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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)

This is page 528 out of 10,317

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VAERS ID: 1889971 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-03
Onset:2021-11-19
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 211D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Infection, Neck pain
SMQs:, Arthritis (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: Montelukast
Current Illness: unknown but received antibiotic one month prior
Preexisting Conditions: fibromyalgia, neuropathy
Allergies: Doxycycline
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient came in 2 weeks later stating she was in the hospital for an infection and believes it was from the way the vaccine was administered. She was picking up medications from the hospital and said that she was feeling pain in the side of her neck


VAERS ID: 1890008 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 24-hour full body aches, fever peaking at 102, exhaustion
Other Medications: Apri, Wellbutrin
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Latex
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Vertigo; dizziness, nausea


VAERS ID: 1890023 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Extra dose administered, Headache, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide, Gabapentin, Losartan, Metformin, Fish Oil, Vitamin D
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: After receiving the 3rd Booster of Moderna 11/18/2021, patient started experiencing symptoms 11/19/2021 of fever (101.0), headache and chills. 11/21/2021 symptoms subsided. No noted primary visit/communications.


VAERS ID: 1890040 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Fatigue, Feeding disorder, Headache, Heart rate increased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fatigue, headache, wouldn''t eat or drink because she was to tired. Elevated BP, elevated pulse and fever.- as described by daughter. Taken to hospital to be evaluated.


VAERS ID: 1890074 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-05
Onset:2021-11-19
   Days after vaccination:287
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Ejection fraction, Ischaemic cardiomyopathy, Rheumatoid arthritis, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Arthritis (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), 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: Pt has ischemic cardiomyopathy with EF of 45% and RA and taking medication. Pt has felt more short of breath the last few days and was found to be COVID positive.


VAERS ID: 1890082 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash
SMQs:, Hypersensitivity (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: Loratadine, Carbidopa25/Levidopa100, Plavix, Lisinopril, Aspirin 81mgs, Multivitamin,Vit D3, Docusate, Flomax,Lipitor, & Omega 3
Current Illness: none
Preexisting Conditions: Ischemic heart disease (7 stents) , Parkinson''s Disease
Allergies: Altace, Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash & itching at the injection site developed after 48 hrs. Treated with Benadryl cream & cold packs. It resolved after 3 days.


VAERS ID: 1890086 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-24
Onset:2021-11-19
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: lung CA stage 4,
Preexisting Conditions: 4 lung CA
Allergies: NKA
Diagnostic Lab Data: COVID POSITIVE 11/19/21
CDC Split Type:

Write-up: COVID + 11/19/21 ADMITTED TO HOSPITAL


VAERS ID: 1890087 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Cough, Fatigue, Hypersomnia, Injection site bruising, Injection site erythema, Injection site pain, Injection site swelling, Lethargy, Lymphadenopathy, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fever-Medium, Systemic: Joint Pain-Medium, Systemic: Lymph Node Swelling-Severe, Systemic: Nausea-Mild, Systemic: Vomiting-Mild, Additional Details: Patient reports her underarm lymph nodes are swollen, bruised at injection site, has joint muscle pain, a hacky cough, vomitted once, and reported she slept for 3 days. This all started the day after the vaccine in the afternoon.


VAERS ID: 1890090 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Facial paralysis, Salivary hypersecretion
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: 11-19-2021 at 6pm started to present paralysis on face right side and eliminating excess saliva.


VAERS ID: 1890096 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-11-19
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Pt has a history of CAD status post CABG. Presents to ED with increased shortness of breath. Admitted with COVID-19 infection with pneumonia with acute hypoxic respiratory failure.


VAERS ID: 1890104 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 RA / IM

Administered by: Military       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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PT WAS 11Y 8MO AND RECIVED 12 ANMD OVER COVID PFIZER DOSE. PER MOP PT, PT HAS NTO EXPERINCED AND ADVERS REACTIONS.


VAERS ID: 1890144 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-22
Onset:2021-11-19
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Lung infiltration, Mental status changes, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CLL
Allergies:
Diagnostic Lab Data: COVID + 11/19 CXR - Bilateral pulmonary infiltrates.
CDC Split Type:

Write-up: admitted with COVID PNA requiring supplemental oxygen family reported altered mental status and cough pt started on decadron and remdesivir


VAERS ID: 1890172 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Myalgia, Oedema peripheral, Pain, Peripheral swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: celexa topamax omeprazole pottasium magnesium
Current Illness: none
Preexisting Conditions: migraines
Allergies: codiene compazine imitrx
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: left arm swollen hot all the way into the arm pit and down the left ar the elbow. EVERY JOINT IN MY BODY HURTS TO MOVE. FEEL LIKE NO ENERGY AND SOME OF MY MUSCLES FEEL LIKE THEY ARE ON FIRE. ITS BEEN 3 DAYS ALREADY ITS GETTING WORSE NOT BETTER


VAERS ID: 1890180 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Malaise, Muscle spasms, Myalgia, Night sweats
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: second Shingles shot. only lasted approx 6hrs
Other Medications: Allegra
Current Illness: none
Preexisting Conditions: none
Allergies: topical aloe Vera
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I thought this booster would be a breeze, as the only reaction to my second Moderna vaccine was, besides a sore arm for a few days, a slight headache and tiredness, that was alleviated with Tylenol and only lasted about 24 hrs. I was fine with the Moderna booster until approximately 6 hrs later, I felt ill, had extreme chills, muscle and joint aches. The spasms from chills tightened my back and chest muscles for minutes at a time. The spasms, joint and muscle aches were intermittent and lasted for more than 24 hrs. I felt ill all the next day but didn''t vomit and took Tylenol, drank lots of liquids and rested. That night I awoke and was drenched in sweat, to the point of getting up, changing my nightgown, putting a towel down on the wet sheets and sleeping again. I was still felt tired on waking, but felt a little better. Drank fluids, took Tylenol at intervals,some soups, and rested. I just felt tired with a headache the next day and today I feel well this morning. I had a similar reaction to the second shingles shot I received, with spasms, dizziness, and chills, but it only lasted about 6hrs and was fine after that. Hope this report helps others.


VAERS ID: 1890197 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-24
Onset:2021-11-19
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E131602 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E191906 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Hyporesponsive to stimuli, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unknonw
Preexisting Conditions: Arythmia , Anxiety, Hypothyroid , Atrial Fibulation
Allergies: Cephelosporine, Penicillen, pseudovent
Diagnostic Lab Data: C-19 postive 11/19/2021.
CDC Split Type:

Write-up: Patient admitted to hospital on 11/19/2021 Presented with confusion and Decreased responsiveness. Patient was treated with TYLENOL, Benzonatate.


