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

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



Case Details (Reverse Sorted by Onset Date)

This is page 54 out of 8,010

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VAERS ID: 1759658 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 RA / IM

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

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

Write-up: We gave patient Janssen on 10/1/21 because patient said she had not receive any Covid vaccine before. Insurance rejection showed that patient received Pfizer vaccine on 09/27/2021.


VAERS ID: 1759664 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoacusis, Tinnitus
SMQs:, Hearing impairment (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: sulfa drugs, morphine, red dye 5
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 6 hours after the vaccine I woke up from a nap with a humming noise in my left ear (same side as injection). It sounds like a quick pulsating noise and it interrupts my hearing. The quality of sound in the effected ear sounds slightly muffled. When I listen to a person''s voice on the phone using the effected ear their voice has a slight robotic quality to it. The condition has not progressed as of now -- 3 days after the vaccine -- however I am concerned if I should receive my second shot.


VAERS ID: 1759675 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

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

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

Write-up: Swollen lymph node in right supraclavicular area


VAERS ID: 1759699 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

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

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

Write-up: This was NOT an adverse event, patient received the WRONG vaccine. She came in for the Shingrix vaccine and there was a break down in our verification procedures at time of administration. There were multiple people waiting for vaccines and the patient''s name was called to be brought into the health room , a woman stood up entered room and was given the COVID vaccine. We found out shortly after the vaccine was given that she was NOT the person whose name was called into the room. Patient was contacted about the mistake and she asked if this would count as her booster because she was due to get it. I did reach out to her MD to verify her first vaccine dates and she was currently eligible for her booster shot. I had her come back into the pharmacy to have her sign the VAR and to update her CDC card accordingly. I did NOT give her the vaccine that she had originally came in for (Shingrix) because her surgeon told her NEVER to get a vaccine in her right arm and I did not feel comfortable giving the Shingrix in the same arm that she had just had the Covid the day before. I asked her to return 14 days later for her Shingrix.


VAERS ID: 1759711 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 UN / IM

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

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

Write-up: Pt came into the internal vax clinic and received a Pfizer booster. It was later found out after looking at the white COVID card that he had actually gotten Moderna for his original series. Health department has recommended that we submit a VAERS for this.


VAERS ID: 1759738 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

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

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

Write-up: The adverse event was 10/1 patient was given 0.3ml of UNDILUTED PFIZER. PLEASE NOTE: WE HAVE SPOKEN WITH PATIENT AND SHE IS FINE! We are contacting Dr and so is patient.


VAERS ID: 1759747 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-22
Onset:2021-10-01
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid on 10/3/2021
CDC Split Type:

Write-up: Client was vaccinated with Pfizer vaccines for Covid in May and on April 22, 2021. Symptoms started 10/1 - nasal congestion, sore throat, vomiting x 1 day. Tested positive PCR for Covid on 10/3. Reported as a case of breakthrough Covid illness in a previously vaccinated person


VAERS ID: 1759753 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Gait disturbance, Headache, Immediate post-injection reaction, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Severe muscle aches throughout body (not just injection sites), so severe that walking was difficult. Severe headache immediately after injection. Unsteady balance. Symptoms started to improve on third day after injections.


VAERS ID: 1759775 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness:
Preexisting Conditions: Stage 3 cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Silver dollar-sized raised spot; red and itching.


VAERS ID: 1759784 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Product administered to patient of inappropriate age, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Patient was inadvertently administered the vaccine. The patient is currently too young to receive the Moderna Covid-19 vaccine under the current Emergency Use Authorization. Patient has not experienced any symptoms out of the ordinary. He has a headache and slept most of the next day following vaccination.


