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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 502 out of 8,753

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VAERS ID: 1730324 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
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 032B21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental underdose
SMQs:, Medication errors (narrow)

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

Write-up: some of the vaccine oozed out; This spontaneous case was reported by a pharmacist and describes the occurrence of ACCIDENTAL UNDERDOSE (some of the vaccine oozed out) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032B21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Sep-2021, the patient experienced ACCIDENTAL UNDERDOSE (some of the vaccine oozed out). At the time of the report, ACCIDENTAL UNDERDOSE (some of the vaccine oozed out) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. No treatment information was provided.


VAERS ID: 1730361 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-12
Onset:2021-09-15
   Days after vaccination:34
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: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Patient got the shot from the vial that has been thawed more than 30 days; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient got the shot from the vial that has been thawed more than 30 days) in a 24-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 038821A) for COVID-19 vaccination. No Medical History information was reported. On 12-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 15-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient got the shot from the vial that has been thawed more than 30 days). On 15-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Patient got the shot from the vial that has been thawed more than 30 days) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient was administered with a vial that was thawed from the freezer more than 30 days ago and the expiration of vaccine is on 25-sep-21 and the administration was done on 15-sep-21 .However the vials were removed from the freezer to refrigerator storage on 08-april-21.


VAERS ID: 1730709 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Kentucky  
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 048F21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic sinusitis (just stuffy nose and a bit of drainage)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: I am anxious about my sinus allergies; Arm tenderness; This spontaneous case was reported by a consumer and describes the occurrence of ANXIETY (I am anxious about my sinus allergies) and INJECTION SITE PAIN (Arm tenderness) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048F21A) for COVID-19 vaccination. Concurrent medical conditions included Allergic sinusitis (just stuffy nose and a bit of drainage). On 15-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Sep-2021, the patient experienced INJECTION SITE PAIN (Arm tenderness). On an unknown date, the patient experienced ANXIETY (I am anxious about my sinus allergies). At the time of the report, ANXIETY (I am anxious about my sinus allergies) outcome was unknown and INJECTION SITE PAIN (Arm tenderness) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. 6 hours after the vaccination Patient experienced tenderness in the arm.No concomitant medications were reported. No treatment medications were reported.


VAERS ID: 1730723 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-18
Onset:2021-09-15
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling cold, Gait disturbance, Hypoaesthesia, Paraesthesia, Peripheral coldness, Skin discolouration
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Hands are still cold and numb,feet have remained ice cold,[feet] feel a little cold; Really hurts to walk; Pins and needles; she was really cold; Feet and hands went numb; They were a little blue and purplish hasn''t gotten better,[hands] turning a little blue; This spontaneous case was reported by a consumer and describes the occurrence of FEELING COLD (she was really cold), HYPOAESTHESIA (Feet and hands went numb), SKIN DISCOLOURATION (They were a little blue and purplish hasn''t gotten better,[hands] turning a little blue), PERIPHERAL COLDNESS (Hands are still cold and numb,feet have remained ice cold,[feet] feel a little cold) and GAIT DISTURBANCE (Really hurts to walk) in a 23-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 0481217 and 939902) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 18-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Sep-2021 at 6:30 AM, 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 FEELING COLD (she was really cold), HYPOAESTHESIA (Feet and hands went numb) and SKIN DISCOLOURATION (They were a little blue and purplish hasn''t gotten better,[hands] turning a little blue). On 16-Sep-2021, the patient experienced PERIPHERAL COLDNESS (Hands are still cold and numb,feet have remained ice cold,[feet] feel a little cold) and PARAESTHESIA (Pins and needles). 16-Sep-2021, the patient experienced GAIT DISTURBANCE (Really hurts to walk). At the time of the report, FEELING COLD (she was really cold), HYPOAESTHESIA (Feet and hands went numb), SKIN DISCOLOURATION (They were a little blue and purplish hasn''t gotten better,[hands] turning a little blue), PERIPHERAL COLDNESS (Hands are still cold and numb,feet have remained ice cold,[feet] feel a little cold), GAIT DISTURBANCE (Really hurts to walk) and PARAESTHESIA (Pins and needles) had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported.


VAERS ID: 1730750 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Alabama  
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 003F21A / UNK - / OT

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

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

Write-up: Expired vaccine administered way beyond 12 hours after first puncture; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered way beyond 12 hours after first puncture) in a 23-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 003F21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered way beyond 12 hours after first puncture). On 15-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered way beyond 12 hours after first puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications reported. No treatment information was provided. On 15-Sep-2021, the patient received a dose of Moderna COVID-19 vaccine from an expired vial that was sitting in the refrigerator way beyond 12 hours after it was first punctured. The vial was first punctured on 24-Aug-2021 then placed in the refrigerator and injected to one patient on 15-Sep-2021. The vial did not undergone any previous temperature excursions.


VAERS ID: 1730911 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Mississippi  
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 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Hypoglycaemia (broad)

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

Write-up: fever, chills, sweating, muscle aches, rigors, nausea


VAERS ID: 1730925 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-20
Onset:2021-09-15
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Product preparation error
SMQs:, Medication errors (narrow)

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

Write-up: 15 dose vial thawed only for 30 minutes before administration left out to thaw at room temperature for only 30 minutes, instead of 1 hour and 30minutes; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT PREPARATION ERROR (15 dose vial thawed only for 30 minutes before administration left out to thaw at room temperature for only 30 minutes, instead of 1 hour and 30minutes) in a 24-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 033B21A and 025C21A) for COVID-19 vaccination. No Medical History information was reported. On 20-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 15-Sep-2021, the patient experienced PRODUCT PREPARATION ERROR (15 dose vial thawed only for 30 minutes before administration left out to thaw at room temperature for only 30 minutes, instead of 1 hour and 30minutes). On 15-Sep-2021, PRODUCT PREPARATION ERROR (15 dose vial thawed only for 30 minutes before administration left out to thaw at room temperature for only 30 minutes, instead of 1 hour and 30minutes) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was provided No treatment received by the patient. The vial was removed from the freezer at 9:30am on 15sep2021.The patient has not reported any side effects.


VAERS ID: 1730960 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tic
SMQs:, Dyskinesia (broad), 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: NONE
Current Illness: NONE
Preexisting Conditions: COPD - Light
Allergies: NONE
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I don''t want to make a big deal about this BUT - I am 60, a heavy smoker, In very good health for my age. I have developed a Tic - a very small area - almost right betwwen my eyes , above the bridge of my nose , closer to wear my right eyebrow starts by my nore , has a thobbing sensation - like a "Tic". It vibrates off and on for lack of a better description. I can see it when it occurs - like the nerves are twitchinng just under the skin. I have zero history of "Tics" or any involuntary Muscle or Nerve Movements. I do not suffer from anxiety or any other disorder that I have ever been aware of. I have some COPD (100yr smoker) and the "tic" is prevalent immediatley after I cough - which is smoething I do a lot. It lasts only a few seconds then goes away. I can Palpate the area during the "tic" and feel the movement under the skin - it feels like a really fast pulse sort of. I have not notified any medical personnel and do not feel that it is a serious matter - just kind of uncomfortable. There is no pain or discomfort associated with it - It just feels funny to me. I rarely go to the Doctor , I am as normal as it gets and tough as a nail. I just felt like I should say something - this started a few days after my 2nd shot - I have never experianced anything like this before in my life. I am Pre Hypertensive 135/88-90 , slightly overweight and a heavy smoker and Moderate drinker. I have felt the "Tic" approx 7 times in the time it took me to type this up. Thank You.


VAERS ID: 1731195 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Areflexia, Asthenia, Blood glucose normal, Borrelia test negative, CSF culture negative, Dysaesthesia, Gait disturbance, Guillain-Barre syndrome, Herpes simplex test negative, Immunoglobulin therapy, Lumbar puncture normal, Lymphocyte percentage increased, Muscular weakness, Nucleated red cells, Protein total increased, Red blood cell count increased, Varicella virus test negative, Viral test
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: telmisartan-hydrochlorothiazide, indomethacin, atorvastatin
Current Illness: No recent illness of any kind.
Preexisting Conditions: Hypertension, hyperlipidemia, recent knee surgery
Allergies: None
Diagnostic Lab Data: Lumbar puncture with normal opening pressure, protein elevated at 118, nucleated cells in tube #1 was 8, nucleated cells in tube #4 was 16 with 71% lymphocytes. 8850 RBC in tube #1, 8450 RBC in tube #4. Glucose normal. Infectious serology''s including HSV, VZV and Lyme were negative. CSF cultures negative. Meningitis PCR panel negative.
CDC Split Type:

Write-up: 56 year old man presented with dysesthesias in his distal legs and hands, and then shortly after developed weakness in his feet, legs, hands and difficulty walking. He had his second Moderna Covid-19 vaccination on 9/10/21 with these symptoms developing an estimated 5 days later. His physical exam is remarkable for intact cranial nerves, strength is 4/5 (reduced) in both legs and most severe with ankle flexion/extension. Intrinsic hand muscle strength 4/5. Sensation intact to light touch and pin prick. Reflexes were diffusely absent. Lungs clear, heart regular without murmur, abdomen non-tender with intact bowel sounds. No rash. He was diagnosed with Guillain-Barre syndrome and treated with IVIG 400mg/kg for 5 days. He is currently on day 3 of treatment (9/24/21). Clinically he has remained stable since receiving IVIG. He did not have an EMG/nerve conduction study.


VAERS ID: 1731240 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal mass, Abdominal pain, Cholecystitis, Computerised tomogram abnormal, Splenomegaly
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: Test: CT Abdomen and Pelvis W Iv Contrast, performed on September 16th, 2021 at 11:36AM Results: Gallbladder/biliary tree - gallbladder is mildly distended but appears thin walled. Difficult to exclude endoluminal sludge or noncalcified stones. Spleen- mildly enlarged, 12cm.
CDC Split Type:

Write-up: Enlarged Gallbladder (cholecystitis) and Enlarged Spleen, resulting in sharp abdomen pain & visible mass/lump on the right side of abdomen; symptoms lasted over the course of approximately 3 days.


VAERS ID: 1731257 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Oklahoma  
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 - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Chest discomfort, Hypoaesthesia, Vaginal haemorrhage
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: My PCP has ordered and ultrasound and an echo. Have not yet been completed yet.
CDC Split Type:

Write-up: Within 30 minuets of getting the vaccine my stomach started to hurt and my chest began to tighten. My right hand began to go number along with both feet. I went to the restroom at 3pm that same day and I had vaginal bleeding ( not my period) the next day I felt like I had covid all over again. My chest is still tightening and having pressure to this day since the vaccine.