VAERS ID: 1890208 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dysgeusia, Headache
SMQs:, Taste and smell disorders (narrow), 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:
Current Illness: Type 2 diabetes
Preexisting Conditions: Hypertension Hypothyroidism Type 2 diabetes High cholesterol
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Metallic taste in mouth 15 minutes after receiving vaccine also headaches & chills diarrhea


VAERS ID: 1890216 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered, Paraesthesia oral, Refusal of vaccination
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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: UNKNOWN WHAT MEDICATIONS PT WAS TAKING.
Current Illness: PT STATED SHE HAD NO CURRENT ILLNESSES.
Preexisting Conditions: PT STATED NO CHRONIC OR LONG-STANDING HEALTH CONDITION.
Allergies: PT STATED AT THE TIME OF VISIT THAT SHE HAD ANAPHYLAXIS TO PENICILLIN, DOXYCYCLINE, ALEVE, GABAPENTIN, AND ERYTHROMYCIN.
Diagnostic Lab Data: NONE CONDUCTED.
CDC Split Type:

Write-up: PT WAS ADMINISTERED A JANSSEN VACCINE OUTSIDE THE 6 HOUR WINDOW HELD AT 36-46 DEGREES FAHRENHEIT. THE 6 HOUR TIME FRAME WAS MISCALCULATED AND ADMINISTERED AT EXACTLY 7 HOURS. PT WAS MONITORED FOR 30 MINUTES AND PT NEVER EXHIBITED SYMPTOMS OF ANAPHYLAXIS OR DISTRESS. THE ERROR WAS CAUGHT BY MYSELF 30 MINUTES AFTER THE PT HAD LEFT. I CONTACTED JANSSEN AND THEY HAD NO GUIDANCE AND STATED TO MAKE MY BEST CLINICAL JUDGEMENT. THE CDC GUIDANCE ON COVID-19 VACCINE ADMIN ERRORS AND DEVIATIONS STATES THAT IF THE MANUFACTURER DOES NOT HAVE DATE TO SUPPORT THE STABILITY OF THE VACCINE TO REPEAT THE DOSE. I CONTACTED THE PT AND SHE STATED " I WILL NOT GET REVACCINATED, DUE TO ME ONLY GETTING IT BECAUSE MY WORK WANTS ME TO." THE PT THEN TOLD ME THAT SHE STARTED EXPERIENCING TINGLING OF THE TONGUE, LIPS, AND GUMS. PT DENIED SOB, DIFFICULTY BREATHING, AND SWELLING OF THE MOUTH/THROAT/FACE. ADVISED PT TO TAKE BENADRYL AND TO GO TO THE ER IMMEDIATELY BECAUSE IT SOUNDED LIKE SHE COULD POSSIBLY BE HAVING A REACTION. PT REFUSED. REEDUCATED THE IMPORTANCE OF GOING TO THE ER TO PT AND SHE REFUSED A SECOND TIME. PT STATES " MY DAUGHTER IS AND RN AND WILL MONITOR ME."


VAERS ID: 1890231 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-06
Onset:2021-11-19
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8782 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Cough, Headache, Nasal congestion, Respiratory tract congestion, Sinus congestion, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baclofen 10 MG Tablet 2 tablets with food or milk Orally Three times a day Gabapentin 100 MG Capsule 2 capsules Orally two times a day Imitrex 100 MG Tablet 1 tablet Orally twice a day as needed for mgraine Tizanidine HCl 4 MG Caps
Current Illness: none
Preexisting Conditions: Hypertension. Multiple Sclerosis - relapsing/remitting Hypercholesterolemia. Migraines - 3 to 4/month. Kidney stones. Adenomatous colon polyp - 5/06 (recheck 5/2011) - He Declines Colonoscopies (5/2018). Chronic Kidney Disease, Stage III Insomnia. Myoclonus (Abdomen). Lung Nodule - Managed by Pulmonology.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache-minor, nonproductive cough, sinus congestion, nasal congestion, post nasal drainage, chest congestion, chest feels sore.starting 11/19/21


VAERS ID: 1890239 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-11-19
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Please contact primary care provider APRN-CNP for further history.
Current Illness: Please contact primary care provider, APRN-CNP for further history.
Preexisting Conditions: Please contact primary care provider, APRN-CNP for further history.
Allergies: Please contact primary care provider APRN-CNP for further history.
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1890242 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Injection site warmth, Rash, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Hypotonic-hyporesponsive episode (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: None
Current Illness: No
Preexisting Conditions: None that I am aware of.
Allergies: Bees, pollens, salicylic acid , benzoyl peroxide
Diagnostic Lab Data: None
CDC Split Type:

Write-up: This was my booster shot, my second dose I did get covid arm but it was not as severe, this time I got extremely sick and got everything that is listed as a symptom. Even my covid arm, however, my rash appeared on 11/19, grew larger on 11/20, it however is now wrapping around my arm into the inside part of the arm. This is all surrounding the injection site. As of today it comes and goes. It is hot to the touch and itchy, which I assume is normal for a covid arm rash. But, it grew in size and has a purple tint occasionally.


VAERS ID: 1890254 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-13
Onset:2021-11-19
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 vaccinated against and then tested positive for COVID


VAERS ID: 1890273 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Dysstasia, Fatigue, Gait disturbance, Injection site pain, Pain, Pain in extremity, Sciatica, Sitting disability
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), 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? Yes
Hospitalized? No
Previous Vaccinations: fatigue and soreness after 1st Pfizer dose
Other Medications: Birth control
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: Lab work from urine sample on 11/21/2021 and nothing abnormal.
CDC Split Type:

Write-up: Significant pain in the sciatic nerve in the back and down to the lower left leg. Pain was so debilitating that I could barely walk, sit or stand. Pain increased over time. Pain in the sciatic nerve began on Friday, Nov 19 after the the vaccination was administered and has continued. Also, soreness of right arm at injection and fatigue.


VAERS ID: 1890279 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-08
Onset:2021-11-19
   Days after vaccination:284
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Please contact primary care provider for further history.
Current Illness: Please contact primary care provider for further history.
Preexisting Conditions: Please contact primary care provider for further history.
Allergies: Please contact primary care provider for further history.
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1890280 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client is 12 years old and came and received 0.2ML of 5-11 year old Pfizer vaccine instead of appropriate dosage for a 12 year old (0.3ML 12+ year old Pfizer). No symptoms or signs involved. Parent notified on 11/22/2021 2pm and informed of dosage mistake. Parent understood that client must receive 0.3ML of 12years+ Pfizer vaccine for 2nd dose. Will schedule accordingly.


VAERS ID: 1890295 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-31
Onset:2021-11-19
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 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: Please contact primary care provider for further history.
Current Illness: Please contact primary care provider for further history.
Preexisting Conditions: Please contact primary care provider for further history.
Allergies: Please contact primary care provider for further history.
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1890309 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Pain in extremity, Spinal pain, Testicular pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Persistent pain in spine, arms, legs, testicles. Intermittent chest pain. Level of pain gradually reducing since injection, but still noticeable as of 11/22.


VAERS ID: 1890311 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-23
Onset:2021-11-19
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 vaccinated against and then tested positive for COVID19


VAERS ID: 1890322 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-25
Onset:2021-11-19
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 vaccinated against and then tested positive for COVID-19


VAERS ID: 1890331 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-10
Onset:2021-11-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Peripheral swelling, Pruritus, Rash, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), 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: Sertraline
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: n/a - Consult with Allergist on 11/22
CDC Split Type:

Write-up: Full body rash, hives, swollen hands and feet, extremely itchy


VAERS ID: 1890339 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Electrocardiogram normal
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? 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: EKG normal, Referred to ED but patient refused signing out.
CDC Split Type:

Write-up: Pt states she has been having chest pressure and shortness of breath worse when laying flat since receiving Moderna booster on 11/19 form.


VAERS ID: 1890352 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pravastatin
Current Illness: none
Preexisting Conditions: none
Allergies: Cold meds, dyes, iodine, bioxin, ioseppin, cloazapom
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting 10 hours after vaccination, chills to the bone (never had with previous 2 doses). The next morning, chills were gone, but her tongue was swollen. Tongue continues to be swollen 3 days later. Rash from neck to groin. Reached out to PCP. Not able to take anything for symptoms as she is severely susceptible to reaction to meds. Advised to reach out to 911 if tongue swells further.


VAERS ID: 1890362 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid; claritin, Famotadine, Vitamin b-12, Vitamin C
Current Illness: n/a
Preexisting Conditions: Asthma; Migraine headaches, obesity, sleep apnea
Allergies: Z-pack
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever, headache, extreme fatigue


VAERS ID: 1890381 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Facial pain, Facial paralysis, Feeling abnormal, Hemiplegia, Movement disorder, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Depression (excl suicide and self injury) (broad), Hearing impairment (broad), Hypoglycaemia (broad)

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

Write-up: Treated in the emergency room on Friday 11/19/2021 with left sided facial paralysis, left temple pain, tremors, and nausea. Given IV fluids. Continues to feel poorly and having difficulty concentrating at work, feels as if she''s "in a fog and like I can''t get my brain to tell the rest of my body what to do".


