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From the 1/14/2022 release of VAERS data:

Found 1,031,637 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

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VAERS ID: 1897236 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-11-20
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Alcohol withdrawal syndrome, Balance disorder, Bursitis, COVID-19, Cognitive disorder, Computerised tomogram thorax abnormal, Lung opacity, Muscular weakness, Pleural effusion, Polyneuropathy, SARS-CoV-2 test positive, Spinal stenosis, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Interstitial lung disease (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), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler Bacillus Coagulans-Inulin (PROBIOTIC FORMULA PO) Calcium Carbonate-Vit D-Min (CALTRATE 600+D PLUS PO) cholecalcifero
Current Illness: 11.8.21 - CT thorax with contrast: Small to moderate left pleural effusion, new from previously. Minimal groundglass opacities in the left lung, nearly resolved from previously. No evidence for metastatic disease in the chest. 11.9.21 - outpatient neurology visit (He presents for post-hospital follow-up regarding lower extremities weakness and cognitive concerns. Agree with inpatient team that weakness and imbalance was likely multifactorial and related to polyneuropathy, spinal stenosis, bursitis, and deconditioning.) Alcohol-induced polyneuropathy / alcohol abuse / cirrhosis
Preexisting Conditions: Unspecified essential hypertension Former smoker Pulmonary nodules Chronic rhinitis Alcohol abuse Cancer of true vocal cord OSA (obstructive sleep apnea) Prediabetes Neuromuscular weakness Cardiomyopathy
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (11.22.21); COVID-19 positive (11.20.21); Fully Vaccinated Diagnosis: COVID-19, Acute respiratory failure with hypoxia Discharge Provider: MD Primary Care Provider at Discharge: MD Admission Date: 11/22/2021 Discharge Date: 11/23/2021 DETAILS OF HOSPITAL STAY PRESENTING PROBLEM: Hypoxic [R09.02] COVID-19 [U07.1] Acute respiratory failure with hypoxia [J96.01] HOSPITAL COURSE: Patient is a 66 y.o. male with a past medical history of liver cirrhosis secondary to alcohol abuse, chronic obstructive pulmonary disease, hypertension and obstructive sleep apnea who with hypoxia, COVID-19 positive. Patient was admitted to the medical service. He was started on dexamethasone and remdesivir. His clinical condition improved overnight. The patient was had no evidence of hypoxia on ambient air. Vital signs were stable. He did receive Ativan for tremors thought to be secondary to alcohol withdrawal. The patient''s wife is a nurse. The patient was discharged on 11/23/2021 in stable condition. He was asked to return to the hospital if he had worsening fever chills or evidence of hypoxia.


VAERS ID: 1897262 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was accidently given 0.2 mL of adult Prizer 30 MCG/0.3 mL instead of Pfizer 10 MCG/0.2 mL. There have been no known adverse events reported, or treatments needed that facility is aware of.


VAERS ID: 1897263 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 RL / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was accidently given 0.2 mL of adult Prizer 30 MCG/0.3 mL instead of peds Pfizer 10 MCG/0.2 mL. There have been no known adverse events reported, or treatments needed that facility is aware of.


VAERS ID: 1897274 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 RL / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was accidently given 0.2 mL of adult Pfizer 30 MCG/0.3 mL instead of peds Pfizer 10 MCG/0.2 mL. There have been no known adverse events reported, or treatments needed that facility is aware of.


VAERS ID: 1897278 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 RL / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was accidently given 0.2 mL of adult Pfizer 30 MCG/0.3 mL instead of peds Pfizer 10 MCG/0.2 mL. There have been no known adverse events reported, or treatments needed that facility is aware of.


VAERS ID: 1897286 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 LL / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was accidently given 0.2 mL of adult Prizer 30 MCG/0.3 mL instead of peds Pfizer 10 MCG/0.2 mL. There have been no known adverse events reported, or treatments needed that facility is aware of.


VAERS ID: 1897289 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was accidently given 0.2 mL of adult Prizer 30 MCG/0.3 mL instead of peds Pfizer 10 MCG/0.2 mL. There have been no known adverse events reported, or treatments needed that facility is aware of.


VAERS ID: 1897292 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Heart rate increased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Fluconazole 50mgx 1/day
Current Illness: Sore/irritated throat for 3 months - attempting treatment with Fluconazole.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills and increased heart rate for approximately 5 hours.


VAERS ID: 1897294 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was accidently given 0.2 mL of adult Pfizer 30 MCG/0.3 mL instead of peds Pfizer 10 MCG/0.2 mL. There have been no known adverse events reported, or treatments needed that facility is aware of.


VAERS ID: 1897297 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was accidently given 0.2 mL of adult Prizer 30 MCG/0.3 mL instead of peds Pfizer 10 MCG/0.2 mL. There have been no known adverse events reported, or treatments needed that facility is aware of.


VAERS ID: 1897304 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Erythema, Infection, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I got a large red hot to touch on Saturday morning. I went to a Urgent Care told me it was a secondary infection cellulitis I was prescribed antibiotic. I''m better today.


VAERS ID: 1897309 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LL / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Gingival swelling, Pain, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient''s mother relates that patient got her 1st COVID vaccine on Thursday, 11/18/2021, along with her other siblings. On Friday, 11/19/2021, she was feeling tired and achy and she gave her a dose of Ibuprofen. Then on Saturday, 11/20/2021, patient woke up with swelling to the right side of her face and her upper gums. Patient''s mother called and spoke with a provider at a prompt care and was encouraged to bring patient to an ER. Patient was brought to the ED on 11/20/21 after giving her a dose of Benadryl at home. Patient''s mother relates that patient was discharged from the ED with instructions to continue Benadryl and cool compresses. The ED notes state that patient had minimal swelling to the right eyelid and the upper gums and had no swelling to the tongue, lips, or pharynx and was not having any difficulty with breathing. Patient''s mother relates that patient is doing better and has not had to have any Benadryl since Sunday, 11/21/2021.


VAERS ID: 1897316 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GJ1611 / 3 RL / IM

Administered by: Public       Purchased by: ?
Symptoms: Immunisation, Incorrect dose administered, Incorrect route of product administration, No adverse event, Syringe issue
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: An IM injection was administered in the patient''s right arm. When the plunger on the syringe was pushed liquid leaker out around the needle. The vaccinator was unable to determine how much of the dose was injected into the patient, and how much leaked out. Pt has a contraindication to receiving injection in left arm due to hx of breast cancer. Full dose of vaccine was then administer in patient''s right thigh. No adverse effects to vaccination reported.


VAERS ID: 1897326 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Dyspnoea, Fall, Grunting, Hyperhidrosis, Loss of consciousness, Muscle rigidity, Mydriasis, Pallor, Seizure like phenomena, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Multiple events of lightheadedness with vaccination and blood draws.
Other Medications:
Current Illness:
Preexisting Conditions: Patient and his wife reported that he gets lightheaded with blood draws and normally needs to be lying down for them. They also reported that with his 2nd Moderna dose 6 months prior he got very lightheaded and possibly passed out at that time as well.
Allergies:
Diagnostic Lab Data: On 11/22/21 this PHN made a call to Nurse (this PHN did not get Patient''s number on site) to check in. Patient is feeling much better, but does have lab work scheduled as well as an appt with his PCP and a cardiologist as follow-up.
CDC Split Type:

Write-up: A staff member reported there was a client "on the floor" in the observation area. This PHN asked NP to assist with possible emergency. Both providers to patient side, this PHN went to grab cot as patient reported feeling "lightheaded." Patient initially refused treatment, but was then willing to move to cot from floor. After about a minute on the cot, Patient became more pale and lost consciousness. Patient''s pupils dilated fully, RR was 6 with wheezes, gasps, and grunts, and his body went rigid with tonic clonic, seizure-like movements. His wife, was present and this PHN asked her to call 911, Patient came to several seconds later and was able to respond to his name. VS: 110/60, HR: 68. RR even and increased, skin: color returning but pale, diaphoretic. EMTs arrived shortly after Patient regained consciousness and we transferred care to them. They eventually cleared Patient, as he declined transportation to the ED, and he left the site.


VAERS ID: 1897398 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, Rash macular
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: VIT C, B12,
Current Illness:
Preexisting Conditions:
Allergies: CEPHALOSPORINS, ERYTHROMYCIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: RED ITCHY BLOTCH ON ARM AND FOREHEAD


VAERS ID: 1897405 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-27
Onset:2021-11-20
   Days after vaccination:297
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1897420 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-15
Onset:2021-11-20
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 - / -

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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: POS on admission 11.20.21
CDC Split Type:

Write-up: dyspnea


VAERS ID: 1897452 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Peripheral swelling, Pruritus, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: dizzyne and headache, arm became hot and swollen throught the night, itchy


VAERS ID: 1897495 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-12
Onset:2021-11-20
   Days after vaccination:281
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

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

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

Write-up: Patient has active COVID19 after being fully vaccinated with 2 doses of Moderna (jan & february 2021)


VAERS ID: 1897504 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, vitamin D, Cymbalta, Pepcid, Glucotrol, Xalatan, Cozaar, Glucophage, Lopressor, Procardia XL, Crestor, Amlactin,
Current Illness: CAD, GERD, Obesity, PVD, Diastolic Heart Failure, Paraxysmal A Fib
Preexisting Conditions: HTN, CKD Stage 2, DM Tyoe 2
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received a fourth COVID 19 vaccine dose during an office visit to see his primary care provider.


VAERS ID: 1897523 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Neuralgia, Pain
SMQs:, Peripheral neuropathy (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: Guardasil, IM Vannine, 2008
Other Medications: Levothyroxine, Omeprazole, Zoloft, Mylan, Pre-natal vitamins
Current Illness:
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Nerve pain started after the second vaccination. Felt in all 4 limbs. Strong, sharp, throbbing pain that comes and goes without warning or cause.


VAERS ID: 1897560 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-11-20
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 11/20/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1897574 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Febrile convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 50mg zoloft sprintec birth control .5mg klonopin
Current Illness: n/a
Preexisting Conditions:
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: febrile Seizure / fever


VAERS ID: 1897598 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-11-20
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / -

Administered by: Public       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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 11/20/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1897600 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Hypoaesthesia, Immediate post-injection reaction
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Sexual dysfunction (broad)

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

Write-up: IMMEDIATELY AFTER INJECTION SHE INDICATED SHE HAD TROUBLE BREATING AND FELT NUMB ALL OVER HER BODY.PHARMCY TECHNICIAN CALLED 911 FOR PARAMEDICS IN THE MEANTIME I GAVE HER AN EPIPEN INJECTION WHICH SHE IMMEDIATELY INDICATED SHE FELT BETTER AND HAD IMPROVED BREATHING. THE PARAMEDICS CAME IN A FEW MINUTES AND CHECKED HER AND TOOK HER TO THE HOSPITAL. LATER IN THE DAY SHE STOPPED IN WITH A PRESCRIPTION FROM ER AND INDICATED SHE WAS FEELING BETTER.