VAERS ID: 1731321 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / -

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

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

Write-up: severe vertigo,


VAERS ID: 1731425 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Arizona  
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 FF2588 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Immunodeficiency, Musculoskeletal chest pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Biktarvy, celebrex, diclofenac, magnesium oxide, albuterol inhaler, aspirin 81mg, calcitrate/vit d, rosuvastatin, lisinopril, fexofenadine, diphenhydramine
Current Illness: allergic rhinitis
Preexisting Conditions: HIV, depression, osteoporosis, numbness of limbs, sciatica, constipation, hyperlipidemia, hypertension, restless legs syndrome, asthma, impair glucose tolerance, chronic low back pain
Allergies: amitriptyline- anxiety, codeine- reaction not documented, gabapentin- drowsy, delirium, dry eyes, feeling agitate, penicillin-rash
Diagnostic Lab Data: No testing done at PIMC, pt was seen in hospital, records have not been received at time of report.
CDC Split Type:

Write-up: Pt received a 3rd dose of Pfizer vaccine since HIV/AIDS, 73 years old and multiple co-morbidities, at high risk for adverse outcomes due to COVID19. Vaccination dates 1/12/21, 2/2/21 and 9/15/21. Pt left a voicemail on 9/15, sounded inadvertent, where can hear family say "mom, if you don''t eat, I''m going to take you to the hospital". Attempted to call pt back but unable to reach. After additional calls pt finally spoke with RN, approx 17:00 on 9/15/21. reported was in a hurry to pick up grandchildren at school and didn''t wait the 15 min observation time. She became short of breath and felt she couldn''t breath while driving. At the school, the staff called 911 and she was transferred to hospital by EMS. She was given oxygen and this improved all symptoms. After feeling better, pt left AMA because of concerns for out of pocket expenses. At time of phone call, pt was feeling better and at home. Additional follow-up the next day, spoke with patient''s daughter. She said her mom was doing ok, "almost back to normal", some soreness in her ribs and tired. The patient came to phone, asked if she had been on anxiety medication previously, felt she had a panic attack after the vaccine. Pt still has unpaid hospital bills from prior situations so was concerned about money. Pt was scheduled with Dr., internal medicine and psychiatry, to determine if needs intervention for possible anxiety/panic attack on 9/21/21, pt did not keep this appointment.


VAERS ID: 1731522 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
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 - / UNK - / -

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

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

Write-up: Immediate swelling, warm, pruritus at vaccine site (left shoulder) followed by waxing and waning of the same symptoms over the following week.


VAERS ID: 1731574 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Wisconsin  
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 034C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest discomfort, Chills, Electrocardiogram, Immediate post-injection reaction, Migraine, Nausea, Pyrexia, SARS-CoV-2 test negative
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), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Patient had work up of chest X-ray, EKG, and blood work in the Emergency Room. COVID-19 test came back negative.
CDC Split Type:

Write-up: Patient reports nausea, migraine, chills, and fever immediately post vaccination. The following day the patient experience fever and chest tightness radiating to the left arm. Patient went to the Emergency Room.


VAERS ID: 1731612 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-01
Onset:2021-09-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, Menstrual disorder, Rash erythematous, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Allergies: Allergies to Penicillin and Sulfa, plastic band-aids.
Diagnostic Lab Data:
CDC Split Type:

Write-up: My menstrual period has changed. I am on Nexplanon birth control implant, I hardly bled before these vaccines doses, and now I am bleeding a lot, I actually bled through my pants. This is not normal and I would like it documented. Also, three weeks after my second dose, my left upper arm where I got both doses of this vaccine, it is sore still. The soreness went after after a week and now it is back, this is also not normal. I also have a red rash that comes and goes in the same area. Both doses required me to take Benadryl afterwards because it causes my throat to itch.


VAERS ID: 1731672 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: North Carolina  
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 (JANSSEN)) / JANSSEN - / 1 RA / IM

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

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

Write-up: Tinnitus in both ears. Ear pain in both ears.


VAERS ID: 1731682 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-06
Onset:2021-09-15
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, COVID-19, Cough, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (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: Cetirizine 10mg daily fluticasone nasal daily
Current Illness: None documented
Preexisting Conditions: allergic rhinitis
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated Runny nose, cough, congestion, loss of taste


VAERS ID: 1731727 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Pennsylvania  
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 (JANSSEN)) / JANSSEN 59676-0580-15 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Induration, Lymphadenopathy, Pyrexia, Thrombosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (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: Vitamin D 5000 iu 1x/day Claritin 1x/day Ritual pre natal vitamin 2 capsules 1x/day Dupixent 300mg subcutaneous every other week.
Current Illness: N/a
Preexisting Conditions: Asthma, eczema, seasonal allergies
Allergies: N/a
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Fever of 102 first day, second and third day went down to 100.8. Had menses during time of vaccine and passed a large piece of tissue that was approximately 1.5 inch x 1.5 inch. Appeared to be tissue/clot, was firm to the touch. Also developed enlarged lymph under armpit, that has not subsided on arm that received Injection.


VAERS ID: 1731778 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-01
Onset:2021-09-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site swelling, Mobility decreased, Rash
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish oil. Vitamin D and Daily vitamin.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: For three days post vaccine I had excruciating shoulder pain that immobilized my right arm. 8 days post-vaccine the shoulder pain/immobilization returned as did a rash and bump at the injection site.


VAERS ID: 1731856 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood urine present, Intensive care, Myalgia, Red blood cells urine negative, Rhabdomyolysis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data: 09/18/2021: CPK 69,589; CK-MB 27.8; Troponin peak value 7.41; creatinine 1.57; urine large blood with no RBC visible on microscopy.
CDC Split Type:

Write-up: Severe muscle pain from rhabdomyolysis. The muscle pain began on 9/15/21, the evening of the vaccination. Presented to the ER on 9/18/21, treatment was initiated and he was transferred to an ICU bed at Hospital for ongoing management.


VAERS ID: 1731867 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-26
Onset:2021-09-15
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 RA / IM

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

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

Write-up: Vaccinated patient hospitalized with COVID-19.


VAERS ID: 1731918 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Blood test, Chest discomfort, Inflammation, Palpitations, Panic attack
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: zyrtec for allergies
Current Illness: none
Preexisting Conditions: none
Allergies: allergy to the TB test
Diagnostic Lab Data: 9/20/21 - EKG normal, blood lab work completed at Hospital indicated inflammation. 9/23/21 - EKG normal at HSHS
CDC Split Type:

Write-up: On 9/15/21 around 2:30pm heart palpitations started and lasted on/off for about 1.5 hours. I had chest tightness/heaviness/pain following the palpitations that has remained ongoing and fluctuating in intensity. I contacted my dr''s office on 9/15/21 around 4:00pm and spoke to a nurse who stated it was likely a panic attack despite my stating I was not feeling anxious prior to the palpitations starting & that the only thing different was the vaccination. The palpitations have not reoccurred since 9/15, however the chest tightness/heaviness/pain has remained constant since 9/15 and is still currently present as of 9/24. I was sent to be checked out at Hospital on 9/20/21 where my EKG, heart rate, BP, and all labs came back normal except for one bloodwork that came back showing elevated levels for inflammation. The ER doctor told me it was likely some inflammation around the heart and that it would go away on its own in time. Said to follow up with my dr. I went to see Dr. on 9/23/21 for a follow up appointment. She did another EKG, and it as well as my vitals came back normal. After examining, she stated the labwork from the hospital showed inflammation but not specific to the heart. She stated she thinks it''s inflammation of the ribcage, and stated it is likely due to the vaccination. I requested her to put that in a note for my work since they would pay for my time off work if the symptoms/appointments are due to a covid vaccination, and she refused to do so. As of today, 9/24/21 at 2:19pm, I am still experiencing chest pain/tightness/heaviness that is central/right and radiates around the side of my ribcage. I have not been given any medication or treatment measures, other than being told it will go away on its own in time and to contact their office if it gets worse.


VAERS ID: 1731982 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vitiligo
SMQs:, Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: vitiligo on arm and around eyes, flu vaccine fall 2020, patient age 28
Other Medications: St Johns Wort tincture
Current Illness:
Preexisting Conditions: graves'' disease in remission
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Small patches of vitiligo on arm


VAERS ID: 1731984 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Unknown  
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 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Diarrhoea, Pyrexia
SMQs:, Anaphylactic reaction (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Since the first night, fever and chills, that continued for 6 days, started nonstop coughing on the 7th day, started having diarrhea on the 8th day and is still continuing today which is his 9th day. He has been taking cold medicine now cough medicine and cold and sinus pills?


VAERS ID: 1732148 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-09-15
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Rashes, welts, itchiness over body. Looks like covid like rash.


VAERS ID: 1732282 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Pharyngeal swelling, Swollen tongue, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none to my knowledge
Preexisting Conditions: anemia, seizures
Allergies: Depakote, Dilantin (similar reaction to Dilantin over 10 day period with anaphylactic symptoms and had to be hospitalized)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 9/15/21: two days after injection , developed tongue swelling that has improved 09/24/21: has had throat "swelling" and irritation Has been taking OTC benadryl Given Decadron 10 mg IM (9/24/21) and medrol dose pack (6 day course) and epi pen as prescriptions and advised to have low threshold to go to ER if symptoms worsen


VAERS ID: 1732615 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-15
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Lichen planus, Steroid therapy
SMQs:, Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone 2.5mg for lichen planus, skyrizi first year of doses completed next dose is October 7th
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have a couple of autoimmune issues and because of this I recieved the booster shot. Almost 2 weeks after my lichen planus flared up worse than ever and now it has spread to place I''ve never experienced. With my first two Pfizer shot I did not experience this. I am seeing a dermatologist and explained my current issue. We have increased my steroids so what effect does that have on the vaccine? I got the booster on September 3rd and started noticing the first flare up around September 13th. Still dealing with lichen planus and the increase of prednisone is not helping.


