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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

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VAERS ID: 1970691 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 RA / -

Administered by: Work       Purchased by: ?
Symptoms: Immunisation, Movement disorder, Vaccination site pain
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (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: PHENTERMINE; XANAX; ZOFRAN [ONDANSETRON]; SUMATRIPTAN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Migraine (other medical history: occasional migraines); Shellfish allergy (known allergies: Shellfish)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101706311

Write-up: have had excruciating pain and tenderness at the injection site; have had excruciating pain and tenderness at the injection site; I could not lift/move my arm; booster; This is a spontaneous report received from contactable reporter(s) (Other HCP). The reporter is the patient. A 34 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm right, administration date 19Nov2021 08:30 (Lot number: FH8028) at the age of 34 years as dose 3 (booster), single for covid-19 immunisation. Relevant medical history included: "Anxiety" (unspecified if ongoing); "occasional migraines" (unspecified if ongoing), notes: other medical history: occasional migraines; "Shellfish" (unspecified if ongoing), notes: known allergies: Shellfish. Concomitant medication(s) included: PHENTERMINE; XANAX; ZOFRAN [ONDANSETRON]; SUMATRIPTAN. Vaccination history included: Bnt162b2 (Dose Number: 1, Batch/Lot No: EH9899, Location of injection: Arm Left), administration date: 18Dec2020, when the patient was 33 years old, for COVID-19 immunization; Bnt162b2 (Dose Number: 2, Batch/Lot No: EL1284, Location of injection: Arm Left, Vaccine Administration Time: 10:45 AM), administration date: 08Jan2021, when the patient was 33 years old, for COVID-19 immunization. The following information was reported: IMMUNISATION (non-serious) with onset 19Nov2021 08:30, outcome "unknown", described as "booster"; VACCINATION SITE PAIN (non-serious), VACCINATION SITE PAIN (non-serious) all with onset 19Nov2021 09:00, outcome "not recovered" and all described as "have had excruciating pain and tenderness at the injection site"; MOVEMENT DISORDER (non-serious) with onset 19Nov2021 09:00, outcome "not recovered", described as "I could not lift/move my arm". The events "have had excruciating pain and tenderness at the injection site", "have had excruciating pain and tenderness at the injection site" and "i could not lift/move my arm" were evaluated at the physician office visit. Therapeutic measures were taken as a result of vaccination site pain, vaccination site pain, movement disorder. Additional information: The patient has not received any other vaccines within 4 weeks prior to the COVID vaccine. Since about 30 minutes after receiving my Covid booster shot. As the day went on the pain became unbearable and to the point that I could not lift/move my arm. I went to the walk in clinic the follow day and was told it was probably a reacation to the vaccine, was put in a sling, given anti-inflamatories, put on light duty work and was told to follow up with my employee health doctor if things didnt get better. On 30Nov2021 (11 days later) I went to my employee health doctor as things still have not gotten better, he also told me it was a reaction to the booster and has put me on steriods, I will see him back on 10Dec2021, I continue to be on lifting restrictions. AE treatment- sling, medication, lifting restrictions. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1970838 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Muscle spasms, Muscular weakness, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy (Known allergies: Penicillin)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101797248

Write-up: Muscles spasms; Burning sensation; Pins and needles in feet; Weakness in legs and arms; This is a spontaneous report from a contactable reporter (other healthcare professional). The reporter is the patient. A 29-year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 19Nov2021 (Lot number: EW0175) at the age of 29 years as dose 1, single for COVID-19 immunisation. Relevant medical history included: "Penicillin allergy" (unspecified if ongoing), notes: Known allergies: Penicillin. Concomitant medications were not reported. The following information was reported: MUSCLE SPASMS (non-serious) with onset 19Nov2021, outcome "not recovered", described as "Muscles spasms"; BURNING SENSATION (non-serious) with onset 19Nov2021, outcome "not recovered", described as "Burning sensation"; PARAESTHESIA (non-serious) with onset 19Nov2021, outcome "not recovered", described as "Pins and needles in feet"; MUSCULAR WEAKNESS (non-serious) with onset 19Nov2021, outcome "not recovered", described as "Weakness in legs and arms". The events "Muscles spasms", "Burning sensation", "Pins and needles in feet" and "Weakness in legs and arms" were evaluated at the physician office and the emergency room visit. Therapeutic measures were taken as a result of muscle spasms, burning sensation, paraesthesia and muscular weakness. Additional information: Therapeutic measures included treatment with BACLOFEN and GABAPENTIN (neurology). The patient did not receive any other vaccines within four weeks prior to the COVID-19 vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19.


VAERS ID: 1971292 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Headache, Heart rate increased, Platelet count normal
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Erythromycin
Diagnostic Lab Data: I was seen by local Cardiology 12/15/21 and my blood pressure was taken multiple times at or around 160/100. My normal blood pressure before the vaccine had never reached that high at rest. I also had a blood panel done at a local urgent care to check platelet levels which came back normal. The local cardiology prescribed Norvasc (Amlodipine) to reduce high blood pressure.
CDC Split Type:

Write-up: Began experiencing severe headaches along with heart rate increase from normal (44) to over 100 on or around November 20th 2021. Also my blood pressure increased to 160/100 for weeks until I was seen by the cardiologist and prescribed Norvasc (Amlodipine) to reduce high blood pressure.


VAERS ID: 1971410 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-11-19
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Blood test, Computerised tomogram, Facial paralysis, Gait disturbance, Glycosylated haemoglobin, Grip strength decreased, Headache, Hypoaesthesia, Magnetic resonance imaging, Muscular weakness, Scan with contrast, Thyroid function test, Transient ischaemic attack, Urine analysis, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 11/19/2021- 11/22/2021 Hospitalized. Discharged papers said I had a Transient Ischemic Attack (mini-stroke). I had full bloodwork, urine, A1C, thyroid, etc. X-ray, CT scan, with and without dye, MRI.
CDC Split Type:

Write-up: Left arm completely numb, weak, not able to make a fist. Headache about left eye. Left side numb, weak, poor balance walking. Left side facial drooping. 11/19/2021 approximately 6pm went to Urgent care to be evaluated, sent via ambulance straight to Emergency Room.


VAERS ID: 1971565 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dyspnoea, Fatigue, Injection site pain, Movement disorder, Myalgia, Pain in extremity, Paralysis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Did not go to hospital or doctor - symptoms subsided after a few hours.
CDC Split Type:

Write-up: After receiving my booster dose?Normal symptoms such as injection site soreness, sore arm, fatigue. But at 4AM next morning I awoke paralyzed, couldn?t move, couldn?t feel my arms or legs, could barely breathe. Took short breaths and kept trying to move. Finally got feeling and then I could feel EVERY a joint in my body. Intense joint and muscle pain. Kept taking deep breaths until I got enough feeling to walk. Took Ibuprofen and Tylenol, symptoms subsided over the next few hours. Fatigue and muscle soreness the next 24-36 hours. Did not go to hospital or doctor.


VAERS ID: 1971717 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan Potassium, Amlodipine Besylate
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none. didn''t go to Dr.
CDC Split Type:

Write-up: tingling, numbness in right arm a day or two after Jansen Booster shot


VAERS ID: 1972047 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018F21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, SARS-CoV-2 test negative
SMQs:, Medication errors (narrow), 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: 2 films Suboxone 12mg/3mg Sublingual Film, Q AM sofosbuvir-velpatasvir 400mg-100mg, Q noon Docusate 100mg, 1 Cap Daily Senna 17.2 mg, 1 cap daily
Current Illness: None reported
Preexisting Conditions: Hepatitis C Depression Substance use disorder
Allergies: NKA
Diagnostic Lab Data: Patient was PCR Covid-19 tested on 12-11-21 and 12-18-21 with NOT Detected results. Patient was also Rapid POC covid-19 tested on 12-14-21 with Negative results.
CDC Split Type:

Write-up: Patient received Moderna Vaccines initial on 5-7-21 and 6-2-21 . Patient was given booster on 11-19-21 before the complete 6 month interval approved for the booster to be given.


VAERS ID: 1974189 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Maine  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Immunisation, Poor quality product administered, Product temperature excursion issue
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: USPFIZER INC202101655348

Write-up: booster; temperature range of 41-43 degrees Fahrenheit.; stored in refrigerator state and intact with a temperature range of 41-43 degrees Fahrenheit.; expired on the 14Nov2021 but 4 doses were administered on 19Nov2021; This is a spontaneous report received from a contactable reporter(s) (Other HCP) from medical information team for a Pfizer sponsored program (159558). A patient (no qualifiers provided) received bnt162b2 (BNT162B2, solution for injection), administration date 19Nov2021 (Batch/Lot number: unknown, Expiration Date: 14Nov2021) as dose number unknown (booster), single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Covid-19 vaccine (Primary Immunization series complete but unknown manufacturer, Dose 1.), for Covid-19 immunization; Covid-19 vaccine (Primary Immunization series complete but unknown manufacturer, Dose 2.), for Covid-19 immunization. The following information was reported: IMMUNISATION (non-serious) with onset 19Nov2021, outcome "unknown", described as "booster"; POOR QUALITY PRODUCT ADMINISTERED (non-serious) with onset 19Nov2021, outcome "unknown", described as "temperature range of 41-43 degrees Fahrenheit."; PRODUCT TEMPERATURE EXCURSION ISSUE (non-serious) with onset 19Nov2021, outcome "unknown", described as "stored in refrigerator state and intact with a temperature range of 41-43 degrees Fahrenheit."; EXPIRED PRODUCT ADMINISTERED (non-serious) with onset 19Nov2021, outcome "unknown", described as "expired on the 14Nov2021 but 4 doses were administered on 19Nov2021". Additional information: Reporter said that the vaccines should be discarded on 14Nov (30th day) but 4 doses were given to patients on 19Nov. I am a nurse for a medical office, and we received Pfizer vaccines for our patients and of course when they come out of deep freeze, they are good for 30 days after and we had patients that received the dose of the booster doses five days past the date that they should have been discarded. The lot number for bnt162b2 was not provided and will be requested during follow up.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101656254 same reporter/drug/event, different pt;US-PFIZER INC-202101656255 same reporter/drug/event, different pt;US-PFIZER INC-202101656256 same reporter/drug/event, different pt


VAERS ID: 1974216 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure measurement, Immunisation, Supraventricular extrasystoles
SMQs:, Supraventricular tachyarrhythmias (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PROZAC; CRESTOR; TERAZOSIN
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: 3 (PAC''s) show up during a BP test; Result Unstructured Data: Test Result:3 (PAC''s); Comments: 3 (PAC''s) show up during a BP test
CDC Split Type: USPFIZER INC202101706363

