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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 529 out of 10,317

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VAERS ID: 1894050 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-02
Onset:2021-11-19
   Days after vaccination:262
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/19/2021- COVID 19 detected
CDC Split Type:

Write-up: admitted to the hospital with s/s of COVID, tested positive


VAERS ID: 1894078 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
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 33026BD / UNK RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / UNK LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Vaccine positive rechallenge
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: migraine, extreme sensitivity to medications or drugs, no other health issues
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shot 1 (Booster) above - severe illness, high fever, severe headache to migraine, body aches, nausea, dizziness, lymph node swelling and soreness - this is Day 5 for all symptoms; Shot 2 above in May 2021 - same reactions as above except that lymph node swelling continued for 60 days; Shot 3 above in April 2021 - less severe reactions, however, lymph nodes swollen until next shot.


VAERS ID: 1894124 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: South Carolina  
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 - / UNK - / -
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Condition aggravated, Dyspnoea, Fatigue, Headache, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, aspirin, vit d, ezetimibe, fenofibrate, lisinopril, rosuvastatin, titropium bromide
Current Illness: Received flu vaccine 1 week prior
Preexisting Conditions: Emphysema, hyperlipidemia, htn
Allergies: Latex, metoprolol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received flu vaccine 11/12/21 and started to feel fatigued right before covid vaccine on 11/19/21. He reports shortness of breath that finally resolved today. He is still fatigued, congested and has a headache that improves with tylenol


VAERS ID: 1894130 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Hawaii  
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 FH8020 / 1 LA / IM

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

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

Write-up: Patient was given an adult dose of Pfizer at our Covid Vaccine Clinic on 11/19/2021. Patient is 11 years of age and it was not caught at the time of check-in or vaccination. Patient was given the adult dose of Pfizer and completed the 15 min observation time without any side effects or symptoms. Patient was called by provider to inform them of the incident and follow up over phone was completed.


VAERS ID: 1894169 (history)  
Form: Version 2.0  
Age: 36.0  
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 (JANSSEN)) / JANSSEN 211D21A / UNK LA / -

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Headache, Malaise, Muscle spasms, Pain, Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (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: Vitamin B12, Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe headache for hours, Tylenol did not help Dizziness Body shaking Tingling sensations in legs Feeling sick Muscle cramps, was painful to move


VAERS ID: 1894192 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: North Carolina  
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 LA / IM

Administered by: Public       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client was given pediatric dose. Was supposed to get adolescent/adult dose. Pt tolerated well. No adverse reaction to vaccine. Parents and client informed. Discussed repeat dose not indicated and client should get adolescent/adult dose at her 2nd dose appointment.


VAERS ID: 1894210 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: North Carolina  
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 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient received pediatric Pfizer Dose 1 on 11/03/2021. Dose 2 of pediatric Pfizer administered 16 days later on 11/19/2021, which was too early. Patient has had no negative effects, no symptoms or adverse reactions. Patient''s mother was notified on 11/23/2021 that he must be re-vaccinated with Dose 2 on 12/10/2021 (21 days after early dose 2 administration) per Immunization Consultant.


VAERS ID: 1894241 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-13
Onset:2021-11-19
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/19/2021 -ARS Coronavirus-2, PCR detected
CDC Split Type:

Write-up: Pt tested positive for COVID on admission screening. Was admitted for non COVID related reasons and asymptomatic for COVID


VAERS ID: 1894297 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-19
Onset:2021-11-19
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Cough, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and 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? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH/Chronic conditions include celiac, COPD, DM, CAD.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets criteria for vaccine breakthrough review. SxS include, continued cough. Possible COVID infection weeks ago but was not tested. Was admitted for CVA, no specific COVID related symptoms.


VAERS ID: 1894309 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
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 FK5127 / UNK LA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Peds Pfizer administered during off site clinic instead of Pfizer due to age level.


VAERS ID: 1894327 (history)  
Form: Version 2.0  
Age: 34.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: phentermine, mirena, omeprazole, amitriptyline
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: zofran
Diagnostic Lab Data: seen in office
CDC Split Type:

Write-up: joint pain specifically knees, difficulty walking


VAERS ID: 1894394 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-22
Onset:2021-11-19
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Cough, Dyspnoea, Exposure to SARS-CoV-2, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: PMH/Chronic conditions include Afib, HTN, CHF, TIA.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets criteria for vaccine breakthrough review. Known exposure to family. Sx include SOB, cough, chest pain.


VAERS ID: 1894423 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-27
Onset:2021-11-19
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Diarrhoea, Hypoxia, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH/Chronic conditions include end stage COPD<, CAD, HTN.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets criteria for vaccine breakthrough review. SxS include fever, cough, hypoxia, diarrhea. Thought to be COPD exacerbation, COVID+.


VAERS ID: 1894447 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Oregon  
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 EF3590 / 1 RA / IM

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

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

Write-up: Patient received a 12yrs and up Pfizer vaccine instead of the pediatric 5-11 year dose. So far no adverse reactions reported.


VAERS ID: 1894455 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Ohio  
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 - / UNK LA / IM

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

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

Write-up: Body rash, itchiness,


VAERS ID: 1894459 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Georgia  
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 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Nausea, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Nausea/vomiting Low grade fever- gave Motrin Fatigue- rest Facial rash-Beanadryl