VAERS ID: 1890392 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Breast pain, Chest pain, Hypoaesthesia, Injection site pain, Lymph node pain, Lymphadenopathy, Oropharyngeal blistering, Pain, Pyrexia, Streptococcus test
SMQs:, Severe cutaneous adverse reactions (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Lipodystrophy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 100mg daily, Estradilog 1mg daily,, Vit D 2, 000 IU''s daily, Motrin 800mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Strep test
CDC Split Type:

Write-up: 11/19/21 woke up and was running a low grade fever, pain at injection site and felt a softball size lump under left axilla. throughout the day fever increased to 102.8 F. Also experiencing numbness down to left hand into fingers. Experiencing chest pain radiating to left shoulder and breast as well. She took Motrin and Tylenol - did help fever and did not help the pain. Came to the on 11/22/21 to see physician. Physical exam completed. Did see blisters in throat and did a strep test today. Still a lot of pain in the axilla area, but much better than it was.


VAERS ID: 1890401 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Chills, Extra dose administered, Laboratory test, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin Tablet Give 81 mg by mouth one time a day related to PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS (Z86.73) Pharmacy Active 10/6/2021 08:00 10/6/2021 Drug overdose. Fosamax
Current Illness: PNEUMONIA, UNSPECIFIED ORGANISM Pulmonary 5/14/2021 Primary Present on Admission 10/6/2021 view R13.12 T DYSPHAGIA, OROPHARYNGEAL PHASE N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis 3 Present on Admission 3/26/2021 view R41.841 T COGNITIVE COMMUNICATION DEFICIT N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis 4 Present on Admission 3/26/2021 view E44.1 MILD PROTEIN-CALORIE MALNUTRITION NTA (1 pts) Medical Management 10/5/2021 Diagnosis 5 Present on Admission 10/6/2021 view D63.1 ANEMIA IN CHRONIC KIDNEY DISEASE N/A, not an acceptable Primary Diagnosis 10/5/2021 Diagnosis Present on Admission 10/6/2021 view Z86.73 PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS N/A, not an acceptable Primary Diagnosis 10/5/2021 Diagnosis Present on Admission 10/6/2021 view L95.8 OTHER VASCULITIS LIMITED TO THE SKIN N/A, not an acceptable Primary Diagnosis 10/5/2021 Diagnosis Present on Admission 10/6/2021 view G60.9 HEREDITARY AND IDIOPATHIC NEUROPATHY, UNSPECIFIED Acute Neurologic 10/5/2021 Diagnosis Present on Admission 10/6/2021 view N39.0 URINARY TRACT INFECTION, SITE NOT SPECIFIED Acute Infections 9/4/2021 Diagnosis 9/4/2021 view K56.690 OTHER PARTIAL INTESTINAL OBSTRUCTION Medical Management 5/14/2021 Diagnosis Present on Admission 5/14/2021 view F31.61 BIPOLAR DISORDER, CURRENT EPISODE MIXED, MILD Medical Management 5/14/2021 Diagnosis Present on Admission 10/7/2021 view F01.50 VASCULAR DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE N/A, not an acceptable Primary Diagnosis 4/9/2021 Diagnosis Present on Admission 4/9/2021 view R62.7 ADULT FAILURE TO THRIVE N/A, not an acceptable Primary Diagnosis 4/3/2021 Diagnosis Present on Admission 4/3/2021 view E78.5 HYPERLIPIDEMIA, UNSPECIFIED Medical Management 3/13/2021 Diagnosis Present on Admission 3/13/2021 view G40.911 EPILEPSY, UNSPECIFIED, INTRACTABLE, WITH STATUS EPILEPTICUS NTA (1 pts) Medical Management 3/13/2021 Diagnosis Present on Admission 3/13/2021 view M62.81 T MUSCLE WEAKNESS (GENERALIZED) N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/26/2021 view R26.2 T DIFFICULTY IN WALKING, NOT ELSEWHERE CLASSIFIED N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/26/2021 view J43.9 EMPHYSEMA, UNSPECIFIED NTA (2 pts) Pulmonary 3/8/2021 Diagnosis Present on Admission 3/8/2021 view N18.31 CHRONIC KIDNEY DISEASE, STAGE 3A Medical Management 3/8/2021 Diagnosis 3/8/2021 view F41.9 ANXIETY DISORDER, UNSPECIFIED Medical Management 3/8/2021 Diagnosis Present on Admission 3/8/2021 view I77.6 ARTERITIS, UNSPECIFIED Cardiovascular and Coagulations 3/8/2021 Diagnosis Present on Admission 3/8/2021 view G89.4 CHRONIC PAIN SYNDROME N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view M35.9 SYSTEMIC INVOLVEMENT OF CONNECTIVE TISSUE, UNSPECIFIED NTA (1 pts) Non-Surgical Orthopedic/Musculoskeletal 3/8/2021 Diagnosis Present on Admission 3/8/2021 view K57.90 DIVERTICULOSIS OF INTESTINE, PART UNSPECIFIED, WITHOUT PERFORATION OR ABSCESS WITHOUT BLEEDING Medical Management 3/8/2021 Diagnosis Present on Admission 3/8/2021 view M54.12 RADICULOPATHY, CERVICAL REGION Non-Surgical Orthopedic/Musculoskeletal 3/8/2021 Diagnosis Present on Admission 3/8/2021 view K21.9 GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view H91.93 UNSPECIFIED HEARING LOSS, BILATERAL N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view I10 ESSENTIAL (PRIMARY) HYPERTENSION N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view N62 HYPERTROPHY OF BREAST Medical Management 3/8/2021 Diagnosis Present on Admission 3/8/2021 view Z79.52 LONG TERM (CURRENT) USE OF SYSTEMIC STEROIDS N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view C80.1 MALIGNANT (PRIMARY) NEOPLASM, UNSPECIFIED Cancer 3/8/2021 Diagnosis Present on Admission 3/8/2021 view D47.2 MONOCLONAL GAMMOPATHY Medical Management 3/8/2021 Diagnosis Present on Admission 3/8/2021 view M19.90 UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view G47.00 INSOMNIA, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view M96.1 POSTLAMINECTOMY SYNDROME, NOT ELSEWHERE CLASSIFIED Non-Surgical Orthopedic/Musculoskeletal 3/8/2021 Diagnosis Present on Admission 3/8/2021 view N40.0 BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view M06.9 RHEUMATOID ARTHRITIS, UNSPECIFIED Non-Surgical Orthopedic/Musculoskeletal 3/8/2021 Diagnosis Present on Admission 3/8/2021
Preexisting Conditions: PNEUMONIA, UNSPECIFIED ORGANISM Pulmonary 5/14/2021 Primary Present on Admission 10/6/2021 view R13.12 T DYSPHAGIA, OROPHARYNGEAL PHASE N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis 3 Present on Admission 3/26/2021 view R41.841 T COGNITIVE COMMUNICATION DEFICIT N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis 4 Present on Admission 3/26/2021 view E44.1 MILD PROTEIN-CALORIE MALNUTRITION NTA (1 pts) Medical Management 10/5/2021 Diagnosis 5 Present on Admission 10/6/2021 view D63.1 ANEMIA IN CHRONIC KIDNEY DISEASE N/A, not an acceptable Primary Diagnosis 10/5/2021 Diagnosis Present on Admission 10/6/2021 view Z86.73 PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS N/A, not an acceptable Primary Diagnosis 10/5/2021 Diagnosis Present on Admission 10/6/2021 view L95.8 OTHER VASCULITIS LIMITED TO THE SKIN N/A, not an acceptable Primary Diagnosis 10/5/2021 Diagnosis Present on Admission 10/6/2021 view G60.9 HEREDITARY AND IDIOPATHIC NEUROPATHY, UNSPECIFIED Acute Neurologic 10/5/2021 Diagnosis Present on Admission 10/6/2021 view N39.0 URINARY TRACT INFECTION, SITE NOT SPECIFIED Acute Infections 9/4/2021 Diagnosis 9/4/2021 view K56.690 OTHER PARTIAL INTESTINAL OBSTRUCTION Medical Management 5/14/2021 Diagnosis Present on Admission 5/14/2021 view F31.61 BIPOLAR DISORDER, CURRENT EPISODE MIXED, MILD Medical Management 5/14/2021 Diagnosis Present on Admission 10/7/2021 view F01.50 VASCULAR DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE N/A, not an acceptable Primary Diagnosis 4/9/2021 Diagnosis Present on Admission 4/9/2021 view R62.7 ADULT FAILURE TO THRIVE N/A, not an acceptable Primary Diagnosis 4/3/2021 Diagnosis Present on Admission 4/3/2021 view E78.5 HYPERLIPIDEMIA, UNSPECIFIED Medical Management 3/13/2021 Diagnosis Present on Admission 3/13/2021 view G40.911 EPILEPSY, UNSPECIFIED, INTRACTABLE, WITH STATUS EPILEPTICUS NTA (1 pts) Medical Management 3/13/2021 Diagnosis Present on Admission 3/13/2021 view M62.81 T MUSCLE WEAKNESS (GENERALIZED) N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/26/2021 view R26.2 T DIFFICULTY IN WALKING, NOT ELSEWHERE CLASSIFIED N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/26/2021 view J43.9 EMPHYSEMA, UNSPECIFIED NTA (2 pts) Pulmonary 3/8/2021 Diagnosis Present on Admission 3/8/2021 view N18.31 CHRONIC KIDNEY DISEASE, STAGE 3A Medical Management 3/8/2021 Diagnosis 3/8/2021 view F41.9 ANXIETY DISORDER, UNSPECIFIED Medical Management 3/8/2021 Diagnosis Present on Admission 3/8/2021 view I77.6 ARTERITIS, UNSPECIFIED Cardiovascular and Coagulations 3/8/2021 Diagnosis Present on Admission 3/8/2021 view G89.4 CHRONIC PAIN SYNDROME N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view M35.9 SYSTEMIC INVOLVEMENT OF CONNECTIVE TISSUE, UNSPECIFIED NTA (1 pts) Non-Surgical Orthopedic/Musculoskeletal 3/8/2021 Diagnosis Present on Admission 3/8/2021 view K57.90 DIVERTICULOSIS OF INTESTINE, PART UNSPECIFIED, WITHOUT PERFORATION OR ABSCESS WITHOUT BLEEDING Medical Management 3/8/2021 Diagnosis Present on Admission 3/8/2021 view M54.12 RADICULOPATHY, CERVICAL REGION Non-Surgical Orthopedic/Musculoskeletal 3/8/2021 Diagnosis Present on Admission 3/8/2021 view K21.9 GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view H91.93 UNSPECIFIED HEARING LOSS, BILATERAL N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view I10 ESSENTIAL (PRIMARY) HYPERTENSION N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view N62 HYPERTROPHY OF BREAST Medical Management 3/8/2021 Diagnosis Present on Admission 3/8/2021 view Z79.52 LONG TERM (CURRENT) USE OF SYSTEMIC STEROIDS N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view C80.1 MALIGNANT (PRIMARY) NEOPLASM, UNSPECIFIED Cancer 3/8/2021 Diagnosis Present on Admission 3/8/2021 view D47.2 MONOCLONAL GAMMOPATHY Medical Management 3/8/2021 Diagnosis Present on Admission 3/8/2021 view M19.90 UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view G47.00 INSOMNIA, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view M96.1 POSTLAMINECTOMY SYNDROME, NOT ELSEWHERE CLASSIFIED Non-Surgical Orthopedic/Musculoskeletal 3/8/2021 Diagnosis Present on Admission 3/8/2021 view N40.0 BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS N/A, not an acceptable Primary Diagnosis 3/8/2021 Diagnosis Present on Admission 3/8/2021 view M06.9 RHEUMATOID ARTHRITIS, UNSPECIFIED Non-Surgical Orthopedic/Musculoskeletal 3/8/2021 Diagnosis Present on Admission 3/8/2021
Allergies: Duloxetine, Gabapentin, Pregabalin, Penicillins
Diagnostic Lab Data: 11/19/21
CDC Split Type:

Write-up: 104 F TEMP FOR 24 HOURS. WAS SENT OUT TO HOSPITAL WITH HIGH TEMP AND CHILLS. WAS REPORTED BY LN THAT FEVER STARTED WITHIN 10 MINUTES OF RESIDENT RECIEVING HIS BOOSTER VACCINE. (#3)


VAERS ID: 1890403 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intermenstrual bleeding, Menometrorrhagia
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: hormonal birth control pill
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: breakthrough bleeding, irregular menstrual bleeding


VAERS ID: 1890445 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / N/A LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Fatigue, Headache, Lymph node pain, Lymphadenopathy, Myalgia, Nausea, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: 1st Pfizer vaccine 3/25/21 @ 37 y.o., 2nd Pfizer vaccine 4/15/21 @ 37 y.o.: both vaccines administered via injection to left arm
Other Medications: Junel, Cymbalta, Simvastatin
Current Illness: None
Preexisting Conditions: Scoliosis, Arthritis, Anxiety, Depression, Vitiligo
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms: nausea, left arm pain, swollen and painful lymph nodes in left armpit, all over muscle pain, low grade fever, fatigue, headache; Treatment: acetaminophen, ibuprofen, cold packs, heating pad; Time course: worst symptoms started about 24 hours after injection and started to subside 48 hours after injection, most symptoms gone by 96 hours after injections, remaining symptoms are left arm pain (mostly gone), swollen and painful lymph nodes in left armpit (mostly gone), and nausea (mostly gone)


