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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 533 out of 10,317

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VAERS ID: 1916415 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916437 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916439 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916443 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916446 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916456 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916462 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916468 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916472 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916486 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916494 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916507 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916512 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916514 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5168 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Emotional disorder, Fatigue, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (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? No
Previous Vaccinations: Arm soreness and slight fevers with childhood vaccines
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: Sore arm at injection site following injecting. Developed fever (school nurse stated 102.3) with nausea within a few hrs of 24 hrs. Very tired and emotional. Checked heart rate and was 178 resting. Call to pediatrician sent us to urgent care. They treated with additional fluids and Motrin while observing. Returned home same evening, continued to treat with alternating Tylenol & Motrin. No additional nausea, fever and heart rate came down to normal within the next 24 hrs.


VAERS ID: 1916529 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-24
Onset:2021-11-19
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Dyspnoea, Lung infiltration, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, Hypothyroid, Mantle cell Lymphoma, stage 4 CKD, obesity
Allergies: none
Diagnostic Lab Data: SARS-COV-2 by NAA detected SARS on 11/19/21.
CDC Split Type:

Write-up: Pt received Pfizer vaccines on 02/24/21, 03/17/21 and 10/02/21. Pt presented to the ED on 11/19 with complaints of SOB. Pt was found to have oxygen saturation of 83%, so she was placed on supplemental oxygen. Pt was tested for COVID, which was positive. CXR showed COVID pneumonia with bilateral infiltrates. Pt was discharged home on 11/25/21 with home care.


VAERS ID: 1916548 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Decreased appetite, Fatigue, Feeling hot, Heart rate increased, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Arthritis (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot from about 8 years ago, haven''t had a flu shot since.
Other Medications: 2 types of blood pressure medication (1 morning/1 night); Eliquis; Famotidine 40 mg 2x; Supplements such as BioFlex, etc.
Current Illness: Just allergies.
Preexisting Conditions: A-fib; Hiatal hernia; Diverticulosis; Osteo-arthritis.
Allergies: Epinephrine and Anti-inflamatories.
Diagnostic Lab Data: Waiting to see the cardiologist - choosing "yes" for question 20, but I am slowly recovering from some but not all reactions.
CDC Split Type:

Write-up: This was my first shot and I am a little concerned with getting the next one. Long family history of hear disease. My symptoms started that night after the shot: Rapid heart beat - lasted over an hour - continued having daily episodes (this is my biggest concern, seeing a cardiologist next Friday.) Face felt very hot and head was sweaty multiple times each day (starting to subside, I think.) Joint pain was very severe - pain was twice the normal amount of daily pain, again, having daily episodes but seems to be lessening. Exhaustion - still have issues with this Loss of appetite.


VAERS ID: 1916597 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-11-16
Onset:2021-11-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase normal, Blood folate normal, Blood homocysteine normal, Blood test normal, Blood thyroid stimulating hormone normal, C-reactive protein normal, Computerised tomogram head, Computerised tomogram normal, Fatigue, Feeling abnormal, Full blood count normal, Insomnia, Laboratory test, Metabolic function test, Muscle spasms, Neck pain, Pain, Pain in extremity, Red blood cell sedimentation rate normal, Tremor, Vitamin B12 normal
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: Rx Protonix Pepcid and Carafate as well as OTC Vitamin D and Fish Oil daily Rx Sumatriptan and Fioricet PRN (not recent)
Current Illness: none
Preexisting Conditions: GERD, HAs, Vit D def, allergies
Allergies: Doxycycline
Diagnostic Lab Data: NL labs 11/19/21: cbc cmp tsh b12 folate mma homocystein cpk esr crp CT head from ER essentially normal as well
CDC Split Type:

Write-up: General tremors and left arm pain began the evening that pt received his Moderna booster vaccine. Pain described as sharp and aching and radiated up to the left side of his neck and down to his fingers. Pain was relieved with Tylenol and has improved from a 7/10 at its worst to a 3/10 at its worst over the last day. No associated weakness/numbness or tingling. No fever/chills rash or HA and slight blurry vision with seeing distant objects. Tremors along with muscle spasms began that evening with migration of spasms to different muscle groups. Spasms lasted about 24 hours and he was unable to sleep from this as well as stating he felt "wired, like on adrenaline". Symptoms improved except for tremors, which were present at rest and improved with holding on to his thighs or if laying under a weighted blanket; but they are much worse with reaching/grasping. He went to ER on 11/22/21 for worsening tremors and fatigue Tremors mostly resolved by 11/29/21 w/ OTC Vit C D B12 zinc and NAC supplements and pt scheduled to see Neuro for evaluation Mild/slight lingering fatigue and tremors as of last visit on 11/29/21 Appt to establish with/be evaluated by Neuro 12/22/21


VAERS ID: 1916611 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-08
Onset:2021-11-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / UNK RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Some kind of undiagnosed inflammatory issue which causes sever stiffness in lower back and sciatica that I take Meloxicam for as needed. I also have costochondritis.
Allergies: I am only allergic to some cats
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had my booster on Nov 8 2021 which was my 3rd dose of Moderna. On November 19th shortly after waking up I started experiencing severe itching. My head itched like crazy as if I had lice and then the itching started moving all around my body - my palms,, my neck, armpits, elbow, legs, ears, The itching was not everywhere at once but multiple places at at time. I finally took an anti histamine that night and have had to take one every day since. I think (hope) my symptoms are finally subsiding today Dec 2 2021 because I have not had the anti histamine in over 36 hours and I am not severely itchy. The anti histamine worked perfectly and relieved all symptoms.


VAERS ID: 1916743 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

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

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

Write-up: The patient inadvertently received the pediatric dose of Pfizer vaccine instead of the adult. Patient will be given the adult dose in 21 days. Call was made to Pfizer who stated that they follow CDC guidelines. In this instance the patient will be considered fully vaccinated following his 2nd dose which will be of the adult dose.


