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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 53 out of 8,010

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VAERS ID: 1757486 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-13
Onset:2021-10-01
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Extremely heavy onset of (on time) menstrual cycle, with bleeding 5X the volume of typical cycle.


VAERS ID: 1757507 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Decreased appetite, Dysgeusia, Fatigue, Feeling abnormal, Headache, Pain
SMQs:, Taste and smell disorders (narrow), Dementia (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:
CDC Split Type:

Write-up: Chills, swimmy head, extreme tiredness, soreness throughout entire body, headache, weird after taste in mouth, no appetite


VAERS ID: 1757512 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling of lymph Node above clavicle bone


VAERS ID: 1757548 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Discomfort, Injection site pain, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer Shot #2 3/26/21; soreness in injection area; fatigue, chills
Other Medications: Daily multi-vitamin; chanca piedra at meals, Vitamin C (500 mg), Vitamin D (1000 iu every other day); 3mg melatonin at night
Current Illness: None
Preexisting Conditions: Obesity, high blood pressure
Allergies: Allergic to Morphine, ampicillin and penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm in the injection site, similar to second dose reaction. Have developed swollen lymph nodes in my left armpit with irritation and pain. Did not seek treatment after researching the effects. After 24 hours of onset, the pain started to decrease. 48-60 hours after onset, the pain is nearly gone and swelling has started to decrease. I will be seeing my doctor tomorrow for another reason and will discuss the situation with him. I wanted to report the event even though it has not fully dissipated.


VAERS ID: 1757549 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Lymphadenopathy, Mobility decreased, Pain
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: My lymphatic system on my right side swelled in my neck, under arm and right pectoral to the point that all 3 areas were twice the size of left. It became very painful and difficult to move my neck, arm and chest from the swelling . This did not happen after the first 2 shots given on 12/28 and 1/18/2021


VAERS ID: 1757579 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER - / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Lymph node pain, Lymphadenopathy, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Prescription Medications: Ibuprofen 600 MG Tablet- PRN Cyclobenzaprine 10 MG Tablet- PRN Ventolin HFA 90 MCG Inhaler- PRN Cetirizine HCL 10 MG Tablet- 1 Tablet 1x Nightly Sprintec 0.25-0.035 MG Tablet- 1 Tablet 1x Nightly Famotidin
Current Illness:
Preexisting Conditions: Hashimoto''s Ehlers-Danlos Syndrome Removel of a vascular tumor left arm on the inside just above elbow 2007 Papillary Thyroid Cancer diagnosed 12/2019 Total Thyroidectomy 12/2019 Radioactive Iodine Treatment 02/2020 Seasonal Allergies Depression w/anxiety Primary Insomnia Other Specified Hypothyroidism Dysmenorrhea, Unspecified Cardiac Murmur, unspecified Mild Intermittent asthma without complication Allergic rhinitis, unspecified type Gastro-esophageal reflux disease without esophagitis Migraine without status migrainosus, not intractable, unspecified migraine type
Allergies: Carbatrol - Aplastic anemia (blood Platelets drop) Codineb- H/A, Vomiting Vicodan - H/A, Vomiting Imitrex - Tingling in face and hands Propranolol - Increased heart rate, Inability to sleep Artificial Sweeteners - Migraine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Feeling of tiredness and pain at injection site lasting 2 days after receiving the injection. 3 days after receiving the COVID vaccine the lymph nodes under right arm began to swell with mild pain and itchiness. Taking acetaminophen and ibuprofen at staggered times for pain. If pain and itchiness last longer than 10 days I will contact someone.


VAERS ID: 1757587 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Hyperhidrosis, Hypoaesthesia, Insomnia, Nausea, Pain in extremity, Pollakiuria, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Fever, violent chills, sweating, joint pain, back pain, nausea, arm pain, numbness in left fingers, left shoulder pain, soreness,(left shoulder), sleeplessness, frequent urination with little to no urine, rash (spread across neck collar region, up and down entire spine, and under pectorals).


VAERS ID: 1757883 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Dehydration, Electrocardiogram normal, Muscle spasms, Musculoskeletal stiffness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Headache, tired, Moderna, 37, Jan 2021, February 2021
Other Medications: Multivitamin Took humira week before
Current Illness: None
Preexisting Conditions: Crohns disease
Allergies: Pine nuts Penicillin Sulfa
Diagnostic Lab Data: Ekg clear 10/1/2021 Given 2 bags IV, zolfran, benadryl, and steroid Blood work taken, low potassium and magnesium
CDC Split Type:

Write-up: Nausea, vomiting, hands and feet cramped and stiff, stomach tightness and pain, dehydrated, ended up in ER


VAERS ID: 1757898 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 LA / IM

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

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

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


VAERS ID: 1757901 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Oedema peripheral, Rash pruritic
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Entire body red confluent pruritic rash which began about 12 hours after the vaccine and progressed. Includes lips and base of penis. Some edema of lower extremities. No SOB, tongue swelling, hypotension or other signs of anaphylaxis. Outcome is that I started him on a 5-day course of prednisone 40mg qd.


VAERS ID: 1757903 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Incorrect route of product administration, Injection site pain, Mobility decreased
SMQs:, Parkinson-like events (broad), Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Severe, Systemic: Joint Pain-Severe, Additional Details: Patient reported pain and unable to lift arm up. Patient believed shot was administred too high. Patient has not seen doctor or anything yet.


VAERS ID: 1757909 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Presyncope
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Medium, Additional Details: pt had near syniscope per emt. pt did not sit and wait the 15 minute waiting period was walking around after 2 minutes of recieving the vacinne pt almost fainted called emt and was taken to er and released with diagnois of near syniscope no pain at the injection site just dizzy


VAERS ID: 1757915 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Fatigue, Impaired work ability, Musculoskeletal pain, Pain in extremity, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: thyroid
Allergies: sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: very tired --sleepy--- had to leave work. later in evening arm pain-- relief taking tylenol--every 5 hs - 2nd day--- back pain-- under shoulder blades == better 24 hrs later.