VAERS ID: 1733259 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Migraine, Pain in extremity, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: ongoing migranes from date of vaccine, chronic pain through entire left arm for the last 4 days, shaking that comes and goes


VAERS ID: 1733880 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 - / OT

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

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

Write-up: administered a dose from a vial left out at room temperature "greater than 24 hours"past expiration; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered a dose from a vial left out at room temperature "greater than 24 hours"past expiration) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered a dose from a vial left out at room temperature "greater than 24 hours"past expiration). On 15-Sep-2021, EXPIRED PRODUCT ADMINISTERED (administered a dose from a vial left out at room temperature "greater than 24 hours"past expiration) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported. The reporter declined being aware if the patient experienced any side effects Reporter did not allow further contact


VAERS ID: 1733914 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / OT

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

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

Write-up: one of the clinics gave an underage girl the first Moderna dose; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (one of the clinics gave an underage girl the first Moderna dose) in a 15-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Sep-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (one of the clinics gave an underage girl the first Moderna dose). At the time of the report, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (one of the clinics gave an underage girl the first Moderna dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications was not reported. Treatment medications was not reported


VAERS ID: 1733928 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-11
Onset:2021-09-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Feeling hot, Rash, Rosacea, Vaccination site erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: flared up the rosacea; rash on my opposite arm of the shot; arm that received the vaccine is "alson red like a sunburn"; it is red like a sunburn did not itched/face is red like a sunburn and feels like heat like a sunburn; my face is red like a sunburn and feels like heat like a sunburn; This spontaneous case was reported by a patient and describes the occurrence of ERYTHEMA (it is red like a sunburn did not itched/face is red like a sunburn and feels like heat like a sunburn), FEELING HOT (my face is red like a sunburn and feels like heat like a sunburn), ROSACEA (flared up the rosacea), RASH (rash on my opposite arm of the shot) and VACCINATION SITE ERYTHEMA (arm that received the vaccine is "alson red like a sunburn") in a 66-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048F21A) for COVID-19 vaccination. Concurrent medical conditions included Rosacea and Thyroid disorder. On 11-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Sep-2021, the patient experienced ERYTHEMA (it is red like a sunburn did not itched/face is red like a sunburn and feels like heat like a sunburn), FEELING HOT (my face is red like a sunburn and feels like heat like a sunburn), RASH (rash on my opposite arm of the shot) and VACCINATION SITE ERYTHEMA (arm that received the vaccine is "alson red like a sunburn"). On an unknown date, the patient experienced ROSACEA (flared up the rosacea). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Adverse event, at an unspecified dose and frequency. At the time of the report, ERYTHEMA (it is red like a sunburn did not itched/face is red like a sunburn and feels like heat like a sunburn), FEELING HOT (my face is red like a sunburn and feels like heat like a sunburn), ROSACEA (flared up the rosacea), RASH (rash on my opposite arm of the shot) and VACCINATION SITE ERYTHEMA (arm that received the vaccine is "alson red like a sunburn") had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient had taken Concomitant medication namely thyroid medication in two doses, Blood pressure medication , Lipid medication , Allergy medication and cream for the rosacea for unknown indication with an unspecified date. Patient also reported that his Rosacea condition was present before vaccination but got flared up after first dose of vaccination. This case was linked to MOD-2021-321080 (Patient Link).


VAERS ID: 1733933 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-08
Onset:2021-09-15
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Body temperature, Dysstasia, Gait disturbance, Headache, Inappropriate schedule of product administration, Pain in extremity, Pyrexia, Vaccination site haemorrhage
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: QUINAPRIL; PRAVASTATIN; HYDROCHLOROTHIAZIDE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: For 26-27 hours the patient had been having 100.8 degree Fahrenheit
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: can hardly stand up; arm really hurts; when took band aid off it was kind of bloody; Aches and pains in knees; light headache; higher fever, for 26-27 hours the patient has been having 100.8 F; First shot on 08Aug2021/Second shot on 15Sep2021; Patient had to grab onto things, and patient was staggering/could hardly get out of bed; This spontaneous case was reported by a consumer and describes the occurrence of GAIT DISTURBANCE (Patient had to grab onto things, and patient was staggering/could hardly get out of bed), DYSSTASIA (can hardly stand up), PAIN IN EXTREMITY (arm really hurts), VACCINATION SITE HAEMORRHAGE (when took band aid off it was kind of bloody) and ARTHRALGIA (Aches and pains in knees) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 048F21A and 017E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 in 2021. Concomitant products included QUINAPRIL, PRAVASTATIN and HYDROCHLOROTHIAZIDE for an unknown indication. On 08-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 15-Sep-2021, the patient experienced GAIT DISTURBANCE (Patient had to grab onto things, and patient was staggering/could hardly get out of bed). 15-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First shot on 08Aug2021/Second shot on 15Sep2021). On an unknown date, the patient experienced DYSSTASIA (can hardly stand up), PAIN IN EXTREMITY (arm really hurts), VACCINATION SITE HAEMORRHAGE (when took band aid off it was kind of bloody), ARTHRALGIA (Aches and pains in knees), HEADACHE (light headache) and PYREXIA (higher fever, for 26-27 hours the patient has been having 100.8 F). The patient was treated with PARACETAMOL (TYLENOL) on 15-Sep-2021 at a dose of 500 mg twice a day and ACETYLSALICYLIC ACID (ASPIRIN LOW) for Adverse event, at an unspecified dose and frequency. On 15-Sep-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (First shot on 08Aug2021/Second shot on 15Sep2021) had resolved. At the time of the report, GAIT DISTURBANCE (Patient had to grab onto things, and patient was staggering/could hardly get out of bed), DYSSTASIA (can hardly stand up), PAIN IN EXTREMITY (arm really hurts), VACCINATION SITE HAEMORRHAGE (when took band aid off it was kind of bloody), ARTHRALGIA (Aches and pains in knees), HEADACHE (light headache) and PYREXIA (higher fever, for 26-27 hours the patient has been having 100.8 F) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 100.8 degree fahrenheit (High) For 26-27 hours the patient had been having 100.8 degree Fahrenheit. This case was linked to MOD-2021-321134 (Patient Link).


VAERS ID: 1733936 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-18
Onset:2021-09-15
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 05E21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling hot, Influenza like illness, Joint swelling, Vaccination site pain
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Both of my legs and my stomach feel hot to the touch off and on; I have flu like symptoms; I have swelling on my left ankle; Felt very tired; I get chills; Injection site left arm is sore / injection site left arm is painful; This spontaneous case was reported by a consumer and describes the occurrence of FEELING HOT (Both of my legs and my stomach feel hot to the touch off and on), INFLUENZA LIKE ILLNESS (I have flu like symptoms), JOINT SWELLING (I have swelling on my left ankle), VACCINATION SITE PAIN (Injection site left arm is sore / injection site left arm is painful) and FATIGUE (Felt very tired) in a 63-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 939906 and 05E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. Concomitant products included PARACETAMOL (ACETAMINOPHEN) for an unknown indication. On 18-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-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, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced VACCINATION SITE PAIN (Injection site left arm is sore / injection site left arm is painful). On 16-Sep-2021, the patient experienced FEELING HOT (Both of my legs and my stomach feel hot to the touch off and on), INFLUENZA LIKE ILLNESS (I have flu like symptoms), JOINT SWELLING (I have swelling on my left ankle), FATIGUE (Felt very tired) and CHILLS (I get chills). At the time of the report, FEELING HOT (Both of my legs and my stomach feel hot to the touch off and on), INFLUENZA LIKE ILLNESS (I have flu like symptoms), JOINT SWELLING (I have swelling on my left ankle), VACCINATION SITE PAIN (Injection site left arm is sore / injection site left arm is painful), FATIGUE (Felt very tired) and CHILLS (I get chills) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Treatment information was not provided. This case was linked to MOD-2021-321153.


VAERS ID: 1733958 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-19
Onset:2021-09-15
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Feeling cold, Myalgia, Pain, Pyrexia, SARS-CoV-2 test, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 test; Test Result: Negative ; Result Unstructured Data: negative
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: don''t feel good; Feeling cold; arm hurts; body hurts/pain in body; Fever; vaccinated arm hurts; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (don''t feel good), FEELING COLD (Feeling cold), PAIN (arm hurts), MYALGIA (body hurts/pain in body) and PYREXIA (Fever) in a 51-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 050E21A and 017E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 19-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-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 FEELING ABNORMAL (don''t feel good), FEELING COLD (Feeling cold), PAIN (arm hurts), MYALGIA (body hurts/pain in body), PYREXIA (Fever) and VACCINATION SITE PAIN (vaccinated arm hurts). The patient was treated with PARACETAMOL (TYLENOL) ongoing since an unknown date for Symptomatic treatment, at an unspecified dose and frequency. At the time of the report, FEELING ABNORMAL (don''t feel good), FEELING COLD (Feeling cold), PAIN (arm hurts), MYALGIA (body hurts/pain in body), PYREXIA (Fever) and VACCINATION SITE PAIN (vaccinated arm hurts) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: negative (Negative) negative. No relevant concomitant medications were reported.


VAERS ID: 1733978 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-01
Onset:2021-09-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Peripheral swelling, Vaccination site warmth
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Sexual dysfunction (broad)

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

Write-up: Hot feeling on vaccinated spot; arm swollen; Arm numb; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (Hot feeling on vaccinated spot), PERIPHERAL SWELLING (arm swollen) and HYPOAESTHESIA (Arm numb) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In September 2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Sep-2021, the patient experienced VACCINATION SITE WARMTH (Hot feeling on vaccinated spot), PERIPHERAL SWELLING (arm swollen) and HYPOAESTHESIA (Arm numb). At the time of the report, VACCINATION SITE WARMTH (Hot feeling on vaccinated spot), PERIPHERAL SWELLING (arm swollen) and HYPOAESTHESIA (Arm numb) outcome was unknown. Concomitant medications were not provided by reporter. Treatment information was not provided by reporter. Patient''s First, second and third dose details were not reported. Reporter did not allow further contact


VAERS ID: 1734193 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101212839

Write-up: patient reports the stiffness has gotten worse, she doesn''t think it could get any worse.; received her second dose yesterday 14Sep2021 and now her whole body is stiff.; This is a spontaneous report from a contactable consumer (patients fiance). A 44-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: FF2588, Expiration date: 14Sep2021), dose 2 via an unspecified route of administration, administered in Arm Left on 14Sep2021 13:10 (age at vaccination 44 years) as dose 2, single for covid-19 immunisation. Medical history included ongoing asthma. The patient''s concomitant medications were not reported. Patient received historical vaccine Flu shot 2017 Flu Shot, ended up in the hospital because she got both strains of the flu. NDC, Lot, Expiration: Unknown Patient previously took first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, Batch/Lot Number: FA7485) via an unspecified route of administration on 24Aug2021 as single dose for COVID-19 immunization and experienced headache. The patient experienced received her second dose yesterday 14sep2021 and stiffness now her whole body is stiff on 15Sep2021, the stiffness has gotten worse, she doesn''t think it could get any worse on an unspecified date. Reporter stated caller is calling on behalf of her fiance. Her fiance received the first dose on 24Aug2021 and had a headache after this that she still has from the first dose and received her second dose yesterday 14Sep2021 and now her whole body is stiff. And asking if this is a side effect. Patient not visited physician office or emergency room. The patient did not receive any treatment for reported events. The outcome of event was not recovered. No follow up attempts are needed, No further information expected.