VAERS ID: 1916779 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: History of cutaneous mastocytoma (solitary), otherwise healthy
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Within 2 hours of the vaccine being administered, patient developed swelling of right eyelid. Swelling persisted x 24 hours.


VAERS ID: 1916831 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Heart rate increased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B12; vitamin D; PROTONIX; SYNTHROID; DILANTIN; lorazepam
Current Illness: None
Preexisting Conditions: Epilepsy; Asthma; Gastroesophageal reflux problems
Allergies: Penicillin; erythromycin; LYRICA; tetracycline
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: Heart rate went up 147 heart rate and stayed high for 48hours; fatigue; chills; fever 101 lasted 24hours and came down to a 100 to a couple of days; headache; general body pains; joint pains.


VAERS ID: 1916895 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: Went to emergency room due to rapid heart rate and palpations increase. Hr in 130s


VAERS ID: 1916916 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916933 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916934 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-10
Onset:2021-11-19
   Days after vaccination:282
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Anticoagulant therapy, Cardiac arrest, Cardiac imaging procedure abnormal, Cardiomyopathy, Cardioversion, Catheterisation cardiac abnormal, Chest X-ray abnormal, Chest tube insertion, Computerised tomogram head normal, Computerised tomogram thorax abnormal, Deep vein thrombosis, Ejection fraction decreased, Endotracheal intubation, Implantable defibrillator insertion, Mechanical ventilation, Pneumonia aspiration, Pneumothorax, Pulmonary embolism, Resuscitation, Ultrasound Doppler abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Cardiomyopathy (narrow), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cardiazem 240mg QD, HCTZ 25mg QD, MVI
Current Illness: N/A
Preexisting Conditions: Hypertension, Arthritis
Allergies: Sulfa
Diagnostic Lab Data: 11/18/21 Chest XRay - Pneumothorax Head and Chest CT 11/18/2021 - Negative, Cardiac Cath - Non-Obstructive Cardiomyopathy, Echo - EF 25-30% - Repeat Chest CT = Bilateral PEs, Doppler Ultrasound - Left Popliteal DVT,
CDC Split Type:

Write-up: 11/18/2021 - Sudden Cardiac Arrest requiring CPR 45 minutes, 3 shocks, intubation, mechanical ventilation - transported to ER, Pneumothorax, chest tube placement, aspiration pneumonia - Chest/Head CT negative, Cardiac Cath showed non-ischemic cardiomyopathy with decreased EF (25-30%). Transferred to Hospital for further care. Extubated 11/21/2021. Additional CT showed bilateral PEs, and Left Popliteal DVT - anticoagulation started. Cardiac MRI completed. AICD implant 11/23/2021. DC to home11/30/2021 recovering.


VAERS ID: 1916937 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose. Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916943 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916955 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916963 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916965 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916976 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

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

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

Write-up: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916981 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1916988 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917014 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

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

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

Write-up: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917026 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917036 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect dose: Moderna booster dose administered 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917041 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917043 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917048 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

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

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

Write-up: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917057 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917068 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

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

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

Write-up: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917077 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917081 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917086 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917092 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Dose Moderna booster dose administered was 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917094 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect dose: Moderna booster dose administered 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917100 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect dose: Moderna booster dose administered 0.5 milliliters. Booster dose should have been 0.25 milliliters.


VAERS ID: 1917104 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Alopecia, Fatigue, Headache
SMQs:

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

Write-up: Patient reports experiencing headaches, fatigue, and hair loss in the last two weeks since receiving her first moderna vaccine. Hair loss on scalp measures 3.5cm by 4.5cm. Recommended that the patient be seen at urgent care for further evaluation and workup.


VAERS ID: 1917172 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 AR / 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: None Administration Error ? dose administered 13 days after the QR code expiry date


VAERS ID: 1917174 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medications: Flonase 1 spray nasally BID Cetirizine 10mg PO daily Progesterone 100mg PO Daily
Current Illness:
Preexisting Conditions: PMH: Right Tinnitus Postmenopausal (on HRT) Allergic Rhinitis
Allergies: Allergies: Sulfa (GI Symptoms)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12mins post vaccination pt states she feels dizzy and lightheaded and "spaced out". Vitals WNL. No remarkable findings on assessment. Vitals: 130/82, 80, 19, 99% Pt stable and released from the vaccination site.


VAERS ID: 1917275 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Product administration error, 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: None Administration Error ? dose administered 13 days after the code expiry date


VAERS ID: 1917330 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Extra dose administered, Fatigue, Incorrect dose administered, Myalgia, Pain, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar reaction with the second dose of Moderna vaccine given on 03/05/2021
Other Medications: Calcium with Vit D3, 1000 mg and 25 mcg Rosuvastatin, 5 mg
Current Illness: BluU photosensitivity treatment on arms three days prior to vaccine booster
Preexisting Conditions: actinic keratosis treatments
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received the full dose of vaccine, rather than the half dose. Very sore are, could not sleep on that side, chills, myalgia and fatigue for 2 to 3 days.


VAERS ID: 1917342 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 UN / 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: None. Administration Error - dose administered 13 days after the code expiry date.


VAERS ID: 1917361 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: None Administration Error ? dose administered 13 days after the QR code expiry date


VAERS ID: 1917533 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 UN / 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: None. Administration Error - dose administered 13 days after the QR code expiry date.