VAERS ID: 1758580 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid test on 10/1, negative
CDC Split Type:

Write-up: headache, body aches, fever


VAERS ID: 1758583 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-27
Onset:2021-10-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO202 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Plaquenil, Methotrexate, Vitamin D, B Complex, Folic Acid, Proair HFA
Current Illness: none
Preexisting Conditions: Rheumatoid Arthritis, Asthma
Allergies: no known allergies
Diagnostic Lab Data: 9/30/2021, went to ER, was given 1cc steriod injection right deltoid. 10/01/2021 went back to ER because patient was having more symptoms, was given oral steroid pack, muscle relaxer and was advised to take OTC Claritin 1 pill daily.
CDC Split Type:

Write-up: Patient states that he received 3rd shot - Booster on 9/27/2021, On Thursday, 9/30/2021, Patient started feeling squeezing and tightening in chest, difficulty in getting air in.


VAERS ID: 1758590 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-14
Onset:2021-10-01
   Days after vaccination:260
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1758597 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rybelsus, Metformin, Januvia, Glyburide, Crestor, Premarin, Celexa, Toprol
Current Illness: none
Preexisting Conditions: Diabetes
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: all over body aches, low grade fever,chills, headache, extreme soreness to injection site , extreme fatigue x 48 hours


VAERS ID: 1758605 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Latex
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: N/A


VAERS ID: 1758638 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Feeling abnormal, Hallucination, Nightmare
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: Ambien
Current Illness: None
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had terrible nightmares and hallucinating. Felt really terrible


VAERS ID: 1758640 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Fatigue, Hyperhidrosis, Palpitations, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Sweating profusely, heart palpitation, visual disturbances and weakness/tired.


VAERS ID: 1758644 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary mass, Discomfort, Injection site inflammation, Limb mass, Oedema peripheral, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Aspirin 81mg, Vitamin D3, Calcium, Alendronate, Hydroxyzine, Dicyclomine
Current Illness: None
Preexisting Conditions: Diabetes, osteoporosis, arthritis
Allergies: None
Diagnostic Lab Data: None yet due to the weekend. I am waiting on the clinic to open to get medical advice.
CDC Split Type:

Write-up: The day after vaccine I had a lump on my arm and under my arm at my arm pit. On the 3rd day I had a rash on my whole left arm (non-itchy). This morning I no longer have a rash but still have some slight inflammation at my armpit and injection site, with some discomfort if pressed on.


VAERS ID: 1758648 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Extra dose administered, Fatigue, Loss of consciousness, Muscle spasms, Myalgia, Nausea
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), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Pt. states that after receiving the 3rd dose of Phizer Booster 09/30/2021, started experiencing symptoms 10/01/2021 01:15am of chills, muscle aches, muscle spasms, and passed out x1. Self-treated with Tylenol for pain. 10/03/2021 still feeling fatigued and nausea. No noted Primary visit.


VAERS ID: 1758655 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 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? 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: No adverse symptoms. Given at only 17 years and 10 months old.


VAERS ID: 1758667 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Rash on legs, diffuse itching.


VAERS ID: 1758668 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013S8A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid, 3/1/21 & 3/22/21 Fever, fatigue, aches. But fever not as high as this last one.
Other Medications: Influenza
Current Illness: Stage three kidney disease, high blood pressure, psoriatic arthritis
Preexisting Conditions: Stage three kidney disease, high blood pressure, psoriatic arthritis
Allergies:
Diagnostic Lab Data: Probably should have called 911, but was afraid that he would just sit in an ER. I felt I could get the fever down. Was afraid he would sart seizing if I drove him to the hospital.
CDC Split Type:

Write-up: He began with the chills, then developed a fever of 103.2. I was putting cold compresses on him, administering Tylenol, ice water, popsicles. Fever continued to climb to 105. I then pulled out cold packs out of the freezer and a bowl with cold water and ice. I just kept alternating to different parts of his body. After two hours of "ice bathing", the fever came down to 99.5, and then broke later in the morning. It was a scary night.


VAERS ID: 1758692 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA CVN73 / 2 - / -

Administered by: Military       Purchased by: ?
Symptoms: Back pain, Blood creatine phosphokinase increased, Burning sensation, Chest pain, Ejection fraction normal, Electrocardiogram ST segment elevation, Myocarditis, Pain, Pericarditis, Troponin, Vaccination complication
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no prescription medications, patient attempted Pepcid at home and states threw it up
Current Illness: Covid PCR+ on 8/20/21
Preexisting Conditions: none noted
Allergies: no known allergies
Diagnostic Lab Data: Troponin 736 on admit 10/2, 1026 today 10/4. CPK 659 on admit, 299 today. EKG with diffuse ST elevation suggestive of acute pericarditis. EF 64%. Patient has received nitroglycerin, morphine, indomethacin, ketorolac, and ondansetron since admission.
CDC Split Type:

Write-up: per Cardiology, patient developed Myopericarditis from covid vaccine. Patient received 2nd shot of Pfizer on 9/30/21 and within 24h developed chest pain in left upper chest radiating towards his back, sharp and burning in nature. Admitted to hospital on 10/2. Still admitted as of today 10/4.