VAERS ID: 1890450 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abnormal behaviour, Akinesia, Anticoagulant therapy, Anxiety, Atrial fibrillation, Bundle branch block left, Cardiac index decreased, Cardiac output, Catheterisation cardiac abnormal, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram QT interval, Electrocardiogram abnormal, Endotracheal intubation, Hyperhidrosis, Hyporesponsive to stimuli, Hypotension, Left ventricular dilatation, Left ventricular dysfunction, Left ventricular hypertrophy, Mechanical ventilation, Nausea, Oxygen saturation decreased, Positive end-expiratory pressure, Pulmonary arterial pressure increased, Pulmonary arterial wedge pressure, Pulmonary hypertension, QRS axis, Right ventricular systolic pressure, Right ventricular systolic pressure increased, Scan with contrast abnormal, Stress cardiomyopathy, Tachycardia, Tricuspid valve incompetence, Troponin I increased, Vascular resistance systemic, Ventricular hypokinesia, Vomiting
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Parkinson-like events (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine besylate atorvastatin calcium carvedilol clonidine HCl furosemide hydralazine HCl potassium chloride rosuvastatin calcium valsartan/hydrochlorothiazide
Current Illness: Short of Breath in month prior to vaccination (not reported to screener)
Preexisting Conditions: COPD (chronic obstructive pulmonary disease) Diabetes mellitus, type II Hyperlipidemia Hypertension Osteoarthritis
Allergies: ciprofloxacin seafood
Diagnostic Lab Data: 11/19: EKG: Rate: 76 QRS: 12 QRSD: 166 T: 153 QT: 462 QTc: 520 Interpretive Statements Atrial fibrillation Left bundle branch block 11/19: ECHO: FINDINGS LV Ejection Fraction: 35 Focused echo for ejection fraction. Definity was injected to enhance left ventricular endocardial border definition. Moderate to severely reduced left ventricular systolic function, with an estimated ejection fraction of 35%. Severe hypokineis of the inferoseptum. Akinesis of the anteroseptum. Regional variability otherwise noted. Mild concentric left ventricular hypertrophy. Mild left ventricular dilatation. LVEDVI= 76 ml/m2. Normal right ventricular size and systolic function. Septal flattening suggests RV pressure overload. Trivial tricuspid regurgitation. Unable to accurately estimate PAP. Normal dimensions of the ascending aorta. Suboptimal image quality for global longitudinal strain tracking. IMPRESSION Focused echo for ejection fraction. 1. Moderate to severely reduced left ventricular systolic function, with an estimated ejection fraction of 35%. 2. Severe hypokineis of the inferoseptum. Akinesis of the anteroseptum. Regional variability otherwise noted. 3. Normal right ventricular size and systolic function. Septal flattening suggests RV pressure overload. Compared to prior study dated 4/25/2014, left ventricular function has worsened. 11/19: Cardiac Catheterization: Result Text o LM: normal o LAD: min dz o LCX: min Dz o RCA 60% distal 12 cc contrast RRA TR band No culprit for an ACS. Suspect stress CMP. Now off pressors and HD stable. RAP 17, RVP 56/12, PAP 59/30 (39), PCWP 20, CO 3.7, CI 2.6 SVR 1697 IMP: Suspected stress CMP, pHTN-PCWP may be lower off vent/peep. Troponin 11/19/2021 10:13 Troponin I, 0HR HS: 196 (HH) 11/19/2021 12:07 Troponin I, 2HR HS: 187 (HH) 11/19/2021 16:19 Troponin I, 6HR HS: 194 (HH)
CDC Split Type:

Write-up: Pt appeared to have slight cough when presenting for vaccination. Patient was asked a series of questions before receiving Vaccine including the patient''s current status and whether they are currently having any symptoms of Covid, Illness, or Infection. Patient denied any symptoms. Patient continued to have a slight but constant cough. Patient was given Pfizer Covid Vaccine First Dose 0.3mg. Within two minutes the patient began to show signs of anxious behavior. Patient suddenly said he "needs to walk" and got up from his chair. He walked down a small hallway with the LPN who administered the Vaccine following close behind. Patient was asked if he was SOB and he stated he was. Patient sat down in waiting room. Patient was asked to return to the Covid Vaccine Clinic for assessment. On his way back to the Clinic, the patient had to take many pauses to breath. Patient was asked if the SOB was sudden after receiving Vaccine and patient denied this and stated that he was feeling SOB prior to arriving. Upon return to the Covid Vaccine Clinic the patient had an SpO2 attached and patient''s O2 was at 81% on room air. Emergency Response Team was notified of situation. O2 was provided at 2L via cannula and patient SpO2 raised to 85%. Patient''s PCP was notified and responded to the Covid Vaccine Clinic. Physician was informed of vitals and immediately had EMS called. 02 was increased to 4L and patient''s levels raised to 89% but began to decline to 86%. Patient exhibited tachycardia and was diaphoretic. 02 was increased to 6L with patient declining to 84%. EMS arrived and took over control of care. Upon arrival, he had complaints of nausea and vomited multiple times. He was placed on monitor and oxygen saturations were reading 53% and HR 120''s with rhythm concerning for atrial fibiralltion. He became minimally responsive requiring BVM and was then emergently intubated for airway protection with etomidate, succinylcholine, 150 mcg of fentanyl and 3 mg of IV ativan. After intubation, he became profoundly hypotensive with SBP 50s and MAPs in the 30s. He was given 100 mcg of IVP phenylephrine and was initiated on Norepinephrine infusion to maintain MAPs $g 65. His initial troponin-1 was 196 . He was started on a Heparin infusion and bedside ECHO with EF 35%. Diagnosed with Stress-induced cardiomyopathy with Takotsubo presentation. Of note, since being diagnosed with COVID 19 in October 2020 he had worsening dyspnea with intermittent chest pain., but had not yet followed up with pulmonary and cardiology docs.


VAERS ID: 1890464 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-17
Onset:2021-11-19
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Resuscitation
SMQs:

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

Write-up: presented to hospital from nursing home after EMS was called for possible cardiac arrest , per report EMS states they arrived to find staff doing CPR, however pt had normal VS on their arrival.


VAERS ID: 1890484 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear pain
SMQs:

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

Write-up: Dull with occasional sharp pains behind the left ear. Started on Sunday 11/21/2021 in the evening.


VAERS ID: 1890498 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 3 LA / IM

Administered by: Other       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: none
Current Illness: Vitiligo, asthma
Preexisting Conditions: vitiligo asthma
Allergies: none
Diagnostic Lab Data: Exam only
CDC Split Type:

Write-up: Developed shingles in the L2 dermatome


VAERS ID: 1890503 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-24
Onset:2021-11-19
   Days after vaccination:299
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 - / IM

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

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

Write-up: patient hospitalized


VAERS ID: 1890508 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 4 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Iron, Zyrtec, vitamin B6, Multivitamin, cranberry, omeprazole, Levothyroxine, Lovastatin, Vitamin D,
Current Illness: None
Preexisting Conditions: Dementia, hypothyroidism, Vit D deficiency, Vitamin B deficiency, GERD, Hypokalemia, Iron Deficient anemia, Allergic rhinitis, hx UTI, hx. Pulmonary Embolism
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The patient was given her 3rd dose of moderna a booster dose on 11/10/2021. The family returned a second consent and a 4th dose of moderna a booster done was administered on 11/20/2021


VAERS ID: 1890520 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain
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: melatonin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given 0.2 ml of the Pfizer Covid 19 vaccination 12 and up formulation, instead of the 5-11 year old formulation. When realized, Provider called to check on patient 11/22/2021-mother reports no adverse reaction, only soreness in arm where vaccine was given. No other symptoms. Mother advised according to CDC guidelines that second dose is optional and mom elects to proceed with second dose.


VAERS ID: 1890537 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

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

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

Write-up: Patient received first dose of Moderna vaccine on 5/26/2021 and second dose on 7/14/21. Patient received 3rd dose of Moderna booster by error on 11/19/2021 despite lack of 6 months between time of receiving second dose.


VAERS ID: 1890579 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: patient described a headache starting 4 hours after vaccination. At around 7pm that night fever, sweats, extreme chills and nausea began in addition the the headache. Patient stated these symptoms lasted for about 48 hours.


VAERS ID: 1890620 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Influenza virus test negative, Injection site erythema, Injection site oedema, Injection site pain, Injection site warmth, Interchange of vaccine products, Myalgia, Pyrexia, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALPRAZOLAM, CLONIDINE, PROZAC
Current Illness: NONE REPORTED
Preexisting Conditions: ANXIETY AND DEPRESSION
Allergies: NKA
Diagnostic Lab Data: INFLUENZA TESTING DONE PER PATIENT REQUEST 11/22/2021. RESULTS NEGATIVE.
CDC Split Type:

Write-up: PATIENT REPORTS THAT SHE RECEIVED A MODERNA COVID-19 BOOSTER VACCINE IN THE AM OF 11/19/2021. PATIENT HAD PREVIOUSLY RECEIVED 2 DOSES OF THE PFIZER COVID-19 VACCINE. PER PATIENT, BY THE EVENING OF 11/19/2021 SHE WAS EXPERIENCING LOCALIZED PAIN AT THE INJECTION SITE, FEVERS UP TO 102, CHILLS, FATIGUE AND MYALGIAS. PATIENT SEEN IN MINUTE CLINIC 11/22/2021 FOR EVAL. PATIENT REPORTING FEVERS HAVE RESOLVED AS OF THIS MORNING. PATIENT REQUESTED INFLUENZA TESTING. RIGHT UPPER ARM, SITE OF INJECTION, WARM TO TOUCH, TENDER TO TOUCH, MILDLY ERYTHEMATOUS AND MILDLY EDEMATOUS. NO INDURATION PALPATED.