VAERS ID: 1894467 (history)  
Form: Version 2.0  
Age: 53.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Aptyalism, Chest X-ray, Cough, Dry mouth, Dysphagia, Dyspnoea, Ear pain, Electrocardiogram, Eye pain, Fatigue, Headache, Hypertension, Oxygen saturation decreased, Pain, Photophobia, Pyrexia, Tremor, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Hypertension (narrow), Cardiomyopathy (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On Friday November 19th at approximately 9:30am at the Hospital Covid vaccine clinic, I received the Pfizer Covid vaccine 1st dose, within 5 minutes of receiving the vaccine, my hands started shaking, then followed up with mouth getting dry and no saliva, I was provided water to drink, drinking water didn?t help and now starting a wheezing cough, the cough became more constant and unable to take a moderate breath without coughing or talking without coughing, and shortness of breath, then started having difficulty swallowing. The nurse was evaluating me during this time as I gave the nurse notice of a possible reaction can occur due to current medical conditions. After an estimated 20 minutes I was at the Emergency Department being admitted and IV started, with IV push meds were given. Xray chest AP portable was used, EKG 9 performed, and blood work. Clinical Impressions as of November 19 2021, Allergic reaction, initial encounter ? to Covid vaccination. After hospital treatment, wheezing cough, fever 100 degrees, severe headaches, throbbing left and right eye pain and light sensitive, throbbing left and right ear pain, low oxygen saturation at times, lowest at 92 sat with pulse 115 resting, high blood pressure 168/82 pulse 109, Spiroflow Peak Flow meter at 425 which is very low, at my critical zone, and fatigue. I had Epi pens available while recovering at home in case symptoms reoccurred and needed to return to Hospital. Prescribed Hydroxyzine and Prednisone - 60 mg daily for 5 days. Provided message to primary care an hour after leaving hospital, notifying specialty doctors (Pulmonologist, Allergist, Nephrologist) on 11-22-21 for possible follow up visits. I submitted a request # UR0206840 and assigned to HRIT Operations to provide information on my health condition and recommended by primary and specialty doctors to have Covid vaccine at the Hospital and immediately taken to Emergency Department to be monitored for reactions.


VAERS ID: 1894492 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Texas  
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 003F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Incorrect route of product administration, Mobility decreased
SMQs:, Parkinson-like events (broad), Drug abuse and dependence (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: Pt complained that her Left shoulder was very sore and had limited movement after her injection on 11/19/21. She called our clinic today to report her symptoms. She does not feel is a reaction to the vaccine but a placement issue. She currently states she cannot move her shoulder and is going to see her PCP today.


VAERS ID: 1894499 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Vermont  
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 - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Back pain, Chest pain, Lymphadenopathy, Pain
SMQs:, Retroperitoneal fibrosis (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: losarten hctz
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen Armpit and pain/discomfort in armpit along with radiating ache in chest and back. possibly some heart palpitations not sure if it''s related.


VAERS ID: 1894539 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Massachusetts  
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 - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 woke up approximately 15 hours later after vaccine was given with facial swelling and hives


VAERS ID: 1894607 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-13
Onset:2021-11-19
   Days after vaccination:279
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Nasal congestion, Rhinorrhoea, SARS-CoV-2 test positive, Upper respiratory tract infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple Vitamin, Protonix, Nasacort allergy 24hr
Current Illness:
Preexisting Conditions: Arthritis o Collapse of left lung 1963 o Colon polyp o Diverticulosis o GERD (gastroesophageal reflux disease)
Allergies: Sulfa antibiotics
Diagnostic Lab Data: 11/19/21 SARS-CoV-2 PCR Detected Abnormal
CDC Split Type:

Write-up: 11/19/21 He is fairly healthy for his age, has chronic allergies with allergic rhinitis, worked a day before his symptom onset in his front yard, raking the leaves with mask on. URI The primary symptoms include nasal congestion and nasal drainage. Primary symptoms do not include fever, headaches, sore throat, cough, wheezing, myalgias or shortness of breath. The current episode started 3 to 5 days ago (4 days). This is a new problem. The problem has not changed since onset. Symptoms associated with the illness include congestion and rhinorrhea. The illness is not associated with chills. Risk factors for severe complications from URI include being elderly. He shares symptoms with no others. 11/19/21-Regeneron inf


VAERS ID: 1894625 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 3 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest discomfort, Chest pain, Magnetic resonance imaging heart, Myocarditis, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cardiac Catherization Cardiac MRI
CDC Split Type:

Write-up: Full vaccine information is not known as not provided by this provider, but rather potential side effect being reported was during an admission. Developed chest pain, pressure several days post covid vaccine booster (reported as Pfizer per patient) and sought care at hospital. Troponins elevated, cath performed which was normal. Cardiac MRI suggestive of myocarditis.


VAERS ID: 1894653 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-20
Onset:2021-11-19
   Days after vaccination:303
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL4176 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/23 SARS/COV-2, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1894680 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Indiana  
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 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient was given 0.2 mL, but due to age should of received a 0.3 mL on 11/19/2021 at 11:38 A.M. Per CDC guidelines, do not repeat the dose. Wait 21 days, then give adult (0.3 mL) dose to complete the primary series.


VAERS ID: 1894720 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Ohio  
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 077C21B / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Approx 15-20 min after receiving the vaccine, Pt complained of "tingling under her tongue", 5 minutes later also complained of "tingling of her lips" No swelling of face, lips, gums, inner mouth or neck noted, no hives, no rash or redness noted. Pt given 50 mg of Benadryl. BP 130/98 Pulse 88 and regular, breathing normal, non labored. After 30 minutes, Pt stated her lips still feel "tingly". BP 122/92, Pulse 92 and regular, breathing normal, non labored. Pt called her physician. Physician told PT to follow up with Urgent Care.


VAERS ID: 1894767 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-23
Onset:2021-11-19
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ascorbic Acid (VITAMIN C) 250 MG CHEW 11/19/21 o Calcium Carbonate-Vitamin D (CALCIUM + D PO) o ferrous gluconate (FERGON) 324 MG tablet o fexofenadine (ALLEGRA) 180 MG tablet o levothyroxine (SYNTHROID) 88 MCG tablet o Multiple Vit
Current Illness:
Preexisting Conditions: Allergic rhinitis o Family history of breast cancer o Fibrocystic breast disease o GERD (gastroesophageal reflu 11/19/21 large hiatal hernia o Hyperlipidemia o Hypothyroidism 2002 o Impaired fasting blood sugar o Osteoporosis 2002 spine -2.8, hip-1.66 o Post-menopausal osteoporosis spine -2.8, hip-1.66 o Thyromegaly o Vitamin D deficiency
Allergies: Codeine, soybean oil, latex
Diagnostic Lab Data: 11/19/21 SARS-CoV-2 PCR Detected Abnormal
CDC Split Type:

Write-up: 11/19/21-76 yo female presents with chief complaint of cough, nasal drainage, and sinus pressure x 6 days. She has been taking Mucinex-DM and Robitussin to help with her symptoms. She states that her symptoms have been mild but she has been more concerned about her cough and worried about it going into pneumonia. She states that she is not having SOB but is having some tightness with her cough. Denies any trouble breathing. She denies any known exposure to anyone that has tested positive to COVID-19. She is fully vaccinated. She reports having a fever of 99.9 but nothing other than that. She states that her cough is turning more into a "croupy" cough now. Denies any loss of taste or smell.