Write-up: 3rd dose; had 3 (PAC''s) show up during a BP test; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 65 year-old male patient received bnt162b2 (BNT162B2), administered in arm left, administration date 18Nov2021 09:30 (Lot number: FH8020) at the age of 65 years as dose 3 (booster), single for covid-19 immunisation. The patient had no relevant medical history. Concomitant medication(s) included: PROZAC; CRESTOR; TERAZOSIN. Past drug history included: None, reaction(s): "Allergy", notes: other medical history: No. Vaccination history included: Bnt162b2 (Dose Number: 2, Batch/Lot No: ER8735, Location of injection: Arm Left, Vaccine Administration Time: 01:00 PM), administration date: 28Apr2021, when the patient was 64 years old, for COVID-19 immunization; Bnt162b2 (Dose Number: 1, Batch/Lot No: EW0150, Location of injection: Arm Left, Vaccine Administration Time: 01:00 PM), administration date: 07Apr2021, when the patient was 64 years old, for COVID-19 immunization. The following information was reported: IMMUNISATION (non-serious), outcome "unknown", described as "3rd dose"; SUPRAVENTRICULAR EXTRASYSTOLES (non-serious) with onset 19Nov2021 04:00, outcome "recovering", described as "had 3 (PAC''s) show up during a BP test". The event "had 3 (pac''s) show up during a bp test" was evaluated at the physician office visit and emergency room visit. Relevant laboratory tests and procedures are available in the appropriate section. It was unknown if therapeutic measures were taken as a result of supraventricular extra systoles. Additional information: The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Had P.,A.C''s show up at Blood donation, which alerted me to this condition. they only showed occasionally until the day after my . They are getting better, sometimes none. Just felt I should report. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, patient has not been tested for COVID-19. No other vaccine in four weeks. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1974239 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320030BD / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation, Menstrual disorder, Menstruation irregular
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METOPROLOL; BUSPAR; VITAMIN D [COLECALCIFEROL]; CALCIUM
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101738748

Write-up: Dose number: 3; I am age 50 and have an IUD/I began having periods again.; I am age 50 and have an IUD/I began having periods again; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 49 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 19Nov2021 09:00 (Lot number: 320030BD) at the age of 49 years as dose 3 (booster), single for covid-19 immunisation. The patient''s relevant medical history was not reported. Concomitant medication(s) included: METOPROLOL; BUSPAR; VITAMIN D [COLECALCIFEROL]; CALCIUM. Vaccination history included: Bnt162b2 (Dose Number: 1, Batch/Lot No: EN6204, Location of injection: Arm Left, Vaccine Administration Time: 11:00 AM), administration date: 17Mar2021, when the patient was 49 years old, for COVID-19 immunization; Bnt162b2 (Dose Number: 2, Batch/Lot No: EW0158, Location of injection: Arm Left, Vaccine Administration Time: 11:00 AM), administration date: 07Apr2021, when the patient was 49 years old, for COVID-19 immunization, reaction(s): "I am age 50 and have an IUD / I began having periods again.", "I am age 50 and have an IUD / I began having periods again.". The following information was reported: IMMUNISATION (non-serious) with onset 19Nov2021 09:00, outcome "unknown", described as "Dose number: 3"; MENSTRUAL DISORDER (non-serious) with onset 2021, outcome "unknown", described as "I am age 50 and have an IUD/I began having periods again."; MENSTRUATION IRREGULAR (non-serious) with onset 2021, outcome "unknown", described as "I am age 50 and have an IUD/I began having periods again". Therapeutic measures were taken as a result of menstrual disorder, menstruation irregular. Additional information: It was reported that, the patient was not received any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination the patient had not diagnosed with COVID-19. Since the vaccination the patient had not been tested for COVID-19. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1974249 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ENBREL
Current Illness: Rheumatoid arthritis (current medical condition)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101742074

Write-up: Booster; Interchange of vaccine products; extremely sore and painful; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP) for a sponsored program. A 57 year-old female patient received bnt162b2 (BNT162B2), administration date 19Nov2021 (Batch/Lot number: unknown) at the age of 57 years as dose 2 (booster), single for covid-19 immunisation. Relevant medical history included: "Rheumatoid arthritis" (ongoing), notes: current medical condition. Concomitant medication(s) included: ENBREL taken for rheumatoid arthritis. Past drug history included: Johnson & johnson covid-19 vaccine for COVID-19 immunization, reaction(s): "did not get any antibodies", notes: dose 1. The following information was reported: IMMUNISATION (non-serious) with onset 19Nov2021, outcome "unknown", described as "Booster"; INTERCHANGE OF VACCINE PRODUCTS (non-serious) with onset 19Nov2021, outcome "unknown", described as "Interchange of vaccine products"; PAIN (non-serious) with onset 19Nov2021, outcome "not recovered", described as "extremely sore and painful". Additional information: Action taken with Enbrel with Single Dose Prefilled Autoinjector was reported as unknown for the event pain. The causal relationship between the event pain and Enbrel and Single Dose Prefilled Autoinjector was not provided by the consumer. No treatment information was received. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1974921 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C218 / 3 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Condition aggravated, Electrocardiogram abnormal, Fatigue, Headache, Pain, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID-19 Moderna Dose #1, 70 Y/O, Mild Headache and fatigue: COVID-19 Moderna Dose #2, 70 Y/O, Severe headache, heart palpitatio
Other Medications: Levothyroxine; Atenolol; Rosuvastatin; Duloxetine'' Tizanidine'' Buspirone; Inhaler; Flonase,; Multivitamin; Vitamin C; Probiotics; Magnesium Malate
Current Illness: Tick bite the night before
Preexisting Conditions: Fibromyalgia; Previous Heart Attack; Asthma; and COPD; Chronic Sinusitis.
Allergies: Penicillin; Sulfa; Keflex; Azithromycin; Tetracycline; Cipro; Trees; Molds
Diagnostic Lab Data: EKG was performed and deemed a slight palpitation changes.
CDC Split Type: vsafe

Write-up: Evening before on 11/18/2021 I noticed a Tick attached to my arm and removed it completely. The next day 11/19/2021 I went in to get my booster and discussed the Tick bite as well and ruled it as a black legged deer tick. Public health decided it was okay to administer booster shot and I also received doxycycline from NP for tick bite. Roughly six hours after booster I began to experience horrible frontal headaches, body aches and pain got extremely bad, and chills, and my temperature went down to 95 degrees which is very low for me, and fatigue set in very bad. The following fatigue was bad as well. Symptoms started to improve slowly after about 36 hours and after 5 days I started to feel much better. During this time I was feeling heart palpitations as well. Currently, I do have slight headaches, the heart palpitations have ceased and I have changed heart medications to Metoprolol.


VAERS ID: 1974926 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-16
Onset:2021-11-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cerebrovascular accident, Computerised tomogram, Echocardiogram, Electrocardiogram, Electroencephalogram, Magnetic resonance imaging
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: MRI, CAT scans, EEG, EKG, Blood work, Echo Cardiogram (12/20 - 12/22)
CDC Split Type:

Write-up: suffered a stroke


VAERS ID: 1975187 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Gait inability, Head titubation, Headache, Muscular weakness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl 50mg
Current Illness: none
Preexisting Conditions:
Allergies: amoxicillin , latex, codiene, strawberries, bee stings, molds,
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever 103.8 , chest pain !, chills, muscle aches, unable to walk legs felt weak , horrific headaches, unable to hold my head up


VAERS ID: 1975355 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Discomfort, Fatigue, Rash, Sluggishness
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot.
Other Medications: Vitamin C; Crestor.
Current Illness: None.
Preexisting Conditions: High Cholesterol; Seasonal Allergies.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type: vsafe

Write-up: Felt tired, sluggish, heavy, rashes.


VAERS ID: 1980639 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Unknown  
Location: Florida  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 3 - / 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.MOD20214

Write-up: 55 patients received a dose of a vial after 12 hours of initial puncture; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (55 patients received a dose of a vial after 12 hours of initial puncture) in a 69-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939902) 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) 1 dosage form. On 19-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (55 patients received a dose of a vial after 12 hours of initial puncture). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (55 patients received a dose of a vial after 12 hours of initial puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant and treatment information was not provided by the reported. This case was linked to MOD-2021-418964 (Patient Link).


VAERS ID: 1980640 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Unknown  
Location: Florida  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 3 - / 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.MOD20214

Write-up: 55 patients received a dose of a vial after 12 hours of initial puncture; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (55 patients received a dose of a vial after 12 hours of initial puncture) in a 63-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939902) 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) 1 dosage form. On 19-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (55 patients received a dose of a vial after 12 hours of initial puncture). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (55 patients received a dose of a vial after 12 hours of initial puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant information was reported. No treatment information was reported. This case was linked to MOD-2021-418964 (Patient Link).


VAERS ID: 1980834 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / OT

Administered by: Private       Purchased by: ?
Symptoms: Complex regional pain syndrome, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Menopause
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101828829

Write-up: Patient has Chronic Reflex Sympathetic Dystrophy of Right Lower Extremity; had an acute exacerbation of burning pain in the right lower extremity which is the affected limb; This is a spontaneous report from a contactable reporter (physician). A 56 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), intramuscular, administered in arm left, administration date 19Nov2021 (Lot number: unknown) at the age of 56 years as dose 2, single for COVID-19 immunisation. Relevant medical history included: "Menopause" (unspecified if ongoing). There were no concomitant medications. Past drug history included: Clindamycin, reaction(s): "Drug allergy", notes: Known allergies: Clindamycin; Bactrim, reaction(s): "Drug allergy", notes: Known allergies: Bactrim and Amoxicillin, reaction(s): "Drug allergy", notes: Known allergies: Amoxicilllin. Vaccination history included: Bnt162b2 (DOSE 1, SINGLE Lot number: UNKNOWN Anatomical location: Arm Right, Route of Administration: Intramuscular), administration date: 15Oct2021, when the patient was 56 years old, for COVID-19 immunisation. The following information was reported: COMPLEX REGIONAL PAIN SYNDROME (non-serious) with onset 19Nov2021, outcome "not recovered", described as "Patient has Chronic Reflex Sympathetic Dystrophy of Right Lower Extremity"; PAIN (non-serious) with onset 19Nov2021, outcome "not recovered", described as "had an acute exacerbation of burning pain in the right lower extremity which is the affected limb". The events "Patient has Chronic Reflex Sympathetic Dystrophy of Right Lower Extremity" and "had an acute exacerbation of burning pain in the right lower extremity which is the affected limb" were evaluated at the physician office visit. Therapeutic measures were taken as a result of complex regional pain syndrome and pain. Additional information: It has been constant and has not stopped since patient''s vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive other vaccines within four weeks prior to COVID vaccine. Since the vaccination, it was unknown whether the patient had been tested for COVID-19. Therapeutic measures included gabapentin (MANUFACTURER UNKNOWN) and GRALISE from an unknown date and unknown if ongoing. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1981588 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pt experienced redness, warmth and swelling around the injection site within several minutes of receiving the Pfizer injection. She denied difficulty breathing, chest tightness, dizziness, itching, or any discomfort. She was given 2 tsp of Siladryl (diphenhydramine hydrochloride) at 945 as well as an ice pack. Pt stayed 30 min after receiving injection. Redness and swelling had improved by the time her 30 minutes were up. She denied any discomfort or difficulty breathing. Dad will give benadryl if rash appears and tylenol if she experiences flu-like symptoms. Instructed to notify vaccinator of reaction at next appointment.