VAERS ID: 1890654 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Mouth swelling, Oral mucosal erythema, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Unknown immunization.
Other Medications: Allegra
Current Illness: None
Preexisting Conditions: History of allergic reaction, obesity
Allergies: Penicillin, Cefprozil, Ciprofloxacin, Clarithromycin, Clindamycin, Codeine, Levofloxacin, NSAIDS, Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had itching, mouth swelling, redness around the mouth and felt short of breath. Patient stated the symptoms started at 8 am this morning on 11/19/2021. Patient stated he got his COVID-19 shot on 11/18/2021. He took Allegra and Benadryl this morning on onset of symptoms. Patient was given a prescription for Kenalog, Aristocort (triamcinolone acetonide) 0.1 % cream and prednisone 20mg tablet to help with allergic reaction symptoms.


VAERS ID: 1890777 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Face injury, Fall, Haematoma, Orbital swelling, Syncope, Tooth fracture, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 10 yo girl presented for first covid without PMD or allergies who 2 mins after reported have cloudy vision then fell forward from chair hitting the right side of face .exam remarkable for mild orthostasis of blood pressure supine 140/100 sitting 120/80 standing 100/60 appearance anxious well developed well nourished girl with swelling over right superior orbit but alert and responsive approximately 30 seconds of syncope. head with 1.5x1 cm hematoma over the superior orbit without laceration or ecchymosis eyes visual acuity 20/16 right eye and 20/20 left eye PERRL unable to do fundi due to lack of opthalmoscope no clear drainage for nare mouth with chipped incisor neck full range of motion chest clr p and a cor rrr neuro o&a x3 after syncope cranial nerve 2,3,4,&6 as well as other cranial nerves grossly intact motor grip good cerebellar grossly intact no romberg dtr wnl. impression +post vaccination vasovagal syncope c/b right orbital hematoma and chipped right incisor thus advised ED visit for orbital imaging and evaluation whether hematoma might require I&D but if taken home apply ice pack and use tylenol rather than NSAIDs and observe for altered mental status ie somnolence or progressive headache with nausea or blurry vision or bulging of the eye or double vision


VAERS ID: 1890938 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Fatigue, Injection site rash
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna vaccine second dose. Age 60 on 2/19/2021. Headache, body aches, pain in joints, severe fatigue, chills, and some chest p
Other Medications: Multi Vitamin.
Current Illness: None.
Preexisting Conditions: Occasional Acid Reflux.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Mild fatigue starting around 3 hours later and lasting 1 day. 2 days later rash around injection sight with no itching, and lymph node under armpit right side sore.


VAERS ID: 1891002 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKDA
Diagnostic Lab Data: None that I am aware of. The event was reported to the physician on 11-22-2021.
CDC Split Type:

Write-up: This patient was given a Pfizer Booster (0.3ml) and she was 17 years old. The booster is only approved for 18 years and older. It should be noted, the patient received doses 1&2 on March 31, 2021 and April 25, 2021 at a different facility. She was 16 years old at the time. May 10, 2021 was the date Pfizer was approved for 12-17 years old. I called the mother on 11/19/2021, at approximately 7pm, and the mother did not report any reactions from the vaccine.


VAERS ID: 1891009 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft;Prenatal vitamin;Zyrtec.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Shell fish.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seizure.


VAERS ID: 1891025 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0.25 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Headache, Injection site erythema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (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: severe headache
Other Medications: Vitamin B1, B6, Nexum, Caltrate
Current Illness: Cold
Preexisting Conditions: Peritoneal Cancer metastasized to lung
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness near injection site. Severe headache, fever 101.3, upset stomach,


VAERS ID: 1891027 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Influenza like illness, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lacatose-
Current Illness: None
Preexisting Conditions: Hep C -cured 2014/ liver damage
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever-chills-all joints hurt-vomiting. Flu like symptoms


VAERS ID: 1891198 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-05
Onset:2021-11-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 - / IM

Administered by: Public       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Not applicable
CDC Split Type:

Write-up: Shingles


VAERS ID: 1891200 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-12
Onset:2021-11-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Limb discomfort, Pain, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Prenatal vitamin Pantoprozole Vitamin D Levothyroxine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heavy arm. Pain down arm from shoulder all the way to fingers. Dull ache non stop. Bruising at injection site.


VAERS ID: 1891216 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-01
Onset:2021-11-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry skin, Rash, Rash erythematous, Sensitive skin
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Junel Fe 1/20 QD, Claritin 10mg QD, Singulair 10mg QD, Azelastine 0.1% BID, Fluticasone 50mcg BID, Multivitamin QD, D3 2,000IU QD, B6 25mg QD, Align Probiotic QD, Restasis 0.05% BID
Current Illness:
Preexisting Conditions: Asthma
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on top of hands about 2 weeks after the 1st vaccination. The rash does not itch or burn, but the skin is extremely dry compared to the rest of my hands. The rash is a brighter color red and more noticeable in the evening. The skin is also very sensitive in hot water.


VAERS ID: 1891226 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-11-16
Onset:2021-11-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Pruritus, Rash erythematous
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: Vitamin D, Amlodipine, HCTZ, baby Aspirin, Ibuprofen
Current Illness:
Preexisting Conditions: High blood pressure, hearing loss
Allergies: Bivalves, nitrous oxide
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Red rash and extreme itch on the underside of the arm where injection took place.


VAERS ID: 1891235 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Pt was under dosed with 0.2mL vs 0.3mL, no adverse symptoms reported.


VAERS ID: 1891426 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Headache
SMQs:, Glaucoma (broad)

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

Write-up: Strong head pain right side, including the right eye.


VAERS ID: 1891630 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 RA / SC

Administered by: Other       Purchased by: ?
Symptoms: Breast swelling, Lymphadenopathy, Pain in extremity
SMQs:, Angioedema (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ambien, Singular, Crestor, Fish Oil, Co-Q10, Magnesium Citrate, Fiber, PQQ, B12 injections, L-Methylfolate, Tambocor, Allergy shots, Vitamin D3, Multivitamin and Buspirone
Current Illness: normal post viral ME/CFS symptoms, but healthy at time of vaccine
Preexisting Conditions: ME/CFS, PVC''s, AVM - heart, allergies, osteopenia
Allergies: Imodium, Bentyl, Septra, Macrodantin, Macrobid, Metrogel Multiple food and environmental allergies, no allergies or previous reactions to vaccines allergic to bees
Diagnostic Lab Data: none
CDC Split Type:

Write-up: normal sore arm, but also swelling in right axilla and into right breast only after booster shot, no symptoms with other 2 vaccines


VAERS ID: 1891641 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Feeling hot, Flushing, Hyperhidrosis, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Mild, Systemic: Weakness-Mild, Additional Details: Patient said she felt dizzy, hot, weak, lightheaded about 5-10 mins post vaccination. Her hands were shaking and she looked sweaty. This lasted about 5 minutes. She remainded seated a while longer, then said she felt better and left.


