasm ? COVID-19 ? POTS (postural orthostatic tachycardia syndrome) ? SOB (shortness of breath) ? Episodic cluster headache, not intractable ? Intermittent palpitations ? Anxiety state ? GERD (gastroesophageal reflux disease)
Allergies: Keflex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 9/19/2021 COVID-19 positive 9/15/2021; fully vaccinated Pt is a 26 y.o. female past medical history of POTS, episodic cluster headaches, anxiety, history of COVID infection who is presenting today with speech disturbance. Patient had worsening health since originally diagnosed with COVID in November 2020. She states she was off work for 6 months. She has been dealing with episodic cluster headaches. She is currently weaning off Elavil, she had been trying triptans but had severe side effects. Patient presented as stroke code to emergency department. Original NIH of 1. Patient was tachycardic but all other vital signs stable. NIHSS was 1 for LLE ataxia. Patient was emergently taken for advanced imaging. CT head revealed no evidence of acute infarction or hemorrhage. Tpa was not given due to low suspicion of stroke and low NIHSS. CTP revealed no evidence of core infarct or penumbra. CTA head/neck revealed no evidence of LVO or high grade stenosis. She was seen by Neurology who recommended treating for complex migraines. She did exhibit some degree of anxiety on exam, which was acknowledged by patient. It was unclear what the source of the patient''s transient aphasia was however it may be related to complex migraine/anxiety/post COVID neurologic symptoms. She was prescribed ketorolac/Compazine/lorazepam to be taken in limited duration after discharge. She will follow-up with neurology. She was discharged home on 09/20/2021 in stable condition. COVID-19 - original + test 11/2020; positive again 9/15/2021. Status post monoclonal antibody 9/16/2021.


VAERS ID: 1726852 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0202 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Cold sweat, Confusional state, Electrocardiogram abnormal, Feeling abnormal, Headache, Loss of consciousness, Malaise, Muscle rigidity, Nausea, Sinus bradycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Dementia (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient was in his car in the vaccine administration area. Approximately 7 minutes after vaccine administration, patient waved at RN and expressed not feeling well, feeling "strange". RN called for help. Went unconscious and arms rigid, but breathing 12-15 with pulse 60-65, regular. Provider team arrived and patient was coming too, breathing well and pulse remains 60-65. Color pale, clammy though in the car and sunny outside. No rash or itching, no difficulty breathing or swallowing. Patient knew name and date of birth, two minutes until he remembered where he was. Nauseated and vomited x 4 intact food. Able to stand and pivot to wheelchair to get into a cooler site. Cool cloths applied to neck and head. Continues to vomit, although now smaller amounts. Wife called. EMS unit arrives; vital signs 90-94/60-64. Pulse ox 90%''s. Remains heart rate 60-65. CBG 111. EKG sinus bradycardia, regular rate and rhythm. Complains of severe head ache and briefly severe chest pain. EMS transport to hospital Patient was discharged hoe at 9/16/21 at 0200 per hospital.


VAERS ID: 1726915 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-02
Onset:2021-09-15
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Fall, Headache, Pain, Regurgitation, Vertigo
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Noninfectious diarrhoea (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: Flecanide, Xarelto, Estradiol, Sertraline, vitamins C, D, zinc
Current Illness: None.
Preexisting Conditions: Afib.
Allergies: Epinephrine.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stomach aches lasting 3 days with diarrhea and regurgitation. Painful body aches and headaches lasting 3 days. Sudden onset of vertigo causing fall to floor. I stayed at home. If it escalated in intensity, I would have gone to ER or my doctor.


VAERS ID: 1726960 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-26
Onset:2021-09-15
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / UNK - / -

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

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

Write-up: Covid positive work


VAERS ID: 1726965 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1726971 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1726978 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1726980 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-27
Onset:2021-09-15
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Covid positive family contact


VAERS ID: 1726998 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Nausea, Night sweats, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, Metformin, synthroid, Premarin, Progesterone, low dose Naltrexone
Current Illness:
Preexisting Conditions: Multiple Sclerosis
Allergies: Tetracycline, Librium
Diagnostic Lab Data:
CDC Split Type:

Write-up: Persistent fevers for 5 days of up to 103.2 F only partially relieved by Tylenol and ibuprofen to come down to 101F. Nausea and vomiting for 5 days. Night sweats still occurring at 7 days from vaccination. Abdominal rash from day 3 still present day 8/present.