VAERS ID: 1917545 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 UN / IM

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

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

Write-up: None Administration Error- dose administered 13 days after QR code expiry date


VAERS ID: 1917710 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: None Administration Error ? dose administered 13 days after the QR code expiry date


VAERS ID: 1917717 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: None Administration Error ? dose administered 13 days after the QR code expiry date


VAERS ID: 1917727 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: None Administration Error- dose administered 13 days after QR code expiry date


VAERS ID: 1918898 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-22
Onset:2021-11-19
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Pain in extremity
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TERAZOSIN; METOPROLOL; HYDRALAZINE; ATORVASTATIN; ISOSORBIDE; IBUPROFEN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Open heart surgery
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: chest pains; sore arm; This spontaneous case was reported by a consumer and describes the occurrence of CHEST PAIN (chest pains) and PAIN IN EXTREMITY (sore arm) in a 64-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 003B21A, 027821A and 027H21B) for COVID-19 vaccination. The patient''s past medical history included Open heart surgery. Concomitant products included TERAZOSIN, METOPROLOL, HYDRALAZINE, ATORVASTATIN, ISOSORBIDE and IBUPROFEN for an unknown indication. On 22-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Nov-2021, the patient experienced CHEST PAIN (chest pains) and PAIN IN EXTREMITY (sore arm). The patient was treated with GLYCERYL TRINITRATE (NITROGLYCERINE) for Chest pain, at an unspecified dose and frequency. At the time of the report, CHEST PAIN (chest pains) had not resolved and PAIN IN EXTREMITY (sore arm) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient reported taking nitroglycerin after the chest pains and still experiencing the chest pains. Patient passed his stress test.


VAERS ID: 1919320 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 2 LA / OT

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

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

Write-up: Expired vaccine used; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) in a 59-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046C21A) for COVID-19 vaccination. No Medical History information was reported. On 19-Nov-2021 at 10:00 AM, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 milliliter. On 19-Nov-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine used). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product information was not provided by the reporter. No treatment information was provided. This case was linked to MOD-2021-391981 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 23-Nov-2021: The follow up version is 19-Nov-2021 but taken as 23-Nov-2021 due to limitations owing the being 23-Nov-2021 of the initial version. The patient initials, date of birth, race, reporter details and dosing information updated.


VAERS ID: 1919323 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-02
Onset:2021-11-19
   Days after vaccination:262
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA C31L2A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site swelling
SMQs:

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

Write-up: red swelling on the left arm; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE SWELLING (red swelling on the left arm) in a 51-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 067F21A, C31L2A and C31L2A) for COVID-19 vaccination. Concurrent medical conditions included Allergy and Gastro-intestinal disorder NOS. Concomitant products included LUBIPROSTONE and BUPROPION for an unknown indication. On 02-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Nov-2021, the patient experienced VACCINATION SITE SWELLING (red swelling on the left arm). At the time of the report, VACCINATION SITE SWELLING (red swelling on the left arm) had not resolved. Other concomitant medications included Allergy medication, name was not specified and patient was also taking digestive medication. For treatment Patient put ice to reduce the swelling The swelling is still ongoing. Patient had taken her booster shot around 4 PM on Fri 19th Nov. The patient stated that She had no reaction after the first and second dose.


VAERS ID: 1919339 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 RA / OT

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

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

Write-up: 9 patients received expired vaccines; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (9 patients received expired vaccines) in a 54-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 067F21A) for COVID-19 vaccination. No Medical History information was reported. On 19-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .25 milliliter. On 19-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (9 patients received expired vaccines). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (9 patients received expired vaccines) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication were reported. No treatment information was provided by the reporter. The vial was initially stored in the refrigerator on 11Nov2021 and was first punctured at10 AM on 18Nov2021. No temperature excursions occurred.


VAERS ID: 1919379 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 - / OT

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

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

Write-up: received dose from expired vial; This spontaneous case was reported by a consumer and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (received dose from expired vial) in a 45-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046C21A) for COVID-19 vaccination. No Medical History information was reported. On 19-Nov-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (received dose from expired vial). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (received dose from expired vial) had resolved. Concomitant medication information was not provided by the reporter. Treatment information was not provided by the reporter.


VAERS ID: 1919385 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-11-19
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Erythema, Eye pain, Fatigue, Headache, Pain
SMQs:, Anaphylactic reaction (broad), Glaucoma (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: VITAMIN D [VITAMIN D NOS]; MULTIVITAMIN [VITAMINS NOS]; VITAMIN B-12
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Eye pain on the right side; Soreness in the armpit; Bad headache; Tired; Achy; Whole arm turned red/spread far on my whole arm; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (Achy), EYE PAIN (Eye pain on the right side), ERYTHEMA (Whole arm turned red/spread far on my whole arm), AXILLARY PAIN (Soreness in the armpit) and HEADACHE (Bad headache) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 033F21A, 044A21A and 040B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was provided by the reporter. Concomitant products included VITAMIN D [VITAMIN D NOS], MULTIVITAMIN [VITAMINS NOS] and CYANOCOBALAMIN (VITAMIN B-12) for an unknown indication. On 13-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 10-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Nov-2021, the patient experienced ERYTHEMA (Whole arm turned red/spread far on my whole arm). On 20-Nov-2021, the patient experienced PAIN (Achy) and FATIGUE (Tired). On 23-Nov-2021, the patient experienced HEADACHE (Bad headache). On 24-Nov-2021, the patient experienced EYE PAIN (Eye pain on the right side) and AXILLARY PAIN (Soreness in the armpit). The patient was treated with NAPROXEN (MOTRIN [NAPROXEN]) for Headache, at a dose of 1 dosage form. At the time of the report, PAIN (Achy) and FATIGUE (Tired) had resolved, EYE PAIN (Eye pain on the right side) and AXILLARY PAIN (Soreness in the armpit) outcome was unknown, ERYTHEMA (Whole arm turned red/spread far on my whole arm) was resolving and HEADACHE (Bad headache) had not resolved. The patient said they had a severe reaction. The patient received the Moderna COVID-19 booster vaccine on 19-Nov-2021. After receiving the vaccine, their whole arm turned red where they got the shot. The patient said it spread far on their whole arm and by 20-Nov-2021, Saturday they felt achy and tired. On 21-Nov/22-Nov-2021, it went back to normal. On 23-Nov-2021, the patient got a bad headache and took Motrin. On 24-Nov-2021, the patient woke up with a headache and characterized it as a headache with eye pain on the right side. The patient does have soreness in the armpit where they got the shot as well. Reportedly, the redness was going away and the was their main concern. This case was linked to MOD-2021-396560, MOD-2021-395909 (Patient Link).