VAERS ID: 1758720 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / UNK UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Chest X-ray normal, Computerised tomogram head, Confusional state, Electrocardiogram normal, Fatigue, Full blood count normal, Headache, Hyperhidrosis, Impaired work ability, Metabolic function test, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tamsulosin
Current Illness: N/A
Preexisting Conditions: BPH
Allergies: NKDA
Diagnostic Lab Data: Head CT, chest xray, EKG, CBC, CMP- all WNL
CDC Split Type:

Write-up: The patient received his booster dose of Pfizer vaccine on 09/30/2021. His previous doses were received on 01/29/2021 and 02/19/2021 respectively, without incidence. On the evening of 09/30/2021, the client reports that he had a sore arm and went to bed. He failed to show up to work the next day and co-workers went to check on him at his residence as he lives alone. The patient was discovered in bed and acting very confused and unable to form rational sentences. He was immediately brought to the ER by a co-worker and a work-up was performed. At this time, he was also complaining about a severe headache and had profuse sweating. Imaging, EKG, and blood work were all performed and there was no notable abnormalities seen. He was later released from the hospital the same day, per his request. He notes that his headache has resolved but that he feels tired and fatigued. Also, he is still c/o abnormally profuse sweating.


VAERS ID: 1758739 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra 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:
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was administered 3rd dose of Moderna vaccine, but it turns out he did not meet criteria for severely immunocompromised. He tolerated the dose well with no adverse reaction, but I am filling out this report as patient did not meet criteria outlined by FDA EUA and ACIP recommendations for 3rd dose Moderna vaccine.


VAERS ID: 1758744 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor Losartan Baby Aspirin Methadone
Current Illness:
Preexisting Conditions: High Blood Pressure High Cholesterol
Allergies:
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I had a bad nose bleed for a few hours. I went to the ER and they put a clap on my nose and they ran some blood tests to make sure my blood pressure was fine. They diagnosed it as a nose bleed. This nose bleed would not stop.


VAERS ID: 1758745 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Gastrointestinal disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer 3/31/2021
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stomach issues-chills,


VAERS ID: 1758753 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Antibody test abnormal, Blood test, Fatigue, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vasculitis (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: April blood work testing all blood levels September all levels plus antibodies. My anti bodies are 5 times the normal Now from March
CDC Split Type:

Write-up: Since the day after the last shot I have been extremely run down. I can?t make it through a full day without a nap and I can?t stay up late without struggling


VAERS ID: 1758777 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye swelling, Feeling hot, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 15 minutes after receiving vaccine, patient felt dizzy, hot, had swollen eyes, and rash on neck. Pharmacist administered 50 mg of liquid benadryl Asked when patient had last eaten and provided 15mL of regular soda after learning it had been $g6 hours


VAERS ID: 1758780 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-16
Onset:2021-10-01
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Exposure to SARS-CoV-2, Pyrexia, Vaccine breakthrough infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic conditions include Afib, CHG, CKD, COPD, DVT, HTN, Reiter''s syndrome.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets criteria for vaccine breakthrough review. Known household exposure. SxS include fever, weakness, diarrhea.


VAERS ID: 1758782 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products
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: N/A
Current Illness: N/A
Preexisting Conditions: Unknown
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received Moderna for 3rd dose booster instead of Pfizer as patient had completed the 2 series of Pfizer vaccine. Patient waited for 30 minutes post vaccine and did not experience any of the following: wheezing; chest tightness; rashes; swollen lips, tongue, eyes or face.


VAERS ID: 1758838 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Lymphadenopathy, Lymphoedema
SMQs:, Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (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: Thyroid med
Current Illness: no
Preexisting Conditions: hypothyroid
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lymphodema. Baseball sized lump under l arm and some swelling in neck


VAERS ID: 1758844 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076CA / 1 RA / IM

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

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

Write-up: Pt lied and said she had never had any Covid vaccines. When entering into system vaccine given 10/1/2021, saw Pt had Covid-19 Vector-NR (JSN) on 3/8/2021 from Pharmacy.


VAERS ID: 1758872 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-25
Onset:2021-10-01
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Moderna on 2/25 and 3/25. Positive on 10/1


VAERS ID: 1758878 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Lymph node pain, Lymphadenopathy, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: Synthroid,plavix,lipitor,multivitamins,riboflavin,zinc and magnesium.
Current Illness: None
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I woke up the next day after the injection and my right underarm is swollen and very painful. The lymph nodes. Still swollen and sore and today is day 4.


VAERS ID: 1758880 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID- 19 2ND Dose, 49, 02 04 2021, Pfizer - Fever, Chills, Sweats, Fatigue, Headache, Body Aches and Soreness at Injection Site
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache Fatigue Soreness at Injection Site Swollen Lymph Node Chills


VAERS ID: 1758890 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-24
Onset:2021-10-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / SYR

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

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

Write-up: Hives/rash present over faces, eyes, upper and lower extremities, and back. Symptoms noticed the evening of 10/1, one week after first dose. Reaction currently remains with no change in diminishing.


VAERS ID: 1758933 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-10-01
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802065 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, COVID-19, Chest X-ray normal, Cough, Diverticulitis, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Current Home Medications 1. atorvastatin 40 mg oral tablet : 1 tab(s) orally once a day 2. bisoprolol 10 mg oral tablet : 1 tab(s) orally once a day 3. clopidogrel 75 mg oral tablet : 1 tab(s) orally once a day 4. fenofibrate 160 mg oral ta
Current Illness:
Preexisting Conditions: COPD Asthma CAD CHF HTN anemia
Allergies: Aleve
Diagnostic Lab Data:
CDC Split Type:

Write-up: fevers as high as 101 ?F as well as worsening left lower quadrant abdominal discomfort and a worsening cough and shortness of breath. Patient''s oxygen saturation was 73% on room air on presentation. 9:56 AM patient was placed on supplemental oxygen at 3 L and immediately went to 94%. Remaining vitals are stable. She will have some repeat abdominal labs as well as chest x-ray. She will also be tested for Covid. Patient will be given Decadron for her breathing. Further disposition is to follow. 11:07 AM patient''s x-ray is unremarkable however she is positive for Covid. Patient will be admitted for further care and treatment with supplemental oxygen and continued treatment of her diverticulitis.