VAERS ID: 1727046 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-09-15
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Pneumonia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: COVID breakthrough - cough dyspnea, pneumonia


VAERS ID: 1727226 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic shock, Blood test, Pain, Paraesthesia, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (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: Advair, Albuterol, Spiriva, Zyrtec, Singulair, Flonase, Astelin, Portia, Gabapentin, Benadryl, Xyzal
Current Illness: None
Preexisting Conditions: Asthma, Seasonal and Environmental Allergies
Allergies: Jansen J&J and Pizer CoVID Vaccine, Allergy shot(not sure of brand)
Diagnostic Lab Data: (9/15/2021)Blood test
CDC Split Type: vsafe

Write-up: (9/15/2021)Antiphallic Shock, Dizzy, itchy throat, given Benadryl but continued to worsen. Two epinephrine, albuterol treatment, Ativan, and Decadron was given under nurse/paramedic/ER care. During the ER visit the shock was halted and was discharged. Later that night had tingling started at extremities but quickly covered my body and had to visit another ER. Was given IV and Norco for pain.


VAERS ID: 1727326 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sumatriptan
Current Illness: No
Preexisting Conditions: Migraines
Allergies: Sulfa; DILAUDID; sage; lavender
Diagnostic Lab Data: Blood work.
CDC Split Type: vsafe

Write-up: On 9/14/21 150/100 blood pressure which gave me a migraine. I went to the ER on 9/15 and was given an IV and other medications. I was sent home and had to go back to the ER on the 18th. I went back because I still had a migraine. I was given steroids on top of the regular medicine. I was able to get my sumatriptan refilled. My blood pressure has went down since then but it is still a little bit high.


VAERS ID: 1727359 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-26
Onset:2021-09-15
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute myocardial infarction, Anticoagulant therapy, Blood test, Cardiac stress test, Echocardiogram, Electrocardiogram ST segment elevation, Fatigue, Mobility decreased, Palpitations
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Echocardiogram, Stress Test, Blood Test
CDC Split Type: vsafe

Write-up: Three days after the vaccine I started to have extreme fatigue. One week after that I started to have heart palpitations and I called my doctor. I went to the ER and I had ST elevations in my Stemi. I was in the hospital one night. I was given a Heparin drip and aspirin. I was discharged with an unexplained ST elevation and MI. I normally run Marathons and I have been having a lot of problems since the vaccine. I had extreme fatigue two weeks after the shot and I was unable to get out of bed. I am still having Palpitations every day intermittently after three weeks. I am still extremely fatigued. When I was getting the scans I could hear my arm vibrating.


VAERS ID: 1727384 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-23
Onset:2021-09-15
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness unilateral, Retinal artery occlusion
SMQs:, Embolic and thrombotic events, arterial (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood pressure meds, Cholesterol meds
Current Illness: NONE
Preexisting Conditions: High blood pressure, High Cholesterol Prostate cancer
Allergies: NONE
Diagnostic Lab Data: Stroke intervention
CDC Split Type:

Write-up: Wife called in to report that Husband received booster shot on 08/23/2021, and had a stroke in his right eye on 09/15/2021. Also stated that husband has lost vision in his right eye.


VAERS ID: 1727401 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-09
Onset:2021-09-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID19 test
CDC Split Type:

Write-up: Breakthrough COVID19 infection and ED visit on 9/15/21


VAERS ID: 1727429 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-08
Onset:2021-09-15
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixiban, atorvastatin, coenzyme Q10, diltiazem, famotidine, metoprolol, Omega 3s, probiotics.
Current Illness:
Preexisting Conditions: abnormal serum cholesterol, adenomatous colon polyp, benign neoplasm of colon, diverticulosis, GERD, GAD, hx PE, hyperlipidemia, migraine variant, OSA, obesity.
Allergies: tetracycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt completed 1 dose series of J&J Covid-19 vaccine on 4/8/2021. Tested positive for COVID-19 and presented to ED on 9/15/2021, then admitted to this hospital later that day. Discharged from hospital 9/17/2021