VAERS ID: 1894809 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Pain in extremity, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Friday night he reports that his heart felt like it was exploding out of his chest. Saturday his left arm started aching and he felt tiredness. By Sunday night, symptoms were resolved.


VAERS ID: 1894883 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
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 FH8030 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Feeling cold, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin 500mg, rosuvastatin 20mg
Current Illness: no
Preexisting Conditions: high blood pressure
Allergies: steroids
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Woke up the next morning she had a terrible nausea. Then she started having chills and couldn''t get warm. The chills has been constant.


VAERS ID: 1894922 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HIVES AND ITCHING ALL OVER HIS BODY. PT WENT TO EMERGENCY ROOM AS A RESULT


VAERS ID: 1894924 (history)  
Form: Version 2.0  
Age: 13.0  
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 (MODERNA)) / MODERNA 939909 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: None
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Moderna administered to the patient. She is under 18 years old. She should have been administered Pfizer. We have notified the mother of the incident. She said the patient is fine. Just a little tired. No other issues since.


VAERS ID: 1895072 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
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 - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chromaturia
SMQs:, Rhabdomyolysis/myopathy (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: Lasix,, protein supplement, potassium, magnesium, allegra, albuterol. symbicort,metoprolol, allopurinol, Vit C, Vit D, Fish Oil, Synthroid
Current Illness:
Preexisting Conditions: paraplegia for 50 yrs, , post nasal drip, aFib
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: urine turned brown with purple sediment in the bottom of my urine bag. My urine is always yellow.


VAERS ID: 1895106 (history)  
Form: Version 2.0  
Age: 33.0  
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 / SYR

Administered by: Work       Purchased by: ?
Symptoms: 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily multivitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None know.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives/ itching in random parts ph my body. They pop up and then they go away. Constant hives all day long. Don?t last long, maybe an hour in one spot before they go away and new ones in a different reappear. Started taking Benadryl on Saturday night (day after the booster) and the Benadryl will keep the hives away but they come back when they Benadryl wears off. Today is Tuesday - I have been itching since Friday.


VAERS ID: 1895116 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dehydration, Dizziness, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Nonr
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Hydration and Meclizine Hydrochloride. 25mg
CDC Split Type:

Write-up: Extreme Vertigo requiring medical attention. Sissy ness and nausea lasting 24hours..


VAERS ID: 1895346 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Ohio  
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 330268D / UNK LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS FT779 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Malaise, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: After vaccination she is waiting in waiting area. After 5 minutes she came to me and said, she is not feeling good. Immediately I went over there and she fainted. We called 911 and mean while she came back to normal after 5 min and said she feels little dizzy. Once para medics came , they checked BP and blood glucose, they are normal. she waited 20 min, initially she don''t want to go to ER but finally went there by walking. She completely normal by the time she is leaving


VAERS ID: 1895352 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: Levothyroxine topiramate propranoloL metFORMIN sertraline
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itching, bruising, swelling, fever in spot of injection Itching and swelling starting moving down arm


VAERS ID: 1895358 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Massachusetts  
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: Other       Purchased by: ?
Symptoms: Eye movement disorder, Fall, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No know medication.
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Unknown, pt was checked in ER.
CDC Split Type:

Write-up: Upon completion of administering the vaccination, when the guest was getting up she fainted as she was going to observation. Guest fell to floor, I was 5'' away at another vaccination station. Staff who vaccinated her responded directly to her. She was unconscious and eyes rolled back. She was out for about 10 seconds. Vitals were taken and guest was talking to us. I left guest with staff and two other RN''s and called emergency for an ambulance from EMS. We monitored guest until EMS arrival. EMS was given report and care was transferred to EMS. They put her on the stretcher and transported. to Hospital. Talked with her mother Monday 11/22/2021 and she said she was checked in ER and it was determined that it was a Syncopel Episode and she was released.


VAERS ID: 1895539 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-06
Onset:2021-11-19
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Pruritus, Rash erythematous, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Prenatal multi-vitamin daily Cetirizine 10mg daily Fluticasone 50mcg nasal spray, 1 spray in each nostril daily Vitamin D 2,000 units daily Breo 200/25 mcg 1 puff inhaled orally daily
Current Illness:
Preexisting Conditions: Asthma
Allergies: Fentanyl=itching
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Itching that started in my right ankle at night. The following morning, my chest became very itchy. Throughout the day, more parts of my body became extremely/intensely itchy and I developed red plaques/rash on my trunk/under the breasts, on my back, on my shoulders/blades. I took 1 dose of Benadryl 25mg, which helped a lot, but then later at night, the itchiness came back. I called the on-call service for my doctor''s office, and per the recommendation of the nurse, I applied hydrocortisone 1% cream to the affected areas. I had difficulty sleeping due to the itching, so I took Benadryl 25mg. By the morning, the itching/rash improved a lot. Later in the day, there was some mild itching that I treated with hydrocortisone. I am currently 4.5 months pregnant with an expected due date of May 4th 2022.