VAERS ID: 1919535 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 2 LA / OT

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

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

Write-up: Expired vaccine used; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) in a 62-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046C21A) for an unknown indication. No Medical History information was reported. On 19-Nov-2021 at 10:00 AM, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine used). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication information was provided. No treatment medication were provided. It was reported that offender were called back to the clinic and vital signs were taken and were normal. No signs of any distress was present and when offender was asked if he had sign he denied any at that time. This case was linked to MOD-2021-391981 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 23-Nov-2021: Follow up received on 23-Nov-2021: Patient''s date of birth and race were updated.


VAERS ID: 1919590 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-09
Onset:2021-11-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, PO2
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, aspirin, Plavix, tricor, hydrochlorothiazide, losartan, melatonin, metoprolol, nifedipine, prazosin, sertraline, simvastatin, tramadol, trazodone, vitamin D 3, Claritin, albuterol
Current Illness: unsure
Preexisting Conditions: AFIB, chronic kidney disease, diabetes type 2, heart failure, hypertension, renal artery stenosis, neuropathy
Allergies: penicillin
Diagnostic Lab Data: pO2 arterial (blood gas) on 12.3.2021: 57 pulse ox 12.3.2021 on arrival: 88% room air
CDC Split Type:

Write-up: Shortness of breath. Originally admitted November 19, 2021 and discharged November 23, 2021. Now being readmitted December 3, 2021.


VAERS ID: 1919674 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature, Body temperature decreased, Confusional state, Dizziness, Lip swelling, Mental impairment, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211119; Test Name: Body temperature; Result Unstructured Data: Test Result:lower
CDC Split Type: USPFIZER INC202101630774

Write-up: This is a spontaneous report received from a non-contactable reporter (consumer) via COVID-19 Vaccine Adverse Event Self-Reporting Solution (COVAES) portal. The reporter is the patient. A 32 year-old female patient (not pregnant) received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection), administered in arm left, administration date 18Nov2021 at 15:00 (Lot number: FH8028) at the age of 32 years as dose 1, single for COVID-19 immunization. The vaccination facility type was a pharmacy or drug store. The patient''s relevant medical history and concomitant medications were not reported. The patient had no known allergies (NKA). The patient had no other vaccine in four weeks. It was unknown if the patient had COVID-19 prior vaccination. The patient was not tested for COVID-19 post vaccination. The following information was reported: MENTAL IMPAIRMENT (medically significant) with onset 19Nov2021 17:00, outcome "not recovered", described as "mental brain fog"; LIP SWELLING (non-serious) with onset 19Nov2021 17:00, outcome "not recovered", described as "Lip swelling"; SWOLLEN TONGUE (non-serious) with onset 19Nov2021 17:00, outcome "not recovered", described as "tongue swelling"; DIZZINESS (non-serious) with onset 19Nov2021 17:00, outcome "not recovered", described as "lightheadedness"; CONFUSIONAL STATE (non-serious) with onset 19Nov2021 17:00, outcome "not recovered", described as "some confusion"; BODY TEMPERATURE DECREASED (non-serious) with onset 19Nov2021 17:00, outcome "not recovered", described as "lower body temperature". Therapeutic measures were not taken as a result of mental impairment, lip swelling, swollen tongue, dizziness, confusional state, and body temperature decreased. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1919698 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH5020 / 3 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Bedridden, Dysmenorrhoea, Heavy menstrual bleeding, Immunisation, Polymenorrhoea
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: TRAZODONE; PROGESTERONE; IBUPROFEN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; Endometriosis; Infertility
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101653705

Write-up: I got my period 2 weeks early - on November 21st, only 11 days after the start of my last period.; My bleeding was much heavier than usual; the cramping was severe.; I was bedridden; Dose received: 3; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 42 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 19Nov2021 (Lot number: FH5020) at the age of 42 years as dose 3 (booster), single for covid-19 immunisation. Relevant medical history included: "Asthma" (unspecified if ongoing); "endometriosis" (unspecified if ongoing); "infertility" (unspecified if ongoing). Concomitant medication(s) included: TRAZODONE; PROGESTERONE; IBUPROFEN. Vaccination history included: Bnt162b2 (Dose Number: 2, Batch/Lot No: EW0153, Location of injection: Arm Right), administration date: 08Apr2021, when the patient was 41 years old, for Covid-19 immunization; Bnt162b2 (Dose Number: 1, Batch/Lot No: EP7534, Location of injection: Arm Right), administration date: 18Mar2021, when the patient was 41 years old, for Covid-19 immunization. The following information was reported: IMMUNISATION (non-serious) with onset 19Nov2021, outcome "unknown", described as "Dose received: 3"; POLYMENORRHOEA (non-serious) with onset 21Nov2021, outcome "recovering", described as "I got my period 2 weeks early - on November 21st, only 11 days after the start of my last period."; HEAVY MENSTRUAL BLEEDING (non-serious) with onset 21Nov2021, outcome "recovering", described as "My bleeding was much heavier than usual"; DYSMENORRHOEA (non-serious) with onset 21Nov2021, outcome "recovering", described as "the cramping was severe."; BEDRIDDEN (non-serious) with onset 21Nov2021, outcome "recovered" (23Nov2021), described as "I was bedridden". Therapeutic measures were not taken as a result of polymenorrhoea, heavy menstrual bleeding, dysmenorrhoea, bedridden. Additional information: The patient did not receive any other vaccines within four weeks prior to the vaccination. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient did not have any known allergies. The patient did not received treatment for the events. Facility where the most recent COVID-19 vaccine was administered was Doctor''s office/urgent care Follow-up attempts are completed. No further information is expected.