VAERS ID: 1758940 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-10-01
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT came in with weakness, shortness of breath and cough for 4 days prior to coming in. PT is on remvesivir; cescriaxone, doxycycline PT is still in hospital


VAERS ID: 1758958 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood creatine phosphokinase MB increased, C-reactive protein increased, Chest pain, Electrocardiogram ST segment elevation, Pyrexia, Red blood cell sedimentation rate increased, Troponin increased, Ultrasound scan normal
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Lab work was repeated here and is significant for ESR 33, CRP 2.9, Troponin 16.88, CK-MB 56.4, CK 823. She had a bedside US in the ED (limited study), which did not show any effusions. EKG was significant for diffuse ST segment elevation.
CDC Split Type:

Write-up: She received the 2nd dose of the COVID vaccine (Pfizer) on 9/30. Beginning on 10/3, she started complaining of constant, sharp, left lateral chest pain. The pain does not radiate. Minimal aggravation with position. It is not worse with deep breaths or chest wall palpation. She also had a fever with TMax 102F. She was trying to manage symptoms at home with Tylenol, Gas-X and Alka Seltzer, but pain persisted so she presented to ED on 10/3.


VAERS ID: 1758971 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 302558A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: Multi vitamin
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Nkda
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Right axial lymph node swelling started one day after injection. 800mg of Advil controlled pain. On day 3, took 50mg benadryl and this lessened pain and swelling.


VAERS ID: 1758975 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Medication errors (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec, Zofran, Pepcid, Meladox, Levsin,
Current Illness: Hodgkin Lymphoma, Menorrhagia, Microcytosis, Iron Deficiency w/o Anemia, Multiple Pulmonary Nodules
Preexisting Conditions: Hodgkin Lymphoma, Menorrhagia, Microcytosis, Iron Deficiency w/o Anemia, Multiple Pulmonary Nodules
Allergies: Ciprofloxacin Hydrochloride, Compazine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient reports after receiving her 1st Covid Vaccine to her Left Arm on 01/09/21 she experienced numbness/tingling to her left hand that improved. At time of booster visit on 10/01/21 endorses residual numbness since the initial injection on 01/09/21 only to her left pinky finger. Reports after 2nd Covid Vaccine on 01/30/21 to her right arm she experienced no numbness or tingling to her right arm. After receiving her booster (3rd injection) to her right arm on 10/01/21 patient endorsed numbness to right hand pinky finger rated 9/10 and improved to 3/10 during observation period. Patient advised to report to ER for MD provider evaluation but declined. Encouraged to follow up with MD provider outpatient. Patient reports history of cancer requiring chemotherapy infusion with infiltration during infusion due to loss of peripheral IV access with subsequent numbness/tingling to Left Arm. Patient requested VAERS be completed.


VAERS ID: 1758979 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 AR / IM

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

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

Write-up: PATIENT DID NOT EXPERIENCE ADVERSE EVENTS. THE PATIENT IS 16 YEARS OLD AND WAS INADVERTENTLY GIVEN A MODERNA VACCINE, WHICH IS NOT YET APPROVED FOR ANYONE UNDER THE AGE OF 18.


VAERS ID: 1758982 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Nausea, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Methylphenidate 20mg
Current Illness: None
Preexisting Conditions: Environmental Allergies
Allergies: Oatmeal
Diagnostic Lab Data: No tests taken. Just vaccination administration at 9am before onset of symptoms.
CDC Split Type:

Write-up: Severe shivers, sweating, nausea, fatigue and headache. Lost 4 pound over night. Initial 12 hours the worst. Then 24 hours of fatigue, headache and nausea. Symptoms resolving on day 4.


VAERS ID: 1758984 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: Developed Bell''s Palsy 2 days after vaccination


VAERS ID: 1759015 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Cold sweat, Headache, Injection site pain, Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Tested positive for Covid SARS-2 on 8/23/2021. Took first vaccination as instructed by vaccine event on 9/10/2021 and the second vaccine on 10/1/2021.
Preexisting Conditions: Primary lymphedema in RLE
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received my second dose of the Pfizer vaccine at 3:00 p.m. on 10/1/21. By around 7:00 p.m. my left arm (injection site) was extremely sore and a headache. As the night went on I had fever, chills, cold sweats, headache and swollen lymph nodes in neck and under arms. 10/2/21-still all symptoms present as on 10/1/21 and add no taste and barely able to smell. These symptoms lasted until 10/3/21 afternoon around 4:00 p.m. I still cannot fully taste or smell and my lymph nodes are still somewhat swollen or sore.


VAERS ID: 1759042 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-21
Onset:2021-10-01
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide, metronidazole, linagliptin, lisinopril, diclofenac topical
Current Illness: Acute Kidney injury, Hyponatremia, Anemia, HTN, Anemia, HTN, DM 11 Hyperlipidemia, obesity
Preexisting Conditions: Acute Kidney injury, Hyponatremia, Anemia, HTN, Anemia, HTN, DM 11 Hyperlipidemia, obesity
Allergies: morphine
Diagnostic Lab Data: rapid covid
CDC Split Type:

Write-up: Covid positive


VAERS ID: 1759078 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC13184 / 6 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Impaired work ability, Injection site erythema, Injection site oedema, Injection site pain, Injection site warmth, Localised oedema, Lymphadenopathy, Neck pain, Pain in extremity
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: valsartan 100mg qd. coreg 25mg bid, Lasix 40 mg qd, spirlactone 25 mg qd. ,
Current Illness: augmentin for abscess tooth week prior to vaccine
Preexisting Conditions: hypertension, pulmonary hypertension
Allergies: ultram
Diagnostic Lab Data: none were done as yet. employee did miss a scheduled day of work do to pain and the increased edema
CDC Split Type:

Write-up: started 14 hours after injection, very hot at site and spreading outward, pink to red to color, edema with pain from injection site up to and including lateral neck surface , from injection site down arm to finger tips , swelling underneath arm , axillary area, did not note lymph node edema


VAERS ID: 1759097 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-22
Onset:2021-10-01
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

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

Write-up: Vaccine breakthrough. Symptomatic inpatient admit


VAERS ID: 1759106 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-10-01
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Frequent bowel movements
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Got the poops


VAERS ID: 1759117 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Lymphadenopathy, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Tingly and numb fingers, swollen lymph node. Both are still ongoing


VAERS ID: 1759124 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Hyperhidrosis, Presyncope, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (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: Adderall, citalopram, flu vaccine on Sep 21, 2021 (ten days prior to booster)
Current Illness: none
Preexisting Conditions: beta thalassemia trait
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever between 100 and 101 for two days; extremely tired; threw up once; almost passed out once; no appetite; woke up in a pool of sweat on day 3 and was mostly recovered at that time.