VAERS ID: 1895563 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Ohio  
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 320305D / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site erythema, Injection site mass, Injection site pain, Injection site warmth, Mobility decreased, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin XR 1500MG Tablet Simvastatin 10MG Tablet Metoprolol Succinate 25MG Tablet Hydrochlorothiazide 25MG Tablet Vyvanse 30MG Capsule Escitalopram Oxalate 15MG Tablet Bupropion HCL 300MG Tablet Cetirizine 10MG Tablet Montelukast 10MG Tab
Current Illness: Asthma flare-up High blood glucose: adjusting medications to get my blood glucose under control
Preexisting Conditions: Asthma Diabetes High Blood Pressure High Cholesterol Mild Sleep Apnea Anxiety Depression ADHD Poly Cystic Ovarian Syndrome (PCOS)
Allergies: None that are known.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shot was at 11:30AM: I initially had pretty severe pain at the injection site that subsided about an hour after the shot. 1PM: I started having moderate shoulder pain. I could not lift anything or reach certain ways. The injection site not longer hurt, but my entire left shoulder did. 9PM: I developed a firm dollar coin sized lump under the injection site. This lump was hot to the touch and red in color. I drew a circle around the area to monitor growth. I also noted hive rashes in various parts of my body including the injection site, my right upper arm, my left eye, and my legs. The next day, approx. 10:30 AM: injection site lump and rash had spread 1-1 1/2 inch from growth monitoring circle. Most hive rashes on the rest of my body started to go away. Shoulder pain still moderate, very noticeable. I was running a fever of 101.4 F. 9PM: Same symptoms as the morning. Took Benadryl per suggestion of pharmacist. In the morning, the injection site lump and rash were still visible, but less. The shoulder paid was starting to fade slightly. As of now, 11/23/2021 10PM: shoulder paid is barely noticeable. Slight lump under injection site and still a little warm to the touch, but nowhere close to what it was. Hives have went away.


VAERS ID: 1895718 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
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 067F21A / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood magnesium, Electrocardiogram, Extra dose administered, Full blood count, Generalised tonic-clonic seizure, Hypotonia, Metabolic function test, Urine analysis
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vimpat Prozac Amitryptaline Protonix Depakote
Current Illness: None
Preexisting Conditions: Epilepsy
Allergies: Peanuts Tree nuts Amoxicillin Tramadol
Diagnostic Lab Data: CBC CMP Magnesium EKG Vimpat Urinalysis
CDC Split Type:

Write-up: I had two grand Mal seizures 6 hours after receiving my COVID booster. I was witnessed having 1 grand Mal seizure which lasted 4 minutes. Then I went limp and immediately went into a second grand Mal seizure. I was transported ER by EMS


VAERS ID: 1896538 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: First time taking probiotic, Rae. Otherwise, no other medications.
Current Illness: None reported
Preexisting Conditions: Reports no chronic conditions
Allergies: Reports no allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client reported feeling dizzy and heart palpitations. Lasted for 15 minutes.


VAERS ID: 1896546 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chills, Fatigue, Intervertebral disc protrusion, Laboratory test, Ligament sprain, Magnetic resonance imaging, Muscle spasms, Pain
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Accidents and injuries (narrow), Tendinopathies and ligament 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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Hospitalized. Mri. Labs
CDC Split Type:

Write-up: Day after I had chills, body aches and fatigue. I spent 15 hours in bed and woke up with lower back pain. Within several hours I could walk due to severe pain. I presented to the emergency department the following morning and have a herniated disc with tear and lumbar sprain/spasms. I?m on day 3 of admission for pain management. The disc and tear may not be new or vaccine related but this severe back pain i think could be.


VAERS ID: 1896548 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Canalith repositioning procedure, Dizziness, Mobility decreased
SMQs:, Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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: One day of intermittent vertigo-like experiences several weeks after my second Moderna. I didn''t link it with the vaccine at th
Other Medications: Duloxetine, Levothyroxine, Multivitamin, Calcium supplement, fish oil supplement, Tylenol several hours after vaccine
Current Illness: None
Preexisting Conditions: None
Allergies: Contact allergy to nickel (i.e. metal jewelry)
Diagnostic Lab Data: Medical care not sought
CDC Split Type:

Write-up: Dizziness / apparent vertigo: First noticed during my bike ride to work, around 25 minutes into the 30 minute ride. When I was about to resume riding after stopping at a stop light, I felt unsteady and dizzy to the point of nearly blacking out momentarily, but it subsided as quickly it started and I made it to work unscathed. Throughout the day, if a tilted my head to either side, I would feel unsteady, but I was able to work relatively normally (but attempted to keep my head as straight as possible). I attempted the Epley maneuver toward the end of the morning; I didn''t experience nystagmus during the first step, but seemed better for at least an hour afterwards before it came back (though it remained mild). The next day, Saturday, I initially thought the problem was over, but while I was at work, I had several brief episodes, but again, tried to keep my head straight and didn''t experience any problems during the bikes to and from work. On Sunday, the problem was intermittent at work. I continued to try to keep my head straight. On Monday, I had one intense episode in the morning after getting out of bed and entering the bathroom, but no others , though I tried to keep my head as straight as possible during my work-day. I had no episodes today, Tuesday.


VAERS ID: 1896788 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Paraesthesia, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Shakiness-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Parametics response was very fast and took all vitals. Patient walked out of store after 15-20 more minutes. By the way, the pharmacist that gave the vaccine did not sign in after his lunch break, so all afternoon doses had the wrong pharmacists name attached!


VAERS ID: 1896803 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 1 RA / IM

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

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

Write-up: No reactions or symptoms to this event.


VAERS ID: 1896983 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Decreased appetite, Fatigue, Headache, Impaired work ability, Pain in extremity, Pyrexia, Rash, Upper-airway cough syndrome, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Initial J&J Covid19 vaccine
Other Medications: Vitamin d, multi vitamin
Current Illness:
Preexisting Conditions: Asthma, high blood pressure
Allergies: Penicillin, mold (airborne and food), cow''s milk, gluten, latex
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever, chills, rash on neck (throat area), wheezing, fatigue lasting more than two days , post nasal drip, dry cough, sore arm going on 6 days, on and off headache going on 6 days, change in appetite. Fatigue has interfered with ability.to work


VAERS ID: 1897004 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-11-19
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: + COVID 11/22/21
CDC Split Type:

Write-up: Patient received booster dose of Moderna 10/27/21 (unclear exactly when patient got 1st two doses due to not having information available). Patient became weak, tired, coughing and positive for COVID which led to admission 11/22/21. Patient is still admitted


VAERS ID: 1897090 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-11-19
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK RA / IM

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

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

Write-up: COVID


VAERS ID: 1897119 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-10
Onset:2021-11-19
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK LA / IM

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

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

Write-up: covid


VAERS ID: 1897131 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH80247 / 1 LA / IM

Administered by: Unknown       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that she passed out 2 hours after receiving her COVID-19 vaccine at her local grocery store. There were 2 episode of syncope back to back, no other symptoms occurred.