VAERS ID: 1734195 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Rhabdomyolysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210915; Test Name: CPK levels; Result Unstructured Data: Test Result:but didn''t have the results listed yet.
CDC Split Type: USPFIZER INC202101218230

Write-up: Rhabdomyolysis; This is a spontaneous report from a contactable pharmacist. This pharmacist reporting same events under the same suspect product for 3 patients. This is the first of three reports. A 14-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot number: FC3180, expiry date: 16Sep2021), via an unspecified route of administration, administered in Deltoid Left on 15Sep2021 (at the age of 14-years-old) as dose 2, 0.3 ml single for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient previously received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot number: FC3180, expiry date: 16Sep2021,) via an unspecified route of administration, administered in deltoid left on 14Aug2021 (at the age of 14-years-old) as dose 1, 0.3 ml single for covid-19 immunization. The pharmacist was calling about the Pfizer covid 19 vaccine and went out to a facility yesterday on 15Sep2021, gave second dose and experienced Rhabdomyolysis within 20 minutes of the vaccine. It was a mild case of rhabdomyolysis and the patient did not have to stay in the hospital. The patient went to the emergency room but was never admitted as a patient. This event happened with the patients second dose. This patient was not a foreign exchange student. The pharmacist wants to know if Pfizer has any information on this. No Serious was reported. The patient had her CPK levels checked yesterday, on 15Sep2021, but did not have the results listed yet. The outcome of the event was not recovered.; Sender''s Comments: Based on plausible temporal relationship, a possible causal association between event Rhabdomyolysis and the suspect drug BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1734197 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-24
Onset:2021-09-15
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NEXIUM [ESOMEPRAZOLE MAGNESIUM]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: Test Date: 20210915; Test Name: covid-19 virus test; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101218656

Write-up: tested positive for COVID 19; tested positive for COVID 19; This is a spontaneous report from a contactable consumer (patient). A 53-year-old non pregnant female patient received bnt162b2 (Pfizer-BioNTech COVID-19 Vaccine, solution for injection), dose 1 intramuscular on 03Mar2021 12:00 (at the age of 52-year-old) (Batch/Lot Number: E13247) as DOSE 1, SINGLE and bnt162b2 (Pfizer-BioNTech COVID-19 Vaccine, solution for injection), dose 2 intramuscular, administered in Arm Left on 24Mar2021 12:00 (at the age of 52-year-old) (Batch/Lot Number: EP6955) as DOSE 2, SINGLE for covid-19 immunisation. Medical history included Known allergies to Penicillin and Celebrex from an unknown date and unknown if ongoing. Concomitant medication included esomeprazole magnesium (NEXIUM [ESOMEPRAZOLE MAGNESIUM]) taken for an unspecified indication, start and stop date were not reported. After dose 2, the patient tested positive for covid 19 (vaccination failure) (medically significant) on 15Sep2021 12:00. The patient underwent lab tests and procedures which included covid-19 virus test (Nasal swab): positive on 15Sep2021. Patient did not receive any treatment for adverse events. Patient did not have pregnancy at time of vaccination. Patient did not receive any other vaccine in four weeks. It was reported that the patient had not been diagnosed with covid prior to vaccination. Outcome of events were not recovered. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1734229 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Dysmenorrhoea, Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101251683

Write-up: Unexpected / off-cycle vaginal bleeding and cramping for 5 days; Unexpected / off-cycle vaginal bleeding and cramping for 5 days; This is a spontaneous report from a contactable consumer, the patient. A 42-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0185) via an unspecified route of administration in the left arm on 13Sep2021 at 12:30 (at the age of 42-years-old) as a single dose for COVID-19 immunisation. The medical history included hypertension. The patient had no known allergies (NKA). Prior to vaccination, it was unknown whether the patient was diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The concomitant medications included unspecified antihypertensive medications and unspecified birth control medication; both from unknown date and unknown if ongoing. On 15Sep2021 at 06:00, the patient experienced an unexpected off-cycle vaginal bleeding and cramping for 5 days after vaccination. The event did not result in doctor or other health care professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events unexpected off-cycle vaginal bleeding and cramping for 5 days was recovered on 20Sep2021.


VAERS ID: 1734422 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Herpes simplex
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, lamotrigine, spironalactone, alprazolam, Norco, levothyroxine, liothyronine, Naprosyn, ibuprofen, acetaminophen, multivitamin, phentermine, vitamins C, D, B2, B12, biotin, chromium
Current Illness: None
Preexisting Conditions: Chronic Lyme, Hashimoto?s, HSV2, arthritis, tremors, polyarthralgia, migraines, dry eye
Allergies: Avelox, Aciphex, Zithromycin, Imitrex
Diagnostic Lab Data:
CDC Split Type:

Write-up: HSV2 outbreak the day following the vaccine administration


VAERS ID: 1734466 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 AR / SYR

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1734474 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Muscle spasms, Pregnancy test negative, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (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: Naproxen
Current Illness: N/A
Preexisting Conditions: Neck and back pain.
Allergies: Shellfish
Diagnostic Lab Data: Pregnancy test- negative
CDC Split Type:

Write-up: Severe cramping and vaginal bleeding for 3 days. On the first day it started a mild cramping with some spotting but got progressively worse for the next day.


VAERS ID: 1735126 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-01
Onset:2021-09-15
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

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

Write-up: The resident tested positive for COVID-19


VAERS ID: 1735129 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-01
Onset:2021-09-15
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

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

Write-up: Resident tested positive for COVID-19


VAERS ID: 1735135 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-01
Onset:2021-09-15
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

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

Write-up: The employee tested positive for COVID-19


VAERS ID: 1735459 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamin, topamax, singulair, wellbutrin, allegra, flonase, stelara
Current Illness: none
Preexisting Conditions: hashimotos thyroiditis , sjogrens, psoriasis, psoriatic arthritis, allergies, asthma, migraines
Allergies: Ceclor
Diagnostic Lab Data: none
CDC Split Type:

Write-up: extreme fatigue, body aches and diarrhea


VAERS ID: 1736025 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Oropharyngeal pain, Paranasal sinus discomfort
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Celexa Probiotic
Current Illness: None
Preexisting Conditions: Alports syndrome
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache Sore throat Sinus pressure Fatigue Still experiencing


VAERS ID: 1736159 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Computerised tomogram, Dyspnoea, Electrocardiogram, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood work/ ekg/ ct scan/ chest X-ray
CDC Split Type:

Write-up: Severe, Chest pain/ shortness of breath/ rapid heart rate/


VAERS ID: 1736691 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-11
Onset:2021-09-15
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Diarrhoea, Malaise, Nasal congestion, Rhinorrhoea, SARS-CoV-2 test, Vaccine breakthrough infection
SMQs:, Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 09/15/2021 PCR+ COVID-19 case at St Josephs Hospital Atlanta
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 9/15/2021: Runny Nose/Congestion, Loss of smell or taste. Hospitalized with diarrhea 9/15/2021, admitted for at least 6 days.


VAERS ID: 1736742 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-14
Onset:2021-09-15
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Anxiety, COVID-19, Computerised tomogram normal, Laboratory test normal, SARS-CoV-2 test positive, Suicidal ideation
SMQs:, Acute pancreatitis (broad), Suicide/self-injury (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), 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: Famotidine 20 mg BID FLuoxetine 40 mg daily Trazadone Hydroxyzine
Current Illness: Seen in ED prior to vaccination with painful swallowing
Preexisting Conditions: Anxiety Bipolar glaucoma Hyperlipidemia Drug abuse
Allergies: Codeine
Diagnostic Lab Data: 9/15 COVID swab +
CDC Split Type:

Write-up: Patient seen in ED with N/V (chronic problem - multiple ED visits for epigastric pain, abdominal pain, n/v) and abdominal pain - took 2 trazodone prior to admission and "passed out". Seen in ED; assessed as anxious, benign abdominal exam; labs and CT scan unremarkable during ED visit the day prior for the same. Pt was planning to be d/c and stated that "she was going to kill herself"; pt admitted with 72 hr hold for suicide. During routine testing found to be COVID +. No symptoms consistent with COVID - appears to be incidental finding.


VAERS ID: 1736856 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-05
Onset:2021-09-15
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, Cough, Fatigue, Pain, Rhinorrhoea, SARS-CoV-2 test positive, Sinus congestion, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None.
Preexisting Conditions: Mild asthma. No daily medications
Allergies: None
Diagnostic Lab Data: Covid-19 Rapid Test- mobil lab - Positive result received on 9/16/21 Covid-19 PCR Test-mobil lab - Positive result received on 9/17/21 Chest X-ray- City MD Negative for Pneumonia. Clinical indication: Asthma - 9-26-21
CDC Split Type:

Write-up: Pt had a runny nose, sinus congestion, mild cough, aches and fatigue after school on 9/15/21. She was tested for Covid (rapid and PCR) on 9/16 and tested positive on both. She was quarantined at home until 9/25/21. Coughing stopped after 3-4 days. On 9/23 she began coughing again. On 9/24, she began nebulizer treatments every 3-4 hours to control her coughing and wheezing symptoms. On 9/26 we went to urgent care because her wheezing and coughing were not improving despite continued nebulizer treatments. She received a chest x-ray, which was negative for pneumonia. Dr. prescribed a 5-day, tapering dose of Prednisone, beginning with 40 mg.


VAERS ID: 1736898 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-09
Onset:2021-09-15
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: fever/cough/chills/shortness of breath, positive covid test


VAERS ID: 1736978 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-31
Onset:2021-09-15
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 40 mg, Promacta 50 mg, Diltiazem ER 120 mg, Ezetimibe 10 mg,
Current Illness: Immunodeficiency, low platelet count
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Short breath, fadigue, increase of heart beat,


VAERS ID: 1736988 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Allergy to vaccine, Choking sensation, Hypersensitivity, Interchange of vaccine products, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Hypersensitivity (narrow), Medication errors (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? Yes
Hospitalized? No
Previous Vaccinations: Patient had an anaphylactic reaction to the Pfizer vaccine
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Bee pollen, Egg, Gluten, IV dye, Iodine containing, and Milk products
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The patient received her 1st dose Pfizer vaccine outpatient at a different facility and she had an anaphylactic reaction. However, the patient wanted to stay protected from COVID so she spoke to her doctor. Both, doctor and the patient discussed the risk vs benefit and decided to go with the Moderna vaccine as a patient 2nd dose series. The patient presented to Hospital on 9/15/21 to get her scheduled 2nd vaccine dose. Since the patient had an anaphylactic reaction previously doctor premidicated the patient with acetaminophen 2x 325mg PO ONCE, diphenhydramine 25mg PO ONCE, and loratadine 10mg PO ONCE half-hour (1:30 pm) prior to getting the vaccine dose. The patient received the 2nd dose at 2:00 pm and was stable for a half-hour after receiving the vaccine. Around 2:30 pm she started to feel itchy and felt a choking sensation so she administered her on EpiPen. Due to this, the patient was evaluated by a full code rapid response team and referred to ER. In ER she was diagnosed with an acute allergic reaction to vaccination with complete resolution. The patient felt better while she was in ER and was monitored for another half-hour prior to discharge.