VAERS ID: 1759130 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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: LISINOPRIL 40MG, ATORVASTATIN 40MG, CENTRUM SILVER, MAGNESIUM 500MG, BAYER LOW DOSE ASPIRIN, LEVOTHYROXINE 75 MCG
Current Illness: NONE
Preexisting Conditions: HEART MURMER, LBBB, PACEMAKER (AS OF 8/12/2021)
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: CHILLS, FEVER, SWEATS, WEAKNESS , HEADACHE LASTED 24 HOURS - 10:30 PM FRI. TO 10:30 PM SAT, SOME REMAINING EFFECTS INTO MONDAY (WEAKNESS)


VAERS ID: 1759151 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-10-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Genital herpes
SMQs:, Opportunistic infections (broad)

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

Write-up: Outbreak of genital herpes 6 days after vaccination for Covid


VAERS ID: 1759155 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-07
Onset:2021-10-01
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1759163 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-15
Onset:2021-10-01
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Chest pain, Hypoxia, Troponin increased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Acute on chronic respiratory failure with hypoxia; pneumonia due to COVID-19; chest pain; elevated troponin


VAERS ID: 1759164 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Feeling abnormal, Heart rate increased, Loss of consciousness, Paraesthesia oral
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Immediately felt ?funny? but nothing of alarm. Went home and about 2 hours later still felt different. I was resting on the couch in preparation for any side effect such as flu like feelings. 2 hours after shot, I noticed my heartbeat rising. I wear an iwatch and I monitored my heart rate. I was resting, not moving and I watched the beats per min go from 80s, and rise all the way to 165. Within minutes. I passed out for a quick second before calling my husband for help. I had trouble breathing. My face and lips felt tingly. My heart was out of control beating so fast and I was scared. I am 35 and work out high intensity at least 2x a week with no prior conditions. When I work out my highest bpm is around 150/160. My resting rate is low 70s. My sleep rate is 50s. I have all this data tracked and logged bc of my watch. On the day of the second dose, it spiked to 165 while in rest and later in the 120s. My resting heart rate increased to the 80s. And my sleep rate is now in 70s. I am concerned.


VAERS ID: 1759171 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Extra dose administered, Fatigue, Injection site erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Received 3 vaccinations in one day, Fluzone HD vaccination, Pneumococcal vaccination 23 25 MCG 4/0. FML INJ, and PFIZER vaccination. For 2 days had fatigue, no apetite, itching and redness at injection site.


VAERS ID: 1759182 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy
SMQs:, 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: Famotidine 10 mg for GERD, 1 tab qd
Current Illness: GERD
Preexisting Conditions: Exercise-induced asthma Anxiety Insomnia GERD
Allergies: None
Diagnostic Lab Data: Appointment with NP scheduled for Fri 10/8/21
CDC Split Type:

Write-up: Left axillary lymphadenopathy and pain, large palpable axillary lymph nodes (at least 2). Onset slightly greater than 24 hrs following 3rd dose of Pfizer COVID-19 vaccine. Problem ongoing still 4 days following.


VAERS ID: 1759202 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Grip strength decreased, Hypoaesthesia, Pain, Peripheral swelling, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Sexual dysfunction (broad)

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

Write-up: my left arm swelled up from my neck and left breast plate area to fingers to the first knuckle/ pain/ numbness/unable to hold objects/this was a booster shot


VAERS ID: 1759229 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Erythema, Extra dose administered, Fatigue, Headache, Impaired work ability, Induration, Migraine, Neck pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, vitamin b6, emgality, asa, tizanidine, vitamin d, pristiq, aldactone, fish oil, slow release iron, propranolol magnesium glycinate, Tylenol prn - Valium prn - tramadol prn
Current Illness: One month prior: pink eye - cleared by the time I had my injection.
Preexisting Conditions: PCOS, factor 5 liden, endometriosis, Meineres Disease, migraines, depression,
Allergies: Morphine, sulfa, trazadone, ibuprofen, compazine, Walnuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I felt fine the day I got my vaccine - the next day my arm was sore - to be expected- & a little pink I had a dull headache & low neck ache - tired - but still able to work 4 shift On 10/2 - still fatigued with the headache- clammy - now I see that the redness I had the day before is more of a formed raised oval - kinda wondered if this was normal- but no one mentioned it I wanted to go to the urgent care by my house - but did not go til Sunday the 3rd Arm does not hurt as much & the pink redness is more spread out but you can feel the induration I was give a script for keflex that I can use if I need to my discretion since I Work in a ER I have never reacted like this - no site inflammation or whatever with the first 2 Pfizer shots Cold, heat, Tylenol treatment modalities Today Monday I am the most exhausted I have been & my headache was pretty intense this am so much so I Am missing work - feels different than the migraines I suffer from


VAERS ID: 1759265 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-10-01
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

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

Write-up: Blood pressure 2014/97 within 10 min. Still is high


VAERS ID: 1759270 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products
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: n/a
Preexisting Conditions: n/a
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: No symptoms, Was given 2nd dose Pfizer instead of Moderna vaccine.


VAERS ID: 1759288 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: no symptoms, 2nd dose covid was given Pfizer instead of Moderna.