VAERS ID: 1982147 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F211A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Injection site pain, Injection site swelling, Lymph node pain, Lymphadenopathy, Rhinorrhoea, Sneezing, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (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: Moderna 2 dose
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: penicillin, strip-mine, shell fish
Diagnostic Lab Data: n/a
CDC Split Type: vsafe

Write-up: I was very sleep and tired. I had swollen and pain where the injection site was. A week later, I was still very fatigue. I had sneezing, nose running, and diarrhea. My lumpy nodes in my face was a little sore and swollen.


VAERS ID: 1982161 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-13
Onset:2021-11-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 182281 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Electrocardiogram, Feeling abnormal, Full blood count, Metabolic function test, Palpitations, Panic attack
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC-W Test, Metabolic Panel, Electrocardiogram, TSH test
CDC Split Type:

Write-up: Persistent brain fog, palpitations, and panic attacks


VAERS ID: 1982442 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Musculoskeletal discomfort
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Sexual dysfunction (broad)

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

Write-up: Numbness in the left hand and fingers and pain/discomfort in left shoulder


VAERS ID: 1984004 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-11-19
   Days after vaccination:295
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M204 / 2 - / 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.MOD20214

Write-up: expired vaccine used; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (expired vaccine used) in a 78-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 004M204 and 010L21A) for COVID-19 vaccination. No Medical History information was reported. On 28-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Nov-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 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. Not Provided For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication reported. No treatment information was provided.


VAERS ID: 1984054 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-01-13
Onset:2021-11-19
   Days after vaccination:310
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, Interchange of vaccine products, Off label use, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Medication errors (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Covid-19 test; Result Unstructured Data: Test Result:positive
CDC Split Type: USPFIZER INC202101637499

Write-up: this individual has been tested for Covid numerous times after vaccination since it is provided for free at their site of work; this individual has been tested for Covid numerous times after vaccination since it is provided for free at their site of work; Booster was Moderna and the first two Pfizer; Booster was Moderna and the first two Pfizer; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). A 25 year-old male patient received bnt162b2 (BNT162B2), administration date 13Jan2021 (Lot number: EL1283) at the age of 24 years as dose 2, single and administration date 23Dec2020 (Lot number: EH9899) as dose 1, single for covid-19 immunisation; covid-19 vaccine mrna (mrna 1273) (MODERNA COVID-19 VACCINE), administration date 19Nov2021 (Lot number: 066H219) as dose 3 (booster), single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: OFF LABEL USE (medically significant), INTERCHANGE OF VACCINE PRODUCTS (medically significant) all with onset 19Nov2021, outcome "unknown" and all described as "Booster was Moderna and the first two Pfizer"; COVID-19 (medically significant), DRUG INEFFECTIVE (medically significant), outcome "unknown" and all described as "this individual has been tested for Covid numerous times after vaccination since it is provided for free at their site of work". The patient underwent the following laboratory tests and procedures: Covid-19 test: positive. Clinical course: Patient had not heard of any adverse events, but since the booster was Moderna and the first two Pfizer, patient was reporting since patient wasn''t sure if it was a risk to mix the two vaccines. It was also reported that location of vaccination based on picture stamp posted through social media. Patient was sorry and believe individual 25 YO as of recent. Forget ages during which received each of the vaccines, but I believe all dates are recorded. When the patient was asked to provide some further information on the experience (s) patient have reported and have attached a questionnaire, it was reported that one follow-up for this one, this individual has been tested for Covid numerous times after vaccination since it is provided for free at their site of work. They do not know how many times when this report was submitted, but it is a good amount (guess around 11x or more) Follow-up attempts are completed. No further information is expected. Follow up (11Dec2021): This is a follow up-spontaneous report from a contactable consumer. This consumer reported for the patient in response to consumer letter sent via email which included that: clinical information added Follow-up attempts are completed. No further information is expected. Follow-up (13Dec2021): This is a spontaneous follow-up report received in response to the mail trail sent regarding the confirmation of below mentioned query. The response included: New events: Covid-19 and Drug ineffective were added and case was upgraded to serious.


VAERS ID: 1984628 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-13
Onset:2021-11-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal X-ray, Abdominal discomfort, Arthralgia, Chest X-ray, Chest pain, Computerised tomogram, Constipation, Contusion, Diarrhoea, Discomfort, Dry eye, Dysphagia, Echocardiogram normal, Electrocardiogram, Erythema, Eye pain, Eye pruritus, Flushing, Headache, Nausea, Neck pain, Ocular hyperaemia, Oral pain, Oropharyngeal pain, Pain, Pain in extremity, Rash, SARS-CoV-2 test negative, Sensitive skin, Skin irritation, Skin warm, Streptococcus test negative, Throat irritation, Tongue pruritus, Tongue ulceration, Urticaria, Vulvovaginal discomfort, Vulvovaginal erythema, White blood cell count decreased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: allergy medication once daily - Zyrtec 5 mL daily and Flonase Sensimist nose spray, one spray per nostril Over the counter vitamin: Garden of Life my kind organic multivitamin gummies
Current Illness: None
Preexisting Conditions: Season allergies
Allergies: None that we are aware of other than seasonal allergies
Diagnostic Lab Data: November 25 - stomach X-ray showed moderate amount of stool in colon, strep test negative, COVID test negative November 29 - lab work showed low white blood cell count December 9 - chest x ray showed possible bronchiolitis, but it was a misdiagnosis December 10 - lab work normal other than slightly low white blood cell count December 14 - ct scan showed large adenoids but not sinus or ear infection as previously thought December 15 - lab work normal December 16 - EKG showed possible left ventricle hypertrophy December 21 - echocardiogram was normal
CDC Split Type:

Write-up: First symptom was stomach discomfort and constipation then flare ups of pain began soon after followed by the following symptoms? Throat hurt and had sores on back of tongue and red throat Tongue had little red spots Said bottom front teeth have felt dirty Hurt to swallow Said her saliva tasted bad Roof of mouth hurt complained of an itchy tongue Skin got red and irritated easily When she wore a mask, her cheeks got red and she looked flushed Stomach pains and felt nauseous - stomach pains were sometimes in the lower tummy below her belly button. Other times the pain was around the entire belly. Bowel movements were loose and normal at times (no signs of constipation after the first week symptoms began) Had an appetite, but wasn?t eating as much as normal Flare-ups of pain in joints and random parts of her body (bottom of feet, head, chin, front and back bottom, chest, finger tips, toes, legs, arms, neck) Her pain in her feet was so uncomfortable at times, she wanted to wear tennis shoes in the house Holding on to her tennis racket made her fingers hurt A little redness in eyes that I noticed one day that came and went Eyes hurt sometimes and felt dry or itchy Based on chest x-Ray, she was misdiagnosed with bronchiolitis She was then diagnosed with possible walking pneumonia - the only symptom I observed was chest pain, but it was more like the flare ups of pain that occurred in different parts of her body (arthralgia) Hives all over legs and feet, especially after warm bath Hives also have appeared on elbows, abdomen, behind her ears, neck, arms, tummy Discomfort on her private areas - redness/irritation around the vagina, small rash similar to red pimples on her buttocks, pain/discomfort when wiping after a bowel movement It did not hurt when she urinated or had a bowel movement. It was the outside skin that was sensitive and irritated She was bruising more easily - we thought it was her new bike riding skills but it seemed more than just her legs Her temperature hovered around 99, which is above normal for her She didn?t want to play as much because of all the discomfort Her knees have turned red and itchy and felt warm to the touch Medicines prescribed - Miralax Azithromycin Prednisolone Cefdinir Hydroxyzine Pepcid


VAERS ID: 1984670 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Injected limb mobility decreased, Pain, Pain in extremity
SMQs:, Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Recipient states that approximately 2 hours or less after vaccination her left arm began to hurt. As of today she states radiating pain, weakness, and inability of full use of left arm. I advised her to not receive 2nd dose of COVID vaccine and to see PCP.


VAERS ID: 1984733 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Disturbance in attention, Fatigue, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

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

Write-up: I experienced fatigue, lack of concentration and blurry vision.


VAERS ID: 1985767 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Condition aggravated, Movement disorder, Neuralgia, Pain in extremity, Sciatica
SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (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:
Current Illness:
Preexisting Conditions:
Allergies: Sesame seeds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Worsening of severe lower back pain and sciatica. Difficulty with movement, shooting nerve pain in left leg. Ongoing.


VAERS ID: 1989031 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood thyroid stimulating hormone normal, Chest X-ray normal, Cold sweat, Computerised tomogram normal, Dizziness, Electric shock sensation, Full blood count normal, Heart rate increased, Muscular weakness, Paraesthesia, Scan with contrast, Vitamin D decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine, selenium and daily multi-vitamin
Current Illness: hashimotos thyroiditis
Preexisting Conditions: hashimotos thyroiditis
Allergies: none
Diagnostic Lab Data: 11-26-2021: CBC, thyroid TSH and T4 levels, CT scan with contrast: all normal 12-02-2021: CBC, thyroid TSH and chest x rays: all normal 12-10-2021: vitamin D levels and CBC: all normal, vitamin D levels high (105 with high limit in reference range = 100) 02-09-2022: soonest I can see a neurologist
CDC Split Type:

Write-up: about 10 minutes after the injection I was walking around the store and had a very sharp and jolting almost zap in my head. Then my heart rate jumped to about 135bpm from what was around an average of 75bpm prior. I got very dizzy, weak in my whole body and began having cold sweats. My next event was 11-26-2021. I had extreme muscle weakness, tingling in my limbs and felt dizzy. I went to the ER and they ran thyroid blood work, and a CBC. All came back normal. They also performed a CT scan with contrast and to look for clotting. All looked ok. Over the next 3 weeks I went to the ER 2 more times, once in an ambulance. Same symptoms: weakness that one day is on my right side, then to my left, sometimes my entire body. The time I went to the er in an ambulance, was due to sever weakness and very high jump in heart rate while sitting and reading in my home town. I had chest x rays (not sure why) and more blood work...all came back normal. I have NEVER experience anything like this in my 40 years until after I received the JNJ covid 19 shot.


VAERS ID: 1989109 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-12
Onset:2021-11-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood thyroid stimulating hormone, Chest X-ray, Chest discomfort, Chest pain, Full blood count, Human chorionic gonadotropin, Immune system disorder, Lymphadenopathy, Metabolic function test, Painful respiration, Troponin
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/19/21: CXR, CBC, CMP, PTT, Troponin and CK Cardiac Panel, TSH, HCG, EKG. Suspicion for local adenopathy and immune reactivity from COVID vaccination.
CDC Split Type:

Write-up: 1 week after vaccine, had heaviness and sharp upper chest pain without radiation. Exacerbated by deep inspiration.