VAERS ID: 1759787 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / UNK LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Bell's palsy, Dysgeusia, Eyelid function disorder, Hypoaesthesia oral
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hearing impairment (broad), Periorbital and eyelid disorders (narrow), Ocular motility 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: beta-alinine 3.2g / l-citruline 3.4g / creatine 5g / one-a-day gummy / fish oil / tumeric / cinnamon / gingko baloba / fennugreek / Whey isolate / casein
Current Illness: none
Preexisting Conditions: numb spots left front thigh and right buttock
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 1HR after shot- numbness in mouth and metallic taste. 2HR after shot- eyes blinking at different rates. 12HR after shot- complete Bell''s Palsy right side of face.


VAERS ID: 1759790 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood gases, Blood lactic acid, Blood magnesium normal, Blood thyroid stimulating hormone decreased, Dyspnoea, Fibrin D dimer, Full blood count, Hyperhidrosis, Metabolic function test, Procalcitonin, Troponin I increased, Urine analysis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Urine D-dimer (341) Procalcitonin (<0.05) Troponin 1 (<0.04) CBC TSH (0.33) Magnesium (1.9) Lactic Acid, plasma (3.0) Blood gas, venous CMP
CDC Split Type:

Write-up: Patient presented to local ER: Per ER records from local HCP: Pt states that he woke up feeling weak and short of breath. Pt denies chest pain. Pt is diaphoretic. At approximately 1215, Patient and/or parent advised this RN they no longer desired to wait due to "wanting to go home" and decided to leave against medical advice. This RN highly discouraged patient leaving and advised the following: EDP in room for risks and benefits, please return to the emergency department at a later time if possible. If you decide NOT to return to the emergency department, please follow up with PCP/Urgent Care the following day and/or as soon as possible.


VAERS ID: 1759823 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Lymphadenopathy, Musculoskeletal stiffness, Myalgia, Nausea, Pain, Pain in extremity, Peripheral coldness, Pyrexia, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, Fish Oil, Cholestoff, Biotin, Probiotic, Claritin, Desvenlafloxine
Current Illness: None
Preexisting Conditions: Degenerative Disc Disorder, Infertility, High Cholesterol, Anxiety, Depression
Allergies: Sulfa, Topamax, Relpax, Ancef and Azythromycin
Diagnostic Lab Data: Negative COVID-19 test on 10/1/21.
CDC Split Type:

Write-up: I woke up the morning of 10/1/21 feeling well. I noticed early on that day that I couldn''t get my hands to warm up but chalked that up to the temperature in the building. By noon, I started to have nausea but thought that was because I didn''t get a lunch. I also noticed that I started to have mild body aches and joint pain. 30 minutes later, I requested to leave work because the joint pain and body aches were becoming too much. I became very chilled and fatigued as well. 30 minutes later once I got home, the chills became severe as well as the joint pain and body aches. I wasn''t able to move a muscle without being in severe pain. I then developed a headache. I was able to take Tylenol and Ibuprofen. About an hour after that, I spiked a fever of 102.9 but the body aches and joint pain decreased slightly, enough for me to be able to get out of bed to use the bathroom. I still continued to have nausea and fatigue. I took Tylenol and Ibuprofen round the clock. Woke up the next day (10/2/21) and the body aches and joint pain were moderate. Still continued to be febrile, fatigued, nauseous and had a headache. I developed lymphadenopathy in my right axilla and that was very painful even on medication. Again, took Tylenol and Ibuprofen round the clock. Sunday, 10/3/21 the body aches and joint pain were now mild. Continued to be fatigued and had a headache. Lymphadenopathy still present. Afebrile at this point. Today, 10/4/21, I am only having mild body aches and joint pain on my right side, fatigue, headaches are still the same, afebrile and have moderate lymphadenopathy. Have continued to take Tylenol and Ibuprofen round the clock since 10/1/21. I will note that my neck has been very stiff since this all started. My previous COVID vaccines (both Pfizer) I only had a sore arm for two days following my vaccinations.