VAERS ID: 1759311 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3D145BB / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dexilant 30mg Famotidine (Pepcid) 40mg Simvastatin 10mg Biotin 10,000mcg Culturelle probiotic 1 pill/day Contrave 8mg/90mg Lexapro 20mg Vesicare 5mg Synthroid 0.125mcg Vitamin D3 2000 IU Raw B Complex 1 pill/day Mometasone furoate Sumatri
Current Illness: None
Preexisting Conditions: Hashimoto''s hypothyroiditis Slightly elevated cholesterol Acid refluc
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarrhea and nausea


VAERS ID: 1759312 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Lymphoedema
SMQs:, Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mega Men Multivitamin and Mega Men Prostate & Virility
Current Illness: none
Preexisting Conditions: none
Allergies: grass pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: My lymph nodes under my right arm (arm pit) were swollen with fluid. I am being observed and told to returned in a week unless pain or the side effect worsens.


VAERS ID: 1759313 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bilirubin conjugated, Blood magnesium, Electrocardiogram, Full blood count, Hypoaesthesia, Pain, Paraesthesia, SARS-CoV-2 test negative, Throat tightness, Thyroid function test, Troponin I
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), COVID-19 (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Womens daily vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 10/2/21 EKG bilirubin direct, HCG qualitative, CBC with Differential, Magnesium Level, Thyroid Profile, Troponin 1 High Sensitivity, Covid test Rapid
CDC Split Type:

Write-up: I went in to get my 1st pfizer shot, and my right hand started tingling within five minutes of receiving the vaccination in my right arm. I sat in the waiting room for fifteen minutes and friends told me they had slight tingling that didn''t last very long so I left. I took a nap the tingling got worse throughout the day, I ended up in the ER that night of 10/2/21 when the pain started to set in I had numbness in my shins and feet and tingling in my hands and numbness in my hands. They treated me with an IV drip, did tests drew blood, gave me a potassium pill and a rapid covid test which came back negative. They acknowledged this was from the Pfizer shot. I was released then I came back in to the ER that next morning of 10/3/21 as the pain got worse and they told me to come back in if it indeed got worse. They treated me with steroids as my throat was starting to close up, and the tingling and numbness got worse. It felt like someone was grabbinig me hard around my wrists and knees as well. They released me and diagnosed me with Parasthesia.


VAERS ID: 1759314 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CVS 1819 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site haemorrhage, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: valcyclovir, Lipitor, Osteo Biflex, multi vitamin, fish oil, B complex, Chromium
Current Illness: n/a
Preexisting Conditions: obesity, high cholesterol
Allergies: Penicillin, Sulfa, Keflex, Levoquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: The vaccinator must''ve hit the blood stream because I had a stream of blood go down my arm after the shot (I''m not a bleeder). I''ve had a low grade fever, nausea, and exhaustion ever since.


VAERS ID: 1759321 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Extra dose administered, Fatigue, Feeling abnormal, Headache, Myalgia, Polyuria, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: On day 2 (1/16/2021) at 6 AM after my 2nd dose of Pfizer / BioNtech, I had the same side effect profile - myalgias, arthralgias,
Other Medications: metoprolol; amlodipine; apixaban; losartan; atorvastatin; finasteride; gabapentin; duloxetine
Current Illness: A-flutter (treated)
Preexisting Conditions: osteoarthritis ill-defined skin condition (slow healing lesions - non infectious) L sided sciatica LE and UE peripheral neuropathy (unknown etiology) Glaucoma suspect Obesity
Allergies: Terbinafine (distant history - whole body rash)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dose received at 1:15 PM on October 1, 2021. Began to experience myalgias and arthralgias at 10:00 PM, along with HA, "brain fog" and fatigue. I took my evening meds and went to bed. At 11, I began to rigor and continued to rigor with fever for the next 7 hours. The fever broke at 5 AM on 10/2/21. I was completely incapacitated the entirety day of 10/2 , only getting up (as a falls risk) to toilet. Interestingly, I had nothing to drink that entire time, but then had polyuria during the morning / afternoon of 10/3 (getting rid of toxins?). Felt moderately better on 10/3. Ate a small bite and drank some water. I would have stayed home from work today, 10/4, but due to project work and meetings, I felt well enough to come to work.


VAERS ID: 1759341 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Drooling, Dysarthria, Headache
SMQs:, Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

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

Write-up: Employee received Pfizer Covid vaccine booster on 10/1/2021 @ 1510 @ Hospitals. After booster was administered, employee was monitored for 15 minutes at the vaccination clinic for any adverse/side effects and no adverse/side effects were noted or reported. Then, employee walked back to her department. Shortly after, she began having headache, drooling and slurred speech. At approximately 1600, employee was transported from hospital location to another location. Health and Safety Officer contacted Emergency Department @ 1710 and was informed that the employee was still there receiving treatment and being monitored. As of 10/4/2021, per Health and Safety Officer employee is still in medical facility.


VAERS ID: 1759366 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO198 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product 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 events or outcome, just that the vaccine was administered after the 30 days of received by our clinic.


VAERS ID: 1759372 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

Write-up: patient was 16 and received the moderna vaccine. Patient had no adverse effects reported as of 10/4/2021


VAERS ID: 1759377 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO198 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product 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 events or outcome, just that the vaccine was administered after the 30 days of received by our clinic.


VAERS ID: 1759392 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO198 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product 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 events or outcome, just that the vaccine was administered after the 30 days of received by our clinic.


VAERS ID: 1759395 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Appendicitis, Ultrasound abdomen abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ultrasound showed acute appendicitis
CDC Split Type:

Write-up: Patient presented with abdominal pain that started after receiving his COVID vaccine and was found to have acute appendicitis


VAERS ID: 1759406 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO198 / 2 LA / IM

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

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

Write-up: No adverse events or outcome, just that the vaccine was administered after the 30 days of received by our clinic.