VAERS ID: 1989308 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Antiphospholipid syndrome, Asthenia, Cerebrovascular accident, Cognitive disorder, Depression, Essential hypertension, Hemiparesis, Immune thrombocytopenia, Infusion, Livedo reticularis, Seizure, Sneddon's syndrome, Type 1 diabetes mellitus
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Depression (excl suicide and self injury) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), 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? Yes
Hospitalized? Yes, 38 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Multiple active problems. Recurrent depressive disorder, Type 1 diabetes, generalized weakness, Sneddon syndrome, idiopathic livedo reticularis with thrombotic CVAs, Autoimmune thrombocytopenia ,Antiphospholipid syndrome, Seizure disorder, Hemiparesis affecting the right side secondary to her CVAs, Essential hypertension, Ongoing cognitive impairment status post acute infusion. ED visit on 11/19; Hospitalized on 11/19 (5 days), 11/24 (8 days), 12/4 (11 days), and 12/15-current (14 days). These visits are within 6 weeks of receiving COVID vaccine.


VAERS ID: 1991114 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dehydration, Fatigue, Hyperhidrosis, Impaired work ability, Pyrexia, Urinary tract infection, Urine analysis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin D3 Calcium
Current Illness: None
Preexisting Conditions: None
Allergies: PCN Gluten Intolerance Lactose Intolerance
Diagnostic Lab Data: Urinalysis , 11/22/21
CDC Split Type:

Write-up: Due to the COVID-19 vaccine symptoms (i.e., fatigue, high fever, sweating) - became dehydrated and developed UTI. Missed (2) days of work, 11/22/21 and 11/23/21 Medical Appointment with PCP, 11/22/21 Antibiotic Treatment / Medication for 7 days


VAERS ID: 1991119 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arteriogram coronary normal, Bundle branch block left, Cardiac septal defect, Cardiac stress test abnormal, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram abnormal, Headache, Influenza like illness, Lethargy, Lipids normal, Muscle fatigue, Myocardial ischaemia, Pain, Pyrexia, Scan myocardial perfusion abnormal, Sleep disorder, Ventricular hypertrophy, Ventricular hypokinesia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Congenital, familial and genetic disorders (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: No prior history; PT is a pilot. He receives an annual class and flying class medical examinations. He has no prior history of abnormality.
Allergies: NKDA
Diagnostic Lab Data: 12/2/21 ECG - Abnormal. LBBB 12/3/21 ECG - Abnormal LBBB 12/8/21 LIPID panel - Normal 12/13/21 Nuclear Stress Test - Abnormal - Abnormal myocardial perfusion study. o The left ventricular ejection fraction is calculated at 44 percent. o There is a medium moderate reversible defect in the mid anteroseptal segments and apical septum, consistent with myocardial ischemia. o Wall thickening is abnormal. There is hypokinesis of the mid anteroseptum and apical septum. 12/17/21 Echocardiogram - 09:10 AM BP: 116/80 mmHg - motion is consistent with conduction abnormality. Ejection fraction is visually estimated at 50-55%, consistent with low normal systolic function. 12/20/21 Angiogram -Coronary anatomy Dominance: Right Left main: Angiographically normal Left anterior descending: Angiographically normal Diagonal: Angiographically normal Left circumflex: Angiographically normal Obtuse marginal: Angiographically normal Right cornary artery: Angiographically normal Left ventricle Not performed
CDC Split Type:

Write-up: 11/19/21 - 10:30 0.5ml Vaccine IM left deltoid. - 18:00 PT reports noticeable but mild "flu like" symptoms -Self treats with 800mg NSAID 11/20/21 - PT wakes to mild to severe symptoms that persist for the next 48 hours. These include: fever <103F, muscle fatigue, soreness, headache, and lethargic presentation 11/23/21 - PT''s symptoms begin to subside to "mild" over the next 24-36 hours.


VAERS ID: 1992487 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site reaction, Injection site swelling, Joint range of motion decreased, Mobility decreased, Musculoskeletal stiffness, Myosclerosis, Pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast, albuterol, Zyrtec
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: N/A
Diagnostic Lab Data: N/A - have not seen my PCP about it
CDC Split Type:

Write-up: Left deltoid pain, redness, and swelling much more than any prior dose. It worsened over the first week, resulting in an inability to raise my arm overhead without significant pain. I didn?t use the arm to workout for two weeks and the deltoid is still very stiff and painful to pressure at the injection site. ROM is improving. I did not see my PCP because I thought it was maybe an injury, but now I can feel the muscle and it is hard (like a rope) and still painful when I massage it. Did not happen with the two previous doses in the same arm and site.


VAERS ID: 1992527 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Audiogram abnormal, Deafness, Disturbance in attention, Ear pain, Emotional distress, Insomnia, Tinnitus
SMQs:, Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin daily
Current Illness:
Preexisting Conditions: IBS-D
Allergies: Augmentin (mild itchy rash)
Diagnostic Lab Data: Audiogram and exam: Audiogram shows high frequency hearing loss (unexplained); exam did not uncover any explanation for tinnitus and ear pain.
CDC Split Type:

Write-up: Sudden onset tinnitus (never had tinnitus before) within one day of vaccination, accompanied by intermittent inner ear pain. Following an audiogram and doctor''s exam, doctor determined that cause of tinnitus and inner ear pain is unknown. Tinnitus and ear pain continue, without treatment, increasing in severity, leading to loss of sleep, inability to focus at work, unable to hear some sounds, severe distress.


VAERS ID: 1995093 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 - / 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.MOD20214

Write-up: booster doses administered after expiration date; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (booster doses administered after expiration date) in a patient of an unknown age and gender 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 third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (booster doses administered after expiration date). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (booster doses administered after expiration date) had resolved. Not Provided For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Booster dose was administered in deltoid muscle. No concomitant medications was provided by the reporter. No treatment was provided by the reporter. This case was linked to MOD-2021-400510 (Patient Link).


VAERS ID: 1995217 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature, Cough, Ear pain, Head discomfort, Headache, Oropharyngeal pain, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to nuts
Allergies:
Diagnostic Lab Data: Test Date: 20211119; Test Name: Fever; Result Unstructured Data: Test Result:Unknown; Test Date: 20211122; Test Name: Fever; Result Unstructured Data: Test Result:2 degrees more than it usually
CDC Split Type: USPFIZER INC202101647372

Write-up: Her head feels heavy; Right sided runny nose; on her right side of the body such as ear pain/Right ear pain; Throat pain on right side; coughing; headache; fever; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from medical information team. The reporter is the patient. A 27 year-old female patient received bnt162b2 (BNT162B2), administered in arm left, administration date 17Nov2021 08:45 (Batch/Lot number: unknown) at the age of 27 years as dose 1, single for covid-19 immunisation. Relevant medical history included: "Tree nut allergy" (unspecified if ongoing). There were no concomitant medications. The following information was reported: EAR PAIN (non-serious) with onset 21Nov2021 06:00, outcome "recovering", described as "on her right side of the body such as ear pain/Right ear pain"; OROPHARYNGEAL PAIN (non-serious) with onset 21Nov2021 06:00, outcome "recovering", described as "Throat pain on right side"; HEADACHE (non-serious) with onset 19Nov2021 15:00, outcome "not recovered", described as "headache"; RHINORRHOEA (non-serious) with onset 21Nov2021 22:00, outcome "not recovered", described as "Right sided runny nose"; PYREXIA (non-serious) with onset 19Nov2021, outcome "unknown", described as "fever"; COUGH (non-serious) with onset 21Nov2021, outcome "recovering", described as "coughing"; HEAD DISCOMFORT (non-serious), outcome "unknown", described as "Her head feels heavy". Relevant laboratory tests and procedures are available in the appropriate section. Additional information: She has ear pain and throat pain that was pretty bad. Two days after it, she had fever, which was normal, and a headache. The next day the throat is pretty bad and then ear pain. All are on the right side of her body. The left side where she got vaccine. Right side throat and ear pain was Sunday. By Monday, it was getting a little worse and throat was bad and she was coughing. Today, she has a runny nose, which was still on same right side. She wanted to know if it was a side effect and was not seeing any listed online. Her head feels heavy. Her throat pain was slightly improved, but she has been drinking a lot of stuff and does not know if it was under control right now. Headache was on and off, and now she still has one. Before it was a full side and now it is only on the right side. Fever started on Friday. Yesterday night, she saw temperature on her watch was 2 degrees more than it usually was. She does not think right now she has a fever. She have not had bad coughs like this for over 2 years and she wants to know if these are reported side effects. History of all previous immunization with the Pfizer vaccine considered as suspect (or patient age at first and subsequent immunizations if dates of birth or immunizations are not available) was none. Additional vaccines administered on same date of the Pfizer suspect was none. AE(s) does not require a visit to emergency room/physician office. Prior vaccinations (within 4 weeks) If applicable, list any other vaccinations within four weeks prior to the first administration date of the suspect vaccine(s) was none. AE(s) following prior vaccinations was none. Family medical history relevant to AE(s) was none. Relevant tests done was none. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1995767 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-29
Onset:2021-11-19
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Biopsy bronchus abnormal, Blood beta-D-glucan normal, Bronchial wall thickening, Bronchiectasis, COVID-19, Chest pain, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Dyspnoea, Hypoxia, Immunology test normal, Laboratory test normal, Lung opacity, Mental status changes, Organising pneumonia, Oxygen saturation decreased, Pleuritic pain, Pneumonitis, SARS-CoV-2 test positive, Tachypnoea, Urine analysis normal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 29 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID PCR confirmed positive on 11/19/21
CDC Split Type:

Write-up: Pt presents to ED with worsening dyspnea. Patient has had persistent dyspnea since COVID infection in February and was placed on home O2 in September due to exertional hypoxemia. Over the past three days, wife states that he has had frequent desaturations into low 80s when getting up to go to bathroom or other activities, which causes patient to become anxious and tachypnic. Patient''s wife states his mental status fluctuates when he has desaturations and this has been happening more frequently. He does report of pleuritic chest pain and dry cough however these are not significantly worse over the past month or so. This evening, patient and wife state that he was becoming anxious, short of breath and felt as if he needed to come in. He denies any fevers/chills, night sweats, chest pain, productive cough, nausea/vomiting, abdominal pain, nausea/vomiting or diarrhea -Tested positive on 11/19. Previously diagnosed 2/2021 and underwent treatment. Received 2 doses of Moderna vaccine. -Has had extensive work up outpatient with pulmonary for chronic hypoxia after initial COVID-19 diagnosis. Recently started on steroid taper for organizing pneumonia. Bronch with biopsy 10/8 with chronic inflammation. -CT PE on admission with interval increase in GGOs throughout lungs with bronchial wall thickening, bronchiectasis, and peribronchial fibrotic changes; no PE. -Other infectious work up negative. Urine histo negative. Beta glucan and autoimmune work up negative -S/p course of Remdesivir until 11/24 and IV cefepime until 11/23 -S/p 14d course of baricitinib until 12/2 -As per rehab facility, patient will benefit from pulmonary rehab but denied by 1st facility and accepted at another facility for rehab -Also OPD referral for pulmonary rehab -Oxygen requirement stable on 4L NC currently (baseline~3-4L PTA at home) -Continue prednisone 40mg until outpatient local clinic follow up in 1mo -Continue PPI and PJP ppx with bactrim while on high dose steroids -Continue mucinex for cough, encourage incentive spirometry and PEP therapy -Discussed with IPAC, isolation removed on 12/11 (21 days from positive date) Discharge Disposition/Condition Disposition: Rehab facility Condition: Stable (s/sx potential problems absent or manageable)


VAERS ID: 1995768 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-11-19
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: suspect COVID breakthrough


VAERS ID: 1995793 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-11-19
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

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

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

Write-up: suspect COVID breakthrough


VAERS ID: 1995946 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Incorrect dose administered, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Covid Oct. 18th but unrelated.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Given a full dose instead of a half dose booster. Fever that night with a headache that continued the weekend. Sore arm. Nothing severe. Worst part was the headache that lasted all weekend.