VAERS ID: 1736993 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-18
Onset:2021-09-15
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chills, Echocardiogram, Electrocardiogram, Fatigue, Headache, Myalgia, Myocarditis, Pain, Pericarditis, Pyrexia, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

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

Write-up: 9/16/2021 Began having fever, chills, muscle and body aches, headache and fatigue 9/22/2021 Sent for covid test; Negative 9/23/2021 Screened for having fever, chills, muscle and body aches, headache and fatigue 9/24/2021 Admitted to Hospital for continuation of testing from myocarditis 9/25/2021 Still having inflammation around her heart, and remains in the hospital


VAERS ID: 1737076 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Rash, Rash macular, Skin warm
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: Albuterol Nebulizer, Apixaban, Aspirin, Atorvastatin, B Complex, Calcium, Fluticasone, Furosemide, Guaifenesin, Zicam, Hydroxychloroquine, Losartan, Magnesium, Magnesium Oxide, Meclizine, Montelukast, Multi Vitamin, Omega-3 Fish Oil, Omep
Current Illness: Abscess to to buttocks drained 9-2-21
Preexisting Conditions: A-fib, CHF, HTN, L-BBB, Aortic Stenosis, Keratosis, Nodule of left lung, Arthopathy, Osteoarthritis, Osteopenia, Chronic anticoagulation, Fibromyalgia
Allergies: Cephalexin, Augmentin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient developed a redness on her chest and neck with macular rash, surrounding erythema and warmth. 9-26-21 went to arms and legs.


VAERS ID: 1737190 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Every year with flu vaccine
Other Medications: no
Current Illness: no
Preexisting Conditions: back pain
Allergies: sulfa, epinephrine, codeine aspirin lidocaine latex lots of food allergy
Diagnostic Lab Data: no
CDC Split Type:

Write-up: On September 15injection site developed a rash . Rash spread to hand .


VAERS ID: 1737214 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-17
Onset:2021-09-15
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / UNK - / -

Administered by: Unknown       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:
CDC Split Type:

Write-up: Covid positve unknown contact


VAERS ID: 1737281 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Headache, Injection site pain, Pain in extremity, Peripheral swelling, Pyrexia, Wheezing
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: From previous flu vaccine. She had fever, body ache and wheezing
Other Medications: Albuterol, Zyrtec, Vitamin-D , Vitamin B-12, Iron, Folic acid, Zinc
Current Illness: no
Preexisting Conditions: Asthma, Rheumatoid arthritis
Allergies: Oranges, gluten, Lactose intolerance
Diagnostic Lab Data:
CDC Split Type:

Write-up: Employee received Pfizer Covid19 vaccine on 09/15/2021 and 5 minutes after the vaccine was administered she began feeling pain at the injection site and upper and lower right arm and hand. She also had swelling to the right hand as well. She took 2 extra strength Tylenol at that time. At about 6pm (9/15/2021) she had fever, headache, wheezing and tightness in her chest and she took 2 extra strength Tylenol. These symptoms lasted until 09/26/2021 Today 9/27/21 she only complain of mild pain at the injection site and upper and lower arm.


VAERS ID: 1737333 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-09-15
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
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: ESRD on Hemodialysis
Allergies:
Diagnostic Lab Data: Cycle threshold 22.6 on admission.
CDC Split Type:

Write-up: Patient admitted to the hospital for COVID 19. Reporting per Moderna COVID 19 EUA.


VAERS ID: 1737412 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-09
Onset:2021-09-15
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2, Sick relative
SMQs:, 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 house hold member


VAERS ID: 1737514 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-27
Onset:2021-09-15
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram abnormal, Blood creatinine increased, Bradycardia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax, Confusional state, Diarrhoea, Fibrin D dimer increased, Hypoxia, Lung opacity, Malaise, Pyrexia, Respiratory failure, SARS-CoV-2 test positive, Ultrasound Doppler normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), 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), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, cetirizine, clonidine, furosemide, gabapentin, metformin, oxybutynin, simvastatin, metoprolol succinate
Current Illness:
Preexisting Conditions: Asthma, COPD, Diabetes, Diverticulosis, GERD, HTN, Hypercholesterolemia, Melanoma , OAB , Peripheral edema, and RLS
Allergies: None
Diagnostic Lab Data: 9/19/21 COVID19: positive 9/19/21 chest xray: Patchy ground-glass opacities and airspace disease is seen at the left lung base and within the right upper lobe compatible with COVID pneumonia. No consolidation or pneumothorax is appreciated. No collapse is identified. 9/20/21 US: Neg for DVT 9/20/21 CTA chest: Findings was suggest COVID pneumonia. The reticulation raises a concern for developing fibrosis.
CDC Split Type:

Write-up: Sent from urgent care to ER on 9/19/21 after being found to have confusion. Patient presented to the urgent care for 4 days of fever, diarrhea and malaise. During evaluation in the ED she was found to be positive for covid test done in the urgent care, found to be hypoxic 85% on room air, was put on 5L oxygen. XR suggestive of covid pneumonia. COVID tested positive 09/19/2021. Vaccinated for COVID-19 February 2021, Pfizer. Started on antibiotic, dexamethasone, remdesivir. Patient had Elevated D-dimer, CT angio negative for PE, ultrasound leg negative for DVT. Cr worsened to 1.5 but later on improved with IV hydration to normal. Given 5 dose of remdesivir. Started on dexamethasone 6 mg daily to be completed 10 days of for course. And required oxygen will ranging between 4 L minimum of later with gradual decrease in the need. Through the end of the course patient was on room air saturating at 93, required minimal oxygenation on nasal cannula with exertion and and patient will be requiring home oxygen accordingly. Home oxygen is arranged to be followed up with her primary physician regarding further assessment of home oxygenation as outpatient. Patient developed better bradycardia with heart rate ranging in the 40s that that required adjustment of her medications and to be followed up with Cardiology as outpatient to further adjust her medications. Had altered mental status improved which is most likely due to respiratory failure from COVID pneumonia versus medication induced. Her diabetes was managed with sliding scale and resume the home medications upon discharge Restless leg syndrome was stable. Discharged on 9/24/21


VAERS ID: 1737619 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl taken 1 hour after vaccination
Current Illness: unknown
Preexisting Conditions: none
Allergies: Shellfish Red food coloring Iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 hour after IM injection, patient developed head to toe hives that resolved with oral benadryl


VAERS ID: 1738516 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-03
Onset:2021-09-15
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram, Ear pain, Facial paralysis, Headache, Magnetic resonance imaging
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: Flu vaccine, severe head cold and coughing, Age: 51
Other Medications: metFORMIN, calcium carbonate, metoprolol succinate XL, pantoprazole EC, rosuvastatin, Rybelsus, Vitamin D, Zinc,
Current Illness:
Preexisting Conditions: Diabetes Type 2
Allergies:
Diagnostic Lab Data: CT Scan, MRI
CDC Split Type:

Write-up: Adverse Event: Right side of face drooped, headache, ear pain. Treatment: Emergency room visit at Hospital Outcome: Diagnosed with Bell''s Palsy


VAERS ID: 1740027 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 - / -

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

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

Write-up: Headache; This spontaneous case was reported by a consumer and describes the occurrence of HEADACHE (Headache) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 022c21a) for COVID-19 vaccination. No Medical History information was reported. On 15-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Sep-2021, the patient experienced HEADACHE (Headache). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. At the time of the report, HEADACHE (Headache) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown.


VAERS ID: 1740056 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Off label use, Sensation of foreign body, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METOPROLOL SUCCINATE; ARMOUR THYROID; MELATONIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer (Patient had cancer 10 year ago.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Light in the chest; Lump in the throat; Tachycardia; Dizziness; Her doctor recommended her to delay the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of CHEST DISCOMFORT (Light in the chest), SENSATION OF FOREIGN BODY (Lump in the throat), TACHYCARDIA (Tachycardia), DIZZINESS (Dizziness) and OFF LABEL USE (Her doctor recommended her to delay the vaccine) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046C21A) for COVID-19 vaccination. The patient''s past medical history included Cancer (Patient had cancer 10 year ago.). Concomitant products included METOPROLOL SUCCINATE for Blood pressure, MELATONIN for Sleep disorder, THYROID (ARMOUR THYROID) for Thyroid disorder. On 15-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Sep-2021, the patient experienced OFF LABEL USE (Her doctor recommended her to delay the vaccine). On 18-Sep-2021, the patient experienced CHEST DISCOMFORT (Light in the chest), SENSATION OF FOREIGN BODY (Lump in the throat), TACHYCARDIA (Tachycardia) and DIZZINESS (Dizziness). On 15-Sep-2021, OFF LABEL USE (Her doctor recommended her to delay the vaccine) had resolved. At the time of the report, CHEST DISCOMFORT (Light in the chest), SENSATION OF FOREIGN BODY (Lump in the throat), TACHYCARDIA (Tachycardia) and DIZZINESS (Dizziness) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. On the night of the 17sep2021 Patient took wells sleep tea for Sleeping aid. No concomitant medications was provided by the reporter. No treatment was provided by the reporter. This case was linked to MOD-2021-323073 (Patient Link).


VAERS ID: 1740201 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia
SMQs:, Guillain-Barre 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: Pfizer, Inc. EUA 027034; Pfizer, Inc. EUA 027034; Pfizer, Inc. EUA 027034
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high (Verbatim: High blood pressure); Diabetes (Verbatim: Diabetes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101224213

Write-up: he feel like he kind of weak; he had the side effect, because he is weak; This is a spontaneous report from a contactable consumer or other non hcp. This Patient''s wife reported for a 71-year-old male patient (Husband). A 71-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Batch/Lot Number: not reported; Expiry Date: Unknown), via an unspecified route of administration, administered in Arm Right on 15Sep2021 at 13:30 (at the age of 71-years-old) as dose number unknown, single for covid-19 immunisation. Medical history included diabetes mellitus and high blood pressure. Concomitant medication included metformin; diazepam (BENZOPIN); glimepiride. The patient experienced he feel like he kind of weak; he had the side effect, because he is weak on 15Sep2021. When asked about lot number it was reported that she do not have the card. They did not give her this information, she reported when the patient got the shot on yesterday but she don''t see any card or anything. The reporter informed about her name and her husband''s name. She said her husband received the shot on yesterday and he is not, he feel like he kind of week like ''concenter'' (Further not clarified) and she was just trying to see the status check, and if the patient have to go to hospital or what, he had kid (voice not clear). He was around 169 (Pounds). She reported that she was just trying to find that how long would he had the side effect because he is weak. She was given contact details of Pfizer Medical Information Department. Outcome of the event was unknown. The lot number for the vaccine [BNT162B2] was not provided and will be requested during follow-up.