VAERS ID: 1920216 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac dysfunction, Cardiac monitoring, Chest X-ray normal, Chest pain, Echocardiogram abnormal, Electrocardiogram normal, Myocarditis, Pain, Pericardial effusion, Troponin increased
SMQs:, Cardiac failure (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyrtec, omeprazole, Prozac
Current Illness:
Preexisting Conditions: Anxiety, allergies, acid reflux, asthma
Allergies:
Diagnostic Lab Data: Per medical records, 11/20 EKG and chest X-ray were normal, troponin was elevated and trending up, admitted to hospital for cardiac monitoring and to complete echocardiogram. Echo showed minimal pericardial effusion and decreased function of heart anterior wall. In addition, diagnosed with myopericarditis.
CDC Split Type:

Write-up: Developed left-sided chest pain around 8pm on 11/19, pain worsened when laying down. Presented to emergency department on 11/20 after 16 hours of intermittent chest pain that did not resolve after taking ibuprofen. Diagnosed with myopericarditis and pericardial effusion. Was able to be discharged after 3 nights in hospital. Prescribed medications for treatment and lifestyle modifications for 3-6 months. Follow up appointments and tests with cardiologists to monitor heart function over time.


VAERS ID: 1920219 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-23
Onset:2021-11-19
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Decreased appetite, Dyspnoea, Fatigue, Hypoxia, Nausea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (PROAIR HFA) 108 (90 BASE) MCG/ACT HFA inhaler albuterol (VENTOLIN) (2.5 mg/3 mL) 0.083% nebulizer solution atenolol (TENORMIN) 25 MG tablet buprenorphine-naloxone (SUBOXONE) 8-2 MG SL tablet dexamethasone 6 MG tablet fluticasone
Current Illness: None known
Preexisting Conditions:
Allergies: None known
Diagnostic Lab Data: COVID-19 test positive on 11/19/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 11/23/2021 for generalized fatigue, shortness of breath, loss of appetite, fever, chills, and nausea. She tested positive for COVID-19 infection at a previous emergency room visit on 11/19/2021 and was given ivermectin. She was given monoclonal antibodies on 11/23/2021. She later became hypoxic and was started on supplemental oxygen. She was admitted for further management and was treated is dexamethasone and remdesivir. Her symptoms improved and was weaned off oxygen. She was discharged home on 11/26/2021.


VAERS ID: 1920235 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, Cerebrovascular accident, Computerised tomogram, Fall, Head injury, Magnetic resonance imaging
SMQs:, Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Accidents and injuries (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: Metformin Hydrochloride, Atorvastatin Calcium Tablets, Finasteride, Olmesartan/HTCZ, Omeprazole, Triamcinolone Acetonide Ointment, Warfarin Sodium, Aspirin (Adult low dose), Bio X4, Athlete''s Foot, Gold Bond Medicated Body Powder, Terbinaf
Current Illness: none
Preexisting Conditions: Chronic or long standing health complications relating to these medications listed below: Metformin Hydrochloride, Atorvastatin Calcium Tablets, Finasteride, Olmesartan/HTCZ, Omeprazole, Triamcinolone Acetonide Ointment, Warfarin Sodium, Aspirin (Adult low dose), Bio X4, Athlete''s Foot, Gold Bond Medicated Body Powder, Terbinafine Hydrochloride 1% Antifungal Cream, Fexofenadine Hydrochloride tablets, Glucosamine/Chondroitin, CeraVe Moisturizing Cream, Psyllium , Lubricant Eye Drops, Daily Multi Vitamins & Minerals, Vitamin C, Glucosamine Hydrochloride, Vitamin B-12, Vitamin D3
Allergies: none
Diagnostic Lab Data: Pt states that they did a CT scan and MRI and found evidence of previous small strokes as well.
CDC Split Type:

Write-up: Received booster shot on 11/15/2021. Four days after receiving the booster patient fell and hit his head on something. He was transported by ambulance to the hospital where he went into atrial fibrillation, which he was able to come out of on his own.


VAERS ID: 1920300 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-14
Onset:2021-11-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Haemorrhage, Lymphadenopathy, Pyrexia, Stomatitis, Vaginal discharge
SMQs:, Severe cutaneous adverse reactions (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Vitamin C (Emergen C)
Current Illness: None
Preexisting Conditions: None
Allergies: Shellfish, Aspirin
Diagnostic Lab Data: Contacted my PCP and she ordered a transvaginal ultrasound to be performed on Dec 7th 2021
CDC Split Type:

Write-up: Vaginal discharge about 4 days post booster lasting about a week. On Dec 1st 2021 I started to bleed. I am in menopause and have not had a period for about 24 months. In addition to this I initially had reported high fever post the booster as well as fuzzy mouth and swollen lymph nodes under my right arm (vaccine arm). ** I had no side effects from the first two doses other than a metallic taste in my mouth and sleepiness.


VAERS ID: 1920319 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-12
Onset:2021-11-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (broad)

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

Write-up: discoloration of 3 toes (2 on one foot, one on the other). Occured 7 days after vaccination. non-painful. non-swollen. dusky red color. Gradually improving.


VAERS ID: 1920359 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-13
Onset:2021-11-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Pericarditis, Seizure, Troponin normal
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponin: negative twice Electrolytes: within normal limits ECG: sinus or ectopic atrial rhythm, ST elevation suggests acute pericarditis
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: patient reports chest pain for a few days and a seizure just prior to arrival in the emergency department. Observed, NSAIDs provided, and will be managed as an outpatient.


VAERS ID: 1920395 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-11-09
Onset:2021-11-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mechanical urticaria
SMQs:, Hypersensitivity (broad)

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

Write-up: Dermatographia starting 10 days after booster. Has been persistent since that time. No prior similar issues.