VAERS ID: 1759824 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Lethargy, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: PATIENT CAME BACK INTO THE PHARMACY TODAY COMPLAINING OF POURING SWEAT, NAUSEA AND LETHARGIA AFTER RECEIVING VACCINES


VAERS ID: 1759987 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Adverse reaction, Angina pectoris, Chills, Fatigue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Other ischaemic heart disease (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: crestor, coreg, aspirin, sertraline, clonazepam, Miralax, Metamucil
Current Illness:
Preexisting Conditions: CAD, hypertension, arthritis
Allergies: iodine (X-ray contrast), cyclobenzaprine, singulair, wasp stings
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Approximately 24 hours after the Moderna injection I developed low grade fever, chills and fatigue. However, the adverse reaction was severe heart pain. First episode lasted about 3-4 minutes. then, a second episode of heart pain lasting 2-3 minutes. As I said, the pain was severe and felt like the entire heart muscle was involved. I live alone and one the heart pain subsided, I took tylenol and went to bed.


VAERS ID: 1760017 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-21
Onset:2021-10-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: glucosamine and krill oil
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Did a full motor and sensory check on pt.
CDC Split Type:

Write-up: Pt comes in today for a numbness in left foot and is now starting in left hand x1 day. C/O shortness of breath a few days after receiving vaccine but denies SOB now. Pt states he had J/J vaccine on 9/21/21. Pt present to ER if any worsening symptoms or new symptoms that concern you. If symptoms are not severe you may consult a provider by phone for recommendations. I suspect this may be a vaccine reaction. The patient received the J&J Vaccine.


VAERS ID: 1760235 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia
SMQs:, Taste and smell disorders (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: Hum log, losartan,hctz, cholesterol meds,asthma meds
Current Illness: None
Preexisting Conditions: Diabetes, hbp, cholesterol, asthma
Allergies: Pnut?s, almonds and other outside things
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loss of taste for a few hours


VAERS ID: 1760271 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Decreased appetite, Dysstasia, Feeling abnormal, Feeling cold, Headache, Myalgia, Retching
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Citalopram, Levothyroxine, Amlodipine, Rosuvastatin (new replacement for Pravastatin), Vitamins D3 and C, 81 aspirin.
Current Illness: None
Preexisting Conditions: Obesity (BMI ~36), Hypothyroidism, Hypertension, Pure Hypercholesterolema.
Allergies: Shell Fish, Swimming Fish, Cantaloupe, Strawberries, Molds of any kind. Penicillin and Clindamycin.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Unable to get warm, severe aches in all muscles and joints, dry heaves (did not eat), headache worse than any migraine I?ve ever had, and an inability to maintain a standing position. My brain felt like jelly. This happened again on the two following days but has not come back since.


VAERS ID: 1760472 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received first dose of Pfizer vaccine on 9/24/21 at COVID vaccination clinic. Translation services was provided to patient instructing of Vaccine given, Vaccine information sheet provided, side effects to expect discussed, information regarding when to seem emergency medical services provided and information and written documentation of when second dose of vaccine due was also provided to patient. Patient'' worksite offered another COVID Vaccine clinic the week after patient received first dose of Pfizer. The Moderna Vaccine was being administered on that day for patients to complete their second doses of Moderna. However, patient mistakenly arrived to onsite COVID vaccination clinic requesting administration of COVID vaccine. It was not know at the time of patient''s request that she received Pfizer vaccine the previous week and Moderna vaccine was administered to patient. After Moderna vaccine dose was administered, it was later revealed that patient received Pfizer the previous week. Patient was monitored for 1 hour and CDC was contacted for next steps . Patient had no reaction and no noted adverse effects . Patient contacted and monitored for several days later till date of 10-4-21 and no adverse event and no reactions. CDC indicates no additional doses needed.


VAERS ID: 1760632 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Burning sensation, Dyspnoea, Nasal congestion, Pharyngeal swelling, Pruritus, Skin discolouration, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 200mg Melatonin twice a day
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Not sure
CDC Split Type:

Write-up: Left Vaccine site, nose immediately got congested and couldn''t breathe out of my nose. My body was itchy all day. I was putting my baby girl to sleep and my body felt like it was on fire. After she fell asleep, I went into the bathroom and had hives all over my body. My ears started to turn purple and throat swelled up. It became hard for me to breathe which is when I rushed to the ER and was diagnosed with Anaphylaxis. I was given an epi pen and steroid prescription for the following 3 days.