VAERS ID: 1727441 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-02
Onset:2021-09-15
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, COVID-19, Chest X-ray abnormal, Condition aggravated, Cough, Dementia, Diarrhoea, Dyspnoea, Hyperglycaemia, Hypophagia, Mechanical ventilation, Mental status changes, Pneumonia aspiration, Pulmonary congestion, SARS-CoV-2 test positive, Wheelchair user
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), 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), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications atorvastatin (LIPITOR) 20 MG tablet bumetanide (BUMEX) 2 MG tablet glimepiride (AMARYL) 2 MG tablet metformin (GLUCOPHAGE) 1000 MG tablet metOLazone (ZAROXOLYN) 2.5 MG tablet metoprolol succinate-XL (TOPROL-XL) 50 MG
Current Illness: NA
Preexisting Conditions: Non-Hospital Urinary retention with incomplete bladder emptying Hematochezia Hospital History of DVT (deep vein thrombosis) 3/16/2016 Pneumonia due to COVID-19 virus Aspiration pneumonia (HCC) Dementia (HCC) OSA (obstructive sleep apnea) Prolonged Q-T interval on ECG Complete left bundle branch block Type 2 diabetes mellitus (HCC) Hyperlipidemia Hypertension Morbid obesity (HCC) CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min with superimposed AKI Acute kidney injury (HCC) Acute respiratory insufficiency
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.15.21); COVID-19 positive (9.15.21); Fully Vaccinated Discharge Provider: Primary Care Provider at Discharge: Admission Date: 9/15/2021 Discharge Date: 9/23/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Weakness [R53.1] AKI (acute kidney injury) (HCC) [N17.9] Acute respiratory failure with hypoxia (HCC) [J96.01] Aspiration pneumonia, unspecified aspiration pneumonia type, unspecified laterality, unspecified part of lung (HCC) [J69.0] COVID-19 [U07.1] HOSPITAL COURSE: he patient is an 81-year-old gentleman with presented to the hospital with acute respiratory insufficiency. He was noted to have COVID-19. Number has a past medical history significant for dementia, diabetes mellitus type 2, hypertension, dyslipidemia, CKD 3 and prior DVT for which he is on Xarelto. Apparently the patient became increasingly weak over the past 2-3 days prior to admission. He is normally able to ambulate around the home with use of walker but he was so weak on the day admission that a wheelchair was needed. His also had a cough, diarrhea and reduced oral intake. The patient has dementia at baseline but his mental status has even worsened. Denies any fevers chest pain abdominal pain or vomiting. The patient has a history of having aspiration pneumonia in the past. The patient does have a history of vaccination for COVID in the past. Upon evaluation in the emergency department the patient noted to be hypoxic. He was requiring 2 L of supplemental oxygen. Also found to have AKI on CKD positive for COVID PCR. X-ray chest demonstrated mild pulmonary vascular congestion. Was started on remdesivir and dexamethasone. He is on vent to the conservative management. And was subsequently taken off oxygen. Shortness of breath and cough also resolved. He did have significant hyperglycemia while he was on steroids. The sister was subsequently discontinued. Doing fine off oxygen.Plan is for home with OT/PT.


VAERS ID: 1729087 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308443 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Fatigue, Feeding disorder, Illness, Injection site reaction, Injection site warmth, Insomnia, Pain, Pain in extremity, Pyrexia, Toothache
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall (10mg). Flu Vaccine at same time as 2nd COVID vaccine (Moderna).
Current Illness: None.
Preexisting Conditions: Seasonal allergies.
Allergies: Only seasonal; dust, pollen, grass.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Worst reaction/sickness I''ve ever had due to a vaccine or illness. Fever begin around 6pm, and continued to increase into the late night. Around 2:00am, fever reached 103.2*F. The injection sites for COVID on my left are felt like a contact sport injury to the muscle, and the skin felt like the worse sunburn I''ve ever had. I couldn''t wear a shirt, and rolling over in bed hurt. I have never experienced joint pain in my life, and this was almost debilitating. The pain was excruciating and included my fingers, knuckles, hands, elbows, kneecaps, ankles and hips. I''m an athlete and workout; I''ve never before felt anything like this in these areas. It felt like how elderly people describe arthritis. My skull has never hurt that bad from anything other than a physical injury. The range of painfulness was equal to the area covered by a combat pilot''s visor. (For the range, take your thumbs to your temple, connect your index finger tips over your head, and rotate down until you''ve reached your eyebrows). All of my top teeth were in agony. My bottom teeth did not hurt at all. Could not eat of drink. Did not sleep (was up in weird dream-wake state for 24 hours). Contacted PI, who is MD/PhD. She suggested I don''t do anything until after 48 hours. At 24 hours after reaction began, I took 3 Ibuprofen on the regular, every 4 hours. After the first dose, the fever began to decline (103.2 down to 102.5). Next morning fever broke. Skull has ached since the injection, and I''m extremely exhausted.


VAERS ID: 1729302 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

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

Life Threatening? Yes
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart inflammation (extreme chest pain)