VAERS ID: 1897640 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-11
Onset:2021-11-20
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abscess, COVID-19 pneumonia
SMQs:, 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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid pnuemonia, abscess


VAERS ID: 1897649 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-11-20
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Headache, Nasal congestion, Pain, Pyrexia, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: headache, body aches, dry cough, fever-highest at 102, fatigue, chills, sinus congestion, nasal congestion,. starting 11/20/21


VAERS ID: 1897651 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-11-20
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / UNK LA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897658 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-11-20
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21 / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 RA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897663 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-17
Onset:2021-11-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Mobility decreased, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone - 50mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash, inability to raise arm over shoulder, swelling. Nurse advised to go to Urgent Care, who prescribed Bactrim for Cellulitis.


VAERS ID: 1897666 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-11-20
   Days after vaccination:283
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 RA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897678 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Anticoagulant therapy, Burning sensation, Chest X-ray, Chills, Constipation, Coronary arterial stent insertion, Coronary artery thrombosis, Cough, Dizziness, Echocardiogram, Electrocardiogram, Fatigue, Full blood count, Headache, Hyperhidrosis, Intensive care, Lipids, Metabolic function test, Myalgia, Myocardial infarction, Nausea, Pain, Pyrexia, Surgery, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: low dose aspirin
Current Illness: none
Preexisting Conditions: heart problems: MI in 2014, lifelong paroxysmal atrial tachycardia triggered by stimulants.
Allergies: statins, floxin antibiotics, cephalosporin antibiotics, etc. Robaxal, stimulants like caffeine, cleaning chemicals and air fresheners, beta blockers
Diagnostic Lab Data: In hospital ER, surgery, and ICU conducted, multiple blood tests (lipid, CBC w/o Diff, basic metabolic panel, Troponin, activated clotting time, ) chest x-ray, echocardiogram, EKG,
CDC Split Type:

Write-up: 11/20/2021 headache, chills, fever, aches, soe muscles, shallow cough, twinges, dizzy, nausea, fatigue. Much worse than either of the first two doses of the Pfizer vaccine. All day, all night. 11/21/2021 at approximately 6am nausea, need to have BM without success, profuse full-body sweating. Went to ER. Had a heart attack. Emergency heart surgery found blood clot in the RCA. Implanted two stents in the RCA. Recovered in coronary ICU. Given aspirin, heparin, ticagrelor, metoprolol tartrate, plus some sedative during surgery. 11/22/2021 moved from ICU to coronary ward, recovery continued 11/23/2021 echocardiogram, lipid, and EKG results sufficient to release from hospital. New prescriptions set up - continued Prescribed metoprolol tartrate 25mg daily, repatha 1ml every 14 days, ticagrelor 90mg 2 times a day, aspirin 81mg daily, cholecalciferol 25mcg daily, nitroglycerin PRN. Prescribed 12 weeks of 3x/week cardio rehabilitation. 11/24/2021 recovering at home. Sore, fatigue, but no chest pain. Skin of legs and arms burning. I got my seasonal flu vaccine at the pharmacy and got the standard quadrivalent shot. I am assuming that it was the Afluria Quadrivalent but I do not have the paperwork any longer. I assume the records could be obtained from the pharmacy is needed. I got the flu vaccine 15 days before the booster COVID vaccine.


VAERS ID: 1897758 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-07
Onset:2021-11-20
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization with pneumonia.


VAERS ID: 1897762 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar nausea after second dose of Pfizer, April 23, 2021.
Other Medications: Daily multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I got my booster shot at 4:45pm on a Friday. The next morning I woke up at 4am feeling nauseous and I vomited. At 6am I woke up and vomited again. I had a fever of 102.4, body aches, and a headache. At about 8am I vomited again. By 2pm I felt well enough to eat a little and I took 1000mg Acetaminophen. At 8pm (27 hours after my booster shot) my fever peaked at 104 degrees. I was shivering under five blankets. I took 1000mg Acetaminophen at 8pm. At 9pm my fever had reduced to 102.3. At 11pm my fever was down to 100.2 and I took 600mg ibuprofen. The third day my fever peaked at 5pm at 101.3 (I had taken 1000mg Acetaminophen one hour before). The fourth day I had no fever and felt back to normal. (I had a nearly identical experience with nausea/vomiting after my second shot of Pfizer, but my fever got much higher after the booster shot.)


VAERS ID: 1897838 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-24
Onset:2021-11-20
   Days after vaccination:269
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthenia, Blood folate normal, Blood thyroid stimulating hormone, COVID-19, Dyspnoea exertional, Fall, Monoclonal antibody unconjugated therapy, Physical deconditioning, SARS-CoV-2 test positive, Thyroxine normal, Vitamin B12 normal
SMQs:, Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine-benazepril (LOTREL) 5-20 MG per capsule atorvastatin (LIPITOR) 40 MG tablet donepezil (ARICEPT) 10 MG tablet enzalutamide (XTANDI) 40 MG tablet levothyroxine (SYNTHROID) 175 MCG tablet Relugolix (ORGOVYX) 120 MG TABS
Current Illness:
Preexisting Conditions: Benign essential hypertension Dementia (HCC) History of malignant neoplasm of prostate Hyperlipidemia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 11/20/21-still currently admitted; COVID-19 positive 11/20/21; fully vaccinated ASSESSMENT / PLAN: Patient is an 85yo male with PMH that includes dementia, HTN, HLD, hypothyroidism who is presents with weakness and was found to be COVID positive. #COVID-19 COVID positive on 11/20/21. Received Pfizer vaccine x 2 in February. Symptoms include dyspnea on exertion, unclear date of onset. Stable on RA. - Order CXR - Lovenox - Decadron, remdesivir not indicated, may consider if worsening respiratory status - Consider MAB 11/22/2021 note: COVID-19 Recent increased weakness and falls most likely due to COVID-19 infection or potentially deconditioning. B12/folate WNL. TSH elevated at 9.6, T4 WNL less likely to be due to hypothyroidism. Plan -Monoclonal antibody being administered today -does not qualify for other COVID treatments as patient on room air -PT/OT ordered -Consult to care manager -PMR consult- recommend SAR or home with assistance 11/24/2021 Note: Discharge Coordination/Progress: Patient''s spouse requests to take patient home today.


VAERS ID: 1897843 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Fatigue, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: Pneumonia vaccine , age 57, 2007, fever lasted 1 week, arm swelled and discolored, unknown type of vaccine
Other Medications: Lotrel, Lipitor, Metoprolol, Finasteride, Green Tea, Vit. D, Multivitamin
Current Illness: none
Preexisting Conditions: hypertension,
Allergies: Ancef,
Diagnostic Lab Data: none
CDC Split Type:

Write-up: after slight headache and fatigue for the first 2 days after injection, I felt OK but the third day, early AM I had some diarrhea and dizziness with nausea and headache throughout the next 2 days and I was very tired, achy and headache returned. This was followed by 3 more days of fatigue with slight headache. This is the 7th day and I am feeling somewhat better but still tired. I hope this is the last of it.


VAERS ID: 1897855 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-15
Onset:2021-11-20
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anosmia, COVID-19, Nasal congestion, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: 11/22/2021 PCR + for Covid
CDC Split Type:

Write-up: Client vaccinated with Pfizer vaccines for Covid in April and May 2021. Symptoms developed 11/20 - nasal congestion, loss of smell. Reported as a case of breakthrough Covid in a previously vaccinated person.


VAERS ID: 1897882 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-29
Onset:2021-11-20
   Days after vaccination:326
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM

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

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

Write-up: patient had positive covid test after 2 vaccines


VAERS ID: 1897926 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-16
Onset:2021-11-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013FR21A / 3 RA / IM

Administered by: Unknown       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient noticed a rash that started on his left arm on 11/20/2021, which eventually spread to his right arm. Rash was not on his chest or back. He did not seek medical care. Recommended f/u with PMD at time of patient report.


VAERS ID: 1897953 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: Xybal, Delsym, Robitussin PM, Chamomile,Herbal Tea, CBD Gummie, Albuterol, Mylanta
Current Illness: Nov 6. Upper Respiratory illness (Cough w/mucus, sore throat, sinus pressure, ect.) Resolved on about 14th.
Preexisting Conditions: Seasonal Allergies, Asthma, GERD
Allergies: Iodine, Doxycycline, Norco, medical adhesive
Diagnostic Lab Data: Physical and history. No Test or Labs done.
CDC Split Type: vsafe

Write-up: 11/20/2021 Wheezing on saturday, was constant by that tuesday(10/23/2021) and was constantly coughing and cough syrup and rescue inhaler was not helping much. It was very hard to breath correctly and couldn''t converse much. Went to Urgent care but they did not have the facilities for my asthma. Referred to ER. After observation and confirming 3 prior CoVid test(negative) Oral corticosteroid administered Dexamethasone was issued a new inhaler and was told to resume my Q bar for treatment.


VAERS ID: 1897960 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Dyspnoea, Electrocardiogram normal, Tachycardia, X-ray normal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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: Covid (2nd)- I had a fever and felt sick. (3/29/2021)
Other Medications: Escitalopram 20mg 1xday Victoza 1.2mg injection 1xday Xyzal 5mg 1xday Zetia 10mg 1xday Montelukast 10mg 1xday levothyroxine 88mcg 1xday Propranolol 10mg 2xday Vitamin D3 1000units 1xday Gabapentin 300mg 1xday Repatha shot 1xmonth Nurtec 75
Current Illness: none
Preexisting Conditions: Diabetes Grav''s disease chronic hypothyroid generalized anxiety disorder migraines autonomic neuropathy asthma gastroparesis
Allergies: Iodine Morphine Sulfonamide antibiotic Amoxicillin Simcor Crestor Shellfish
Diagnostic Lab Data: test were done on 11/20/2021 X-ray- heart looked fine blood work- EKG- normal
CDC Split Type: vsafe

Write-up: When I woke up early in the morning I felt a little short of breath. I had a pulse detector so I checked my pulse and it was up to 130 BPM and up to 150 BPM when I started walking around. I was out of breath, but I tried to wait it out to see if it would go down. After 30 minutes it still waivered between 130 and 150. I went to the ER on 11/20/2021 around 3AM that same day. The doctor ran test on me and said I had tachycardia. He also said that it is a reaction to the covid vaccine. They gave me some metoprolol, and that brought pulse down to 109BPM. I wasn''t prescribed anything, but I was informed that if it happens again to take an extra propranolol.


VAERS ID: 1897977 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

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

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

Write-up: Vaccine administration error: Patient stated they had not received a previous dose of any covid vaccine and was administered a full dose (0.5ml) instead of the half dose(0.25ml) for the third dose in the series. Vaccine was given at proper interval for booster dose $g6 months after 2nd dose which was given on (04/21/21). At time of follow-up(11/23/21) patient reported normal side effects (fevers, chills, aches) that started approximately 8 hours post vaccination and had not fully resolved at that time.


VAERS ID: 1897978 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2004-07-13
Onset:2021-11-20
   Days after vaccination:6339
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Ibuprofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a booster vaccination for pfizer, and the guidelines are approved for 18 years older and above. The patient was currently 17 at the time of vaccination.


VAERS ID: 1898172 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site warmth, Vaccination complication
SMQs:, Extravasation events (injections, infusions and implants) (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: penicillins
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient came in stating she had an adverse reaction to a Covid immunization. She said she had some redness and itching at the injection site, as well as heat in the area. She said it was not painful and has resolved with the exception of the itching. She is contacting her prescriber for more information.