VAERS ID: 1996090 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FKS127 / 1 RA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Abnormal behaviour, Condition aggravated, Contusion, Crying, Daydreaming, Dehydration, Epistaxis, Food refusal, Gait disturbance, Gastrointestinal infection, Headache, Indifference, Influenza virus test negative, Insomnia, Parosmia, Peripheral swelling, Pruritus, Pyrexia, Rash, Respiratory syncytial virus test negative, Respiratory tract congestion, Retching, Taste disorder, Throat irritation, Thrombosis, Upper-airway cough syndrome, Urticaria, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Thrombophlebitis (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Several reactions from newborn to age 5 (Flu. Hep A, DTAP, MMR, Hep B)
Other Medications: Vitamin C, D, NAC
Current Illness: No
Preexisting Conditions: Constipation. Post Nasal Drip.
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11/19 Injection. Swollen, painful bruised arm for days 11/21 (Sunday night) Not able to sleep. 11/22 (Monday): Still dark bruised arm. Bump under injection site. Stomach pain and unable to asleep 11/23 (Tuesday): Stomach pain during the night. Refused food in the morning. Bizarre behavior. Lasted a few days. 12/13 (Monday): Awake several hours during the night with a full itchy body that included little hives and bumps on torso and legs, and a lot of post nasal drip/throat clearing irritation. Itching lasted several days. 12/18 (Sunday): Stomach pain and not able to fall asleep. Woke up at 5, vomiting by 7am. 12/19 (Monday): Back to sleep around 9am. Up at 11, fever, stomach pain, back to sleep. Additional information for Item 18: 12/19 (Monday): Back to sleep around 9. Up at 11, fever, stomach pain, back to sleep. Woke up and unable to walk. Crying his body hurt so bad. Went to Children''s UC, then referred to ER. They said "GI Virus" and dehydration. Fever. My son has never had pain like this before - ever. 12/20 � 24 (Tuesday � Friday) Heavy congestion. Fever again on Thursday night. 12/24 (Friday) 2pm Bloody noses. With big clots. Mild fever. Just an hour prior he went from a happy little boy for Christmas to absent minded, aloof, dead look in his yes, buried face from family, doubled over stomach pain. 5pm, more of the same + head pain 8/10 scale. First responder friends provided initial direction of 30 minutes for headache to calm, then go to ER. Children''s recommended ER. We went to ER. Flu, CV, and RSV all negative. At this point I am looking back at last month of health abnormalities and suspect what we have seen is covid 19 pediatric vaccine reactions. For weeks my son has been complaining things taste or smell bad to the point he gags and refuses to eat or drink. Basic things like even filtered, tap, and well water. Allopathic providers dismissed concerns of correlation to cv19 vaccine, all other medical folks and observers did not dismiss. In 2018 I accepted my son was having reactions to previous ''normal'' vaccines. His father did not accept and mandated through Judge my son continue ''normal'' vaccination. As a mother I did not approve of this non FDA approved shot; his father did this behind my back.


VAERS ID: 1997486 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-25
Onset:2021-11-19
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Cerebrovascular accident, Hypoacusis, Myalgia, Tinnitus, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (narrow), 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: Multivitamin, Vitamin D3 2000iu/day, Fish oil 1200mg/day
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Tests on 12/7/21: ANTI-NUCLEAR AB(ANA)-QUANT - ANA TITER/PATTERN Value 160 homogeonous ANTI-NUCLEAR ANTIGEN (ANA) - Value "see titer" C REACTIVE PROTEIN (CRP) Value 0.27 mg/dl CBC and DIFF - All values normal except NEUTROPHILS % 78 and LYMPHOCYTES % 14 COMPREHENSIVE METABOLIC PANEL - All values normal TSH WITH FREE T4 REFLEX 3.02 SED RATE - 15 mm/hr Tests on 12/9/21: JO 1 ANTIBODIES <0.2 Interpretation: Negative RHEUMATOID FACTOR (RF) <10 ANTI-DNA - DNA double strand AB titer value <10 ANTI SSA ANTI SSB AB - Anti-SSA value <0.2 Interpretation: Negative, Anti-SSB value <0.2 Interpretation: Negative ANTI SMITH (SM) ANTI RNP AB - Anti-Smith value <0.2 Interpretation: Negative, Anti-RNP value <0.2 Interpretation: Negative SCL 70 ANTIBODIES - SCL70 Ab value 0.2 Interpretation: Negative CENTROMERE ANTIBODIES - value <0.2 Interpretation: Negative C3 (COMPLEMENT 3) value 98.0 mg/dl C4 (COMPLEMENT 4) value 32.0 mg.dl ELECTROPHORESIS SERUM PROTEIN - Interpretation value - Normal eletrophoretic pattern PROTEIN/CR RATIO, UR RAN - Protein, Random value <4 mg/dl, Creatinine, Random value 21 mg/dl Tests on 12/22/21: PARVOVIRUS B19 AB IGG/IGM - Parvovirus IgG Negative, Parvovirus IgM Negative CCP IGG ANTIBODY value 0.9 U/mL
CDC Split Type:

Write-up: 11/19/2021 - Left ear started ringing loudly. 11/24/2021 - Woke up from a nap with blurred vision and both ears ringing very loudly. Went to Urgent Care. They determined I wasn''t having a stroke, didn''t see anything unusual with the ears, suspected maybe a t-shirt touching my face affected the vision, and I was sent home. The vision gradually improved but the loud ringing continued. 11/27/2021 - The left ear sounded muffled and developed an echo. The loud tinnitus continued. 11/29/2021 - Developed muscle and joint pain in my neck, jaw, fingers, thumb joints, wrists, as well as my right shoulder and right knee. 12/2/2021 - Negative Covid test 12/7/2021 - Woke up in the middle of the night with a buzzing sensation in my body, loud tinnitus, swollen joints, and stiff fingers. I saw the doctor at the clinic who ordered labs to check inflammatory markers, diabetes, and thyroid. He prescribed Voltaren gel. 12/16/2021 - Negative Covid test 12/22/21 - The pain and fatigue continued with only slight improvement. Met with a doctor, an immunologist, to go over the labs and discuss possible causes. She considered an adverse reaction to the Moderna booster, a breakthrough covid infection, and a Parvo infection. I tested negative for Covid twice and also tested negative for Parvo, Rheumatoid arthritis, lupus, multiple myloma, MS, diabetes, and thyroid problems. 1/1/2022 - I still have tinnitus, reactive arthritis, and fatigue. I''m unable to engage in previous activities like working out or walking my dog.


VAERS ID: 1998435 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-24
Onset:2021-11-19
   Days after vaccination:299
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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: AMLODIPINE; DEPAKOTE; GLIPIZIDE; LABETALOL
Current Illness: Chronic kidney disease; Depression; Drug allergy (Januvia); Drug allergy (abilify); Hypertension; Type 2 diabetes mellitus
Preexisting Conditions: Medical History/Concurrent Conditions: Syncope
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Dose given greater than 12 hours post vial puncture; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose given greater than 12 hours post vial puncture) in a 76-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Syncope. Concurrent medical conditions included Drug allergy (abilify), Drug allergy (Januvia), Hypertension, Type 2 diabetes mellitus, Chronic kidney disease and Depression. Concomitant products included AMLODIPINE, VALPROATE SEMISODIUM (DEPAKOTE), GLIPIZIDE and LABETALOL for an unknown indication. On 24-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Feb-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, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose given greater than 12 hours post vial puncture). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Dose given greater than 12 hours post vial puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No treatment details were provided concomitant medication included as AbN. This case was linked to MOD-2021-416295 (Patient Link).


VAERS ID: 1998436 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-26
Onset:2021-11-19
   Days after vaccination:297
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / 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: NORVASC; MULTAQ; NAMENDA
Current Illness: Chronic kidney disease; Dementia; Drug allergy (Restyl); Drug allergy (Remeron); Hypertension; Insomnia; Latex allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: booster given greater than 12 hours post vial puncture; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (booster given greater than 12 hours post vial puncture) in a 97-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for an unknown indication. Concurrent medical conditions included Drug allergy (Remeron), Drug allergy (Restyl), Latex allergy, Dementia, Chronic kidney disease, Insomnia and Hypertension. Concomitant products included AMLODIPINE BESILATE (NORVASC), DRONEDARONE HYDROCHLORIDE (MULTAQ) and MEMANTINE HYDROCHLORIDE (NAMENDA) for an unknown indication. On 26-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Feb-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, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (booster given greater than 12 hours post vial puncture). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (booster given greater than 12 hours post vial puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medication includes Senna. No treatment drugs were reported. This case was linked to MOD-2021-416295.


VAERS ID: 1998462 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-01-24
Onset:2021-11-19
   Days after vaccination:299
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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: ATORVASTATIN; DILANTIN [PHENYTOIN]; ELIQUIS; LASIX [FUROSEMIDE]; LACTULOSE
Current Illness: AFib; Congestive heart failure
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Booster given greater than 12 hours after vial was punctured; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Booster given greater than 12 hours after vial was punctured) in a 69-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Congestive heart failure and AFib. Concomitant products included ATORVASTATIN, PHENYTOIN (DILANTIN [PHENYTOIN]), APIXABAN (ELIQUIS), FUROSEMIDE (LASIX [FUROSEMIDE]) and LACTULOSE for an unknown indication. On 24-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Feb-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, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (Booster given greater than 12 hours after vial was punctured). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Booster given greater than 12 hours after vial was punctured) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered EXPIRED PRODUCT ADMINISTERED (Booster given greater than 12 hours after vial was punctured) to be not related. No treatment information was reported. This case was linked to MOD-2021-416295 (Patient Link).


VAERS ID: 1998464 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-24
Onset:2021-11-19
   Days after vaccination:299
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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: CLONIDINE; FENTANYL; HYDRALAZINE; LEVSIN; SENNA [SENNOSIDE A+B]
Current Illness: Acute kidney failure (AKF); Type 2 diabetes mellitus (DMT2)
Preexisting Conditions: Medical History/Concurrent Conditions: Dementia; Multiple fractures (Multi Fx)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Dose given 12 hours after the puncture; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose given 12 hours after the puncture) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Multiple fractures (Multi Fx) and Dementia. Concurrent medical conditions included Type 2 diabetes mellitus (DMT2) and Acute kidney failure (AKF). Concomitant products included CLONIDINE, FENTANYL, HYDRALAZINE, HYOSCYAMINE SULFATE (LEVSIN) and SENNOSIDE A+B (SENNA [SENNOSIDE A+B]) for an unknown indication. On 24-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Feb-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, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose given 12 hours after the puncture). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Dose given 12 hours after the puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No treatment medications reported. No adverse outcomes noted. It was reported that dose was given greater than 12 hours after the vial was punctured. This case was linked to MOD-2021-416295 (Patient Link).