VAERS ID: 1760647 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037621A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Glossitis, Headache, Myalgia, Peripheral swelling, Pyrexia, Skin warm, Tongue disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pneumovax 23-Val Ps, swelling and inflammation of arm from shoulder to elbow 11/15/2019
Other Medications: Ofev, Anasterole, Pantoprazole,loperamide, vitD3, ASA, Amlodipine, Rosuvastatin, Tessalon Perles
Current Illness:
Preexisting Conditions: Idiopathic Pulmonary Fibrosis, Invasive Breast Cancer post surgery 6/2021, GERD, OSA, hypertension, hypercholesterolemia , melanoma
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Red, swollen, hot arm 10x12.5 cm (still present), fever to 101.7 24 hrs after shot resolved 72 hrs later, muscles aches and headache 48hrs, inflamed tongue with lesion on tip appeared 72 hrs later (still present).


VAERS ID: 1760686 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: 24 hours after receiving the second shot, I was sweaty and feverish, with a low-grade fever. I took Tylenol and felt fine. 48 hours after the vaccine I had a headache and swollen lymph nodes in my neck that lasted two days.


VAERS ID: 1760974 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Pruritus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Flushed / Sweating-Mild


VAERS ID: 1761011 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: The size that the patient described was width not quite the size of a bologne, but the length is the size of bologne. It has been getting bigger and bigger with each day. Advised to contact PCP and pt was seen by her PCP and was given steroid pack.


VAERS ID: 1761021 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pain in the underarm area and extending to chest area. Tenderness in underarm. This is after my first shot, which I received in my left arm. The tenderness and pain are on the same side


VAERS ID: 1761029 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-10
Onset:2021-10-01
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Mellitus, Cardiovascular Disease, and Chronic Lung Disease.
Allergies:
Diagnostic Lab Data: Positive Antigen Test on 10/01/2021
CDC Split Type:

Write-up: Tested for Covid 19


VAERS ID: 1761232 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 3 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Bacterial test, Computerised tomogram, Dysuria, Fall, Paralysis, Pollakiuria, Scan with contrast
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: stool softener, heart meds, diabetes meds, blood pressure meds,
Current Illness: None
Preexisting Conditions: Heart disease, melanoma stage 1, diabetes, high blood pressure,
Allergies: Unknown
Diagnostic Lab Data: Cat scan with and without contrast, multiple tests of urine for bacteria
CDC Split Type:

Write-up: The next day he was left paralyzed in the back and fell. The back has since resolved, but there are ongoing urological symptoms including burning while peeing, frequency of urination and pain in the abdomin


VAERS ID: 1761273 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

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

Write-up: Red, Hard, itchy, painful, and swollen at the injection site. Going to see PCP today


VAERS ID: 1761288 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 05B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: High Blood pressure meds
Current Illness: NONE
Preexisting Conditions: High Blood pressure
Allergies: Patient doesn''t know what she''s allergic to.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that she felt like her throat was going to close, injection site swollen, red and sore. Patient stated that she all through weekend and didn''t start feeling better until this past Sunday.


VAERS ID: 1761292 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No adverse event - reporting Covid vaccine error. Patient received Moderna vaccine for the first 2 doses. Came to facility requesting a booster shot. Patient indicated she had previously received Pfizer vaccine, but did not have her records. Staff did not check the NC State Vaccine system to verify previous records prior to administration of the booster shot. When recording the booster in the state system, nurse noticed that the patient had previously received Moderna. Patient was monitored, but there were no adverse effects. Patient instructed to call clinic with any problems.


VAERS ID: 1761299 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-17
Onset:2021-10-01
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol, atorvastatin, BENZOcaine-menthol, dexAMETHasone
Current Illness:
Preexisting Conditions:
Allergies: Omnipaque [Iohexol], Prochlorperazine, Iodinated Contrast Medi
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted as inpatient on 10/1 due to acute respiratory failure with hypoxia. Patient was tested for COVID-19 and was positive on 10/1.