VAERS ID: 1898209 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 RA / -
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER AB374 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Wrong 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: LISINOPRIL 10MG
Current Illness:
Preexisting Conditions:
Allergies: NO ALLERGIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received BOOSTRIX vaccine instead of SHINGLES vaccine


VAERS ID: 1898618 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-16
Onset:2021-11-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), 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: Multi-vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarrhea and vomiting


VAERS ID: 1898739 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018F21A / 3 LA / IM

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

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

Write-up: The patient reported on Monday that on Saturday she started with a nickle size red swollen area on the left arm where administered and by Monday it was the size of a grapefruit, circular, swollen, warm and red at the injection site. She stated that her coworker was a nurse and said it was an allergic reaction and that she would see her md today at facility. Today I contacted the patient and was told that the md gave her an antibiotic and she reported that the reaction was either caused by the vaccine or how administered and she would start the antibiotics today.


VAERS ID: 1899542 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-28
Onset:2021-11-20
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Alopecia areata
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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101628544

Write-up: Quarter size bald patch (alopecia areata ) on left side of scalp; This is a spontaneous report from a contactable consumer, the patient. A 52-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0172) via an unspecified route of administration in the left arm on 28Oct2021 (at the age of 52-year-old) as a single dose for COVID-19 immunisation. Medical history was not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. Concomitant medication taken within two weeks of vaccination included multivitamin (MANUFACTURER UNKNOWN) for an unknown indication from an unknown date and unknown if ongoing. On 20Nov2021, the patient experienced quarter size bald patch (alopecia areata) on left side of scalp. The patient had no previous history of "AA" (alopecia areata). It was reported that the patient had a dermatologist appointment the next day of this report so it was unknown if treatment would be available at that time. The event resulted in doctor or other healthcare professional office/clinic visit. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event quarter size bald patch (alopecia areata) on left side of scalp was unknown at the time of this report.


VAERS ID: 1899547 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-11-20
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Biliary colic, Immunisation
SMQs:, Acute pancreatitis (broad), Gallbladder related disorders (narrow), Biliary tract disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLU VACCINE VII
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101630698

Write-up: Dose received 3; Pain in stomach; Pain in stomach and gall bladder; This is a spontaneous report from a contactable pharmacist, the patient. A 35-year-old male patient received third (booster) dose of COVID-19 VACCINE-MANUFACTURER UNKNOWN, Lot Number: UNKNOWN, via an unspecified route of administration on an unknown date as a single dose for COVID-19 immunisation. The patient had no medical history and no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. Concomitant medications included influenza vaccine (FLU VACCINE) for immunisation on an unknown date (within four weeks prior to the COVID vaccine). The patient previously received first dose of covid-19 vaccine (MANUFACTURER UNKNOWN, Lot Number: UNKNOWN), and second dose of covid-19 vaccine (MANUFACTURER UNKNOWN, Lot Number: UNKNOWN); both on unknown dates for COVID-19 immunisation. On 20Nov2021 at 13:30, the patient experienced pain in stomach and gall bladder. The events did not result in doctor or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events pain in stomach and gall bladder was not resolved at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1899726 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-20
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Heart rate increased, Induration, Injection site reaction, Joint swelling, Malaise, Myalgia, Peripheral swelling, Pruritus, Pyrexia, Rash erythematous, Rash macular, Rash pruritic, Skin warm, Swelling face, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirena IUD
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: My sister is an emergency room doctor and believes based on pictures and these events that this sounds like a serum sickness like reaction.
CDC Split Type:

Write-up: After my second Moderna shot on May 4th 2021, I got the "Covid arm" response on my left arm 8 days after the second injection. This was a localized red/itchy and circular rash that went away within a week. I received my COVID19 Moderna booster shot on November 11th, 6 months after my second Moderna shot. Nine days later, on 11/19 through 11/20 night, I was flying and experienced strong itchiness on the back of my legs, and in the mirror saw that I had lots of raised white bumps (hives). I took Benadryl, but within 6-8 hours these white bumps had turned to red splotches. The next day (Sunday 21st), I developed intense itchiness on my neck and upper back, and a large rash in those areas and also on my hips. I bought Zyrtec and continued to take that, but itchiness continued. Monday the 22nd, the rash spread to my arms and my wrists and hands started to swell. I can usually clasp my thumb and pinky finger around my wrist, and by Monday evening there was a 1cm gap between these fingers. I also experienced muscle soreness in my quads. My heart rate was in the 80s according to my smart watch, but it is usually 60-65. I had no fever according to a thermometer I used. By Tuesday morning my hands continued to swell and the rash had spread to about 30% of my body. I had no fever according to a thermometer I used, but my heart rate was 100-120 all of the afternoon and evening according to my smart watch. By evening, my wrist was so swollen that there was about a 1 inch gap between my pinky finger and thumb, and the skin on my forearms felt very hard/ did not compress. My hands felt throbbing and warm. My travel group planned to fly that evening, and I decided to fly because medical care is better where we were going. Landing on Wednesday 2am, I went to the emergency room. They measured my BP at 133/77 and heart rate at 125, temperature at around 38. My BP is usually 90-100 and heart rate is usually 60-65. They gave me a hydrocortisone injection, and could barely put the IV in because my hands and arms were so swollen. They could not take my BP in my arm because it was too painful -- they had to use my leg. Wednesday throughout the day the swelling in my hands started to go down, gradually back to only about a 1cm gap when clasping my hand around my wrist by 6pm. However, I experienced six bouts of diarrhea on Wednesday and a slightly increased temperature (99.1 degrees), in addition to feeling general malaise. Thursday the 25th (today), my hand swelling is almost completely gone and I can once again clasp my hand around my wrist with no gap. The rash has gone down significantly since I started taking Allegra last night, but my eyelids and face are very puffy today.


VAERS ID: 1899951 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Gastrointestinal inflammation, Injection site pain, Injection site swelling, Myalgia, Night sweats, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific inflammation (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Large, painful swelling of left auxillary lymph node, 26, year 2010, Tdap vaccine Low grade fever, joint pain, muscle pain, 36,
Other Medications: Allegra 180 mg (as needed, had taken the evening before vaccination for environmental allergies) Omeprazole 40 mg (had been taking for two weeks prior to vaccination due to a perceived heartburn flare-up; discontinued 3 days after vaccinati
Current Illness: None diagnosed by a healthcare professional Had experienced some other GI issues (heartburn, loose stool) two weeks prior to vaccination
Preexisting Conditions: Asthma, mild Occasional heartburn Generalized anxiety disorder
Allergies: None identified Sensitivity to dairy products
Diagnostic Lab Data: None performed
CDC Split Type:

Write-up: Pain and swelling at injection site, began 2 hours after vaccination and resolved in 4 days. Joint and muscle pain in the legs, mild-moderate, began 24 hours after vaccination and resolved within 8 hours without medication. Fever, 99.5F, 30 hours after vaccination, no medication taken. Night sweats (likely fever, temperature unknown), two times in the time frame of 36-44 hours post-vaccination. Feeling of stomach inflammation (burning pain in upper abdomen between bottom of rib cage and belly button, almost like painful hunger) with no other clear cause, began about 32 hours after vaccination. Attempted to treat with antacids (Tums) and peppermint. Symptom persisted until about 74 hours after vaccination and spontaneously resolved.


VAERS ID: 1900071 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cyst, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spiked a fever the within 24 hours. Started developing cysts near back of head/neck. Developed cyst in neck and throat is sore.


VAERS ID: 1900089 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER UNKNOWN / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Condition aggravated, Haemoglobin decreased, Myocardial infarction, Transfusion, Troponin increased
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, apixaban, buspirone, diltiazem, escitalopram, glipizide, hydralazine, hydrocodone, levothyroxine, pantoprazole,
Current Illness:
Preexisting Conditions: coronary artery disease, anemia of chronic disease, possible myelodysplastic syndrome, atrial fibrillation, diabetes mellitus, hypertension, chronic kidney disease,
Allergies: penicillin, lactose, statins
Diagnostic Lab Data: elevated troponin and low hemoglobin on admission: 11/20/21
CDC Split Type:

Write-up: Patient received COVID booster on 11/19, unknown type (I do know that the original series was Pfizer). The following day she was admitted with a myocardial infarction and severe anemia requiring blood transfusion. She has well-established multi-vessel CAD prior to this admission, as well as chronic anemia. At most, the vaccine was only a contributing factor or trigger to something for which she had been liable for years.


VAERS ID: 1900360 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-11
Onset:2021-11-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / 3 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Lip swelling, Pain in extremity, Tendonitis, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Hives for several days over abdomen, back, arms, hands and feet. Tendon swelling and pain in hands and feet, and marked lip swelling.


VAERS ID: 1900364 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-01
Onset:2021-11-20
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Headache, Myalgia, Nasal congestion, SARS-CoV-2 test positive, Sneezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid 11/22/2021
CDC Split Type:

Write-up: Client vaccinated in beginning and end of April x 2 with Moderna vaccines. Symptoms started 11/20/2021 - nasal congestion, sneezing, headache, myalgia. Reported as case of breakthrough Covid in previously vaccinated person.


VAERS ID: 1901716 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Erythema, Extra dose administered, Gait disturbance, Pain in extremity, Peripheral swelling, Pruritus, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 3/20/2021, J&J covid vaccine, fever for several days (4 or 5?)
Other Medications: None
Current Illness: IgA and IgG deficient
Preexisting Conditions: EOE (Eosinophilic esophagitis) and IgA and IgG deficient
Allergies: None known
Diagnostic Lab Data: Went to pediatrician on day 5. No tests, just observation that there is redness, swelling, and rash on hands and feet.
CDC Split Type:

Write-up: My son had covid in Dec 2020. He was given 1 shot of J&J vaccine on March 20, 2021 (had a low fever for a few days.) He was given booster of Moderna on 11/20/2021 and had a fever/ chills for a few days... then on day 5 his hands swelled up and became very red and itchy, and his feet became very sensitive on the bottoms. He said walking felt like his feet were totally bruised. He couldn''t bend his fingers easily bc they''re so swollen. The pediatrician told him to take one Zyrtec a day and it should feel better within 2 weeks. Day 6, a fever spiked again. 101.7. We are now on day 7. He isn''t awake yet, but this is pretty awful.