VAERS ID: 1740208 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash erythematous, Vaccination site erythema, Vaccination site pruritus, Vaccination site rash, Vaccination site swelling
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Surgery (Verbatim: Surgery for brain aneurysm)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101225786

Write-up: red, itchy rash at injection site; Red rash; red, itchy rash at injection site; Swollen size of a half dollar around the injection area; red, itchy rash at injection site; This is a spontaneous report from a contactable consumer (patient). A 53-year-old female patient received second dose of BNT162B2 (PFIZER-BIONTEC COVID-19 mRNA VACCINE, Solution for injection, lot number: 301308A and expiry date was not reported), via an unspecified route of administration, in Arm Right, on 15Sep2021 at 10:00 AM (age at vaccination: 53 years), as a single dose for COVID-19 immunization. The patient''s medical history included surgery (surgery for brain aneurysm) in Jun2020. The patient did not have family medical history relevant to adverse event. Concomitant medication included acetylsalicylic acid (ASPIRIN). Historical vaccine included first dose of BNT162B2 (PFIZER-BIONTEC COVID-19 mRNA VACCINE, Solution for injection, lot number: FA7485 and expiry date was not reported), via an unspecified route of administration, in Arm Left, on 25Aug2021 at 16:00 PM (age at vaccination: 53 years), as a single dose for COVID-19 immunization. The patient reported that on an unspecified date, she experienced red, itchy rash at injection site. The patient was treating the rash with Benadryl and ice packs. She will go see my Primary Care Provider if it gets worse or didn''t go away. On 15Sep2021, it was itchy when she was given the shot on Wednesday. Wednesday evening, she had a mild itch but no rash. The patient also reported that where the vaccine was administered, there was a red rash on 16Sep2021, and it was very itchy. Yesterday morning, at the time she got up, it was a little swollen. She figured it was because that happened with the first shot but, she did not get any rash the first time. Thursday morning, it was about the size of a half dollar around the injection area and it was itching terribly. She used Benadryl and a cold pack that seemed to help a little. The patient asked how long should she just keep treating this like it is not a big deal. When does it become a big deal and she was currently fine. It was slightly swollen and with the swelling, there was the red rash, in the area where she got the vaccine, exactly. It was right around the center, where she got the vaccine, in the right arm. It was up near the top of the shoulder. The rash was the same. The itching was a little more intense, just in the areas of redness. The patient was treated with liquid children''s Benadryl. She is pretty sensitive to Benadryl, so she used the Children''s 5mg liquid Benadryl. It did help her somewhat. The adverse events did not require a visit to emergency room or physician office. The patient did not receive any vaccine within 4 weeks prior vaccinations. There was a Product Complaint and description of complaint was while caller was reporting an itchy rash experienced after the Covid-19 vaccine, she mentioned that she has been taking Children''s Benadryl because she was sensitive to adult Benadryl. Product strength and count size dispensed: unknown NDC, LOT, EXP for adult Benadryl: Unknown, she does not take regular Benadryl because she is sensitive to it. There was no report related to a study or programme. Outcome of the events was not recovered.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101236589 same reporter/patient/product, different dose/event.


VAERS ID: 1740855 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood pressure increased, Blood test, Dyspnoea, Electrocardiogram, Fatigue, Feeling hot, Fibrin D dimer, Full blood count, Hypersomnia, Metabolic function test, Pain, Pain in extremity, Palpitations, Paraesthesia, Paraesthesia oral, Pyrexia, Swelling, Throat tightness, Thyroid function test, Troponin, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Hypertension (narrow), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Armodafinil, Lo Loestrin, B Complex, D3, Magnesium Citrate, Zinc, C, Iron
Current Illness: Unknown
Preexisting Conditions: Gastroparesis, Epstein Barr, Narcolepsy
Allergies: Unknown
Diagnostic Lab Data: Pending results.
CDC Split Type:

Write-up: September 15, 2021: Received Johnson and Johnson COVID vaccine in left arm. Within 5ish minutes felt a "warm rush", blurred vision, racing heart, shortness of breath. Nurse took blood pressure and told me it was elevated but my oxygen was 100%. Nurse stayed with me until felt well enough to go home. At home I began to feel pins and needles in my left hand. September 16, 2021: Experienced extreme fatigue and exhaustion. Had low grade fever of 101 F. Felt achy and developed cramping in left calf which traveled to my left clavicle. Went to ER. Exam and EKG was normal. Declined additional testing that that time. September 20, 2021: Experienced sensation of throat closing as well as tingling of hands, feet and lips. Led to 2nd visit to ER. Normal exam, Blood work included a normal CK, CBC, CMP, thyroid function, and troponin level. D-dimer was normal as well. Declined CT and was recommended to see Neurologist. September 21, 2021: While driving experienced tingling in hands and feet. Unable to open or close hand. Pulled over at gas station and asked worker for ER medical assistance. Once again, vitals came back normal. Declined trip to ER and had husband drive me home. September 27, 2021: Still has significant fatigue. Intermittently experiences paresthesia of hands and feet. Cramping in both calves. Feels swollen in face and hands. Caffeine triggers a panic attack sensation. Sleeping excessively despite continuing to use Armodafinil. Had MRI and blood work for ANA and sedimentation rate. Additional tests have been scheduled for EMG, blood work for B12 and copper level.


VAERS ID: 1740857 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Feeling cold, Hypoaesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (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: Pristique; Wellburtin; Metformin; Serequel; Magnesium; Zinc; Vit D3; Probiotic; Thyroid support.
Current Illness:
Preexisting Conditions: Leucocytosis; Inflammation; Joint pain; Swelling; Diabetes.
Allergies: Pennicillin; Keflex.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Metallic taste in mouth started on 9/15/2021 and still present, hands and feet numb and cold sensation feels like I have bengay on them all the time started on 9/18/2021 and still at the present and also now up in my calfs and my forearms. Im also itching some on my collar bone and legs.


VAERS ID: 1741096 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-23
Onset:2021-09-15
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Never been sick
Preexisting Conditions: Never been sick
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have covid now


VAERS ID: 1741109 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-07
Onset:2021-09-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Arthritis, Hypoaesthesia, Neck pain, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (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: Patient reports taking prescription medication: Losartan
Current Illness: NONE
Preexisting Conditions: Cardiovascular
Allergies: Gentamicin; Iodine; Aspirin; Neomycin; Penicillin
Diagnostic Lab Data: Patient will make appointment with her primary doctor
CDC Split Type:

Write-up: Female patient 91 year old oriented X3 in wheelchair accompanied by her son, she reports 8 days after receiving her first dose vaccine PFIZER with pain, inflammation and "numbness" in the joints. Patient reports pain in the neck, arms, wrists, knees and in the left lower limb, it radiates to the ankle.


VAERS ID: 1741346 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-06
Onset:2021-09-15
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Deafness unilateral, Discomfort, Ear pain, Fatigue, Flank pain, Headache, Herpes zoster, Hypoaesthesia, Paraesthesia, Pruritus, Rash, Rash vesicular, Vertigo
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Upper Respiratory Tract Infection one week prior
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Physical examination by licensed health care provider
CDC Split Type:

Write-up: Moderate symptoms after administration occurring between 24 hours and 48 hours post administration including fatigue and headache. 8 days post administration, numbness and tingling to right side of face developed. 11 days post administration, right flank pain and itching causing severe discomfort developed. 14 days post administration, sever right ear pain developed including vertigo and hearing loss. 19 days post administration, blistering and painful rash appeared on right flank. Following medical evaluation, etiology was determined to be herpes zoster - shingles outbreak. Blisters also visualized in right ear canal during medical evaluation. Anti-viral therapy initiated.


VAERS ID: 1741363 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

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

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

Write-up: Shortness of breath, gasping episodes times 6 that evening when she was lying down trying to sleep. She states that she did not go in to be seen in the ER. She "walked it off" and reports symptoms resolved in the morning. She estimated symptoms lasted 6 hours.


VAERS ID: 1741380 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-19
Onset:2021-09-15
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Computerised tomogram thorax, Demyelination, Dysstasia, Fall, Guillain-Barre syndrome, Hypoaesthesia, Intervertebral disc protrusion, Lumbar spinal stenosis, Magnetic resonance imaging head, Magnetic resonance imaging spinal abnormal, Muscular weakness, Neurological decompensation, Paraesthesia, Paraparesis, Peripheral paralysis, Spinal cord compression, Spinal decompression, Ultrasound scan, Walking aid user
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Optic nerve disorders (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: History of prostate cancer in remission (last treatment July 2021) and recently diagnosed spinal stenosis
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per ED 9/18/2021 note: The patient is an 81-year-old male with history of prostate cancer in remission as well as recently diagnosed spinal stenosis who presents to the emergency department with worsening bilateral lower extremity weakness. The patient was seen in the emergency department on Wednesday 9/15/2021 for new onset bilateral lower extremity weakness. At that time an MRI was done that shows bulging disc at L4-L5 with compression of the spinal canal. Also performed her CT angiogram of the chest and ultrasound bilateral lower extremities as well as MRI brain. The patient was discharged to home with plan to follow-up with Dr. for likely surgery. However, since Wednesday the patient has had worsened lower extremity weakness including a fall today at home. The patient has begun using a walker and was able to get around yesterday. However, today while in the bathroom he lost his balance and did have a fall resulting in no injuries, no head trauma, however he did have difficulty getting up with his wife''s help. He denies any bowel or bladder incontinence. He does have numbness and tingling bilateral lower extremities to his knees. He denies any back pain or pain going down his legs. Repeat MRI lumbar spine done today is unchanged from 3 days ago. Neurologist has recommended admission for surgery early this week. The patient is uncomfortable going home due to weakness and falls. Neuro 9/21/2021 Note: This patient is an 81-year-old male who presented with acute decompensation and paraparesis. He was evaluated in the emergency room and at that point in his clinical course it was thought not to be Guillain-Barr? syndrome. MRI demonstrated critical spinal stenosis at L4-5. The patient underwent urgent decompression following optimization on September 20, 2021. On postoperative day 1 the patient has an ascending paralysis that now involves his hands. His lower extremity weakness is now much more profound with 2 out of 5 strength proximally and distally. The patient''s clinical picture is now more consistent with an acute demyelinating syndrome. Patient does have a history of immunization approximately 4 weeks ago however denies watery or bloody diarrhea.