VAERS ID: 1761331 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 18cm x 14cm red, firm/raised, hyperthermic area noted over upper lateral aspect of right upper arm which was the site of recent Covid booster.


VAERS ID: 1761341 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-09
Onset:2021-10-01
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK931 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid-19 rapid test, positive
CDC Split Type:

Write-up: covid-19 infection


VAERS ID: 1761349 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 RA / IM

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

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

Write-up: Red swollen warm with 6x6 cm rash to R arm injection site


VAERS ID: 1761351 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-22
Onset:2021-10-01
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / IM

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

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1761363 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-01
Onset:2021-10-01
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac monitoring, Chest discomfort, Echocardiogram, Electrocardiogram, Feeling abnormal, Heart rate increased, Loss of consciousness, Supraventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No medications
Current Illness: No illnesses
Preexisting Conditions: No long standing health condtions
Allergies: NKDA
Diagnostic Lab Data: In June 2021, started having severe supraventricular tachycardia. Required ER visit and over night hospitalization to monitor high heart rate. Required cardizem via IV to return to normal sinus rhythm, EKG''s, ECHO, and continoues heart monitoring. Required new presciption for Metoprolol, later added Cardizem which was switched to Verapamil, then later changed again to just Bystolic once a day.
CDC Split Type:

Write-up: In June 2021, started having severe supraventricular tachycardia. Required ER visit and over night hospitalization to monitor high heart rate. Begins with sudden rapid heart rapid, chest tightness, bad feeling goes to head and then I pass out very briefly. I cannot get the fast heart rate to stop on my own. Using the vagal menuever does not work to stop it. It is only controlled by cardiac medications. I had never experienced SVT''s prior to June 2021.


VAERS ID: 1761372 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

Administered by: Military       Purchased by: ?
Symptoms: Loss of consciousness, Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Blacked out/collapsed the morning after Pfizer shot. Pale and nauseous.


VAERS ID: 1761394 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling hot, Headache, Influenza like illness, Injection site pain, Nasopharyngitis, Nausea, Pain, Pain in extremity, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Exemestane 25mg; Venlafaxine ER 37.5; Gabapentin 300mg prescription is take 2 300 mg tablets 3 times daily. At the time of vaccine I had taken 600 mg at breakfast. Naproxen 550 mg Nortriptyline 10mg the night prior
Current Illness: None
Preexisting Conditions: Breast cancer (currently in remission)
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: 10/1/21 at 01:15 am left arm swollen and sore. 05:00 am headache, body aches, warm. 07:00 am cold and nauseated. by 08:00 am I was so cold my teeth were chattering. 11:00 am temperature 100.2. Started alternating between Tylenol and Ibuprofen. 09:00 pm fever was 100.5. Between the hours of 10:30 - 11:00 pm fever broke. Slept overnight. Woke up at 04:30 am body aches were going away. They were slight. Headache was light. Maybe due to not eating. 10/2/21 was slightly fatigued. All flu like symptoms gone except the arm injection site pain. Arm stayed swollen until 10/4/21. 10/5/21 arm still slightly sore. No swelling.


VAERS ID: 1761408 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-25
Onset:2021-10-01
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site rash, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tamsulosin .4mg Amlodipine 2.5mg Finasteride 5mg
Current Illness: none
Preexisting Conditions: Enlarged prostate High Blood pressure
Allergies: Sulfur
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Rash/ blisters on arm at vaccine point frist start on Oct 1 as a red spot with many small blisters. Today not as red but with large blisters.


VAERS ID: 1761431 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: patient received a pfizer bioNtech booster shot at mobile vaccine clinic. Patient did not have vaccine card on him and there was no access on site. His original series was Moderna. Patient was asked prior to receive the booster and he mentioned he took pfizer.