VAERS ID: 1901721 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-11-20
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Benign prostatic hyperplasia, Bipolar disorder, Blood culture negative, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Condition aggravated, Diabetic autonomic neuropathy, Dyspnoea, Hypertension, Lung infiltration, Lung opacity, Mobility decreased, Pneumonia, Pneumonia bacterial, Pollakiuria, Pyrexia, SARS-CoV-2 test positive, Sepsis, Tachycardia, Type 2 diabetes mellitus
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hostility/aggression (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Accu-Chek Aviva Plus Test Strips acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler ascorbic acid (VITAMIN C) 1000 MG tablet aspirin 81 MG EC tablet benzonatate (
Current Illness:
Preexisting Conditions: Type 2 diabetes mellitus with diabetic autonomic neuropathy, without long-term current use of insulin (HCC) Hypertension, benign Benign prostatic hyperplasia with urinary frequency Bipolar disorder in full remission COVID Hyponatremia Pneumonia due to infectious organism Sepsis without acute organ dysfunction Non-Hospital Pure hypercholesterolemia Fecal incontinence Obesity (BMI 30-39.9) Polypharmacy Tremor, unspecified
Allergies: Abilify [Aripiprazole] Fish Allergy Lithium Ointment Base Oint Sulfa Drugs
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time DR CHEST SINGLE VIEW Resulted: 11/23/21 1319 Order Status: Completed Updated: 11/23/21 1322 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/23/2021 12:34 PM TECHNIQUE: Single view chest INDICATION: Shortness of breath COVID COMPARISON: November 20, 2021 ENCOUNTER: Subsequent _________________________ FINDINGS: Trachea is midline. Cardiomediastinal silhouette is within normal limits. No large effusions or pneumothoraces. Left basilar airspace opacities not significantly changed. Some mild vague right basilar opacity suspected _________________________ Impression: 1. Left greater than right mild Covid pneumonia. DR CHEST SINGLE VIEW Resulted: 11/20/21 1145 Order Status: Completed Updated: 11/20/21 1147 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/20/2021 11:32 AM TECHNIQUE: Single view chest INDICATION: Weakness, COVID COMPARISON: Chest radiograph 6/6/2021 ENCOUNTER: Not applicable _________________________ FINDINGS: The patient''s chin projects over the lung apices limiting evaluation of the thorax. Allowing for this, normal cardiomediastinal silhouette. Left basilar infiltrate. The right lung is clear. No pleural effusion or pneumothorax is identified. _________________________ Impression: Left basilar infiltrate. Procedure Component Value Ref Range Date/Time Peripheral Blood Culture Collected: 11/20/21 1503 Order Status: Completed Specimen: Blood, Venous Updated: 11/25/21 2300 Cult Blood Peripheral No bacteria or yeast isolated Peripheral Blood Culture Collected: 11/20/21 1503 Order Status: Completed Specimen: Blood, Venous Updated: 11/25/21 2300 Cult Blood Peripheral No bacteria or yeast isolated COVID-19 PCR - Rapid (Abnormal) Collected: 11/22/21 0828 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 11/22/21 0850 COVID-19 PCR Detected Abnormal
CDC Split Type:

Write-up: Patient currently admitted inpatient stay at (6) days starting 11/20/2021 Patient is a 69 y.o. male who presents today with weakness. He has been in his usual state of health, (which is difficult to define, pt scattered historian; has hospital bed because can''t breathe laying down, though has normal echo from April 2021, gets around by walking slowly) till today when felt so weak, he couldn''t get out of bed. Does have HH to help with needs. PMH of diabetes mellitus, BPH, bipolar, hypertension. In the ED, he was stable, with slight tachycardia 90-100 and fever 101F, CXR showed infiltrate left lower lobe, He was given fluids and tylenol, as well as decadron since he tested (+) for Covid. He is vaccinated. He requires admission for sepsis due to pneumonia. ASSESSMENT / PLAN: Pneumonia due to infectious organism Assessment & Plan -Left sided -Pt is a community dweller, no recent hospitalizations -Low index of suspicion for MRSA, pseudomonas -Not having productive cough -Maintaining sats on room air -Tx for CAP--azithromycin, rocephin * Sepsis without acute organ dysfunction Assessment & Plan -Pneumonia most likely source -Blood cultures pending -Pt has received 2L of fluid, start LR at 200 as still appears dry, HR 90''s COVID Assessment & Plan -Tested positive, but is vaccinated -Has no hypoxia; eating/drinking well -Cause of sepsis seems to be a bacterial pneumonia -Will give BID lovenox, but hold off on steroids, antivirals for now Type 2 diabetes mellitus with diabetic autonomic neuropathy, without long-term current use of insulin Assessment & Plan -On multiple antihyperglycemics, not insulin -Lantus 10 HS and SSI Bipolar disorder in full remission Assessment & Plan -Latuda not in formulary, pt cannot get meds from home -Sub geodon, continue Zyprexa Benign prostatic hyperplasia with urinary frequency Assessment & Plan -Continue finasteride, tamsulosin Hypertension, benign Assessment & Plan -Continue losartan, hold spironolactone/Lasix


VAERS ID: 1901877 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-19
Onset:2021-11-20
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Ageusia, Angiogram pulmonary abnormal, Blood culture negative, Blood lactic acid, COVID-19, COVID-19 pneumonia, Cardiomegaly, Chest X-ray abnormal, Cough, Culture, Diarrhoea, Dyspnoea, Dyspnoea exertional, Electrocardiogram T wave inversion, Fatigue, Fibrin D dimer increased, Goitre, Haemoptysis, Hypophagia, Hypoxia, Intervertebral disc degeneration, Laboratory test, Lung disorder, Lung infiltration, Lung opacity, Lymphadenopathy mediastinal, Malaise, Pain in extremity, Pneumonia, Procalcitonin increased, SARS-CoV-2 test positive, Scan with contrast abnormal, Superficial vein thrombosis, Tachypnoea, Ultrasound Doppler abnormal, White blood cell count normal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Taste and smell disorders (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Other ischaemic heart disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet diclofenac sodium 1 % gel hydroCHLOROthiazide (MICROZIDE) 12.5 MG capsule ibuprofen (MOTRIN) 200 MG tablet losartan (COZAAR) 50 MG tablet omeprazole (PRILOSEC) 20 MG delayed release capsule Respir
Current Illness:
Preexisting Conditions: Non-Hospital Obesity Chronic back pain ADD (attention deficit disorder) Chicken pox Herniated disc History of drug abuse (HCC) Essential hypertension Hyperlipidemia, unspecified hyperlipidemia type Gastroesophageal reflux disease, esophagitis presence not specified Sleep apnea, unspecified type Prediabetes Morbid obesity (HCC)
Allergies: Contrast Dye [Ivp Dye, Iodine Containing]Itching, Cough Penicillins
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time USV Venous Upper Extremity Duplex Bilateral Resulted: 11/23/21 1649 Order Status: Completed Updated: 11/23/21 1651 Narrative: EXAMINATION: Complete Bilateral Upper Extremity Venous Duplex Doppler Ultrasound EXAM DATE: 11/23/2021 4:26 PM TECHNIQUE: Real-time B-mode imaging with and without compression was used to evaluate the right and left upper extremity for deep venous thrombosis (DVT). Duplex Doppler with color and spectral Doppler was used. INDICATION: -Dimer elevation, evaluate for DVT COMPARISON: None _____________________ Right Upper Extremity Findings: Right Internal Jugular Vein: No thrombus. Right Subclavian Vein: No thrombus. Right Axillary Vein: No thrombus. Right Brachial Vein: No thrombus. Right Radial Vein: No thrombus. Right Ulnar Vein: No thrombus. Superficial Veins: Right Basilic Vein: No thrombus. Right Cephalic Vein: Thrombosed at the elbow. Left Upper Extremity Findings: Left Internal Jugular Vein: No thrombus. Left Subclavian Vein: No thrombus. Left Axillary Vein: No thrombus. Left Brachial Vein: No thrombus. Left Radial Vein: No thrombus. Left Ulnar Vein: No thrombus. Superficial Veins: Left Basilic Vein: No thrombus. Left Cephalic Vein: No thrombus. ADDITIONAL FINDINGS: Normal cardiac pulsatility is present in the subclavian veins. _____________________ Impression: There is no sonographic evidence for deep venous thrombosis in the visualized deep veins of the right or left upper extremity. Superficial thrombophlebitis of the right cephalic vein at the elbow. CT ANGIO THORAX WITH IV CONTRAST Resulted: 11/22/21 2237 Order Status: Completed Updated: 11/22/21 2239 Narrative: EXAMINATION: CT Angiography of the Thorax EXAM DATE: 11/22/2021 10:25 PM TECHNIQUE: Standard protocol CT angiogram images were obtained through the chest following the administration of intravenous contrast. Coronal and sagittal MIP 3-D reformations were performed. CONTRAST: The amount and type of contrast are recorded in the medical record. DOCUMENTATION: At least one of the following dose reduction techniques was utilized: Iterative reconstruction, and/or Automatic Exposure Control, and/or mA/kV adjustment based on body size. INDICATION: Shortness of breath respiratory failure. COMPARISON: None ____________________ FINDINGS: Base of Neck & Axillae: There is no lymph node enlargement. Thyroid is diffusely and significantly enlarged and heterogeneous likely due to goiter. A substernal extent of the left lobe encroaches upon the arch of the aorta. Mediastinum & Hila: There is mild reactive mediastinal lymph node enlargement. The esophagus is unremarkable. Cardiovascular: Heart is mildly enlarged. The thoracic aorta is not aneurysmal and there is no dissection. There is no evidence for right heart strain. Pulmonary Arteries: No pulmonary embolism is present. Lungs & Airways: Extensive airspace disease is present throughout both lungs. There are extensive groundglass alveolar densities involving more than half of the alveoli. There is underlying septal thickening. Slightly more dense semisolid infiltrate is present within the lower lobes. Pleural Space: There are no pleural effusions. There is no pneumothorax. Upper Abdomen: Included portions of the upper abdomen are unremarkable. Chest Wall & Musculoskeletal: There is multilevel thoracic degenerative disc disease. ____________________ Impression: 1. There is no evidence of a pulmonary embolism 2. Extensive bilateral bronchopneumonia typical of a COVID infection 3. Significantly enlarged thyroid most likely due to goiter USV Venous Lower Extremity Duplex Bilateral Resulted: 11/22/21 1351 Order Status: Completed Updated: 11/22/21 1353 Narrative: EXAMINATION: Complete Right and Left Lower Extremity Venous Duplex Doppler Ultrasound EXAM DATE: 11/22/2021 1:43 PM TECHNIQUE: Real-time B-mode imaging with and without compression was used to evaluate the right and left lower extremity for deep venous thrombosis (DVT). Duplex Doppler with color and spectral Doppler was used. INDICATION: DDimer uptrending, left leg pain COMPARISON: None _____________________ Right Lower Extremity Findings: Right Common Femoral Vein: No DVT. Right Femoral Vein: No DVT. Right Popliteal Vein: No DVT. Right Posterior Tibial Veins: No DVT, limited Right Peroneal Veins: No DVT, limited Right proximal Greater Saphenous Vein: No thrombus. Left Lower Extremity Findings: Left Common Femoral Vein: No DVT. Left Femoral Vein: No DVT. Left Popliteal Vein: No DVT. Left Posterior Tibial Veins: No DVT, limited Left Peroneal Veins: No DVT, limited Left proximal Greater Saphenous Vein: No thrombus. Duplex Doppler: Spectral Doppler demonstrates bilateral normal respirophasic waveforms in the common femoral veins. Additional Findings: None. _____________________ Impression: There is no deep venous thrombosis in the visualized deep veins of the right or left lower extremity. Limited evaluation of the calf veins due to body habitus and swelling. DR CHEST SINGLE VIEW Resulted: 11/20/21 1409 Order Status: Completed Updated: 11/20/21 1411 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/20/2021 1:50 PM TECHNIQUE: Single view chest INDICATION: Shortness of breath, suspected COVID, significant hypoxia COMPARISON: None. ENCOUNTER: Not applicable _________________________ FINDINGS: The heart, mediastinum, and pulmonary vasculature are normal. Low lung volumes. Extensive bilateral pulmonary infiltrates. No pleural effusion or pneumothorax. _________________________ Impression: Extensive bilateral pulmonary infiltrates. Imaging features can be seen with COVID-19 pneumonia, though are nonspecific and can occur with a variety of infectious and noninfectious processes. Procedure Component Value Ref Range Date/Time Peripheral Blood Culture Collected: 11/20/21 1336 Order Status: Completed Specimen: Blood, Venous Updated: 11/25/21 1401 Cult Blood Peripheral No bacteria or yeast isolated Peripheral Blood Culture Collected: 11/20/21 1336 Order Status: Completed Specimen: Blood, Venous Updated: 11/25/21 1401 Cult Blood Peripheral No bacteria or yeast isolated Narrative: Draw from a different site than draw one. COVID-19 PCR - Rapid (Abnormal) Collected: 11/20/21 1337 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 11/20/21 1359 COVID-19 PCR Detected Abnormal
CDC Split Type:

Write-up: Patient currently admitted at (6) days starting 11/20/2021. Patient is a 61 y.o. male who presents today with progressive shortness of breath. Began last Thursday with fatigue, cough, exertional dyspnea, and malaise. Progressed to significant shortness of breath with diarrhea for last 3 days and poor PO intake due to loss of taste. Patient has been trying to drink gatorade and eat small amounts of crackers or toast when he can but it has been challenging. He tested his oxygen saturation at home (wife works in hospice) the last few days and he was in the 80''s and decided to come in. Heis vaccinated except for his booster shot, but knew he had covid19 after he was helping customers in the sporting goods store he works at who were coughing without masks around him and sounded sick. Admits some blood tinged sputum from cough 2 days prior, and watery stools. He denies chest pain, vomiting, blood in urine/stool, abdominal pain, swelling/pain in legs or extremities. ED course: On arrival he was hypoxic at 57% and tachypneic, normotensive, aox3, breath sounds clear. He was placed on NRB which improved his saturations to around 90, and subsequently switched to HFNC 60L at FiO2 of 100% which brought his saturations up to 90''s. Cultures and labs were drawn, Covid test was obtained and positive. ECG showed NSR with isolated t-wave inversion in lead 3. CXR showed extensive bilateral lung infiltrates. WBC normal, no fever. Lactate was elevated to 2.1. Procal mildly elevated. He received Decadron 6mg IV and was admitted to general floors with acute hypoxic respiratory failure secondary to covid19 pneumonia.


VAERS ID: 1901890 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-18
Onset:2021-11-20
   Days after vaccination:275
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Blood chloride decreased, Blood creatinine normal, Blood sodium decreased, Blood urea normal, COVID-19, Chest X-ray abnormal, Chills, Cough, Diarrhoea, Dyspnoea, Fatigue, Haemoglobin normal, Hypoxia, Lung infiltration, Myalgia, Nausea, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Tachypnoea, Vomiting, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler atorvastatin (LIPITOR) 40 MG tablet dexamethasone (DECADRON) 6 MG tablet diphenhydrAMINE (BENADRYL) 50 MG capsul
Current Illness:
Preexisting Conditions: Chronic migraine without aura, with intractable migraine, so stated, with status migrainosus
Allergies: AdhesiveOther Erythromycin Sulfa Drugs Vancomycin
Diagnostic Lab Data: DR CHEST SINGLE VIEW [350942986] Resulted: 11/20/21 0945 Order Status: Completed Updated: 11/20/21 0947 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/20/2021 8:43 AM TECHNIQUE: Single view chest INDICATION: COVID x 8 days, increasing fevers, cough COMPARISON: August 15, 2020 ENCOUNTER: Initial _________________________ FINDINGS: Cardiac size is within normal limits for the radiographic technique. Lungs are symmetrically expanded but there is an abnormal increase in density in the left retrocardiac area which could represent infiltrate. There are no pleural effusions. _________________________ Impression: Probable left lower lobe infiltrate.
CDC Split Type:

Write-up: Patient discharged after (4) inpatient admission from 11/20-11/24/2021. Patient is a 47 y.o. female with past medical history significant for HTN, HLD, migraines, GERD, depression and anxiety who presents today with chills, fever and cough in setting of known Covid 19 infection. The patient reports first developing fatigue and cough 8 days ago. She has been experiencing intermittent chills and fever over the last five days. She took an at home Covid 19 test which was positive, later confirmed by a PCR. She complains of diffuse myalgias and joint pain. She has also been having loose stool. This morning, the patient woke up with chills and a temperature of 103.8F with nausea, vomiting and shortness of breath, at which time she presented to the ED. The patient is vaccinated. In the ED, the patient was febrile (T102.7F), tachycardic (HR 107), tachypneic (RR 28) and hypoxic requiring 2LNC. Baseline lab work showed sodium 131, chloride 97, BUN 11, Cr 0.74, WBC 7.19, Hgb 13.5. CXR showed probable left lower lobe infiltrate. The patient received tylenol. IV Rocephin, IV doxycyline, IV decadron, IV toradol, IV morphine and IV zofran while in the ED. She will be admitted for further management.


VAERS ID: 1901905 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-14
Onset:2021-11-20
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Headache, Pain, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Aspirin 325 MG Tablet 1 tablet Orally Once a day ?FreeStyle Libre Reader - Device as directed - 1 kit ?Ketoconazole 2 % Shampoo shampoo into scalp Externally once a day, wash off after 5 minutes ?ProAir HFA 108 (90 Base) MCG/ACT A
Current Illness: none
Preexisting Conditions: coronary artery disease status post angioplasty and stent to left anterior descending artery in 1999 as well as angioplasty to the second diagonal branch. Subsequent angiogram in 2002 was normal, but the patient did have a false positive Cardiolite at that time. Normal angiogram with patent LAD stent, 7/2014. Tobacco dependence, quit smoking 2008.
Allergies: Hydrocodone-Acetaminophen: vomiting - Side Effects
Diagnostic Lab Data:
CDC Split Type:

Write-up: dry cough, headache, body aches, scratchy, shortness of breath,. starting 11/20/21


VAERS ID: 1901919 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Malaise, Nausea, Restlessness
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: I received the booster about 10 am. That night I experienced restlessness and chills. The day after, I had a general sense of feeling unwell and nausea, as well as injection site soreness. In the week since I received the booster, I have had a pounding headache 3 days upon waking, and one during the day. I usually only experience a few headaches a year so this is out of the ordinary. I have been able to control these with 1000 mg Tylenol and have not sought any other medical treatment.


VAERS ID: 1901970 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-10
Onset:2021-11-20
   Days after vaccination:283
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 - / -

Administered by: Pharmacy       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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 positive 11/24/21
CDC Split Type:

Write-up: COVID-19 vaccine breakthrough case


VAERS ID: 1901990 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same conditions after second shot, but milder and lasted <24h vs. ~72h
Other Medications: None before event, Tylenol thereafter
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Biaxin, Levoquin
Diagnostic Lab Data: N/A, recovered using time, hydration plus electrolytes, and anti-inflammatory OTC
CDC Split Type:

Write-up: High fever (103) and inflammation in neck and limbs, to the point of being unable to sleep comfortably


VAERS ID: 1901999 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-11-20
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Impaired work ability, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: 14yr old female arrived to ED with complaints of stomach pain which started about 2 hours ago at work. She had to leave work because the pain was too bad. Rates pain 10/10. She has not taken anything for the pain. Pain is located in upper abdomin, constant ache. States she feels nauseated. Had a bowel movement this afternoon, normal for her. She also started her menstrual cycle 3 days ago. ASSESSMENT/PLAN/DECISION MAKING: Epigastric Pain Zofran ODT, nausea improved. GI cocktail, pain improved. Observed For about 30 minutes in the ED, bowel sounds were reassessed and were normal. Autonomic dysfunction addressed with osteopathic manipulation : HVLA to thoracic spine. Administered omeprazole 20 mg in the ED , prescribed Prilosec CP DR twice daily before meals. She is advised to push fluids. She is to follow-up with NP at GI office, as EGD and possible impedance study were proposed. Given body habitus consideration should be given to investigation for Ehlers-Danlos syndrome.


VAERS ID: 1902013 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthritis allergic, Contusion, Dizziness, Fatigue, Head injury, Hypersomnia, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (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: Aspirin; Atorvastatin; Captopril; Carvedilol; Montelukast; Spironolactone
Current Illness: None
Preexisting Conditions: Ventricular tachycardia; pulmonary artery hypertension; mixed restrictive and obstructive lung disease; mitral regurgitation; ischemic cardiomyopathy; hypertension; hyperlipidemia; CAD; CHF
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Received vaccine on 11/19/2021. Felt tired on 11/20/2021, and stayed on couch most of day. During night 11/20-11/21/2021, patient got up from bed to go to kitchen. He felt very dizzy. He fell to his knees in living room, striking head on coffee table leaving a contusion; no bleeding. Patient able to walk to kitchen where he sat for about 4 hours until he felt steady enough to go back to bed. He slept all day. The arm where he received vaccine is still very sore. Dizziness still present at times but very minor compared to Saturday night/Sunday morning. No fever, no chest pain and no SOB. Patient took BP/pulse during dizzy spell. He stated both were "normal."


VAERS ID: 1902079 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2020-12-23
Onset:2021-11-20
   Days after vaccination:332
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Fully vaccinated employee tested positive for COVID-19 11/23/21 . EE vaccinated 12/23/20 and 1/12/21 Pfizer


VAERS ID: 1902222 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Burning sensation, Lip pruritus, Periorbital swelling, Pruritus, Pyrexia, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase, Allegra D, Pantoprazole, Cefuroxime.
Current Illness: Sinus infection and strep throat.
Preexisting Conditions: Seasonal allergies.
Allergies: No known allergies to medications, food, or other products.
Diagnostic Lab Data: I went to a local health clinic on November 22nd. The Nurse Practitioner saw the hives and prescribed a Prednisone taper to help ease the intensity of the hives.
CDC Split Type:

Write-up: On the morning following the Moderna Covid Booster Vaccination, my palms and upper lip became very itchy. The next morning, my right eyebrow was puffy and swollen, and hives appeared on my chest and neck. The hives appear and disappear randomly on my body. When they appear, the hives are itchy, feverish, and burning. They last about thirty minutes to forty-five minutes wherever they appear. After that time, they disappear from that spot on my body and appear somewhere else on my body. This happens day and night and has been going on since the morning after having received the booster shot.