VAERS ID: 1998468 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-23
Onset:2021-11-19
   Days after vaccination:269
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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: COREG; GABAPENTIN; KEPPRA [LEVETIRACETAM]; MIRALAX
Current Illness: Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Booster given greater than 12 hours after vial was punctured; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Booster given greater than 12 hours after vial was punctured) in a 97-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Hypertension. Concomitant products included CARVEDILOL (COREG), GABAPENTIN, LEVETIRACETAM (KEPPRA [LEVETIRACETAM]) and MACROGOL 3350 (MIRALAX) for an unknown indication. On 23-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Mar-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 EXPIRED PRODUCT ADMINISTERED (Booster given greater than 12 hours after vial was punctured). On 19-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Booster given greater than 12 hours after vial was punctured) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No treatment medications were reported. This case was linked to MOD-2021-416295.


VAERS ID: 1999002 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 034F21A / 3 RA / IM

Administered by: Other       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? 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: N/A
CDC Split Type:

Write-up: Moderna booster administered at the clinic on 11/19/21 was expired (Moderna recommends vials be used within 12 hours of opening). No treatment needed. No adverse side effects.


VAERS ID: 1999020 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 034F21A / 3 RA / IM

Administered by: Other       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: N/A
CDC Split Type:

Write-up: Moderna booster administered at the clinic on 11/19/21 was expired (Moderna recommends vials be used within 12 hours of opening).


VAERS ID: 1999177 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-08
Onset:2021-11-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: My 2 previous Moderna vaccinations: 2/9/2021 Moderna vaccination, age 66 3/9/2021 Moderna vaccination, age 66 Delayed urticaria
Other Medications: Symbicort 80, adderall 5mg, levothyroxine .075mg, vitamin c 1000mg, magnesium citrate 225mg, vitamin d3 2000mg, melatonin 3mg
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: Penicillin, seasonal, mold
Diagnostic Lab Data:
CDC Split Type:

Write-up: Full body urticaria (hives) that lasted for more than 3 weeks. Extreme itching.


VAERS ID: 1999201 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site discolouration, Injection site erythema, Injection site reaction, Livedo reticularis, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Within 24 hours developed erythema at the injection site that covered the majority of the deltoid. Rash was not bothersome and he had no other symptoms. Erythema gradually changed to a mottled pattern that is reddish purple. Rash has not decreased in size though has potentially faded a little bit. Parents are observing rash at home. No interventions.


VAERS ID: 1999350 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

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

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

Write-up: Global urticaria, still ongoing to this date, the rash will come and go on all parts of my body, it is painful and itchy


VAERS ID: 1999593 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-29
Onset:2021-11-19
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Crestor Calcium +D Women''s Multi Fish Oil
Current Illness: none
Preexisting Conditions: High Cholesterol
Allergies: Penicillin
Diagnostic Lab Data: Blood pressure check in Doctors office - on Nov 20, 2021. Still very high. Prescribed medication which has brought the BP down, but it is still elevated and somewhat erratic.
CDC Split Type:

Write-up: Extremely high blood pressure. Not noticed until it hit 176/102 and I was very dizzy. Up until this time, my blood pressure had not been a concern.


VAERS ID: 2001387 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-16
Onset:2021-11-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Blood test normal, Breast pain, Cardiac flutter, Cardiac stress test normal, Chest X-ray normal, Chest pain, Condition aggravated, Echocardiogram, Electrocardiogram normal, Lymph node pain, Lymphadenopathy, Pain, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: 2nd dose of Pfizer 04/09/2021- swollen lymph nodes under left arm and L breast was out of proportion to the right. L arm I could
Other Medications: Hyzaar 100mg combination 100mg/12.5mg once daily Hydrochlorothiazide 12.5mg once daily Crestor 10mg once daily Pepcid OTC once daily Pro Air inhaler 4 puffs daily as needed
Current Illness: None
Preexisting Conditions: Asthma (under control), High blood pressure, High cholesterol
Allergies: Rice
Diagnostic Lab Data: Chest X-ray - negative EKG - negative Stress test - negative Ultrasound of Heart - negative Blood work for clots - negative
CDC Split Type: vsafe

Write-up: 2-3 days after receiving my booster, my arm was really sore up underneath my left armpit. My lymph nodes were really swollen. This happened during the 2nd vaccine as well. I didn?t worry about it because they went away and they did. Then on 11/19, I felt sharp pains every 2-3 minutes where my lymph nodes are, into my breast and into the center of my chest. It was bothersome when I would walk. And I put it off for a while because I was afraid to go to the hospital at the time. I went to the doctor, and they gave me some antibiotics and gave me amoxicillin and that was 875 mg. I think it was 2-3 days after that, I just went to the ER because my heart was fluttering, racing, and I was in pain. It got to the point where I had to go because I wanted to know what that was. I went to the ER on New Years in the morning. They did a chest x-ray, EKG, stress test, ultrasound of the heart and everything came back negative. When I spoke to Dr., he said that sometimes the vaccine can have that affect on you where your heart can race and flutter. It was scary.


VAERS ID: 2005441 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-09
Onset:2021-11-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Pain in extremity, Tinnitus
SMQs:, Hearing impairment (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient experiencing pain in knees and feet that comes and goes in the night time when she is sleeping.. Almost two months after vaccination patient reports tiredness and ringing in ears that has not resolved. Patient had a well visit on 11-30-2021 with primary care physician who stated she does not know if it was related to the vaccination.


VAERS ID: 2005893 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml. Patient was not aware and never reported any side effects after injection. This error was caught while checking the scripts a few days later.


VAERS ID: 2005914 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2005955 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2005970 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2005981 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2006143 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2006156 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

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

Write-up: Administered 0.5mL instead of the 0.25mL dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2006163 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2006175 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2006185 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2006209 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2006216 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2006246 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2006253 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-15
Onset:2021-11-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

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

Write-up: Administered 0.5ml instead of the 0.25ml dose. Patient is not aware of the error and never reported any side effects or adverse reactions.


VAERS ID: 2008823 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Burning sensation, Ear discomfort, Gait disturbance, Mobility decreased, Muscular weakness, Pain, Pain in extremity, Paraesthesia, Ultrasound Doppler, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Thimerosal, Penicillin
Diagnostic Lab Data: (12/21/2021) Ultrasound Vein /Vascular ultrasound (both legs) (12/29/2021) Blood work & urine (11/29/2021) Visit with spine/back doctor and waiting to schedule nerve test and potential MRI
CDC Split Type:

Write-up: Tingling fingers (both hands), tingling toes (both feet), tingling back & outside of both legs, tingling top of thighs both legs. Also Burning fingers, burning top of both feet Also Wrist weakness. Also Shooting pain in legs. Occasional pressure both ears. Trouble walking and lifting things Severity varies day by day.


VAERS ID: 2014009 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-22
Onset:2021-11-19
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Chest pain, Dyspnoea exertional
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Known history of ASCVD. The patient was admitted for further evaluation and treatment of acute STEMI associated with symptoms of chest pain and shortness of breath with exertion. ED visit and hospital admission. This visit was within 6 weeks of receiving the COVID vaccine.


VAERS ID: 2014586 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 RA / IM

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

Write-up: Pt received 0.25ml of Moderna that was opened longer than the recommended time. No adverse effects noted. Dr and pt. notified. Per Moderna no additional booster recommended.


VAERS ID: 2014594 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 RA / IM

Administered by: Other       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: end stage renal disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. received 0.25ml of Moderna from a vial that was opened beyond the recommended time. No adverse effects noted. Dr and pt. notified. Per Moderna no additional booster recommended.


VAERS ID: 2014611 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

Administered by: Other       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: end stage renal disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. received 0.25ml of Moderna from a vial that was opened beyond the recommended time. No adverse effects noted. Dr and pt. notified. Per Moderna no additional booster recommended.


VAERS ID: 2017831 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-22
Onset:2021-11-19
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None yet have 2 doctor appointments scheduled I was waiting to see if it would stop
CDC Split Type:

Write-up: I had been post menopause for one year but after receiving my first shot started spotting 1 day later on and off . 2 weeks after the second shot started bleeding heavily and have now had 3 heavier than I have ever had periods 27/28 days apart


VAERS ID: 2018319 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Immunisation, Product use issue, Sleep disorder, Tinnitus
SMQs:, Hearing impairment (narrow), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101797318

Write-up: buzzing/humming and hissing sound in ears; It affects sleep patterns; it became much worse within 24-48 hours after this 3rd dose; booster vaccine; Other vaccine same date vaccine date 19Nov2021; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 71 year-old male patient received bnt162b2 (BNT162B2), administered in arm left, administration date 19Nov2021 11:00 (Lot number: 320308D) at the age of 71 years as dose 3 (booster), single for covid-19 immunisation; influenza vaccine inact sag 4v (FLUAD QUAD), administered in arm right, administration date 19Nov2021 (Batch/Lot number: unknown) as dose 3, single. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Bnt162b2 (Dose Number: 1, Batch/Lot No: EW0171, Location of injection: Arm Left, Administration date:28Apr2021, Vaccine Administration Time: 11:00 AM), administration date: 28Apr2021, when the patient was 71 years old, for COVID-19 Immunization, reaction(s): "buzzing and humming sounds in ears"; Bnt162b2 (Dose Number: 2, Batch/Lot No: EW0185, Location of injection: Arm Left, Administration date:05May2021, Vaccine Administration Time: 10:45 AM, Adverse event start date: 08May2021), administration date: 05May2021, when the patient was 71 years old, for COVID-19 Immunization, reaction(s): "buzzing and humming sounds in ears", "First dose: 28Apr2021; Second dose: 05May2021". The following information was reported: IMMUNISATION (non-serious) with onset 19Nov2021 11:00, outcome "unknown", described as "booster vaccine"; PRODUCT USE ISSUE (non-serious) with onset 19Nov2021, outcome "unknown", described as "Other vaccine same date vaccine date 19Nov2021"; TINNITUS (non-serious), outcome "not recovered", described as "buzzing/humming and hissing sound in ears"; SLEEP DISORDER (non-serious), outcome "not recovered", described as "It affects sleep patterns"; CONDITION AGGRAVATED (non-serious), outcome "unknown", described as "it became much worse within 24-48 hours after this 3rd dose". Therapeutic measures were not taken as a result of tinnitus, sleep disorder. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been 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 any other medications in two weeks. The patient had no known allergies. Within 14 days of vaccine #1 on 28Apr2021 had buzzing and humming sounds in ears. Stayed about same even after vaccine dose #2 on 19May2021. Was an annoyance for most part but something new that I did not have until after the 1st Pfizer vaccine. However, after the booster vaccine on 19Nov2021 it became much worse within 24-48 hours after this 3rd dose. It persists to this date and is louder with buzzing/humming and hissing sound in ears. At times seems to be more piercing sound. I looked on internet and did find that some Covid vaccine recipients experienced these sounds and even tinnitus with ringing in ears. I am not sure if I would describe it ringing, but it is a very annoying sound and is constant. It affects sleep patterns due to this persisting sound when everything should be quiet and ready to sleep. I take no medications or prescriptions, but I would say this is a side effect of the vaccines, much like some people taking meds have side effects. No Treatment was received. No follow-up attempts are possible. No further information is expected.