VAERS ID: 1920422 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-03
Onset:2021-11-19
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Blood uric acid normal, Full blood count normal, Metabolic function test, Pain in extremity, Synovitis
SMQs:, Arthritis (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: sleep apnea
Allergies: NKDA
Diagnostic Lab Data: CBC, CMP normal uric acid 5.2 normal
CDC Split Type:

Write-up: knee and ankle/foot pain, synovitis


VAERS ID: 1920552 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: None Administration Error ? dose administered 13 days after the QR code expiry date


VAERS ID: 1920553 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 AR / 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: None Administration Error ? dose administered 13 days after the QR code expiry date


VAERS ID: 1920555 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 AR / 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: None Administration Error ? dose administered 13 days after the QR code expiry date


VAERS ID: 1920627 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-16
Onset:2021-11-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray normal, Dizziness, Dysstasia, Electrocardiogram normal, Feeling abnormal, Hypertension, Malignant hypertension, Muscular weakness, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Vestibular disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: Moderna #2 (lot 048821A) on 3/6/21--88 yo, same reaction but milder. resolved after feeling weak when trying to stand from sit
Other Medications: enalapril 2.5 mg po QD (in a.m.)
Current Illness: hypertension
Preexisting Conditions: osteoporsis with vertebral compression fracture, mid-thoracic
Allergies: none
Diagnostic Lab Data: COVID (-) on 11/19/21 ECG and CSR on 11/19/21
CDC Split Type:

Write-up: 89 yo woman, very reliable historian, in generally good health except for some hypertension, high cholesterol but clear arteries (other than a widow-maker lesion found about 15 yrs ago from mild ssx and was by-passed succesfully) and an osteoporosis-related mid-thoracic vertebral fracture (3 years ago) causing a dowager?s hump becoming more prominent over time. BPs controlled at 120/75 on enalapril 2.5 mg po q.am. No other medications. PMH?at age 75 had successful but painful DaVinci bypass of ?widow-maker? lesion but all other coronaries were 100% patent. Gets no exercise. Sarcopenia to some extent. Non-obese (never was). Age 84 had descending colon cancer, resected successfully and clear at 5 years without chemo. First Moderna vaccine on 2/6/2021 (lot 030120A). Flu-like symptoms next 24-48 hours, better on tylenol. Second Moderna vaccine on 3/6/2021 (lot 048821A). Flu-like symptoms next 24 hours, better on tylenol. 2 weeks later (~3/20/2021) had an episode of legs feeling funny or weak when she stood up. Didn?t tell anyone, but it passed by the next day. 3/6/21 to 11/16/21: saw primary care doctor for checkup (07/14/2021). BP was 120/80 as it had been this whole time even at other doctor offices (saw ENT once and oncologist another time). No illnesses. Third Modern vaccine on 11/16/2021 (lot 013F21A?lot # may have been transcribed to her vaccine card wrong?what?s the ?F? doing there?). 3 days later (11/19/2021) had episode of feeling unusual and with legs feeling weak progressing to arms. Here?s how it progressed. That day she went to put something in the gas oven (gas leak was ruled out the next day). But she felt like her legs were weak and she felt a bit light-headed so thought it wasn?t safe to bake. She turned off the oven. She carefully made her way about 10? to the dining room table, using her arms (and some legs) as support. She then called 911. They told her to unlock her door (apartment 1200 sq-ft) that was about 20? away. She did, and as she moved from furniture to furniture piece, the weakness worsened and moved up to the arms also; and she felt more light-headed (?out of it?). She unlocked the door and immediately sat in the rocking chair about 2 ? from the door. The paramedics arrived and found her conscious and alert but looking a little out of it. She was taken by ambulance to the hospital around the corner. In the ER, her BP was 280/120. They reflexively put her on IVFs (NS) and gave her I.V. hydralazine, which brough the BP down to about 190/100 or so, and she felt better. Seeing repeat BPs in the 190-210 range, they decided to keep her for overnight observation. They quadrupuled her dose of enalapril to 5.0 mg po BID (am and hs) in the hospital. AFter the morning dose, her BP came down to about 190/90; at night it was about 185/80. She ended up staying, partly at my suggestion, for another 2 nights (3 days total stay). The night and next day of admission, COVID was (-); Stroke and spinal impingement at the vertebral fracture site were ruled out, as were cardiopulmonary problems (ECG, CXR normal). And she could walk and had not felt light-headed since unlocking the apartment door. And she wanted to go home the entire time (real pain in the neck). In the hospital, PT & OT assessed her ability to walk, and she did great. At d/c, her BP was 180/60, which they felt was OK, but it had been as low as 160/80 the preceding 24 hours (once). She followed up with her PMD 8 days later (couldn?t get appt) and BP was 180/70, and noted this was indeed very high for her. So PMD continued enalapril at 5 mg po BID. The episode never recurred nor has she felt light-headed. My theory is that the spike protein this vaccine forces out bodies to produce is saturating the ACE (and probably other anti-Htn receptors). So after the 3 doses of vaccine, each producing spike protein from the mRNA transcription (turns the body into a vaccine manufacturing facility, essentially), the spike protein progressively bound up more and more ACE and other anti-htn receptors. On dose #2, It took 2 weeks of spike protein production to probably cause pretty high BP (never measured, but likely not as high as the 3rd dose), and that?s why she had a similar but lesser reaction 2 weeks after the 2nd dose. Then after the 3rd dose, her ACE receptors were already pretty saturated, and it didn?t take much more spike protein production to bind up the ones that were left. That?s likely why, on the 3rd dose, she suffered nearly malignant hypertension that made her feel light-headed and experience caudal to rostral weakness. Once the BP was lowered in the ER, she felt she could walk again, and through the hospital stay. And the doctor on the unit said that indeed, very high BP could cause exactly the reaction she had. She remains on the 5 mg po BID enalapril dose and with BPs around 150-170/60-80.


VAERS ID: 1920673 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-11-19
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A31A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 RA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1920777 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / UNK LA / IM

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

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

Write-up: Patient given 5-11 year old vaccine and not the 12+ vaccine


VAERS ID: 1920820 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-27
Onset:2021-11-19
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PF2543 / 3 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nor vas, Lipitor, thx, and Lexapro
Current Illness: None
Preexisting Conditions: None
Allergies: Codiene
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Psyriosis


VAERS ID: 1920862 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Incorrect dose administered, Injection site erythema, Injection site pain, Injection site swelling, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Client received 0.5 ml dose as booster dose instead of 0.25 ml dose of Moderna on Friday 11/19. She reports body aches, fatigue, fever, injection site swelling, redness, and tenderness develop within 24 hours. Symptoms persisted for about 24-48 hours with complete resolution at this time.