VAERS ID: 1902478 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-16
Onset:2021-11-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3015508 / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Decreased appetite, Headache, Nasal congestion, Pyrexia, Sinus congestion, Sputum discoloured, Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CYMBALTA, SUBOXONE, AMLODIPINE-VALSARTAN, HYDROCHLOROTHIAZIDE, BUMEX, HYOSCYAMINE
Current Illness: NONE
Preexisting Conditions: ARTHRITIS OF RIGHT HIP, OSTEOARTHRITIS L/R KNEE, LUMBAR RADICULAR PAIN, ARTHRALGIA OF RT KNEE, INFLAMMATORY POLYARTHRITIS, MALIGNANT HYPERTENSION, FATTY LIVER DISEASE, ADULT ONSET STILL''S DISEASE, HYPERALDOSTERONISM, PROLONGED Q-T, PULMONARY EMPHYSEMA, PAINFUL ORTHOPEDIC HARDWARE, HERNAIATED DISC, PINCHED NERVES, NERVE ROOT INFLAMMATION
Allergies: PINEAPPLES, MANGOS
Diagnostic Lab Data:
CDC Split Type:

Write-up: SAT 11/20I WOKE UP WITH AN ITCHY THROAT AND HACKING DRY COUGH THAT CONTINUED THROUGHOUT THE COURSE OF THE DAY. BY 10PM THAT NIGHT, I STARTED A FEVER 99.9 FLUCUATING TO 102.1. WITH THROBBING HEADACHES THAT GOT WORST WHEN I COUGH, LOSS OF APPETITE AND BY 11/23 LOSS SENSE OF SMELL AND TASTE TO PRESENT DATE. AS WELL AS 11/24 DEVELOP SINUS CONGESTION. RIGHT NOW AS OF TODAY, 11/26, THE FEVER AND DRY COUGH HAS STOPPED. THE HEADACHE IS STILL PRESENT BUT NO WHERE AS BAD AS WHEN IT STARTED. I STILL HAVE A COUGH WITH GREEN PLEGM, AND THE NASAL CONGESTION IS STILL ACTIVE, SO I HAVE TO BREATHE WITH MY MOUTH OPEN. I TRIED USING MUCINEX AND THERA FLU FOR COLD AND COUGH HOPING THAT WOULD WORK BUT IT HAS NOT. I STILL CAN''T SMELL OR TASTE ANYTHING AT ALL.


VAERS ID: 1902691 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Extra dose administered, Fatigue, Interchange of vaccine products, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega-3, Multi-Vitamin, Calcium
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Aproximately 9.5 hours after having my booster, Moderna COVID-19 Vaccine EUA (after Pfizer original two doses), I developed dizziness, nausea, fever, chills, all-over body aches, very sore arm, and tiredness. This lasted throughout the night and all the next day. By the day after that, I was fine. Advil helped a lot.


VAERS ID: 1903646 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Hypersensitivity, Pain, Pruritus, Rash, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Redness in the face/Redness in the neck; throat itchy; arm itchy; She feels like little needles that prick; Patient is having a rash in the face/Patient is having a rash in the neck; Allergic reaction; This spontaneous case was reported by a consumer and describes the occurrence of ERYTHEMA (Redness in the face/Redness in the neck), THROAT IRRITATION (throat itchy), PRURITUS (arm itchy), PAIN (She feels like little needles that prick) and RASH (Patient is having a rash in the face/Patient is having a rash in the neck) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939909) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Hyperthyroidism. Concomitant products included LEVOTHYROXINE for Hyperthyroidism. On 19-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Nov-2021, the patient experienced ERYTHEMA (Redness in the face/Redness in the neck), THROAT IRRITATION (throat itchy), PRURITUS (arm itchy), PAIN (She feels like little needles that prick), RASH (Patient is having a rash in the face/Patient is having a rash in the neck) and HYPERSENSITIVITY (Allergic reaction). At the time of the report, ERYTHEMA (Redness in the face/Redness in the neck), THROAT IRRITATION (throat itchy), PRURITUS (arm itchy), PAIN (She feels like little needles that prick), RASH (Patient is having a rash in the face/Patient is having a rash in the neck) and HYPERSENSITIVITY (Allergic reaction) outcome was unknown. No concomitant medications were reported. No treatment information was provided.


VAERS ID: 1903778 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Balance disorder, Decreased appetite, Fatigue, Immunisation, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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:
Preexisting Conditions: Medical History/Concurrent Conditions: Breast cancer (Breast Cancer treated); Kidney cancer (Kidney Cancer resolved); Osteoarthritis; Penicillin allergy (Known Allergies: Penicillin)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101637991

Write-up: Achy joint pain, sharp stabs of pain in joints; unsteady; nauseated; extreme tiredness; loss of appetite continuing for at least two days starting about 10 hours after injection.; The patient received a third/booster dose of BNT162b2.; This is a spontaneous report from a contactable consumer, the patient. A 77-year-old non-pregnant female patient received third (booster) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FE3592) via an unspecified route of administration in the left arm on 20Nov2021 at 11:30 (at the age of 77-years-old) as a single dose for COVID-19 immunisation. Medical history included osteoarthritis, breast cancer which was treated, kidney cancer which was resolved and allergy to penicillin. Prior to the vaccination, the patient was not diagnosed with COVID-19. The concomitant medication included influenza vaccine (INFLUENZA) (Flu shot) for immunization on 16Nov2021. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EN6206) via an unspecified route of administration in the left arm on 05Mar2021 at 11:45 (at the age of 77-years-old) and second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: ER2613) via an unspecified route of administration in the left arm on 23Mar2021 at 15:00 (at the age of 77-years-old) as a single dose for COVID-19 immunisation. On 20Nov2021 at 21:30, about 10 hours after the vaccination, the patient experienced achy joint pain, sharp stabs of pain in joints, unsteady, nauseated, extreme tiredness and loss of appetite continuing for at least two days. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events achy joint pain, sharp stabs of pain in joints, unsteady, nauseated, extreme tiredness and loss of appetite was not resolved at the time of this report.


VAERS ID: 1903789 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Anger, Confusional state, Depressed mood, Depression, Fatigue, Feeling abnormal, Headache, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Depression (excl suicide and self injury) (narrow), 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: SEROQUEL; DULOXETINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Prior to vaccination, was the patient diagnosed with COVID-19?: Yes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101650108

Write-up: Brain fog; Depression; Anger; Sadness; Confusion; Headache; Tiredness; Stomach pain; Body aches even my legs; Body aches even my legs; This is a spontaneous report from a contactable consumer, the patient. A 36-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FJ8757) via an unspecified route of administration in the right arm on 19Nov2021 at 12:00 (at the age of 36-years-old) as a single dose for COVID-19 immunisation. Medical history included COVID-19. Concomitant medications included quetiapine fumarate (SEROQUEL) and duloxetine (MANUFACTURER UNKNOWN); both for unknown indications from an unknown date and unknown if ongoing. The patient did not receive any other vaccines within four weeks prior to COVID-19 vaccine. On 20Nov2021, the patient experienced brain fog, depression, anger, sadness, confusion, headache, tiredness, stomach pain and body aches even in legs. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events brain fog, depression, anger, sadness, confusion, headache, tiredness, stomach pain and body aches even in legs was resolving at the time of this report.


VAERS ID: 1903913 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Diarrhoea, Gastrointestinal pain, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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: balsalazide Lipitor bisoprolol
Current Illness: diverticulitis then colitis
Preexisting Conditions: hyperlipidemia
Allergies: penicillin sulfonamides
Diagnostic Lab Data: none
CDC Split Type:

Write-up: GI distress: severe diarrhea, severe bowel cramping, short term nausea and vomiting, chills, fever. So far the symptoms have lasted for an entire week.


VAERS ID: 1903983 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-11-08
Onset:2021-11-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, 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: Adderall
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles


VAERS ID: 1904068 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Sensitive skin
SMQs:

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

Write-up: Headache, sensitive skin


VAERS ID: 1904109 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying, Fall, Fear, Hypersensitivity, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: About one to two minutes after the patient walked out of the vaccination room, she fainted and fell backwards. The patient cried out and was scared. The patient seemed to be able to talk and breath normally during this time. We called 911 emergency while keeping her laying on her back in the same position that she fell to the ground in. We tried to calm her down while looking for signs of any allergic reactions. 911 emergency services personal then arrived and took over the entire situation. The patient decided not to get into the ambulance. She sat on a chair in front of the pharmacy under the observation of her boyfriend for about 30 minutes. Then she left our facility


VAERS ID: 1904132 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blepharospasm, Pain in extremity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Left under arm pain and swelling, Left eye lower eyelid twitching .


VAERS ID: 1904185 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness, Extra dose administered, Feeling hot, Hyperhidrosis, Nausea, Skin discolouration, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Received COVID booster in right arm and then the flu shot (same arm) about 30 seconds later. About a minute after the lat injection I felt both dizzy and nauseous and had to sit down or felt like I was going to pass out. I was light headed and my vision began to get blurry. Paramedics were called and my blood pressure dropped to 60 over 40 and my lips and hands were blue. My hands were cold but the rest of my body was heating up/sweating. My blood sugar was normal. I started to feel better in about 15 minutes after drinking some water and it was recommended that I go to the hospital for fluids. I declined since I was feeling much better st that point and could stand without getting dizzy. I had never had a reaction like that to any vaccine before, including the first 2 covid shots.


VAERS ID: 1904275 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-22
Onset:2021-11-20
   Days after vaccination:302
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/26/2021 Breakthrough COVID
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1904394 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Extra dose administered, Gynaecological examination
SMQs:, Fertility disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 5mg 1x daily
Current Illness:
Preexisting Conditions:
Allergies: Bananas, phenergen
Diagnostic Lab Data: First vaccine set eliminated cycle. At the time, my gynecologist thought I was interring menopause, but regular cycles resumed after 4 months. Cycle start date was expected after my booster, but never arrived.
CDC Split Type:

Write-up: I missed several menstrual cycles after each vaccine. Vaccine listed was my booster or 3rd shot.


VAERS ID: 1904439 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-02
Onset:2021-11-20
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, 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: Levothyroxine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles two weeks after vaccination


VAERS ID: 1904467 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-11-12
Onset:2021-11-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Peripheral swelling, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: booster dose of 0.25 ml was administered 11/12. Pt said he ran a fever that night and the next day he had a rash. he said his hands swelled to the size of boxing gloves on Nov 20 and on Nov 25, he left dinner to go to ER bec rash and swelling were so bad. Dr gave him steroid shot and Prednisone to take by mouth. Pt said he is still having issues, so I suggested he contact doctor again and let him know that the issues are ongoing


VAERS ID: 1904490 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-11-05
Onset:2021-11-20
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 069F21A / 3 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Bladder catheterisation, Blood bicarbonate decreased, Blood creatinine, Blood potassium increased, Dyspnoea, Endotracheal intubation, Fall, Gastrointestinal haemorrhage, Haematocrit decreased, Haematuria, Haemoglobin decreased, Haemoptysis, Infusion, Paralysis, Platelet count, Prothrombin time
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (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), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Accidents and injuries (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Carvedilol Apixaban Furosemide Losartan Metformin KCl Tramadol
Current Illness: Right hip repair HTN A fib T2DM w/o complications or insulin therapy
Preexisting Conditions: A fib PPM
Allergies: NKMA
Diagnostic Lab Data: To ED on 11/23/2021 with SCr 6.6, HCO3 10, potassium 7.7, all these were normal 1 week prior to vaccination. Prolonged PT and PTT 25 and 48. HgB 5.1 gm/dl and HCT15% PLTs 324K on arrival to ED Repeat labs confirmed abnormalities
CDC Split Type:

Write-up: Within 24 hrs, weakness and falls Then hemoptysis and SOB followed by GI blood loss and gross hematuria. Take to ED in AM 11/23/2021. Was found to have ACUTE RENAL FAILURE, Hemoptysis, GI bleeding and gross hematuria following foley placement. Required intubation, sedation and paralysis. FFP to correct coagulopathy and active bleeding. pRBCs for treatment of acute blood loss anemia, IV glucose with insulin, HCO3 infusion but no acute HD for metabolic disorders and ARF


VAERS ID: 1904530 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None: Not sure if I need to go to the doctor
CDC Split Type:

Write-up: Tightening of chest after activity. Feels like I have a 25lb weight on my chest(in the middle). It goes away and then comes back.