VAERS ID: 1892736 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034PZ1A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Electrocardiogram, Headache, Pain, Painful respiration, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin
Diagnostic Lab Data: All done 11/19/2021 -bloodwork -chest X-ray -ekg
CDC Split Type:

Write-up: Symptoms: chest pain, headache , fever , pain while deep breathing , and painful when moving or lying down


VAERS ID: 1892699 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-11-19
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Irritability, Paraesthesia oral, Pharyngeal hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient had no known allergies. Patient had no any medical history.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211144983

Write-up: IRRITABILITY; FACIAL NUMBNESS; LIP TINGLING; NUMBNESS IN THE BACK OF THE THROAT; This spontaneous report received from a patient concerned a 56 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: Patient had no known allergies. Patient had no any medical history. 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 and has been requested. No concomitant medications were reported. On 19-NOV-2021, the patient experienced irritability. On 19-NOV-2021, the patient experienced facial numbness. On 19-NOV-2021, the patient experienced lip tingling. On 19-NOV-2021, the patient experienced numbness in the back of the throat. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from facial numbness, lip tingling, numbness in the back of the throat, and irritability. This report was non-serious.


VAERS ID: 1892702 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-11-19
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Bursitis, Fatigue, Feeling hot, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211145392

Write-up: LEFT FOOT BECAME ITCHY; FLUID FILLED SPOT ON LEFT FOOT; LEFT FOOT BECAME WARM; LEFT FOOT TINGLY WHEN WALKS; FEELS LIKE DISSIPATING; This spontaneous report received from a patient concerned a 35 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1855194, and expiry: 09-APR-2022) dose was not reported, administered on 17-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 19-NOV-2021, the patient experienced left foot became itchy. On 19-NOV-2021, the patient experienced fluid filled spot on left foot. On 19-NOV-2021, the patient experienced left foot became warm. On 19-NOV-2021, the patient experienced left foot tingly when walks. On 19-NOV-2021, the patient experienced feels like dissipating. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from left foot became itchy, fluid filled spot on left foot, left foot tingly when walks, left foot became warm, and feels like dissipating. This report was non-serious.


VAERS ID: 1892756 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-02
Onset:2021-11-19
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Pallor, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypotonic-hyporesponsive episode (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N?A
CDC Split Type:

Write-up: Generalized transient blanchable hives


VAERS ID: 1892792 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Chills, Malaise, Mobility decreased, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline, 25 mg Omeprazole, 1 tablet daily Flonase
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Malaise, chills, and sore arm by 5pm, Nov 19 Fever of 102 by 9pm, Nov 19 continuing to morning of Nov 21. Right arm became nearly impossible to move. Could not raise it or lift anything. Painful in armpit and around shoulder joint. Fever returned 7pm Nov 21 but stayed at 100.5. Fever returned 7pm Nov 22 but stayed at 100.5


VAERS ID: 1892845 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Face injury, Hypotension, Injection site pain, Nausea, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Hypotension-Mild, Systemic: Nausea-Mild, Additional Details: pt insisted to get up to go to bathroom and got dizzy and fell on her way to bathroom hit the chin face down on the floor


VAERS ID: 1893201 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-16
Onset:2021-11-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, Nausea, Throat irritation, Vomiting
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow)

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

Write-up: A couple days later child began with throat irritation on day 2, nausea on day 3, 4, 5, 6. It is now day 7 and pt. still complains of nausea sensation although it may be subsiding. On day 3, we took a flight for our family vacation and pt. had a couple of instances of light committing. I SUSPECT PT. WAS GIVEN 20 MICROGRAMS RATHER THAN 10 MICROGRAMS. I WILL NEED TO DOUBLE CHECK THE PAPERS WE WERE GIVEN AFTER ADMINISTRATION OF DOSE. We are currently out of the country on vacation.


VAERS ID: 1893417 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Idaho  
Vaccinated:0000-00-00
Onset:2021-11-19
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Off label use, Poor quality product administered
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211145064

Write-up: This spontaneous report received from a physician concerned an adult female.The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1855194, expiry: 09-APR-2022) dose was not reported, administered on 19-NOV-2021 for prophylactic vaccination. No concomitant medications were reported.On 19-NOV-2021, the patient experienced janssen covid 19 vaccine administered after 1 hour past 6 hours expiration, and off label use.The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the janssen covid 19 vaccine administered after 1 hour past 6 hours expiration and off label use was not reported.This report was non-serious.


VAERS ID: 1893418 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-11-19
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213B21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211145081

Write-up: VACCINE TEMPERATURE DROPPED TO 1.4C; TEMPERATURE EXCURSION AND VACCINE GIVEN TO FIVE PATIENTS; This spontaneous report received from a health care professional concerned multiple patients.No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 213b21a and expiry: UNKNOWN) dose was not reported, administered on 19-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 19-NOV-2021, the patient experienced temperature excursion and vaccine given to five subjects. On an unspecified date, the patient experienced vaccine temperature dropped to 1.4c.The action taken with covid-19 vaccine ad26.cov2.s was not applicable.The outcome of the temperature excursion and vaccine given to five patients and vaccine temperature dropped to 1.4c was not reported.This report was non-serious.


VAERS ID: 1893656 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Neurological examination normal, Yawning
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 11/23/21 - seen in clinic for visit. Normal neurologic examination
CDC Split Type:

Write-up: Patient began having excessive yawning day after vaccination. No prior history of motor tics. Yawning as often as once a minute when not talking. Persisted over the weekend. Evaluated in clinic on 11/23/21 with normal neurologic exam. When patient talking, no yawning. When not talking, yawning once a minute at rest. He has no other motor tics observed by parents or this physician


VAERS ID: 1893660 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS N34CK / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Insomnia, Lymphadenopathy, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: 2nd shot of Pfizer covid shot on 04/19/2021
Other Medications: buproprion xl 300 mg
Current Illness: none
Preexisting Conditions: depression
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I received both vaccines simultaneously on 11/19/2021 shortly after 11 AM. 12 hours later around 11 PM the following symptoms occurred - extensive body aches, fever, headache, fatigue, inability to sleep, sore arms. These symptoms continued for the next two days. Also very noticeable are swollen lymph nodes under both arms. Fatigue continues as of today, 11/23/2021.


VAERS ID: 1893710 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Condition aggravated, Induration, Injection site swelling
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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? No
Previous Vaccinations:
Other Medications: Carbadopa/levodopa, lisinapril, ventafaxine, montelukast, metformin, levothyroxine
Current Illness: None
Preexisting Conditions: Parkinsons, Copd, asthma
Allergies: Tomatoes, acidic foods, bleach
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen arm add ejection area hard not in ejection area. Asthma attack had to take inhaler I called doctor on Monday because it still problems went to urgent care was given a steroid shot and prescribed steroid pills


VAERS ID: 1893717 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Nausea, Ocular hyperaemia, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient first complained of nausea about 5 minutes after receiving the vaccine. A technician took the patient outside to get some fresh air. Patient was brought back inside to sit by the doorway to continue getting fresh air and was given a cold bottle of water, while another group was being briefed for their shots. Patient was reexamined and had blood shot eyes and smalls hives on the back of her neck. After seeing the hives, an ambulance was called and the patient was taken to a more private room to lay down and receive a dose of Epinephrine at 08:37 AM. EMS arrived with an ambulance within 5 min of the Epinephrine being given.


VAERS ID: 1893724 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-16
Onset:2021-11-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Electrocardiogram, Full blood count, Metabolic function test, Musculoskeletal chest pain, Pulmonary embolism, Scan with contrast, Troponin
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Claritin-D
Diagnostic Lab Data: All test were done in the ER on November 21: EKG 12 Lead CBC Auto Differential Comprehensive Metabolic Panel w/Reflex to MG Torponin Chest x-ray CT Chest Pulmonary Embolism with Contrast
CDC Split Type:

Write-up: Began having pain on left side of rib cage on Friday, November 19 around 3PM. It became worse on Saturday evening, November 20 at 10:30PM. On Sunday evening, November 21 I went to the Emergency room about 6PM. A CT scan revealed I had Bilateral pulmonary embolism (HCC). I was prescribed ELOQUIS and sent home to follow up with a cardiologist. I have an appointment on November 30 at 3PM.