VAERS ID: 1920904 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 UN / IM

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

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

Write-up: Client received 0.5 ml dose as booster dose instead of 0.25 ml dose of Moderna on Friday 11/19. Pt reports he is doing well. Denies all symptoms following vaccine and at this time.


VAERS ID: 1920917 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 UN / IM

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

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

Write-up: Client received 0.5 ml dose as booster dose instead of 0.25 ml dose of Moderna on Friday 11/19.


VAERS ID: 1920946 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Incorrect dose administered, Interchange of vaccine products, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Client received 0.5 ml dose as booster dose instead of 0.25 ml dose of Moderna on Friday 11/19. Pt received 1 dose of Janssen for primary series. Pt reports body aches, chills, tactile fever, for 24-48 hours following vaccine. Reports a complete resolution of symptoms at this time.


VAERS ID: 1921000 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 AR / IM

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

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

Write-up: Client given 0.5mL Moderna instead of 0.25mL (booster) dose.


VAERS ID: 1921002 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: None. Administration Error - dose administered 13 days after the QR code expiry date.


VAERS ID: 1921042 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient had no medical history noted at the time of the event. No home medications reported at the time of the event to this writer.
Current Illness: No medical issues or illnesses noted to this writer at the time of vaccination and or up to one month prior.
Preexisting Conditions: No chronic or long-standing health conditions noted at the time of event and or reported to this writer.
Allergies: No allergies to medications, food or other products noted at the time of the event or reported to this writer.
Diagnostic Lab Data: Patient was 12 years of age and received a pediatric dose of Pfizer instead of the 12 yr and older dose of Pfizer. Patient received 0.2 ml of Pfizer instead of 0.3 ml. Patient had no prior medical history noted at the time of the event and or reported. No adverse signs and or symptoms noted at the time of event and or after. No treatment noted or necessary at this time or at the time of the event. No further orders/instructions were given per Branch Director, Incident Command and Program Administrator, and or health care provider.
CDC Split Type:

Write-up: Patient was 12 years of age and received a pediatric dose of Pfizer instead of the 12 yr and older dose of Pfizer. Patient received 0.2 ml of Pfizer instead of 0.3 ml. Patient had no prior medical history noted at the time of the event and or reported. No adverse signs and or symptoms noted at the time of event and or after. No treatment noted or necessary at this time or at the time of the event. No further orders/instructions were given per Branch Director, Incident Command and Program Administrator, and or health care provider.


VAERS ID: 1921068 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 AR / IM

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

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

Write-up: Client given 0.5mL instead of booster dose 0.25mL on 11/19/2021. On 11/24/2021, patient had tactile fever and body aches, which lasted 2 days starting on the evening of 11/19/2021. Followed up with patient on 11/16/2021 and 12/1/2021 all symptoms resolved. No reports of new symptoms.


VAERS ID: 1921136 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Condition aggravated, SARS-CoV-2 test negative, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent and albuterol PRN
Current Illness:
Preexisting Conditions: Asthma, Eczema
Allergies: Tree Nuts and Peanuts
Diagnostic Lab Data: Covid negative by PCR on 11/24/2021
CDC Split Type:

Write-up: Developed large hives About 27 hours after injection on torso. Treated with topical hydrocortisone and oral Benadryl. Hives reoccured daily for 5 days then had asthma exacerbation on 11/24. Tested negative for covid.


VAERS ID: 1921139 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-07
Onset:2021-11-19
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Fatigue, Rhinorrhoea
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: Drospirenone-ethinyl estradiol 3mg-0.03mg daily
Current Illness: None documented
Preexisting Conditions: History of hyperlipidemia.
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated. No Booster Fatigue and Runny nose


VAERS ID: 1921168 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No prescriptions, over-the-counter medications, dietary supplements, or herbal remedies were reported being taken at the time of vaccination.
Current Illness: No other illnesses noted at the time of vaccination and or up to one month prior to the event.
Preexisting Conditions: No chronic or long-standing health conditions noted and or reported at the time of the event.
Allergies: No known allergies to medications, food, or other products reported or noted at the time of the event.
Diagnostic Lab Data: Patient at the time of the event was 12 years of age. Patient received the pediatric dose of Pfizer which was 0.2 ml. Patient should have received the 12 year and older dose of Pfizer which is 0.3 ml. No adverse events, treatment and or outcome noted at the time of event and or after. No signs or symptoms noted at the time of event and or after. No further instructions and or orders noted per facility.
CDC Split Type:

Write-up: Patient at the time of the event was 12 years of age. Patient received the pediatric dose of Pfizer which was 0.2 ml. Patient should have received the 12 year and older dose of Pfizer which is 0.3 ml. No adverse events, treatment and or outcome noted at the time of event and or after. No signs or symptoms noted at the time of event and or after. No further instructions and or orders noted per facility.


VAERS ID: 1921170 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 AR / IM

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

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

Write-up: Moderna 0.5mL given instead of 0.25mL on 11/19/20201. No reported symptoms when follow up to client made on 11/24/2021, 11/26/2021 and 12/1/2021.


VAERS ID: 1921248 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Extra dose administered, Nasopharyngitis, Oropharyngeal pain, Pain, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna 0.50ml given instead of Moderna 0.25ML (booster dose). Client reported symptoms began the night of 11/19/21 with body aches. Four days later he reported sore throat, 6 days later report cold symptoms, cough, runny nose, no fevers and no more sore throat. Contact made 12/1/2021 with client reporting all symtoms have resolved, no new symptoms.


VAERS ID: 1921858 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chills, Extra dose administered, Fatigue, Headache, Incorrect dose administered, Injection site discolouration, Injection site pain, Injection site swelling, Muscle spasms
SMQs:, Dystonia (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: - Daily Vitamin - Krill Oil
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Learned subsequently that I was given a third dose, intended for immunocompromised individuals, [.5 milliliters - full dose] in error. I should have been given a booster dose of .25 milliliters. The side effects I experienced were extreme chills, extreme leg cramps, headache, fatigue, and pain, tenderness, swelling, black and blue at the booster site. Upon receiving the first two doses the only side effect I had was tenderness / pain at the immunization site.