VAERS ID: 1904568 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-06
Onset:2021-11-20
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3NA4M / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (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: Loratadine
Current Illness: none
Preexisting Conditions: none
Allergies: cats, dust
Diagnostic Lab Data: none
CDC Split Type:

Write-up: On Saturday, November 27, 2021 client came for vaccination POD accompanied by his Mother for his second Covid-19 Pfizer pediatric dose. During assessment questions, Mom stated to RN, patient received his first dose Covid-19 Pfizer pediatric dose (LOT #: FK5127) on 11/6/21 in his right arm and and a flu shot on his left arm. Two weeks later, Mom stated patient experienced a "pinching sensation" on left side of chest. Mom stated patient would experience this sensation once or two times a day intermittently. The last time it happened was on 11/25/21, Thanksgiving day. Mom stated they spoke with his MD who recommended a 30 minute wait after second vaccination. Patient has no chronic medical conditions and takes Loratadine every day due to allergies to cats and dust. Lead Nurse elevated to Vaccine Operations Lead who was on site, who consulted with County MD. Per County MD, Pfizer pediatric dose was approved and advised client to receive his second dose of Pfizer Covid-19 vaccine with 30 minute observation. Client was vaccinated with Covid-19 Pfizer vaccine (LOT #: FK5618) in his left arm at 2:07 PM. Client and client''s Mother was educated by RN on signs and symptoms of adverse reactions and when to go to the ED/call MD. Client''s Mother was also encouraged to sign-up on v-safe. Client experienced no adverse reaction while waiting in Observation Area and left vaccination site with a steady gait at 2:45 pm.


VAERS ID: 1904678 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood disorder, Blood test abnormal, Blood urine present, Bone marrow oedema, Bone pain, Chest discomfort, Chills, Computerised tomogram abnormal, Condition aggravated, Confusional state, Disorientation, Electrocardiogram normal, Fatigue, Hiatus hernia, Injection site pain, Neck pain, Pain, Tremor, Urine analysis abnormal
SMQs:, Anaphylactic reaction (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Arthritis (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? Yes
Hospitalized? No
Previous Vaccinations: Moderna 2nd vaccine given on April 23, 2021 caused fatigue, body chills, body aches, and headaches for five full days following
Other Medications: Allegra, provide, gi care, repair vite se
Current Illness: None
Preexisting Conditions: Acid reflux, polycystic ovary disease, allergies
Allergies: Eurythramiacin, Norco, gluten, arrowroot starch, alcohol
Diagnostic Lab Data: Tuesday November 23rd at ER they did EKG which was normal, urinalysis which was normal except for blood in my urine, blood work which showed an elevated marker for blood clots, chest CT scan which showed edema in the collar bone area and a hiatal hernia.
CDC Split Type:

Write-up: Saturday November 20th and half of Sunday November 21st I experienced achiness, chills, arm soreness that went from my elbow up to my shoulder and from my shoulder over to the middle of my collarbone around my neck area,and fatigue. The afternoon of November 21st I started to feel better and only the fatigue and arm / collarbone soreness remained. Monday November 22nd at approximately 10:00 p.m. at night I started to have the chills again and went to bed. I woke up around midnight with uncontrollable shaking, chills, chest pressure, confusion, disorientation, achiness. I had my husband take me to emergency room. They did a urinalysis, ekg, blood work, and CT scan. I was just charged seven hours later around 8:00 a.m. on Tuesday November 23rd. The emergency room doctor determined that it was a reaction to the moderna covid booster. I went home and the chills, fatigue, arm and collarbone soreness continued until Thursday November 25th. At that point the fatigue remained and lasted through Saturday November 27th.


VAERS ID: 1904658 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-11-20
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, 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: USJNJFOC20211157402

Write-up: RASH ON STOMACH TO BACK WHICH LOOKED LIKE PRICKLY HEAT; VERY TIRED; This spontaneous report received from a patient concerned a 62 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient was previously treated with covid-19 vaccine for prophylactic vaccination. The patient received macitentan (tablet, route of admin not reported, batch number: Unknown) 10 mg, every 1 day, from 2019, frequency was not reported for an unspecified indication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 19-NOV-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 20-NOV-2021, the patient experienced very tired. On 21-NOV-2021, the patient experienced rash on stomach to back which looked like prickly heat. The action taken with covid-19 vaccine ad26.cov2.s was not applicable; and dose of macitentan was not changed. The patient recovered from very tired on 20-NOV-2021, and was recovering from rash on stomach to back which looked like prickly heat. This report was non-serious.


VAERS ID: 1904831 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-13
Onset:2021-11-20
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 3 - / OT
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Inappropriate schedule of product administration, Lethargy, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: 10 out of 10 pain/pain in every part of body from head to toe; lethargy; severe nausea; headache; inappropriate schedule of vaccine administered; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (10 out of 10 pain/pain in every part of body from head to toe), LETHARGY (lethargy), NAUSEA (severe nausea), HEADACHE (headache) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (inappropriate schedule of vaccine administered) in a 31-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 045C21A) for COVID-19 vaccination. Co-suspect product included non-company product TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) for an unknown indication. No Medical History information was reported. On 13-Mar-2021, the patient received first dose of TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) 1 dosage form. On 03-Apr-2021, received second dose of TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) dosage was changed to 1 dosage form. On 20-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Nov-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (inappropriate schedule of vaccine administered). On an unknown date, the patient experienced PAIN (10 out of 10 pain/pain in every part of body from head to toe), LETHARGY (lethargy), NAUSEA (severe nausea) and HEADACHE (headache). The patient was treated with ACETAMINOPHEN for Adverse event, at a dose of 650 milligram. On 20-Nov-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (inappropriate schedule of vaccine administered) had resolved. At the time of the report, PAIN (10 out of 10 pain/pain in every part of body from head to toe), LETHARGY (lethargy), NAUSEA (severe nausea) and HEADACHE (headache) outcome was unknown. No concomitants medications was reported. This case was linked to MOD-2021-395725 (Patient Link).


VAERS ID: 1904875 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALLEGRA ALLERGY; VITAMIN D [VITAMIN D NOS.]
Current Illness: Allergy (Allegra).
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Lips are swollen; Rash on the neck; This spontaneous case was reported by a consumer and describes the occurrence of LIP SWELLING (Lips are swollen) and RASH (Rash on the neck) in a 52-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 058F21A) for COVID-19 vaccination. Previously administered products included for Product used for unknown indication: Pfizer BioNtech (lot no. EN6204) on 13-Mar-2021 and Pfizer BioNtech (Lot no. EW0151) on 03-Apr-2021.Past adverse reactions to the above products included No adverse event with Pfizer BioNtech and Pfizer BioNtech.Concurrent medical conditions included Allergy (Allegra). Concomitant products included FEXOFENADINE HYDROCHLORIDE (ALLEGRA ALLERGY) for Allergy, VITAMIN D [VITAMIN D NOS] for an unknown indication. On 18-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Nov-2021, the patient experienced LIP SWELLING (Lips are swollen) and RASH (Rash on the neck). At the time of the report, LIP SWELLING (Lips are swollen) and RASH (Rash on the neck) outcome was unknown. Treatment information was not provided.


VAERS ID: 1904877 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Headache, Interchange of vaccine products, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: This spontaneous case was reported by an other health care professional and describes the occurrence of FEELING ABNORMAL (Feel terrible after having our 3rd dose/Felt like death all night after 3rd dose), PAIN (Aches after 3rd dose), PYREXIA (High temperature after 3rd dose), HEADACHE (Terrible headache after 3rd dose) and INTERCHANGE OF VACCINE PRODUCTS (Dose 1 and 2 non-Moderna COVID-19 vaccine) 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.On 20-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Nov-2021, the patient experienced FEELING ABNORMAL (Feel terrible after having our 3rd dose/Felt like death all night after 3rd dose), PAIN (Aches after 3rd dose), PYREXIA (High temperature after 3rd dose), HEADACHE (Terrible headache after 3rd dose) and INTERCHANGE OF VACCINE PRODUCTS (Dose 1 and 2 non-Moderna COVID-19 vaccine). On 20-Nov-2021, INTERCHANGE OF VACCINE PRODUCTS (Dose 1 and 2 non-Moderna COVID-19 vaccine) had resolved. At the time of the report, FEELING ABNORMAL (Feel terrible after having our 3rd dose/Felt like death all night after 3rd dose), PAIN (Aches after 3rd dose), PYREXIA (High temperature after 3rd dose) and HEADACHE (Terrible headache after 3rd dose) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was not applicable.No concomitant medications reported.No treatment reported. This case was linked to MOD-2021-395575 (Patient Link).


VAERS ID: 1905043 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Headache, Interchange of vaccine products, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Feel terrible after having our 3rd dose/Felt like death all night after 3rd dose; Aches; High temperature; Terrible headache; first 2 doses were a different one; This spontaneous case was reported by another health care professional and describes the occurrence of FEELING ABNORMAL (Feel terrible after having our 3rd dose/Felt like death all night after 3rd dose), PAIN (Aches), PYREXIA (High temperature), HEADACHE (Terrible headache) and INTERCHANGE OF VACCINE PRODUCTS (first 2 doses were a different one) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 20-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Nov-2021, the patient experienced FEELING ABNORMAL (Feel terrible after having our 3rd dose/Felt like death all night after 3rd dose), PAIN (Aches), PYREXIA (High temperature), HEADACHE (Terrible headache) and INTERCHANGE OF VACCINE PRODUCTS (first 2 doses were a different one). On 20-Nov-2021, INTERCHANGE OF VACCINE PRODUCTS (first 2 doses were a different one) had resolved. At the time of the report, FEELING ABNORMAL (Feel terrible after having our 3rd dose/Felt like death all night after 3rd dose), PAIN (Aches), PYREXIA (High temperature) and HEADACHE (Terrible headache) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant drugs were not reported. Treatment medications were not provided. This case was linked to MOD-2021-395583 (Patient Link).