VAERS ID: 1897144 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Diarrhoea, Fatigue, Injection site pain, Lymph node pain, Lymphadenopathy
SMQs:, Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 11/19/2021 I noticed a pain in the injection site, the entire shoulder of the left side, and I had chills that night, but no fever. 11/20/2021 woke up to my lymph nodes swollen in the left armpit, pain was closer to the chest, Diarrhea, chills and fatigue. 11/21/2021 the swelling left armpit was now the size of a softball, the pain progressed to the shoulder area, chills and fatigue; took Advil before bed. 11/22/2021 the swelling had gone down to about baseball size, pain had mostly subsided, but still fatigue. I went to the Doctor this day and told me just to take Aleve twice a day. Still just a bit of tenderness on the left side as of today.


VAERS ID: 1897165 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Tenderness
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: Extremely sore tender arm for 7 plus Days


VAERS ID: 1897174 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-11-19
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 RA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1897243 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Computerised tomogram, Echocardiogram, Electrocardiogram, Fatigue, Feeling of body temperature change, Myocarditis, Respiratory rate increased, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Thyroid condition, mental health
Allergies: Amoxicillan
Diagnostic Lab Data: 11/19/21: EKG, chest xray, blood work, CT scan 11/20/21: ultrasound of the heart.
CDC Split Type:

Write-up: I recieved the booster moderna vaccine on 11/18/21. On 11/19/21 I felt tired all day nothing major. Then around 4pm my whole body started shaking, my chest hurt, I was cold and then hot, I was breathing really fast as well. I called 911 and they came and I went to the ER. At the ER they ran a bunch of tests and determined it was myocarditis caused by the Moderna vaccine. I was then admitted to the hospital for observation overnight. The next day 11/20/21 I got a ultrasound of my heart and it was determined that it was normal and that I could go home.


VAERS ID: 1897268 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Product administered to patient of inappropriate age
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Called patient''s mother to check on patient. Mother reports that patient did not have any side effects from the vaccine other than a sore arm. Office visit was offered free of cost to patient''s mother who declined and stated it was unnecessary because he was doing fine. Did tell mother that patient could not receive his second dose until he was 5 years of age.
CDC Split Type:

Write-up: Dose of 0.2ml administered to patient who was only 4 years old at the time the dose was administered.


VAERS ID: 1897282 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline 10 mg at bedtime, tylenol PRN
Current Illness: None
Preexisting Conditions: Cyclical vomiting syndrom
Allergies: Ibuprofen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received an expired dose of peds Pfizer vaccine. The vaccine had been drawn up on 11/18/21 at approximately 1554. It was administered on 11/19/21 at 1521. Pfizer was contacted on 11/22/21 for recommendations but they were unable to provide any additional stability data outside of the 12 hrs. CDC guidance recommends revaccination as soon as possible. Patient''s PCP was consulted and she also recommended revaccination as soon as possible. Patient''s guardian was notified that the vaccine received on 11/19/21 is considered invalid and options were reviewed. Guardian decides to bring patient back in to restart the series on 12/3/21.


VAERS ID: 1897299 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: Patient received an expired dose of peds Pfizer vaccine. The vaccine had been drawn up on 11/18/21 at approximately 1554. It was administered on 11/19/21 at 1521. Pfizer was contacted on 11/22/21 for recommendations but they were unable to provide any additional stability data outside of the 12 hrs. CDC guidance recommends revaccination as soon as possible. Patient''s PCP was consulted and she also recommended revaccination as soon as possible. Patient''s guardian was notified that the vaccine received on 11/19/21 is considered invalid and options were reviewed. Guardian decides to bring patient back in to restart the series on 12/3/21.


VAERS ID: 1897303 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-11-11
Onset:2021-11-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood albumin, Blood immunoglobulin G normal, CSF glucose normal, CSF protein normal, Enterovirus test negative, Epstein-Barr virus antibody negative, Full blood count, Haemoglobin normal, Injection site pain, Lumbar puncture, Magnetic resonance imaging neck, Muscular weakness, Neisseria test, Neuropathy peripheral, Neutrophil count, Platelet count decreased, Posture abnormal, Pruritus, Radial nerve palsy, Red blood cell count normal, Respiratory viral panel, SARS-CoV-2 test negative, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: 11/19/21 CBC with WBC 4.5, Hgb 11.5, Platelets 132, ANC 1,280, ALC 2,700 11/19/21 SARS-CoV-2 PCR negative 11/20/21 MRI of cervical spine and left brachial plexus: normal 11/20/21 Lumbar puncture with CSF WBC 0, RBC 7, Glucose 56, Protein 23, Meningoencephalitis panel negative 11/20/21 CSF IgG 1.3, IgG quantitative 685, Albumin 13.5, GIXALB 3,500, IgG index 0.49 11/20/21 Respiratory pathogen panel negative, HSV 1/2 PCR serum negative, EBV antibody panel negative, EBV serum quant <200, West Nile IgM 0, West Nile IgG 0.11, Enterovirus serum PCR in process, Enterovirus stool culture negative
CDC Split Type:

Write-up: Mom reports he was otherwise in his normal state of health on 11/11 when he got his first COVID-19 vaccine in his left deltoid. He had some pain there the first day and then this resolved--he did well for a week. On the night of 11/18 he began complaining of a little pain in the left upper arm again and went to sleep. On 11/19 AM, he noticed and showed mom that he had difficulty extending his wrist and fingers on that hand. He also has some pain in his lateral arm just above the elbow and some itching of the dorsal surface of the hand, both which started in the previous 24 hours. He was evaluated for acute left wrist drop at Hospital ED, exam notable for "left wrist drop, very weak left finger extensors and weak thumb abduction." He underwent work up there including lab work and MRI (below). He was ultimately discharged with suspected peripheral radial nerve neuropathy of the left hand.