VAERS ID: 1759419 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-26
Onset:2021-10-01
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Polymerase chain reaction positive
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High Blood Pressure
Allergies:
Diagnostic Lab Data: PCR test collected on 10-1-2021, resulted positive
CDC Split Type:

Write-up: asymptomatic


VAERS ID: 1759434 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Incorrect dose administered, Injection site cellulitis, Injection site erythema, Injection site oedema, Product preparation issue
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? 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: 0.3ml vaccine was administered without the diluent. Saturday 2/10/2021 presented with edema and erythema in the punctured area. Evaluated by the Emergency doctor and was diagnosed with cellulitis of the area. Patient is on antibiotics at home.


VAERS ID: 1759442 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-10-01
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19
SMQs:, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID-19 virus infection; general weakness


VAERS ID: 1759455 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / SYR

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

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

Write-up: approximately 2 hours after the shot, I had a large rash that covered my entire right thigh. It did not itch, burn or swell, but the thigh was almost completely covered


VAERS ID: 1759456 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Decreased appetite, Fatigue, Hyperhidrosis, Injection site pain, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (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? No
Hospitalized? No
Previous Vaccinations: Covid-19 booster #2 given 1/8/2021, mild-moderate of same symptoms
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Ampiciliin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Approximately 6-7 hours after receiving my 3rd Pfizer Covid-19 booster vaccine, I experienced EXTREME chills, sweating, shivering, body aches, muscle and joint soreness and debilitating fatigue. The extreme symptoms last about 24 hours, but I had moderate full body soreness, weakness and fatigue for an additional 24 hours. I did not experience any GI symptoms except a decreased appetite during this time. I also experienced very bad soreness at the injection site, which I did not with the first 2 in the series.


VAERS ID: 1759462 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Incorrect route of product administration, Injection site discomfort, Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

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

Write-up: Facility clinic thru Specialty Rx pharmacy provider gave the HCW a booster Pfizer vaccine in the right arm 5.5 inches below the acromion process, which is below the deltoid muscle. The injection went into the tissue below the deltoid resulting in pain, discomfort, itchiness, redness, and warmth to area from site of injection. The area of redness measures 4.5 inches X 2.5 inches.


VAERS ID: 1759466 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature fluctuation, Dizziness, Fatigue, Headache, Heavy menstrual bleeding, Pain in jaw, Vertigo
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Vestibular disorders (narrow), Osteonecrosis (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: Birth control, Daily vitamin, B12 and Iron
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Period still going on from last injection. it stopped for 4 days and started again. Jaw pain is less but still painful. Headaches, and dizziness/ vertigo body is off when it come to temperature easy to overheat or chill last for a short while but often comes and goes. very tired


VAERS ID: 1759467 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051EZ1A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Ear swelling, Erythema, Fatigue, Headache, Heart rate increased, Immediate post-injection reaction, Injection site erythema, Injection site mass, Injection site pain, Injection site pruritus, Injection site swelling, Nausea, Pain, Pain of skin, Paraesthesia, Skin warm, Swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Yellow Fever Vaccine, 16 years old, felt like I had yellow fever and spiked a dangerously high fever.
Other Medications: Metformin 1000 mg twice a day, Lisinopril 5 mg once a day, Januvia 100 mg once a day, Farxiga 5 mg once a day, Gemfibrozil 600 mg twice a day, Meloxicam 15 mg once a day
Current Illness: None
Preexisting Conditions: Type 2 Diabetes, high cholesterol
Allergies: Amoxicillin, Cipro, Welchol, Zocor, Crestor, Glipizide
Diagnostic Lab Data: None to date. I am monitoring how I feel and watching for signs of myocarditis and/or pericarditis that may develop.
CDC Split Type:

Write-up: I developed a headache almost immediately. Thirty minutes after receiving dose 1 of the Moderna Covid 19 vaccine my face, ears, neck, and chest turned bright red. My neck, face and ears swelled up. The skin was hot to touch and painful; it felt like pins and needles. I took one 200 mg Ibuprofen and held cool compresses to my skin. The swelling and redness subsided within 20-30 minutes. Four hours later, I was fatigued. The next day (Saturday, October 2, 2021), I was dizzy, had full body aches, joint pain, a headache, nausea, a fast heart beat (higher than normal for my resting heart rate; it was in the 120s). My arm hurt terribly at the site of injection it swelled up with a big lump, its very tender, and the skin turned red around the injection and itches. After 48 hours, the general side effects subsided. The injection site reactions have shown little to no improvement.


VAERS ID: 1759472 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Vitreous detachment
SMQs:, Accidents and injuries (broad), Retinal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroid 200 MCG QD
Current Illness: None
Preexisting Conditions: hashimotos thyroiditis
Allergies: levaquin ; penicillin
Diagnostic Lab Data: FULL EYE EXAM WITH OCULAR SCAN AND FOLLOW UP WITH A RETINA SPECIALIST 10/2/2021
CDC Split Type:

Write-up: WENT TO OPTHALMOLOGIST I WAS DIAGNOSED WITH A POSTERIOR VITREAL DETACHMENT


VAERS ID: 1759491 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Chills, Headache, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin 40 mg 2x per week ezetimibe 10 mg 1x per day losartan potassium 1x per day 81 mg aspirin 1x per day multivitamin 1x per day calcium 1x per date vitamin c 1x per day fish oil 1x per day vitamin E 1x per day vitamin D 3x per wee
Current Illness: none
Preexisting Conditions: none
Allergies: linsopril sulfa shrimp
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: fever, chills, body aches and headache for 24 hours. Sore arm and underarm


VAERS ID: 1759498 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, Aspirin 81 mg, metamucil
Current Illness:
Preexisting Conditions: atherosclerosis of coronary artery without angina pectoris, chronic hypoxemic respiratory failure, chronic obstructive lung disease, chronic pain syndrome, hypertension, GERD, Hyperlipidemia, hypothyroidism, iron deficiency anemia, secondary peripheral neuropathy, transient cerebral ischemia
Allergies: Amoxicillin
Diagnostic Lab Data: Seen doctor on 10-4-21
CDC Split Type:

Write-up: Hives


VAERS ID: 1759516 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Public       Purchased by: ?
Symptoms: Rash, Rash papular, Treponema test negative
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DESCOVY
Current Illness:
Preexisting Conditions: Previous history of syphilis - tested no evidence of new infection
Allergies: NKDA
Diagnostic Lab Data: Test to rule out syphilis Spoke with provider from primary care provider office and they will order CVC and Blood Cultures.
CDC Split Type:

Write-up: patient had pinpoint palpable rash on hands and feet - intially painful.