VAERS ID: 1741407 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: 3 weeks of right eye lid twitching after first injection


VAERS ID: 1741543 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-10
Onset:2021-09-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Facial pain, Herpes zoster, Pain, Swelling, Tenderness, Vaccination site vesicles
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 100 mcg
Current Illness: none
Preexisting Conditions: hypothyroidism
Allergies: sulfa
Diagnostic Lab Data: telehealth consultation conducted 21 September. Consultation with ENT subsequent on 22 September. Continue to experience pain, swelling, redness, tenderness.
CDC Split Type:

Write-up: 5 days after injection noted onset of L sided facial pain along distribution of trigeminal nerve. progressive severe pain, and then on day 11 post vaccination blisters formed. diagnosed with herpes zoster (shingles) of the trigeminal nerve.


VAERS ID: 1741659 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Appendicectomy, Appendicitis, Blood test, Computerised tomogram, Laparoscopic surgery
SMQs:

Life Threatening? Yes
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood tests: 09/16/2021 CT Scan: 09/16/2021
CDC Split Type:

Write-up: Adverse event: Appendicitis Treatment: Laparoscopic Appendectomy


VAERS ID: 1741788 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-07
Onset:2021-09-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Choking, Cough, Diarrhoea, Dyspnoea, Gastrooesophageal reflux disease, Headache, Nausea, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tacrolimus, prednisone, acyclovir, baby asprin, protonix, culturelle, prenatal
Current Illness: none
Preexisting Conditions: Interstitial Cystitis Uterus transplant patient
Allergies: none
Diagnostic Lab Data: Rapid test was negative
CDC Split Type:

Write-up: On 9/15 I started having nausea and very abnormal acid reflux causing me to choke. On 9/16 I had severe nausea, diarrhea, stomach cramping, headache. During that night, I had all of those symptoms, in addition to difficulty breathing and coughing. On 9/17, I started the day out feeling completely fine, however that evening, I have the severe cramping, diarrhea, nausea and headache that returned. On 9/18, I received a negative rapid covid test after doing a virtual appointment with a Dr.


VAERS ID: 1741811 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Flushing, Headache, Hyperhidrosis, Influenza like illness, Myalgia, Nausea, Pyrexia, Rash, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Entyvio Wakix Ritalin Buspar Prevacid Sulfasalazine Ursodiol Propranolol Effexor Trazadone
Current Illness: none
Preexisting Conditions: Crohn''s disease, narcolepsy without cataplexy, major depressive disorder, generalized anxiety disorder
Allergies: Remicade -hypersensitivity reaction Humira - hypersensitivity reaction seasonal molds - allergy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 15:30 day of vaccine - hives rash, grade 1 on cheeks, forehead and sides of jaw/neck area with flushing day following vaccine: grade 3 flu-like symptoms including headache, nausea, muscle aches, fever, diaphoresis Treated with oral Benadryl 25mg BID x 2 days Acetaminophen 650mg QID x 2 days Ibuprofen 500mg QID x 1 day full-recovered 72 hours following vaccination


VAERS ID: 1741891 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immediate post-injection reaction, Local reaction, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: Pt reports to have received pfizer previouly. Pt reports persistent diffuse right arm pain following injection, from right clavicle to elbow. Resolves with nsaid then pain returns. Denies any pain currently. No tenderness on palpation. Full range of motion and use of arm. Denies any numbness or loss of sensation. Denies any signs or symptoms of anaphylaxis or allergic reaction following last dose. Pt did not seek medical care for arm as it has not been bothersome enough. This RN consulted with colleague, RN, we agreed pt is safe to receive second dose and to follow up with medical provider if arm discomfort does not resolve. Pt agreed. This rn strongly advised pt receive this shot in alternate, left arm, pt refused and adamantly selected right arm despite this rn?s education around reactogenicity. This rn educated pt on low threshold to seek medical care for any urgent/emergent s/s. Pt verbalized understanding. Pt had immediate localized reaction with marked swelling. Pt quickly Left and declined observation -Pt left against medical advice. Asa rn


VAERS ID: 1742745 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Electrocardiogram, Headache, Heart rate increased, Neuralgia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Arthritis (broad), Dehydration (broad)

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

Write-up: Severe joint pain in areas already associated with arthritis and DDD Headache Elevated heart rate $g120bpm Severe nerve stimulation over entire body -felt like hitting funny bone with no stopping -was given atavax x1each 25 mg dose and sent home from first ER visit after being told it was anxiety driven -symptoms returned 8 hours later which resulted in second ER visit-was prescribed 12 each 25 mg dose every 8 hours for three days. No follow on symptoms passed 5 days post vaccination


VAERS ID: 1743528 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Allergy to vaccine, Asthenia, Diarrhoea, Diarrhoea haemorrhagic, Dizziness, Dysgeusia, Dyspepsia, Feeding disorder, Hyperhidrosis, Hyperventilation, Ocular discomfort, Swollen tongue, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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? 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: burning in my stomach; may be allergic to the shot; vomit; sweating profusely; hyperventilate; tongue was slightly swollen; blood in my diarrhea; faint; dizzy; weak; sick to my stomach; chemical or metal taste in my mouth; cloudiness in my eyes; diarrhea; too scared to eat; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA HAEMORRHAGIC (blood in my diarrhea) and SYNCOPE (faint) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 15-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Sep-2021, the patient experienced DIZZINESS (dizzy), ASTHENIA (weak), ABDOMINAL DISCOMFORT (sick to my stomach), DYSGEUSIA (chemical or metal taste in my mouth), OCULAR DISCOMFORT (cloudiness in my eyes), DIARRHOEA (diarrhea) and FEEDING DISORDER (too scared to eat). On 18-Sep-2021, the patient experienced DIARRHOEA HAEMORRHAGIC (blood in my diarrhea) (seriousness criterion medically significant), SYNCOPE (faint) (seriousness criterion medically significant), HYPERHIDROSIS (sweating profusely), HYPERVENTILATION (hyperventilate), SWOLLEN TONGUE (tongue was slightly swollen), ALLERGY TO VACCINE (may be allergic to the shot) and VOMITING (vomit). On 19-Sep-2021, the patient experienced DYSPEPSIA (burning in my stomach). At the time of the report, DIARRHOEA HAEMORRHAGIC (blood in my diarrhea), SYNCOPE (faint), DIZZINESS (dizzy), ASTHENIA (weak), ABDOMINAL DISCOMFORT (sick to my stomach), DYSGEUSIA (chemical or metal taste in my mouth), OCULAR DISCOMFORT (cloudiness in my eyes), DIARRHOEA (diarrhea), FEEDING DISORDER (too scared to eat), HYPERHIDROSIS (sweating profusely), HYPERVENTILATION (hyperventilate), SWOLLEN TONGUE (tongue was slightly swollen), DYSPEPSIA (burning in my stomach), ALLERGY TO VACCINE (may be allergic to the shot) and VOMITING (vomit) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication information was provided No treatment product information was provided company comment: This case concerns a 72-year-old, female patient with no relevant medical history, who experienced the unexpected event of diarrhea hemorrhagic. The event occurred approximately 4 days after the first dose of Moderna Covid-19 vaccine. The rechallenge was not applicable, as the event happened after the first dose. The event was considered related to the product per the reporter''s assessment. The benefit-risk relationship of Moderna Covid-19 vaccine is not affected by this report.; Sender''s Comments: This case concerns a 72-year-old, female patient with no relevant medical history, who experienced the unexpected event of diarrhea hemorrhagic. The event occurred approximately 4 days after the first dose of Moderna Covid-19 vaccine. The rechallenge was not applicable, as the event happened after the first dose. The event was considered related to the product per the reporter''s assessment. The benefit-risk relationship of Moderna Covid-19 vaccine is not affected by this report.


VAERS ID: 1743539 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-17
Onset:2021-09-15
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Balance disorder, Chills, Illness, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: AMITRIPTYLINE; ATORVASTATIN; CYCLOBENZAPRINE; GABAPENTIN; HYDROCHLOROTHIAZIDE; KLOR-CON; LEVOTHYROXINE; LISINOPRIL; MELOXICAM; METOPROLOL; PANTOPRAZOLE; PAROXETINE; TRELEGY
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: COVID-19 test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: she got sick; she could not keep her balance; high fever; chills; her joints hurt; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (she got sick), BALANCE DISORDER (she could not keep her balance), PYREXIA (high fever), CHILLS (chills) and ARTHRALGIA (her joints hurt) in a 68-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 939902 and 048F21A) for COVID-19 vaccination. Concomitant products included AMITRIPTYLINE, ATORVASTATIN, CYCLOBENZAPRINE, GABAPENTIN, HYDROCHLOROTHIAZIDE, POTASSIUM CHLORIDE (KLOR-CON), LEVOTHYROXINE, LISINOPRIL, MELOXICAM, METOPROLOL, PANTOPRAZOLE, PAROXETINE and FLUTICASONE FUROATE, UMECLIDINIUM BROMIDE, VILANTEROL TRIFENATATE (TRELEGY) for an unknown indication. On 17-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-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 ILLNESS (she got sick) (seriousness criterion medically significant), BALANCE DISORDER (she could not keep her balance) (seriousness criterion medically significant), PYREXIA (high fever) (seriousness criterion medically significant), CHILLS (chills) (seriousness criterion medically significant) and ARTHRALGIA (her joints hurt) (seriousness criterion medically significant). At the time of the report, ILLNESS (she got sick), BALANCE DISORDER (she could not keep her balance), PYREXIA (high fever), CHILLS (chills) and ARTHRALGIA (her joints hurt) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, SARS-CoV-2 test: negative (Negative) Negative. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment information was not provided. Company comment: This case concerns a 68-year-old, female patient with no relevant medical history, who experienced the unexpected events of Illness, balance disorder and expected events of Pyrexia, Chills and Arthralgia. The events occurred 29 days after the second dose of Moderna Covid-19 vaccine. The rechallenge was not applicable, as the events did not happened after the first dose. The events were considered related to the product per the reporter''s assessment. The events of Pyrexia, Chills and Arthralgia are consistent with the current understanding of the mechanism of action of the study medication The benefit-risk relationship of Moderna Covid-19 vaccine is not affected by this report.; Sender''s Comments: This case concerns a 68-year-old, female patient with no relevant medical history, who experienced the unexpected events of Illness, balance disorder and expected events of Pyrexia, Chills and Arthralgia. The events occurred 29 days after the second dose of Moderna Covid-19 vaccine. The rechallenge was not applicable, as the events did not happened after the first dose. The events were considered related to the product per the reporter''s assessment. The events of Pyrexia, Chills and Arthralgia are consistent with the current understanding of the mechanism of action of the study medication The benefit-risk relationship of Moderna Covid-19 vaccine is not affected by this report.