VAERS ID: 1897310 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / UNK LA / IM

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

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

Write-up: Patient received an expired dose of peds Pfizer vaccine. The vaccine had been drawn up on 11/18/21 at approximately 1554. It was administered on 11/19/21 at 1521. Pfizer was contacted on 11/22/21 for recommendations but they were unable to provide any additional stability data outside of the 12 hrs. CDC guidance recommends revaccination as soon as possible. Patient''s PCP was consulted and he also recommended revaccination. Parent notified on 11/24/21.


VAERS ID: 1897330 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-11-19
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 11/19/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1897341 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient''s first dose was 11/5/21 and she returned for her 2nd dose and it was administered on 11/19/21. Follow-up phone call with the patient on 11/24/21 and she reports having no side effects from her second dose on 11/19/21. Advised on current CDC recommendations for vaccination <24 days from the first dose of Moderna. Pt voiced understanding.


VAERS ID: 1897363 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / 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: Patient falsified DOB when registering for vaccination. Guardian consented to the vaccination. Department of Health verified with statistical records that the patients actual DOB which made the vaccine a contraindication. No known adverse reactions noted.


VAERS ID: 1897368 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Nasal congestion, Oropharyngeal pain, Pain, Pain in extremity, Tinnitus
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hearing impairment (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: Metoprolol 37.5 mg, hydrochlorizide 25mg, deviant 60mg, vitamin C, zinc, vitamin D with K2, Ocuvite, biotin, iron, evening primrose oil, glucosamine with msm.
Current Illness: Sinus infection
Preexisting Conditions: Hypertension, slight asthma.
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Janssen on March 23, 2021: extremely loud ringing in both ears next morning at exactly 9:00am that lasted several hours! Pfizer Booster on November 18. 2021: fatigue, chills, body aches & sore arm for over 72 hours. Still not feeling completely back to normal after 6 days! Stuffy nose, sore throat and slight cough.


VAERS ID: 1897374 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Pain on site for 3 days (till 11/23) Fatigue/ache till Saturday 7pm


VAERS ID: 1897396 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Back pain, Body temperature increased, Fatigue, Headache, Lethargy, Neck pain, Pain, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine, vitaminD, melatonin, quetiapine fumerate
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: By that evening I felt lethargic, had chills with a temp. of 100.5 and a sore arm. I took one tylenol and one ibuprophen and went to bed. During the night I woke up with generalized aches and severe pain in my lumbar spine. Again waking up with aches and severe pain in my shoulder joint (not the shot arm). And again woke up with severe spinal neck pain, generalized achiness and headache. During the night the achiness was so severe that I could hardly turn over in bed. The next morning my temp was 100.8 I took 1 tylenol and 2 ibuprophen. I was so tired and weak I just sat there in the house. By the second morning I had recovered from the side effects. Really, the booster side effects were just like the way I felt when I was sick covid breakthrough infection. In my entire life I have never had such a reaction or any reaction to any vaccination for any disease ever.


VAERS ID: 1897397 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Chills, Disorganised speech, Dizziness, Electrocardiogram normal, Eye movement disorder, Hyperhidrosis, Influenza like illness, Loss of consciousness, Muscle rigidity, Myalgia, Nausea, Tinnitus
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: During the night I experienced flu-like symptoms (alternating chills and sweat, muscle pain, nausea and dizziness). I woke feeling nauseated around 3:45 a.m. and went to the bathroom. I was overcome with sweats and dizziness on the way there and took a break to lie down on the floor for a few minutes. Then I got up and made it to the toilet to urinate. While sitting there, darkness crept in on my vision and I experienced ringing in my ears. I knew I was about to faint and called for my husband. By the time he arrived in the bathroom, I was unconscious. He said that I was completely rigid and my eyes had rolled to the side of my head but were open. He called 911, managed to wake me, and drove me to the emergency room. I felt sweaty and dizzy when I woke and my husband said my sentences were not completely coherent.


VAERS ID: 1897424 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Eye swelling, Fatigue, Headache, Ophthalmological examination abnormal, Pain in extremity, Ulcerative keratitis
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Optic nerve disorders (broad), Corneal disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN D, MULTIVATIM
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: SHELLFISH
Diagnostic Lab Data: eye exam, corneal alsur
CDC Split Type: vsafe

Write-up: After the vaccination i had a sore arm and i felt tired and had it for 3 days. After a couple of days my right eye was swollen and i went to the doctor and they said i have a corneal alsur. The doctor gave me an eye drop and it is a little better now but i still have the headaches.


VAERS ID: 1897473 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-26
Onset:2021-11-19
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Bronchospasm, Cough, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of thyroid cancer, diabetes, recurrent bronchitis, anxiety, histoplasmosis, status post left thoracotomy
Allergies: Tizanidine, Tramadol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presents to the ED for evaluation of acute bronchospasm, dry non-productive cough, and wheezing. Symptoms developed last Friday.


VAERS ID: 1897493 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

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

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

Write-up: Patient received an expired dose of Pfizer vaccine. The vaccine had been drawn up on 11/18/21 at approximately 1554. It was administered on 11/19/21 at 1521. Pfizer was contacted on 11/22/21 for recommendations but they were unable to provide any additional stability data outside of the 12 hrs. CDC guidance recommends revaccination as soon as possible. Patient''s PCP was consulted and she also recommended revaccination as soon as possible.


VAERS ID: 1897507 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-09
Onset:2021-11-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

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

Write-up: Patient developed active COVID19 after booster dose of Pfizer.


VAERS ID: 1897541 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-01
Onset:2021-11-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Brain natriuretic peptide increased, Cardiac imaging procedure abnormal, Cardiomyopathy, Echocardiogram, Ejection fraction decreased, Orthopnoea, Respiratory failure, Ventricular hypokinesia
SMQs:, Cardiac failure (narrow), 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), Guillain-Barre syndrome (broad), Cardiomyopathy (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ, birth control pill
Current Illness: No
Preexisting Conditions: Hypertension
Allergies: No
Diagnostic Lab Data: TTE 11/23/21: EF 28% with diffuse left ventricular hypokinesis. BNP 1950.
CDC Split Type:

Write-up: Developed orthopnea and respiratory failure found to have new cardiomyopathy.


VAERS ID: 1897547 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ87-57 / 1 LA / IM

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

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

Write-up: no adverse reaction. unknown if patient received 0.2ml of adult or pediatric pfizer


VAERS ID: 1897592 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 LA / IM

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

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

Write-up: no adverse reaction. unknown if patient received 0.2 ml of pediatric or adult pfizer.