VAERS ID: 1729321 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Burning sensation, Chills, Decreased appetite, Fatigue, Fear, Feeling hot, Headache, Pain, Pyrexia, Sleep disorder, Speech disorder, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mens multivitamin, Fish oil, Magnesium, Vitamin C, Glutamine, Multi Greens
Current Illness: Tested positive for Corona Virus on 04AUG2021
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On the 15th of September at 7:30 pm, i started to feel chills followed by shivering. About 5 minutes later, the chills disappeared and were replaced with uncontrollable shaking all over my entire body. Unable to find a position that stopped the shaking, I resorted to hugging my knees and the fetal position as I thought I was going to go into shock, or worse. My legs, lower back, upper back, shoulders, and hands were all shaking so badly that I could hardly speak a sentence clearly. This uncontrollable shaking lasted until about 08:50 pm. Immediately following the shaking, I broke out into a fever that lasted until the middle of the night, peaking at 102.8 degrees for multiple temperature checks. I was unable to sleep until after midnight at a time which is unknown due to my body being so incredibly hot, and was worried that a trip to the ER was going to be necessary. I also had concerns about the temperature of my testicles and scrotum, and resorted to taking my clothes off to try and keep as cool as possible. At one point, I had to have my wife check my skin for burns because I felt as if my limbs were physically burning each other from prolonged contact, making laying in one position for more than a couple of minutes nearly unbearable. The following day i woke with a terrible headache, body aches, a slight fever, and intense fatigue. I spent the entire day in bed, sleeping on and off with absolutely no appetite for two days to follow. Being active duty military, I have received over a dozen vaccines in the last 8 years, and not only have I never felt symptoms such as these or so intensely, but I have never been nearly as afraid as I was following this vaccination.


VAERS ID: 1729454 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-12
Onset:2021-09-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Fatigue, Hot flush, Jugular vein thrombosis, Swelling, Swelling face, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Embolic and thrombotic events, venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose of Pfizer on 9/12/2021 and began experiencing throat tightness, hot flashes and fatigue that day that progressed over the next 3 days to full blown swelling in face and neck. Patient reported to hospital and was found to have a blood clot in her jugular vein and was consequently treated with blood thinners and hospitalized for one week. (per phone conversation with patient)


VAERS ID: 1729485 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Face injury, Fall, Loss of consciousness, Skin laceration, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient had just recieved her first dose of her COVID 19 Pfizer vaccine and was waiting 15 minutes in the pharmacy waiting area where she experienced syncope and fell down from the chair she was sitting and got a cut on her forehead from the fall onto the floor. Patient was unconscious for about 30 seconds. As the pharmacist on duty I quickly responded to the patient''s side as she regained consciousness. EMS was called and quickly responded and took the patient with them under their care. Patient had filled out vaccine consent form prior to getting vaccine, counseled on possible side effects and how to manage those side effects, as well as counseled to remain in the pharmacy waiting are for 15 minutes after receiving the vaccine.


VAERS ID: 1729510 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paraguard, Simvastatin
Current Illness:
Preexisting Conditions: Breast Malignant Carcinoma Infiltration, Breast Neoplasm Fibroadenoma
Allergies: grass pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine beyond use date of 09/04/2021


VAERS ID: 1729512 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

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

Write-up: Patient received vaccine beyond use date of 09/04/2021


VAERS ID: 1729513 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 RA / IM

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

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

Write-up: Patient received vaccine beyond use date of 09/04/2021


VAERS ID: 1729515 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

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

Write-up: Patient received vaccine beyond use date of 09/04/2021


VAERS ID: 1730262 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Body temperature, Fatigue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Bit more tired than usual; Running a temp of 100.7; Sick to my stomach; This spontaneous case was reported by a consumer and describes the occurrence of ABDOMINAL DISCOMFORT (Sick to my stomach), FATIGUE (Bit more tired than usual) and PYREXIA (Running a temp of 100.7) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Immunocompromised. On 14-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 15-Sep-2021, the patient experienced ABDOMINAL DISCOMFORT (Sick to my stomach) and PYREXIA (Running a temp of 100.7 F). On an unknown date, the patient experienced FATIGUE (Bit more tired than usual). At the time of the report, ABDOMINAL DISCOMFORT (Sick to my stomach) and PYREXIA (Running a temp of 100.7F ) had resolved and FATIGUE (Bit more tired than usual) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 100.7 F (High) High. No concomitant products were reported. No treatment information was reported by the reporter. Most recent FOLLOW-UP information incorporated above includes: On 16-Sep-2021: The outcome of event (sick to my stomach and running a temp of 100.7 F) updated to recovered/resolved and newevent (bit more tired than usual) added.


VAERS ID: 1730300 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-17
Onset:2021-09-15
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue
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: USMODERNATX, INC.MOD20213

Write-up: Feeling drained and fatigued; This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (Feeling drained and fatigued) in a 49-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 047C21A and 054C21A) for COVID-19 vaccination. No Medical History information was reported. On 17-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 14-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 15-Sep-2021, the patient experienced FATIGUE (Feeling drained and fatigued). At the time of the report, FATIGUE (Feeling drained and fatigued) outcome was unknown. No concomitant medications were taken by the patient. No treatment medications were taken by the patient. Patient reported that everything was fine on 14 Sep 2021.


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