VAERS ID: 1905296 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Cardiovascular evaluation, Chest X-ray, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram normal, Fibrin D dimer increased, Hyperlipidaemia, Myocarditis, Pericardial effusion, Pericarditis, Pulmonary embolism, Troponin I normal, Troponin increased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Dyslipidaemia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROAIR HFA) 90 mcg/actuation inhaler cyclobenzaprine (FLEXERIL) 10 mg tablet ergocalciferol (VITAMIN D2) 50,000 unit capsule ketorolac (TORADOL) 10 mg tablet metFORMIN XR (GLUCOPHAGE-XR) 500 mg 24 hr tablet naratriptan (
Current Illness: none
Preexisting Conditions: Nervous Pituitary microadenoma Intractable chronic migraine without aura and without status migrainosus Exertional headache Respiratory Asthma, intermittent Circulatory Hypertension, diastolic Palpitations PVC (premature ventricular contraction) Grade IV hemorrhoids Digestive Class 2 severe obesity due to excess calories with serious comorbidity and body mass index (BMI) of 35.0 to 35.9 in adult Vitamin D deficiency Irritable bowel syndrome with constipation Genitourinary Nephrolithiasis PCOS (polycystic ovarian syndrome) Endocrine/Metabolic Solitary thyroid nodule Simple goiter Dysmetabolic syndrome X Hyperlipidemia, mixed Other Insomnia Stress and adjustment reaction Disordered sleep
Allergies: latex
Diagnostic Lab Data: Wed Nov 24, 2021 1054 Troponin I: <0.03 [RR] 1054 D-Dimer, Quant (FEU): 0.49 [RR] 1125 Spoke with cardiologist Dr., states that patient is safe to return home at this time however recommended outpatient echo and cardiac MRI as well as ambulatory referral to cardiology. These orders were placed. Bedside echo was performed and negative for obvious pericardial effusion. Patient discharged with instructions to take ibuprofen 600 mg every 8 hours for 7 days. Return precautions were discussed. Patient was instructed to follow-up with PCP to discuss emergency department visit as well as to clarify whether she is safe to receive second COVID-19 vaccination
CDC Split Type:

Write-up: Patient with asthma, hyperlipidemia and recent COVID-19 vaccination who presents with episodes of self resolving chest pain shortness of breath as well as elevated troponin. On exam, patient is well-appearing and speaking in full sentences. Heart regular rate and rhythm and lungs are clear to auscultation bilaterally. Abdomen soft, nontender nondistended. No notable leg swelling or leg asymmetry on exam. Vital signs within normal limits, oxygen saturation of 99% on room air. EKG normal sinus rhythm with a rate of 94, normal axis and intervals, no ST elevations or depressions. Differential diagnosis includes pulmonary embolism, myocarditis/pericarditis from recent COVID-19 vaccination, asthma. Low suspicion for ACS at this time as patient is otherwise relatively healthy. Heart score is 3. Patient recently obtained a chest x-ray that was negative for pneumothorax, pneumonia, or other acute pathology. Will hold off on repeat chest x-ray at this time. Will obtain lab work including CBC, BMP, delta troponin, as well as D-dimer. Will obtain bedside echo to evaluate for obvious pericardial effusion.


VAERS ID: 1905299 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-14
Onset:2021-11-20
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dysuria, Urinary tract infection
SMQs:

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

Write-up: URINARY TRACT INFECTION R30.0 - Dysuria


VAERS ID: 1905315 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Product administration 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: Zyrtec 10mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: The medical assistant did not use diluent when drawing up vaccine. Therefore my son was given 0.2ml of the concentrated vaccine, resulting in him getting over 2x the dosing he should have received. We were notified of this error a few hours after vaccination.


VAERS ID: 1905316 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-09
Onset:2021-11-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Erythema, Pruritus, 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: Zyrtec, Magnesium, Iron supplement
Current Illness:
Preexisting Conditions: Asthma
Allergies: Dairy intolerance
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash developed 9-11 days after receiving moderna booster. It appears to be dermatographia. I have treated it with antihistamines but continue to have itchiness and redness. The condition is still present. I plan to go to a primary care physician or dermatologist soon.


VAERS ID: 1905321 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site haemorrhage, Injection site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Moderna Booster Shot: 11/19/21, next morning arm felt warm, bruising, hole in arm bleeding, spoke to pharmacist and was told to go to PCP if bruising, bruising starting going away after a day. Patient is still healing from AE


VAERS ID: 1905344 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blister, Erythema, Pain, Pain of skin, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, biscacodyl, olanzapine, miralax, sotalol, vitamin D, saline nasal spray
Current Illness: compulsive behavior, mild LVH, eosinophilia
Preexisting Conditions: glaucoma, hypertension, anemia, atrial fibrillation, diabetes
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11/19/21: received Covid booster dose 11/20/21: Redness to buttocks started, skin started exfoliating and then completely peeled off on the left side of buttocks. Blistered and red on the right side. A spot developed on his neck that blistered and the skin came off. Clothes were removed, aquaphor applied every 1-2 hours. 11/22/21: Areas continued to enlarge and were painful. Desitin (zinc 40%) ordered BID and prn, silver sulfadiazine BID, as well as Aquaphor 11/23/21: temp 99, skin still coming off and painful to touch


VAERS ID: 1905534 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrioventricular block second degree, Influenza like illness, Lethargy
SMQs:, Conduction defects (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Hypokalaemia (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: Alfluzosin 10mg q day
Current Illness: BPH
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none other than observation
CDC Split Type:

Write-up: severe flu symptoms with lethargy for 2 days. Then development of 2nd degree Heart Block, Type 1 for 72 hours


VAERS ID: 1905577 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-06
Onset:2021-11-20
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Arthropathy, Blood thyroid stimulating hormone normal, C-reactive protein increased, Dizziness, Erythema annulare, Fatigue, Full blood count normal, Immunology test, Liver function test normal, Oedema peripheral, Periorbital oedema, Pyrexia, Rash, Renal function test normal, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Dysuria. No UTI
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: Elevated CRP ( 22), Normal CBC, LFT''s, TSH, renal studies. Negative Lyme, ASO titer, strep test and covid test.
CDC Split Type:

Write-up: Fever, dizziness fatigue, b/l wrist arthritis, periorbital edema. hand and pedal edema. Annular rash on trunk.


VAERS ID: 1905691 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-16
Onset:2021-11-20
   Days after vaccination:277
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, Bacterial test, Blood pressure abnormal, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Cardiac failure acute, Chest X-ray abnormal, Chills, Condition aggravated, Cough, Decreased appetite, Dizziness, Dyspnoea, Dyspnoea exertional, Electrocardiogram normal, Exposure to SARS-CoV-2, Fatigue, Haemoglobin decreased, Hypervolaemia, Left ventricular dysfunction, Left ventricular failure, Lethargy, Lung opacity, Myalgia, Nasal congestion, Oedema peripheral, Oropharyngeal pain, Orthopnoea, Pain, Pleural effusion, Polyuria, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Troponin increased, Urinary tract infection, Urine analysis abnormal, Viral test, Wheelchair user, Wheezing, White blood cells urine positive
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet amoxicillin-clavulanate (AUGMENTIN) 875-125 MG per tablet apixaban (ELIQUIS) 5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG chewable tablet atorvastatin (LIPITOR) 20 MG tablet bisacod
Current Illness: 11.5.21: wheezing, cough, sore throat (11.9.21 - COVID PCR - negative) 11.20.21: office visit (PCP) - Patient is a 79 y.o. male who presents to the Urgent Care with COUGH (symptoms started 2 weeks ago. had lethargy, shortness of breath, body aches. multiple family members tested positive for covid. around that time. pt did not get tested. past 3 days if pt lays down or reclines in recliner he cannot breathe. short of breath with activity. ) Patient is a 79-year-old male that presents to urgent care with chief complaint of cough. He reports symptoms started on 11/7/21. He reports COVID-19 contacts in family and believes he had COVID-19 however was never tested. Over the last 3 days reports significant shortness of breath with exertion and difficulty lying flat due to symptoms.
Preexisting Conditions: Type 2 diabetes mellitus BPH (Benign Prostatic Hypertrophy) Dyslipidemia Anemia Macular degeneration Cataract History of ST elevation myocardial infarction (STEMI) Shortness of breath Cardiomyopathy Atrial fibrillation Chronic systolic heart failure Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure Acute cystitis without hematuria
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: TWO hospitalizations (11.20 and 11.26); COVID-19 positive (11.20.21); fully vaccinated Admission Date: 11/20/2021 Discharge Date: 11/23/2021 Presenting Problem: Pneumonia due to COVID-19 virus DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: Per H&P: Patient is a 79 y.o. male with PMH s/o HTN, HLD, DM, 2017 inferior stemi s/p PCI to RCA, HFrEF 45-50% who previously followed with Dr. and with ACV cardiology, presented to ED on 11/20 evening due to worsening DOE, orthopnea and shortness of breath. He went initially to urgent care with CXR returning showing trace pleural effusions and showed patchy airspace opacities in the periphery of both lungs suspicious for developing infectious process. Trace effusions. ER workup found COVID rapid test neg, CXR showing some peripheral opacities. No leukocytosis. Hgb 10. BNP elevated 4375, initial trop of 36. EKG showing no acute ST changes. He was started on IV lasix. At bedside with daughter patient states he has had worsening orthopnea, DOE, and fatigue x 1 month. Noted his weight up about 5 pounds 245 to 250 lbs. Reports slight decrease in appetite. Denies knowing of any prior diagnosis of atrial fibrillation or heart failure. Patient would like to follow with Dr. who he used to see for cardiology care outpatient after this admission. He endorses cough and nasal congestion over the last week. Family members were positive for covid at start of November but patient was not tested at that time. Full viral swab pending, pcr for covid is negative. At this time + orthopnea, dyspnea, peripheral edema. Denies chest pain or pressure or anginal sx. No LH or dizziness or sensation of palpitations." #Covid 19 pneumonia. Covid PCR returned positive 11/20/21, but symptoms started 11/6/21 at which time he had myalgias, chills, dyspnea, cough. During his admission, he was afebrile and oxygenating well on room air, so he was deemed low risk for transmitting the virus and infection control advised discontinuing isolation precautions. No Covid specific therapies were indicated as he was not hypoxic. Admission Date: 11/26/2021 Discharge Date: Nov 28, 2021 PRESENTING PROBLEM: Shortness of breath Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure HOSPITAL COURSE: Patient is a 79 y.o. male hx of CAD s/p PCI to RCA for inferior STEMI 2017, HTN, HLD, type 2 diabetes, HFrEF LVEF 36%, recent Covid infection (symptoms started 11/6/21) who presented 11/26 with recurrence of orthopnea and shortness of breath. He was admitted 11/20/21 to 11/23/21 for acute on chronic systolic/diastolic heart failure and new onset A fib. He was found to have had progression of LV dysfunction, down to 36% from 45% earlier this summer. He was diuresed from 113kg down to 105kg on discharge at which time he was feeling well with no orthopnea, no peripheral edema, and no shortness of breath with ambulating the hallways. He was transitioned to torsemide 40mg daily with good urine output on day of discharge. Patient reports he went to his PCP''s office for follow up on 11/24, was light-headed so was taken up to the office in a wheelchair. The patient states that the PCP recommended holding torsemide and losartan until he followed up with Dr. two days later (11/26). Per the office notes, he was found to be borderline hypotensive 90/54 and complaining of light-headedness, so plan was hold losartan. He was at his dry weight of 105kg/231lbs, and no mention was made of holding torsemide in the note. In the ED, patient was hemodynamically stable, appeared volume overloaded and short of breath so was given IV lasix 40mg with good urine output. UA positive for WBC and bacteria, was given 1g dose of IV ceftriaxone. Pt was transitioned to torsemide 40 mg in the morning and 20 mg in the afternoon. Losartan held on discharge. He was continued on coreg 3.125 mg PO BID. He was discharged with 10-day course of Augmentin for UTI.


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