VAERS ID: 1897597 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Facial paralysis, Impaired work ability, Migraine, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hearing impairment (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: The patient reports that she received the Janssen COVID-19 vaccine on 11-18-21. She developed a migraine, stomach pain, diarrhea, and muscle pain. She was seen in the ER on 11-22-21 and was discharged on 11-23-21. She had a note from provider excusing her from work on the 22nd and 23rd. She continues to have pain and migraine. She also has noticeable left sided facial droop. She was off work because of her reaction from 11-19, 11-22, 11-23, 11-24, and 11-26. She came to work on 11-24-21 and was trying to work but she is taking medication to treat her migraine, butal/acetamin/cf. After talking to HR director and EH RN she was encouraged to go home and take the rest of the week off.


VAERS ID: 1897604 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 LA / IM

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

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

Write-up: no adverse reaction. unknown if patient received adult or pediatric pfizer


VAERS ID: 1897618 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 LA / IM

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

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

Write-up: no adverse reaction. unknown if patient received adult or pediatric pfizer


VAERS ID: 1897626 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-11-19
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897627 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 LA / IM

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

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

Write-up: No adverse reaction. Unknown if patient received adult or pediatric Pfizer.


VAERS ID: 1897634 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 LA / IM

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

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

Write-up: no adverse reaction. unknown if patient received adult or pediatric pfizer


VAERS ID: 1897635 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-11-19
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 RA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897636 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Injection site pain
SMQs:, Guillain-Barre syndrome (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain on the injection site, and body weakess


VAERS ID: 1897639 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-19
Onset:2021-11-19
   Days after vaccination:304
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897641 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-14
Onset:2021-11-19
   Days after vaccination:309
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897647 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-11-19
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897652 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-25
Onset:2021-11-19
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Effusion, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Statin, men''s daily vitamin, turmeric
Current Illness:
Preexisting Conditions: Effusion of right knee occurred 11/19 without any known reason. This is requested followup to my reply to last survey.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Effusion of right knee. Swelling. I saw my doctor who has referred me to an orthopeadic


VAERS ID: 1897695 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Confusional state, Culture urine positive, Drug withdrawal convulsions, Electroencephalogram normal, Generalised tonic-clonic seizure, Lethargy, Urinary tract infection, Urine analysis abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Drug withdrawal (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Baclofen 20mg PO TID; Ibuprofen 600mg PO with meals; tylenol fluticasone/salmeterol 250/50 1 puff bid; lidocaine patches 5% 3 patches Q24 hours; ativan 1 mg at bedtime prn sleep; montelukast 10mg po at bedtime, nicotine 14mg transdermal da
Current Illness: debility; hepatic cirrhosis, back pain
Preexisting Conditions: alcohol abuse, anxiety, arthritis, back pain, benign essential hypertension, GERD, hyperlipidemia, cirrhosis, CKD stage 3, depressive disorder
Allergies: enalapril, lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Came into the ED on 11/12 with worsening R lower back pain and immobility. was awaiting Rehab placement for PT/OT and was getting ativan and baclofen. Became more confused, lethargic. 11/17 baclofen and ativan stopped. Did not appear to be in alcohol withdrawal. had a Grand Mal seizure on 11/19. Received ativan and seizure abated. only other new med was bactrim for UTI. differential was alcohol withdrawal vs hospital acquired delirium vs due to medication vs Infection (UTI) (+ UA and UC but not UTI symptoms). per neurology the single seizure like event likley due to GABAergic withdrawals (ETOH and lorazepam) no history of seizures. . EEG negative for seizures.


VAERS ID: 1897702 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-10
Onset:2021-11-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Alanine aminotransferase increased, Hepatic enzyme increased, Ultrasound abdomen normal
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: ultrasound negative for gallstones and blood work indicated elevated liver enzymes alt 225 ast 190 elevated from 2 weeks ago at primary care office 11/24/2021
CDC Split Type:

Write-up: elevated liver enzymes with RUQ pain after receiving 3rd booster shot


VAERS ID: 1897708 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-02-04
Onset:2021-11-19
   Days after vaccination:288
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Arthralgia, Back pain, Computerised tomogram, Computerised tomogram thorax, Dyspnoea, Fibrin D dimer, Full blood count, Hypoaesthesia, Metabolic function test, Pain, Pain in extremity, Pelvic venous thrombosis, Prothrombin time, Pulmonary embolism, Stent placement, Ultrasound Doppler
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tamoxifen, lexapro, lamictal, calcium
Current Illness:
Preexisting Conditions: Breast cancer, depression, osteoporosis
Allergies: Bananas, avocados, kiwi
Diagnostic Lab Data: Venous US on 2/20/21, D-dimer, CBC, CMP, chest CT. In May 2021, CBC, CMP, PT-PTT, CT scans.
CDC Split Type:

Write-up: I had sciatic-type pain in my left lower limb, starting at hip and radiating down to my ankle, starting the morning of Feb 19th, along with moderate lumbar pain and SOB. Symptoms increased to increased lower back pain, left leg numbness, and increased shortness of breath. I went to the ER on 2/20/21 and was diagnosed with a left common iliac vein DVT and with multiple PEs, I was given lovenox injections and kept overnight, discharged the next morning. I was prescribed Xarelto for 3 months. A stent was placed in 5/29/21.