VAERS ID: 1922966 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Heart rate, Heart rate increased, Palpitations, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; Cardiomyopathy
Allergies:
Diagnostic Lab Data: Test Date: 20211119; Test Name: Heart rate; Result Unstructured Data: Test Result:increased
CDC Split Type: USPFIZER INC202101628052

Write-up: Heart palpitations; increased heart rate; SOB; chest pain; throat closing; This is a spontaneous report received from a contactable reporter(s) (Other HCP). The reporter is the patient. A 25 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 19Nov2021 12:00 (Batch/Lot number: unknown) at the age of 25 years as dose 1, single for covid-19 immunisation. Relevant medical history included: "Cardiomyopathy" (unspecified if ongoing); "Asthma" (unspecified if ongoing). There were no concomitant medications. The following information was reported: PALPITATIONS (medically significant) with onset 19Nov2021 12:30, outcome "recovered with sequelae", described as "Heart palpitations"; HEART RATE INCREASED (medically significant) with onset 19Nov2021 12:30, outcome "recovered with sequelae", described as "increased heart rate"; DYSPNOEA (medically significant) with onset 19Nov2021 12:30, outcome "recovered with sequelae", described as "SOB"; CHEST PAIN (medically significant) with onset 19Nov2021 12:30, outcome "recovered with sequelae", described as "chest pain"; THROAT TIGHTNESS (medically significant) with onset 19Nov2021 12:30, outcome "recovered with sequelae", described as "throat closing". The events "heart palpitations", "increased heart rate", "sob", "chest pain" and "throat closing" were evaluated at the emergency room visit. The patient underwent the following laboratory tests and procedures: heart rate: (19Nov2021) increased. Therapeutic measures were taken as a result of palpitations, heart rate increased, dyspnoea, chest pain, throat tightness. The patient received treatment with Epi pen, iv fluid, fantomide, Benadryl and prednisone. Clinical course: Facility where the most recent COVID-19 vaccine was administered: Pharmacy or Drug Store. Did the patient receive any other vaccines within 4 weeks prior to the COVID vaccine: No. Reported Event: Heart palpitations, increased heart rate, SOB, chest pain, throat closing. Prior to vaccination, patient was not diagnosed with COVID-19. Since the vaccination, patient had not been tested for COVID-19. It was reported that Seriousness criteria-Results in death: No, Seriousness criteria-Life threatening: No, Seriousness criteria-Caused/prolonged hospitalization: No, Seriousness criteria-Disabling/Incapacitating: No Seriousness criteria-Congenital anomaly/birth defect: No The lot number for bnt162b2 was not provided and will be requested during follow up.; Sender''s Comments: As there is limited information in the case provided, the causal association between the events and the suspect drug BNT162B2 cannot be excluded. The case will be reassessed once new information is available. The impact of this report on the benefit-risk profile of the Pfizer product and on the conduct of the study is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1922969 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angioedema, Breast enlargement, Hypersensitivity, Immunisation, Nausea, Pyrexia, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101629577

Write-up: angioedema from the neck up; a severe allergic reaction; urticarial covering entire body; nausea; a persistent high fever; significant swelling under the arm that the shot was administered; doubling size of the right breast; Booster; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 40 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm right, administration date 19Nov2021 13:00 (Lot number: FE3590) at the age of 40 years as dose 3 (booster), single for covid-19 immunisation. The patient had no relevant medical history. There were no concomitant medications. Vaccination history included: Bnt162b2 (Dose Number: 2, Batch/Lot No: EW0161, Location of injection: Arm Right, Vaccine Administration Time: 12:00 PM), administration date: 14Apr2021, when the patient was 40 years old, for Covid-19 immunization; Bnt162b2 (Dose Number: 1, Batch/Lot No: EP7534, Location of injection: Arm Right, Vaccine Administration Time: 12:00 PM), administration date: 23Mar2021, when the patient was 40 years old, for Covid-19 immunization. The patient had no relevant past drug history, reaction or allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient was tested for COVID-19. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient did not receive other medications within 2 weeks of vaccination. The following information was reported: IMMUNISATION (medically significant) with onset 19Nov2021 13:00, outcome "unknown", described as "Booster"; ANGIOEDEMA (medically significant) with onset 20Nov2021 19:00, outcome "not recovered", described as "angioedema from the neck up"; HYPERSENSITIVITY (medically significant) with onset 20Nov2021 19:00, outcome "not recovered", described as "a severe allergic reaction"; URTICARIA (medically significant) with onset 20Nov2021 19:00, outcome "not recovered", described as "urticarial covering entire body"; NAUSEA (medically significant) with onset 20Nov2021 19:00, outcome "not recovered", described as "nausea"; PYREXIA (medically significant) with onset 20Nov2021 19:00, outcome "not recovered", described as "a persistent high fever"; SWELLING (medically significant) with onset 20Nov2021 19:00, outcome "not recovered", described as "significant swelling under the arm that the shot was administered"; BREAST ENLARGEMENT (medically significant) with onset 20Nov2021 19:00, outcome "not recovered", described as "doubling size of the right breast". The events "booster", "angioedema from the neck up", "a severe allergic reaction", "urticarial covering entire body", "nausea", "a persistent high fever", "significant swelling under the arm that the shot was administered" and "doubling size of the right breast" were evaluated at the physician office visit. 30 hours after receiving the booster, patient experienced a severe allergic reaction. Sudden onset of angioedema from the neck up and urticarial covering entire body. Accompanied by nausea, a persistent high fever, and significant swelling under the arm that the shot was administered and doubling size of the right breast. Facility where the most recent COVID-19 vaccine was administered was reported as pharmacy or Drug Store. The patient was treated with enormous amounts of antihistamines. The adverse event resulted in doctor or other healthcare professional office/clinic visit. Therapeutic measures were taken as a result of angioedema, hypersensitivity, urticaria, nausea, pyrexia, swelling, breast enlargement. Follow-up attempts are completed. No further information is expected.


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