VAERS ID: 1743641 (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: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / UNK LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, 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: USMODERNATX, INC.MOD20213

Write-up: Dose given past the 12 hour post puncture time; Patient aged 16 years took vaccine; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose given past the 12 hour post puncture time) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Patient aged 16 years took vaccine) in a 16-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008C21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose given past the 12 hour post puncture time) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Patient aged 16 years took vaccine). On 15-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Dose given past the 12 hour post puncture time) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Patient aged 16 years took vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment information was not provided. This case was linked to MOD-2021-327879 (Patient Link).


VAERS ID: 1744151 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011021A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1744450 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Agitation, Blindness, Chest pain, Dehydration, Dyspnoea, Dyspnoea exertional, Hallucination, Hyperhidrosis, Muscular weakness, Pain, Pancreatitis acute
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: morpholine, hydrocodone, furosemide, ceanaplus, lisinopril, generic Prilosec
Current Illness: No
Preexisting Conditions: Non Hodgkin''s lymphoma, leukemia
Allergies: No
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: I have been having hallucinations and agitations more than usual. I also have loss of vision. I have sharp shooting debilitating pains in my chest. I have also been diagnosed with acute pancreatitis. My breathing has become more labored. I have to take 3-4 breathing treatments a day which I have not had to do before. I cannot walk 500ft without being out of breath. My legs are extremely weak almost to a point where I require a wheelchair. I was sweating profusely much more than my body was taking in and was showing extreme signs of severe dehydration. I had to drink 2 bottles of Pedialyte and had IV hydration. I was put on potassium vitamins for dehydration. These are all new and were not an issue before. Note: I am in hospice care so I am unable to go to the hospital or I will lose my hospice. I was treated in hospice


VAERS ID: 1744492 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-08
Onset:2021-09-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER FC3182 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood test abnormal, Chills, Electrocardiogram normal, Fatigue, Hepatic enzyme increased, Hypoaesthesia, Palpitations, Tremor, Urine analysis abnormal
SMQs:, Liver related investigations, signs and symptoms (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: Prostat Cancer
Allergies: Cefuroxime
Diagnostic Lab Data: Blood and urine high reading of liver Tested 9/16/21 and 9/21/21 Liver improving but still high, more testing to be done. EKG 9/28/21 - normal Tests scheduled Echo, and Stress
CDC Split Type:

Write-up: Weakness, heart pounding, loss of feeling in both arms, chills, shaking, fatigue .


VAERS ID: 1744512 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-16
Onset:2021-09-15
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Hypoxia, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Actos, Mult vit, Apixaban, ASA, Colace, Digoxin, Lasix, Vit D3 Glimepiride, Mag Ox, Metoprolol, Midodrine, Polyethylene glycol, Pravastatin
Current Illness: Unknown
Preexisting Conditions: CAD, CHF, DM, HTN, Parkinson''s disease/dementia, Afib, Hypothyroid, Stage 3 CKD, GERD, Hypercholesteremia, Prostate CA
Allergies: Metformin
Diagnostic Lab Data: 09/15/21 SARS COV2 COVID 19 PCR (DETECTED)
CDC Split Type:

Write-up: 09/15/21 The patient presents with Respiratory distress. Per EMS, they were called after the pt became hypoxic, with accompanying sob, x1 hour. HPI is limited due to pt''s condition. The onset was 1 hours ago. The course/duration of symptoms is constant. Degree at onset unknown. Degree at present severe. The Exacerbating factors is unknown. The Relieving factors is unknown. Risk factors consist of coronary artery disease, congestive heart failure, diabetes mellitus and hypertension.


VAERS ID: 1744657 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-01
Onset:2021-09-15
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Military       Purchased by: ?
Symptoms: Abdominal pain, Ageusia, Anosmia, Asthenia, Chills, Cough, Diarrhoea, Dizziness, Dyspnoea, Fatigue, Headache, Hyperhidrosis, Nasal congestion, Nausea, Polymerase chain reaction, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Migraines
Allergies: Bactrim - Hives
Diagnostic Lab Data: PCR 9/21/21
CDC Split Type:

Write-up: on 9/15/2021 the following symptoms started : cough, nasal congestion, rhinorrhea, fever, chills, sweats, loss of smell and taste, headaches, abd pain, nausea, diarrhea, light headedness, SOB, fatigue, weak, tired


VAERS ID: 1744685 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-31
Onset:2021-09-15
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2584 / 1 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atenenol 25 mg.
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: bloodwork; angiogram
CDC Split Type:

Write-up: mild heart attack - 15 days after vaccination


VAERS ID: 1744767 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-18
Onset:2021-09-15
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, 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? 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: September 15, 2021 in house test COVID-19.
CDC Split Type:

Write-up: Patient tested positive after exposure to child positive for COVID-19 with symptoms and test on 9/15/21 with COVID breakthrough after having full Covid vaccination.


VAERS ID: 1744995 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-05
Onset:2021-09-15
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Homeless, Limb discomfort, Pain, Unemployment
SMQs:, Anaphylactic reaction (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: 9th grade MMR resulted in mumps
Other Medications: no
Current Illness:
Preexisting Conditions: high blood Asthma PTSD Panic attacks
Allergies: Geodome codeine
Diagnostic Lab Data: unable to seek medical care . Homeless and unemployed
CDC Split Type:

Write-up: Reaction on left side of chest and arm . feels like bee sting . Very painful.


VAERS ID: 1745043 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Under the age of 18


VAERS ID: 1745079 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armor thyroid, Vitamin D, Melatonin, Colace, Ibuprofen PRN
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: vasovagal/syncopal episodes morning after receiving the vaccine. Resting HR was 115 BPM for the whole morning.,no fever present. Normally HR is in the 50''s. HR still mildly elevated in the 70''s.


VAERS ID: 1745282 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Full body rash from 9/15/2021 - present


VAERS ID: 1745302 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2024214 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Herpes zoster, Lumbar puncture, Meningitis viral, Neutropenia, Pyrexia, Seizure, Thrombosis, Ultrasound Doppler, Vomiting, X-ray
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: none
Preexisting Conditions: Lymphedema Distichiasis
Allergies: Dairy, Gluten, some cosmetic chemicals
Diagnostic Lab Data: blood test, spinal tap, x-rays, CT scan, doppler ultra sound.
CDC Split Type:

Write-up: High fever and convulsions 9 hours after injection. Diagnosed with shingles 48 hours after injection, within another 48 hours violent vomiting and fever ensued and individual was diagnosed with viral meningitis and neutropenia. 7 days later individual was diagnosed with blood clots in arm and leg. Outcome is yet to be determined.


VAERS ID: 1745346 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-02
Onset:2021-09-15
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Cellulitis, Computerised tomogram head abnormal, Constipation, Cough, Dyspnoea, Hepatitis viral test negative, Illness, Interferon gamma normal, Pyrexia, SARS-CoV-2 test positive, Serology negative, Swelling face, Thrombocytopenia, Viral infection, White blood cell count increased
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), 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: Pt completed 2y maintenance Rituxan on 6/11/21
Current Illness: h/o follicular lymphoma on maintenance Rituxan completed 6/11/21
Preexisting Conditions: 32 Y male h/o follicular lymphoma (Dx 12/2018, no s/p R-CHOP and 2y maintenance Rituxan recently completed 6/2021, currently under annual surveillance), who was COVID+ 9/10/21
Allergies: nka
Diagnostic Lab Data: Results as of 9/29/2021 12:07 9/15/2021 22:30 9/16/2021 05:52 9/17/2021 05:41 CRP, SER QL: 5.1 (H) 9/17/2021 09:45 9/18/2021 05:48 CRP, SER QL: 1.9 (H) 9/19/2021 05:30 9/20/2021 05:50 CRP, SER QL: 2.7 (H) 9/21/2021 05:50 CRP, SER QL: 5.4 (H) 9/21/2021 11:34 9/21/2021 19:53 9/22/2021 06:01 CRP, SER QL: 6.4 (H) 9/22/2021 14:50 9/23/2021 05:49 CRP, SER QL: 2.3 (H) 9/24/2021 05:51 CRP, SER QL: 1.1 (H) 9/25/2021 05:57 CRP, SER QL: 0.5 9/26/2021 06:03 CRP, SER QL: 0.3 9/27/2021 05:48 CRP, SER QL: 0.2 9/27/2021 11:44 9/28/2021 05:43 CRP, SER QL: 0.1 9/29/2021 06:12 CRP, SER QL: 0.1
CDC Split Type:

Write-up: 32 Y male with PMHx of follicular lymphoma diagnosed 12/2018, s/p R-CHOP and 2 year maintenance rituxan recently completed 6/2021, and currently under annual surveillance. Received Moderna vaccine 4/4 and 5/2. Developed fever and cough on 9/8. Tested covid positive on 9/10. Presented with worsening SOB. COVID Pneumonia, Acute hypoxemic Respiratory failure - symptom onset on 9/8/21. COVID positive on 9/10/21. Last fever 9/18. Initially on decadron 6mg daily. Due to increased FiO2 requirement, increased to 10mg daily on 9/17 and switched to solumedrol 125 mg q6h on 9/21 and then 250 mg q6h on 9/22 when his FiO2 increased to 35 lpm and 60%. Started steroid taper on 9/25 and transitioned to decadron 10mg BID on 9/27-28). Then plan 6mg BID x 2 days then stop. FiO2 requirement continues to decrease, now down to 3 lpm. Received tocilizumab on 9/21 and 9/22. Hep panel, gamma interferon, cocci serology are negative. Completed remdesivir course (9/16 - 9/20). Left cheek cellulitis - developed left cheek swelling than increased over several days. CT on 9/27 showed cellulitis. Reviewed with ENT, did not think there was an abscess. Started unasyn. WBC has increased but remains afebrile. Can consider re-imaging if not improving/develops fever. Thrombocytopenia - mild, likely due to viral illness. Resolved. Constipation - resolved with miralax, prn lactulose and changing Robitussin AC to prn Primary Procedures: None Secondary Procedures: None


VAERS ID: 1745375 (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: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BA30135 / 1 RA / SYR

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

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

Write-up: Severe rash/hives on neck, armpits,legs, arms


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