VAERS ID: 1893781 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 RA / IM

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

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

Write-up: On 11/19/21 Patient came in for her first Pfizer vaccine appointment. Consent form was completed without questionable concerns for administration. Patient was administered the Pfizer vaccine while seated in the pharmacy waiting area. After the shot was given, I asked discussed reminder date for second shot, common side effects of vaccine, and asked her to remain seated in the pharmacy area for a little bit to make sure she was feeling alright. While administering the next patient''s vaccine in the pharmacy waiting area just a few minutes (2-3 mins) later, my back was facing Patient across the room and as I was speaking to the other patient, I heard a loud clunk hit the floor. I immediately turned around to see Patient collapsed on the floor in front of her chair. We immediately call 911 and the floor manager and I rush over to her and place her on her side and call her name to elicit a response. She is responsive within about 15 seconds of calling her name. She begins to talk normally while remaining on the floor with me on the floor beside her. I asked if she had ever had a reaction like this to a vaccine to which she said no but she has had fainting episodes in the past. A few minutes go by and she has called her father to come pick her up and shes seated in a chair. The paramedics arrived and discussed with Patient her medical history, took vitals, and asked if she would like to go to the hospital. Patient said no and I confirmed that her father would come to pick her up from the pharmacy. As the paramedics are walking to the exit of the building, Patient fainted again and was quickly responsive again. The paramedics came back over and got her buckled into the stretcher for transport to the ED.


VAERS ID: 1893828 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Finasteride (5 mg), Hydrochlorothiazide (12.5 mg), Alfuzosin HCL er (10 mg)
Current Illness: None
Preexisting Conditions: Non
Allergies: Penicillin
Diagnostic Lab Data: Non
CDC Split Type:

Write-up: There is swelling of the injection site, 2nd Day after the injection. Up to day six the swelling is still there. The swelling feels hard.


VAERS ID: 1893839 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Mother refer patient started with erythematous itchy wheals on face, trunk, and extremities since 11/19/21 morning. No breathing difficulties. No history of prior allergies. At hospital, patient received Benadryl, Solu-medrol, Loratadine, Atarax, Budesonide nebulization. Patient recovered in 3 days and was discharged.


VAERS ID: 1893846 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-07
Onset:2021-11-19
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 11/22/21 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1893859 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893866 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893876 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893883 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893888 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893895 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

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

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

Write-up: Client was given the Pediatric 5-11 age group dose. Patient was 12 years old at the time of the incident and should have gotten the Pfizer 12+ dose.


VAERS ID: 1893897 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893907 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893915 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893920 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893926 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893939 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Unknown  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893945 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins B6, B12, C, D, E, Iron, Multi-Vit, Calcium, Collagen, Milk Thistle, Evening Primrose, Chlor-Trimeton
Current Illness: Nothing
Preexisting Conditions: Nothing
Allergies: All Dairy but not eggs, Cranberries, Vanilla, Goat Milk, Bananas, Oats, Scallops
Diagnostic Lab Data: Positive Covid RT-PCR Test. Negative Flu A & B
CDC Split Type:

Write-up: I received a Booster, and was verbally told it was 1/2 the dose. I now have Covid, and over the past few days, have experienced all of the symptoms and am actively sick. The vaccine is not supposted to be live?


VAERS ID: 1893946 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1822811 / UNK - / -

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

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

Write-up: Patient given 0.5 mL of Moderna when they should have received the booster dose of 0.25 mL of Moderna.


VAERS ID: 1893962 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Adnexa uteri pain, Arthralgia, Bone pain, Breast pain, Chest discomfort, Condition aggravated, Dizziness, Dry mouth, Ear pain, Eye pain, Fatigue, Headache, Hypoaesthesia, Malaise, Maternal exposure during breast feeding, Migraine, Musculoskeletal pain, Pain in extremity, Paraesthesia, Paraesthesia oral, Pharyngeal swelling, Pharyngitis, Pruritus, Respiratory tract congestion, Rhinitis, Sneezing, Throat tightness, Vision blurred, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Agranulocytosis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Lipodystrophy (broad), Osteonecrosis (broad), Neonatal exposures via breast milk (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamin, Vitamin D, Vitamin B6, superfood protein powder, occasional Mama''s Tea
Current Illness: none
Preexisting Conditions: chronic pain syndrome (back, hips, knees, shoulders, wrists, shins, ankles) ADHD, anxiety, depression tension headaches lymphedema acne
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: On November 19, not long after the vaccine, patient got dizzy. Had pre-existing headache that worsened after the vaccine. Patient waited in the parking lot of the clinic for 2 hours, still felt dizzy. Left arm pruritic. Felt sharp pain in LLQ/ovaries. Started feeling occasional pin-like feeling in chest with breathing. Throat felt slightly swollen and ''cotton mouth'' feeling, did not feel dyspneic, felt tight. Pain in L shoulder, scapula, clavicle started that evening. November 20 - more soreness in L arm. Rhinitis, sneezing, slightly dizzy, and slight headache. November 21 - rhinitis, sharp pain in LLQ/ovaries again, increased fatigue that was different than usual. Pain in L breast with lactation (currently nursing). Slight pharyngitis, felt as though cold was starting. November 22 - felt more fatigue, pain in shoulders and wrists, rhinitis, congestion. Had headache that became migraine. Change in vision, seeing spots, blurry vision. Otalgia, pain in eyes. L arm and hand numbness and tingling. Face felt numb, tongue felt tingly. Went to urgent care November 22 to be evaluated. November 23 - fatigue, slight migraine but improving


VAERS ID: 1893970 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-13
Onset:2021-11-19
   Days after vaccination:310
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

Administered by: Work       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: 11/22 SARS/COV-2, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1893990 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-02-20
Onset:2021-11-19
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Erythema, Infection, Peripheral swelling, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: renal insufficiency
Allergies: no known allergies
Diagnostic Lab Data: SNF transfer COVID test + 11/22/2021
CDC Split Type:

Write-up: Breakthrough COVID first vaccine 1/9/2021 This is a pleasant 85-year-old male who was sent from hospital to the ED for swelling and redness of both legs. He had bil doppler studies yesterday which showed no DVT. He has hx of DVT and is on eliquis. He denies dizziness, syncope, chest pain, shortness of breath, or palpitations. Patient has history of : Hypertension, Diabetes Mellitus, morbid obesity, CAD, CKD Hx of DVT on eliquis


VAERS ID: 1894011 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient given Pediatric dose of Pfizer. Child is 12. Patient is fine and no further action is needed. Patient is to receive age appropriate dose when 2nd dose is administered. Patients parent is made aware.


VAERS ID: 1894015 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT AGE IS 17YRS. RECEIVED MODERNA BOOSTER 0.25ML ON 11-19-2021


VAERS ID: 1894020 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Condition aggravated, Cough, Dizziness, Headache, Injection site rash, Nausea, Neuralgia, Oral mucosal blistering, Pain, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (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: 2nd Dose Moderna 03/2021 (nausea, fatigue, muscle aches, headache, fever, dizziness lasting 48hrs)
Other Medications: Tylenol, Valacyvoler, Pravastatin
Current Illness: N/A
Preexisting Conditions: High Cholesterol
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd Booster of Moderna 11/18/2021, started experiencing symptoms 11/19/2021 of fever, chills, body aches, joint pain, nerve pain, headache, pallet blisters, dizziness, nausea, rash at the injection site, and dry cough. Symptoms are subsiding, Primary communications recommendation of Reporting to VAERS.


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