VAERS ID: 1759521 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Bone pain, Chills, Fatigue, Headache, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chills, myalgia, arthralgia, "bone pain," fatigue, nausea, vomiting, headache


VAERS ID: 1759535 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-27
Onset:2021-10-01
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

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

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

Write-up: None stated.


VAERS ID: 1759557 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Discoloured vomit, Illness, Pain, Restlessness
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: Diabetes, high BP, IBS, liver disease
Preexisting Conditions: Diabetes, aneurysm, liver disease
Allergies: Lisinopril, codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cold chills. Pain in body sick, vomited neon green fatigue, restless felt like had vovid


VAERS ID: 1759564 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Unknown  
Location: Missouri  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril 40mg , pravastatin 40 mg thyroxine , calcitriol 25mg, prednisone 10 mg, abiraterone acetate 250mg/4/dat, calcium with vitamin D3 40 mg
Current Illness: I felt great the day of flu shot. I currently have Prostate cancer.
Preexisting Conditions:
Allergies: I have never had any allergies to any other flu shot
Diagnostic Lab Data: called my doctor, gave me pills to help hold stomach from vomiting
CDC Split Type:

Write-up: upset stomach, vomiting 7 or 8 times, diarrhea fever 101.6


VAERS ID: 1759570 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-11
Onset:2021-10-01
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / 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: Tested NAAT positive for COVID 10/1/21 after being fully vaccinated.


VAERS ID: 1759607 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dizziness, Monoplegia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: No
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: On getting a response (from the numerous messages left for the patient ) on 10/4/21 11.45am - she said in ER her BP and O2 levels were deemed normal. No residual paralysis. She was feeling a bit feverish (no thermometer to measure body temperature) and has a slight cough. Reassured her on the feeling of fever and cough, advised her to seek further medical attention if ihese symptoms do not resolve.
CDC Split Type:

Write-up: Patient started complaining of dizziness around 10 minutes after vaccine administration. BP was measured - 102/53. Provided with apple juice. Second BP reading 123/57. Another apple juice provided. Around 10 minutes after second BP reading, patient complained of ''paralysis'' in lower left arm (used a translation app on her phone). This did not resolve and 911 was called. EMTs evaluated patient, advised observation in ER. She did not have the funds to pay for the ambulance - EMTs agreed she was stable enough to get in a car - they would follow her.


VAERS ID: 1759610 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Injection site pain, Injection site reaction, Injection site swelling, Injection site urticaria, Injection site warmth, Loss of personal independence in daily activities, Pruritus
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Potassium supplement Klor-Con M20 Meq 2x/day Vitamin D 5000 IU daily Vitamin C 1000mg daily Zinc 20mg 2x/day Quercitin 500mg daily Re-Mag (Ionic Magnesium 450mg) 3x/day Re-Myte (Ionic Minerals including Sodium, Calcium, Iodine, Magnesium, Z
Current Illness: None, other than the diarrhea.
Preexisting Conditions: Asthma well controlled and improving Weight loss over last 14 months, now at ideal body weight.
Allergies: High histamine causing diarrhea for 3 years. Started low histamine diet 10/1/2021 under dietician advice. Penicillin - hives Sulfa Antibiotics - hives Aspirin - hives Motrin/Ibuprofen - causes ankle swelling
Diagnostic Lab Data:
CDC Split Type:

Write-up: In spite of ice application, lt arm shoulder at and below injection site is painful and single large raised red welt the size of the upper muscle, hot to the touch. Fatigue starting that evening and severe the next day, causing cancellation of plans for eldest granddaughter''s birthday. Still fatigued on 10/3 but less so, and by evening, the arm was a little less red and hot, and started itching. on 10/4 barely tolerated my usual morning walk (managed 50 minutes of my usual 60), quite fatigued after but recovered quicker, still not being very active. Itching in shoulder worse today, but less pain. and noticed some red pinpoints at the lower edges.


VAERS ID: 1759641 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-24
Onset:2021-10-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 developed a red, hot, and hard lump on her arm a week after her vaccine.


VAERS ID: 1759648 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac flutter, Cardiac monitoring, Chest X-ray, Chest pain, Electrocardiogram, Laboratory test
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 75mcg OD, Multi vitamin Hypotensy minerals and dietary supplements, Flu vaccine received the morning of my booster shot as well
Current Illness: None
Preexisting Conditions: In June 2021, had rotator cuff surgery still getting treatment, 2019 neck surgery
Allergies: NKDA
Diagnostic Lab Data: EKG lab work x-ray of the chest heart monitor
CDC Split Type: vsafe

Write-up: I experienced really hard chest flutters and chest pain on 09-30-2021. On 10-01-2021 I went to the ER, they performed lab work, EKG and x-ray of the chest. On 10-01-2021 I was driving and my heart fluttered so hard to the point that my chest raised up involuntarily and so I gripped the steering wheel and parked, lasted about 5 seconds and literally took my breath away. The ER doctor recommended I be placed on a heart monitor to see if this happened again. I will see my PCP next week on 10/12/2021 for follow up and placement of heart monitor. This was unusual for me, took my breath away, never experienced this before. I thought I was having a heart attack.


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