VAERS ID: 2018524 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 - / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Headache, Immunisation, Nasal congestion, Pain, Polymerase chain reaction, Rhinorrhoea, SARS-CoV-2 test, Vaccination failure
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211217; Test Name: PCR; Test Result: Negative ; Comments: Nasal Swab; Test Date: 20211220; Test Name: PCR; Result Unstructured Data: Test Result:Unknown result; Comments: Nasal Swab; Test Date: 20211217; Test Name: Rapid; Test Result: Negative ; Comments: Nasal Swab; Test Date: 20211220; Test Name: Rapid; Test Result: Positive ; Comments: Nasal Swab; Test Date: 20211222; Test Name: Rapid; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101844718

Write-up: Breakthrough Covid-19 infection; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP) from product quality group. The reporter is the patient. A 27 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), intramuscular, administration date 19Nov2021 (Lot number: FD0809) at the age of 27 years as dose 3 (booster), single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. Past drug history included: No. Vaccination history included: Bnt162b2 (Dose Number: 2, Batch/Lot No: EP6955, Route of Administration: Intramuscular), administration date: 10Apr2021, when the patient was 27 years old, for COVID-19 Immunization; Bnt162b2 (Dose Number: 1, Batch/Lot No: EP6955, Route of Administration: Intramuscular), administration date: 20Mar2021, when the patient was 27 years old, for Covid-19 immunization. The following information was reported: immunization, vaccination failure, pain, fatigue, headache, cough, nasal congestion and rhinorrhea all not recovered with onset 19Dec2021. Therapeutic measures were taken as a result of immunisation, covid-19, vaccination failure, pain, fatigue, headache, cough, nasal congestion, rhinorrhoea. Additional information: Patient was treated with Dayquil every 4 hours. Patient was not Covid prior vaccination. Investigational results of RA: The investigation included a review of manufacturing and packaging batch records, deviation investigations, and an analysis of complaint history for the reported lot. The final scope included the reported finished goods lot EP6955, fill lot EP6954, and the formulated drug product lot EP6953. A complaint sample was not returned, and photographs were not received. No related quality issues were identified during the investigation. There is no impact to product quality. No root cause or corrective/preventative actions were identified as the complaint was not confirmed. All release testing performed prior to the release of the reported batch was within specifications.


VAERS ID: 2018864 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-12
Onset:2021-11-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alopecia
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Sulfonamide allergy (Known allergies: Sulfa drugs)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101886132

Write-up: My hair started to noticeably thin after the second shot. Is now much worse and is not stopping.; This is a spontaneous report from a contactable reporter (consumer or other non HCP). The reporter is the patient. A 63-year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in left arm, administration date 12Nov2021 at 12:00 (Lot number: unknown) at the age of 63 years as dose 2, single for COVID-19 immunisation. Relevant medical history included: "Sulfonamide allergy" (unspecified if ongoing), notes: Known allergies: Sulfa drugs. There were no concomitant medications. Vaccination history included: Bnt162b2 (DOSE 1, SINGLE, Lot Number: UNKNOWN), administration date: 22Oct2021, when the patient was 63 years old, for COVID-19 immunisation. The following information was reported: ALOPECIA (non-serious) with onset 19Nov2021, outcome "not recovered", described as "My hair started to noticeably thin after the second shot. Is now much worse and is not stopping". Therapeutic measures were not taken as a result of alopecia. Additional Information: The patient did not receive any other vaccines within four weeks prior to COVID-19 vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The events did not result in doctor or other healthcare professional office/clinic visit, and emergency room/department or urgent care. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 2020511 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: FISICAL EVALUATION 12-23-2021
CDC Split Type:

Write-up: URTICARIA


VAERS ID: 2021010 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fear of injection
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Starting at 12:55 pm, the patient reported feeling dizzy that lasted intermittently until 1:25 pm. She also reported having a fear of needles. It was recommended to call a family member, to pick up. The patient left with Familiar at 1:35 pm without dizziness. Sat 100% pulse 97.


VAERS ID: 2021413 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-16
Onset:2021-11-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Headache, Injection site erythema, Injection site induration, Lymphadenopathy, Neck pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Lipodystrophy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Hardened area at injection site, severely red, pain going into left breast and neck, swollen lymph nodes, and headache. Healthcare professional questioned Polyethylene glycone.


VAERS ID: 2021795 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-09
Onset:2021-11-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Deep vein thrombosis, Imaging procedure abnormal, Ultrasound Doppler abnormal
SMQs:, 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), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: pantoprazole, lasix, proair, prednisone, xarelto
Current Illness: back pain, HTN, OSA, Rheumatoid arthritis,
Preexisting Conditions: back pain, rheumatoid arthritis, osa, htn
Allergies: cipro, sulfa
Diagnostic Lab Data: imaging of brain and leg
CDC Split Type:

Write-up: 10 days after pt received the pfizer covid booster he sustained a stroke and a DVT.


VAERS ID: 2023705 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Laryngitis, Nasal congestion, Nasopharyngitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Rheumatoid Arthritis, Sjogren''s Syndrome, Spinal Stenosis.
Preexisting Conditions: Rheumatoid Arthritis, Sjogren''s Syndrome, Spinal Stenosis.
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: The next day developed laryngitis, annd stuffy nose/head like a bad cold. This was following my Booster shot.


VAERS ID: 2024617 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril 5 mg, atorvastatin 20 mg, meclizine 12.5 mg prn, multivitamin, fish oil 1200 mg daily, calcium-vitamin D BID, pepcid 20 mg prn
Current Illness: none
Preexisting Conditions: HTN, HLD, hyponatremia, glaucoma, CKD stage 3a
Allergies: Augmentin-diarrhea
Diagnostic Lab Data: none
CDC Split Type:

Write-up: She developed a red rash with itching under the injection site. Rash lasted about 1 month. No SOB, lip swelling, or hives.


VAERS ID: 2024640 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hypoglycaemia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (narrow)

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

Write-up: Patient reports feeling dizzy, mother indicates she is hypoglycemic and ate more than 3 hours ago. Doctor is notified, snack is offered and is monitored according to medical order.


VAERS ID: 2025187 (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: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21 / 3 LA / IM

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

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

Write-up: EXTRACTION OF THE MODERNA VACCINE FROM THE VIAL WAS NOT CONSISTENT WITH A MODERNA TECHNIQUE (I.E. MORE THAN 20 BOOSTER DOSES WERE DRAWN UP FROM THE 15ML VIAL).


VAERS ID: 2025346 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Wrong technique in product usage process
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: NONE
CDC Split Type:

Write-up: EXTRACTION OF THE MODERNA VACCINE FROM THE VIAL WAS NOT CONSISTENT WITH A MODERNA TECHNIQUE (I.E. MORE THAN 20 BOOSTER DOSES WERE DRAWN UP FROM THE 15ML VIAL).


VAERS ID: 2027405 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Immunisation, Infarction, Insomnia
SMQs:, Myocardial infarction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hyperlipidemia; Penicillin allergy
Allergies:
Diagnostic Lab Data: Test Name: EKG; Result Unstructured Data: Test Result:Abnormal; Comments: This time it was Abnormal, and it showed I had an infarction; Test Name: EKG; Result Unstructured Data: Test Result:Normal; Comments: Before the vaccinations my EKG was normal
CDC Split Type: USPFIZER INC202101878249

Write-up: I had an infarction; chest pain; was not able to sleep; booster; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 63 year-old female patient received bnt162b2 (BNT162B2), administered in arm left, administration date 19Nov2021 10:30 (Lot number: 330308D) at the age of 63 years as dose 3 (booster), single for covid-19 immunisation. Relevant medical history included: "Hyperlipidaemia" (unspecified if ongoing); "known allergies: pcn" (unspecified if ongoing). The patient''s concomitant medications were not reported. Past drug history included: Amoxicillin, reaction(s): "known allergies: Amoxicillin"; Known allergies: vicodin, reaction(s): "Drug allergy". Vaccination history included: Bnt162b2 (Dose Number: 2, Batch/Lot No: EW0164, Location of injection: Arm Left, Vaccine Administration Time: 11:15 AM), administration date: 21Apr2021, when the patient was 62 years old, for Covid-19 immunization; Bnt162b2 (Dose Number: 1, Batch/Lot No: ER8732, Location of injection: Arm Left, Vaccine Administration Time: 10:45 AM), administration date: 31Mar2021, when the patient was 62 years old, for Covid-19 immunization. The following information was reported: IMMUNISATION (medically significant) with onset 19Nov2021 10:30, outcome "unknown", described as "booster"; INFARCTION (medically significant) with onset 19Nov2021 12:15, outcome "not recovered", described as "I had an infarction"; CHEST PAIN (non-serious) with onset 19Nov2021 12:15, outcome "not recovered", described as "chest pain"; INSOMNIA (non-serious) with onset 19Nov2021 12:15, outcome "not recovered", described as "was not able to sleep". The events "i had an infarction", "chest pain" and "was not able to sleep" were evaluated at the physician office visit. The patient underwent the following laboratory tests and procedures: electrocardiogram: abnormal, notes: This time it was Abnormal, and it showed I had an infarction; normal, notes: Before the vaccinations my EKG was normal. Therapeutic measures were not taken as a result of infarction, chest pain, insomnia. Additional information: The patient was experiencing chest pain the day of and the day after I received my booster. I was not able to sleep whatsoever. I went to the Doctor and an EKG was done. Before the vaccinations my EKG was normal However this time it was Abnormal, and it showed I had an infarction. No other vaccine in four weeks. No covid prior vaccination. No covid tested post vaccination. No follow-up attempts are possible. No further information is expected.


VAERS ID: 2028369 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-17
Onset:2021-11-19
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Dyspnoea, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and has had his booster for coronavirus. Positive COVID test 11/19/2021. Admission dx: shortness of breath, COPD, hypoxemia requiring supplemental oxgen, COVID 19 infection.He developed Cova 19 pneumonia. He progressively worsened. He developed acute hypoxic respiratory failure. He was treated medically and had slow clinical improvement. Treatment: decadron, remdesivir, supplemental oxygen. He qualified for 3 L on discharge. He is discharged to home. He will be staying with his daughter who will help with his recovery.


VAERS ID: 2028489 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-11-19
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, COVID-19, COVID-19 pneumonia, Chest X-ray normal, Fatigue, Fibrin D dimer increased, Nausea, Palpitations, SARS-CoV-2 test positive, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated. Patient is COVID + on 11/19/2021. 81y.o. female who came to the ER with nausea/emesis with fatigue and weakness. CXR was negative for acute processes. She has been on room air. D dimer 609. Admission Dx: palpitations, AKI, pneumonia due to COVID. She improved with conservative management with steroids, lovenox. No need for any Decadron or remdesivir at present. Started the patient on Lovenox 40 mg once a day for DVT prophylaxis. She was discharged home once cleared by all services.