VAERS ID: 1897725 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Full blood count normal, Heart rate increased, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Laboratory test normal, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, flonase
Current Illness:
Preexisting Conditions: Diabetes
Allergies: N/a
Diagnostic Lab Data: Covid, flu A, flu B, pulmonary embolism, CBC, all done 11/19
CDC Split Type:

Write-up: Elevated resting heart rate noticed by my fitness tracker. Resting HR was 115-120 BPM beginning at 1pm on 11/19. Checked into ER 3pm, lots of tests which ask came back negative (covid, flu, pulmonary embolism, blood clot, etc.) ER administered fluids, pulse lowered to 95-99. Discharged from ER with no clear cause at 1am on 11/20


VAERS ID: 1897754 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-09
Onset:2021-11-19
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 11/19/2021 Admitted into the hospital in 11/14/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1897770 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Heart rate increased, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nortriptyline 50 mg PO HS Singulair 10 mg PO HS One A Day Woman''s MultiVitamin
Current Illness: None
Preexisting Conditions: Childhood Asthma COVID 19 in December of 2020
Allergies: Levaquin Seasonal Mold
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 4 minutes of injection started developing hives on the face, neck, arms, abdomen, and the bottom of the feet. Was administered 50 mg of Benadryl PO, development of hives slowed down. 4.5 hour later hives returned, was instructed to take another 50 mg of Benadryl and continue q6h, instructed to take famotidine 20 mg po q12h, physician on site also prescribed 60 mg prednisone PO qday x 5 days. Then continues to have increased HR that evening and through current resting HR averages 110 and walking HR averages 133.


VAERS ID: 1897802 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-12
Onset:2021-11-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Lip swelling, Periorbital swelling, Peripheral swelling, Swelling face, Throat tightness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Throat closing, face swollen, lips enlarged, puffy eyes, dizzy, arms and hands swollen.


VAERS ID: 1897813 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spoke with client 11/24/2021 he states he has a "palm sized area under injection site that is red and warm to the touch." He states Friday night 11/19/2021 is when he discovered


VAERS ID: 1897816 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Immunisation, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: Vaccine Administration Error - Pediatric Formulation Patient received 0.2 ml pediatric dose of Pfizer vaccine, was then provided 0.3 ml dose of Pfizer on same day.


VAERS ID: 1897820 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 4 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: Vaccine Administration Error - Pediatric Formulation Patient administered 0.2 ml pediatric vaccine, then administered 0.3 ml adult dose on 11/19/2021 Previous doses administered on 12/19/2020 and 1/6/2021


VAERS ID: 1897870 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Confusional state, Disorientation, Disturbance in attention, Dysstasia, Fatigue, Feeling cold, Pyrexia, Tremor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GLIPIZIDE,NOVOLOG MIX 70/30 FLEXPEN,AMLODIPINE,VENLAFAXINE,ATENOLOL,PLAVIX,PERCOCET, FAMOTIDINE,NOVOLOG FLEXPEN, TIZANIDINE,LIPITOR,GABAPENTIN, LOSARTAN,LEVOTHYROXINE,AMITRIPTYLINE
Current Illness: none
Preexisting Conditions: Gastro esophageal reflux, pain, hypertension, hypothyroidism, type 2 diabetes, anxiety, hypercholesterolemia
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up following morning after vaccine, felt very disoriented, confused, having hard time balancing and standing. Patient was unable to keep focus when looking something up on her phone and her eyes could not focus on the keyboard. Blood pressure came back 108/61. typically, this patient has high blood pressure even with medication. Felt very tired and fell back asleep for two additional hours. She woke up again trembling and freezing, but had a temperature of 102 degrees Fahrenheit. she covered herself in warm blankets, and took Tylenol. she slept again and woke up five hours later, took another Tylenol, then went to sleep again. Later that evening of the 19th, her fever broke.


VAERS ID: 1897871 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram normal, Fatigue, Headache, Pain in extremity, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid (100 mcg/day)
Current Illness: None
Preexisting Conditions: Celiac disease
Allergies: Celiac disease (gluten allergy), hydrocodone, tramadol
Diagnostic Lab Data: 11/24/2021 - EKG results were normal.
CDC Split Type:

Write-up: Sore left arm, sore area under left arm, heart palpitations, light headache, fatigue that began on Friday and lasted through Sunday. Palpitations are intermittent and have improved, but are still occurring on 11/24/2021. I had no reaction to the first two Pfizer shots; not even arm tenderness. Saw doctor on 11/24/2021.


VAERS ID: 1897966 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxin
Current Illness: none
Preexisting Conditions: thyroid cancer diagnosed in 2009 - thyroidectomy 2009
Allergies: Codeine, bactrim, tree pollen
Diagnostic Lab Data: I have an appointment (hopefully) Monday to have the doctor take a look at it.
CDC Split Type:

Write-up: Sore arm initially - other that that, no problems. Noticed bruising on the morning of Friday 11/19/21. Saturday bruising was almost double in size, Sunday larger still. Just seemed odd to have no bruising for two days before the bruise appeared and then stared to spread out across my arm


VAERS ID: 1897989 (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: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came to covid clinic requesting the pediatric pfizer vaccination, and the patient''s mom insisted on patient getting pediatric pfizer as it was instructed by the family''s physician. The patient was 12 years old at the time of the clinic.


VAERS ID: 1898007 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ775AA / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Nausea, Pallor, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: booster given and pt also received flu vaccine . During observation, pt complained to RN of nausea and "throat was feeling tight. Patient looked pale and anxious. Pt was evaluated by provider. Pr received EpiPen 0.3 mg x1. 911 was called for pt. paramedics provide pt Benadryl 50mg IV.


VAERS ID: 1898026 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Agitation, Anaphylactic reaction, Bronchospasm, Cough, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Unknown called at 1104am for anaphylaxis, patient came for flu vaccine and Pfizer covid vaccine 3rd dose, patient c/o throat closing, coughing, and agitation. V/S BP-176/95, HR- 90, O2 sat -99% RA,RR-30, patient sitting up on a gurney, patient given Epinephrine 0.3mg IM injection on left lateral thigh, for anaphylaxis, observed patient closely, V/S at 1107am: BP-135/82, HR-77, O2sat-99%RA, RR-25, continued to monitor patient closely, patient tolerated IM injection well, 1110am V/S: BP-124/72, HR-86, O2sat-98%RA, 1112am: paramedics came, IV insertion done by paramedics, 1121am, Benadryl 50mg IV given by paramedics, patient talking, patient denies medication and food allergies, translation completed by RN, patient able to open her eyes and talking in full sentences, no signs and symptoms of ARDS, 1125 paramedics picked up pt on the way to Hospital ED. IN ED: No sob, no fevers, no cp, no itchiness, no swelling, no abd pain or n/v. Per ED MD note, pt likely had an episode of bronchospasm. Pt stable and released from ED.


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