VAERS ID: 2028544 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-10
Onset:2021-11-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Alopecia, Condition aggravated, Lymphadenopathy, Pruritus, Psoriasis, Rash, Skin burning sensation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HIGH CHOLESTERAL
Preexisting Conditions: NONE
Allergies: VANCOYMICIN, ASPRIAN, SULFATES, CITRUS FRUITS
Diagnostic Lab Data: CHECKING OUT TISSUE
CDC Split Type:

Write-up: BOOSTER ON NOV 10, 2021. FELT FINE UPON LEAVING CLINIC. WITHIN 12 DAYS, I DEVELOPED HUGH NODULES THROUGHOUT MY LYMPATHIC SYSTEM. IN MY NECK, MY HEAD, MY INNER THIGHS, MY ABDOMEN. MY SKIN DEVELOPED A RASH WITHIN 3 HOURS OF LYMPH NODES. RASH ALL OVER MY TORSO, BACK, SCALP, ARMS, LEGS. VAGINAL AND BUTTOCK.S THE ITCH WAS HORRID AND INTENSE, ALL NIGHT. I WENT TO 2 DOCTORS.. RECEIVED A SERIES OF PREDISOINE. ONE DAY AFTER PERSCRIPTION ENDED. RASH WAS WORSE THEN EVER. HORRIBLE. WENT TO DERMATOLOTIST. HE LOOKED AT RASH AND SAID IT WAS PSORASIS. ALL OVER. IN THE PAST, IN MY 40''S I HAD VERY MILD PSORASIS ON MY SCALP, NECK AND ELBOWS. NOTHING LIKE THIS EVER. MY WHOLE BODY WAS INFECTED WITH PSORASIS. THE DOCTOR DID NOT WANY ANY MORE PREDISONE. HE GAVE ME A STERIOD CREAM. AND WANTED ME TO USE THEIR UVB LIGHT. MY RASH HAS LIGHTENED UP, BUT IT IS STILL HORRIBLE. MY LEGS, MY BODY LOOK AWFUL. I STARTED LOSING MY HAIR WHEN THE RASH FIRST APPEARED. THAT IS STILL GOING ON.. HORRIBLE HAIR LOSS, LIKE A CHEMO PATIENT. NOTHING LIKE THIS HAS EVER HAPPENED TO ME. MY SKIN STILL BURNS. THIS VACINNE DID THIS TO ME. I AM WORKING ON ALL KINDS OF HOMEOPATHIC REMEDIES. THIS IS AWFUL. I COULD NOT TAKE MODERNA, DUE TO VANCOMYCIN REACTION 13 YEARS AGO. JAND J WAS MY ONLY OPTION. CLEARLY I WILL NEVER TAKE THIS AGAIN. PEOPLE NEED TO BE INFORMED OF SKIN REACTIONS.,THIS IS NOT RIGHT.


VAERS ID: 2028708 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphonia, Influenza, Nasopharyngitis, Pain, Respiratory tract congestion, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

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

Write-up: Within 24 hours arm started to swell, became tender and sore, cold/flu symptoms, a change in the voice, and congestion. Healthcare professional advised not to get 2nd dose of vaccination.


VAERS ID: 2031053 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-11-19
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101627425

Write-up: Had a cold/allergies for two weeks; Had a cold/allergies for two weeks; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). Other Case identifier(s): US-PFIZER INC-202101627441 (Pfizer). A patient (no qualifiers provided) received bnt162b2 (BNT162B2) (Batch/Lot number: unknown) as dose 1, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: NASOPHARYNGITIS (non-serious), HYPERSENSITIVITY (non-serious) all with onset 19Nov2021, outcome "unknown" and all described as "Had a cold/allergies for two weeks". Additional information: One of the hosts said had a cold/allergies for two weeks, that they were unsure which one. They did not have a sore throat or fever, and sneezed at least once on the show. The other host is a hypochondriac and also thought was getting sick. Likely both individuals are vaccinated. The show released 24Jun2021. Individual has gone through approximately 75 tissues in 37 mins of episode. Approximately one full 65 tissues tissue box plus around 10 more tissues. Had listened to podcast yesterday, but did not hear this. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 2031914 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Chills, Feeling abnormal, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Hypertension (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Armodafinil; aspirin; Imuran; Symbicort; vitamin D3; Lexapro; Flonase; folic acid; lisinopril; metformin; methylphenidate; Singulair; multivitamin Centrum Silver 50 Plus; Crestor; sodium oxybate; Incruse Ellipta; Nucala; albuterol sol./inha
Current Illness: None
Preexisting Conditions: Diabetes; Hypertension; Depression; Back problems; Churg-Strauss Syndrome; Severe Asthma,
Allergies: Allucate; adhesive on tape
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: I felt funny. I started to shiver but I was sweating. My blood pressure rose and I was rushed to the ER and was given fluids, Benadryl and steroids and an epipen.


VAERS ID: 1888978 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN ABZ 5320 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Oedema, Rash, Rash erythematous, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Rash started within 48 hours of vaccination, spread from a spot on L lateral side of neck to entire anterior neck, from clavicle to mandible and up to mastoid processes behind both ears, edema present with rash. Rash is very hot and red.


VAERS ID: 1889165 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Dyspnoea, Fatigue, Feeling hot, Headache, Nausea, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: Asthma and Tachycardia
Allergies: Codeine, Soma and tape
Diagnostic Lab Data: No testing was one,
CDC Split Type:

Write-up: Serve headaches, hot/cot chills, body aches to the point hurts to laydown, fatigue, nausea chest pain and shortness of breathe. I took Tylenol, Ibuprofen every 4hrs alternating and Vit C,D and Zinc. My symptoms last for 2 1/2 day on all times of vaccines.


VAERS ID: 1894073 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 092D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest pain, Dyspnoea, Electrocardiogram abnormal, Myocarditis
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Myocarditis was diagnosed. Chest pain, trouble breathing one day after receiving vaccine.


VAERS ID: 1903172 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNK / UNK - / -
DTAPIPV: DTAP + IPV (UNKNOWN) / UNKNOWN MANUFACTURER UNK / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia, Nausea, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient has not had symptoms associated with COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210103; Test Name: COVID-19 virus test; Result Unstructured Data: (Test Result:No - Negative COVID-19 test,Unit:unknown,Normal Low:,Normal High:)
CDC Split Type: GBGLAXOSMITHKLINEGB202123

Write-up: Headache; Nausea; Muscle pain; Fatigue extreme; Case received by GSK via RA on 21st November 2021. This case was reported by a consumer via regulatory authority and described the occurrence of headache in a female patient who received DTPa-IPV (DTPa-IPV) for prophylaxis. Co-suspect products included TOZINAMERAN (BIONTECH COVID-19 MRNA VACCINE) for prophylaxis. Previously administered products included COVID-19 VACCINE ASTRAZENECA (on 2nd March 2021, patient received COVID-19 VACCINE ASTRAZENECA) and COVID-19 VACCINE ASTRAZENECA (on 2nd May 2021, patient received COVID-19 VACCINE ASTRAZENECA). Additional patient notes included Patient has not had symptoms associated with COVID-19. On an unknown date, the patient received DTPa-IPV (unknown). On 18th November 2021, the patient received BIONTECH COVID-19 MRNA VACCINE (unknown). On 19th November 2021, unknown after receiving DTPa-IPV, the patient experienced headache (serious criteria other: Serious as per reporter), nausea (serious criteria other: Serious as per reporter), muscle pain (serious criteria other: Serious as per reporter) and fatigue extreme (serious criteria other: Serious as per reporter). On 20th November 2021, the outcome of the headache and nausea were recovered/resolved. On an unknown date, the outcome of the muscle pain and fatigue extreme were not recovered/not resolved. It was unknown if the reporter considered the headache, nausea, muscle pain and fatigue extreme to be related to DTPa-IPV. Additional details were provided as follow: The age at vaccination was unknown. On 3rd January 2021, patient was tested negative for COVID 19 virus test. The duration for headache, nausea was 1 day. Time to onset for headache, nausea, muscle pain and fatigue was 1 day with respect to suspect BIONTECH COVID-19 MRNA VACCINE. It was unknown if the reporter considered the headache, nausea, muscle pain and fatigue to be related to BIONTECH COVID-19 MRNA VACCINE. Note: The event were captured as reported by RA more clear information expected in follow up. Initial information received from consumer via regulatory authority on 21st November 2021: Headache, nausea, muscle pain and fatigue Case narrative: 21-NOV-2021 Within 25 hours of receiving booster vaccination I experienced aches, shivers, pounding headache, nausea, muscle aches all over body, very painful area around vaccination site, blocked nose, itchy eyes. Awful. Still struggling 48 hours after booster Patient is not enrolled in clinical trial.


VAERS ID: 1904609 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Discomfort, Mammary duct ectasia, Maternal exposure during breast feeding
SMQs:, Neonatal exposures via breast milk (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: SARS-COV-2 VACCINE
Current Illness: Breast feeding
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBSA2021SA389927

Write-up: Blocked ducts in the breast on the side of injection only/ developed significant blocked ducts in my left breast only; Initial information was received on 23-Nov-2021 regarding an unsolicited valid serious case from non-healthcare professional via Health Authority (under reference GB-MHRA-EYC 00266998). This case involves a 34-year-old female patient (175 cm and 91 kg) who had blocked ducts in the breast on the side of injection only/ developed significant blocked ducts in my left breast only (mammary duct ectasia), after receiving INFLUENZA VACCINE. The patient''s past medical treatment(s), vaccination(s), and family history were not provided. At the time of the event, the patient had ongoing Breast feeding. Concomitant medications included severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) VACCINE (dose two) for prophylactic vaccination. On 19-Nov-2021, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number and expiry date were not reported) via parenteral route in left arm (upper) for prophylactic vaccination. On 19-Nov-2021, the patient developed a serious blocked ducts in the breast on the side of injection only (mammary duct ectasia) (within 24 hours) following the administration of INFLUENZA VACCINE. This event was assessed as medically significant. Patient was in signify discomfort throughout and have had to apply self-care to reduce the ducts and monitor for signs of it turning to mastitis. She was not asked if she was breastfeeding or advised of this as a potential side effect. Laboratory details were not reported. It was not reported if the patient received any corrective treatment for the event. She was advised to take by Regulatory Agency surgery as currently 6 months post-partum. At time of reporting, the patient was recovering from the event. There will be no information available on the lot number for this case.; Sender''s Comments: This case concerns a 34-year-old female patient who had mammary duct ectasia after vaccination with INFLUENZA VACCINE (unknown manufacturer). The time to onset is compatible. Concomitant medication included SARS-COV-2 VACCINE. However, there is no further information regarding patient''s past vaccination(s) and laboratory tests ruling out other alternate etiologies were not reported. Based upon the reported information, the role of the suspect vaccine cannot be assessed.


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