VAERS ID: 1761441 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-19
Onset:2021-10-01
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Dizziness, Headache, Myalgia, Nausea, Paranasal sinus discomfort, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: PCR test collected on 10-4-2021, resulted positive
CDC Split Type:

Write-up: Headache, dizziness, loss of taste and smell, severe sinus pressure, jaw pain, muscle aches, nausea, cough.


VAERS ID: 1761479 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

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

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

Write-up: Patient received 2nd vaccination from Hospital during a hospitalization. When patient returned back to the long term care facility, and facility requested another vaccination for patient. Patient recieved 2nd dose on 09/30/2021 and then another dose on 10/01/2021.


VAERS ID: 1761488 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-09-08
Onset:2021-10-01
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062C21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthenia, Computerised tomogram thorax abnormal, Dizziness, Dyspnoea, Hypoaesthesia, Lethargy, Pain in extremity, Peripheral swelling, Pulmonary embolism, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan 25mg Omeprazole 40mg Fluticasone 50mcg Symbicort 160/4.5mcg Albuterol 2.5mg
Current Illness: None
Preexisting Conditions: COPD
Allergies: Amoxacillin
Diagnostic Lab Data: Ultrasound, CT scan 10/1/2021
CDC Split Type:

Write-up: Shortness of breath and leg numbness began within 1-2 weeks (specific time unknown) of receiving 2nd dose. Leg pain began 9/29/2021, went to ER 10/1/2021 with severe leg pain and swelling. Ultrasound discovered clot in left leg. CT scan discovered multiple pulmonary embolism in both lungs. Admitted to hospital and started on blood thinners. Was released 10/2/2021 with explicit instructions and prescriptions. Still suffering from leg pain and shortness of breath, light headed and dizzy, weak and lethargic.


VAERS ID: 1761557 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-10-01
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bradycardia, COVID-19, Hypotension, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 79-year-old male with breakthrough COVID-19 infection presenting with hypotension and bradycardia. Upon arrival to the Emergency Department, the patient''s airway was patent, breath sounds were heard bilaterally, and saturation was 93% on room air. The patient was placed on two liters nasal cannula. No further respiratory intervention was needed. We will continue to monitor and assess while in the ED. Patient received a 3rd dose on 08/30/2021


VAERS ID: 1761566 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-28
Onset:2021-10-01
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK LA / IM

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

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

Write-up: This is a 71 y.o. female patient (COVID vaccinated) with a PMH notable for rheumatoid arthritis for which she is immunocompromised on rituximab and Plaquenil, TIA, sleep apnea who presents for evaluation of shortness of breath and weakness x1 week. She has been tested for COVID-19 on 2 prior occasions both of which have been negative, 09/21/2021 and 09/28/2021. Today, she presents feeling so weak and shortness of breath that she cannot function. 1st and 2nd vaccines given at local Medical Center No Lot number documented received 3rd shot 08/26/2021


VAERS ID: 1761573 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-26
Onset:2021-10-01
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Covid positive community/work contact


VAERS ID: 1761574 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-10-01
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: presents to the Emergency Department as a medical resuscitation activation for presumed seizure found to be COVID positive.


VAERS ID: 1761577 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-10-01
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac failure, Cardiac failure congestive
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Decompensated RV systolic CHF and Covid 19 infection


VAERS ID: 1761580 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-10-01
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Covid positive family contact


VAERS ID: 1761658 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-02
Onset:2021-10-01
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

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

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

Write-up: Tested positive for COVID 10/1/21 after being fully vaccinated.


VAERS ID: 1761660 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF883G / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cozaar, toporal, singularity, Lipitor, Mobic, Prozac, nexium, multi vit, humalog, ozempic, vit D, zinc, tresiba
Current Illness: Dm, hypertension, irregular heart beat, sleep apnea, I am being worked up for auto immune problems after having covid.
Preexisting Conditions:
Allergies: Sulfa, bactrim, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bell?s palsy, steroids, anti viral, eye drops and eye ointment


VAERS ID: 1761675 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Decreased appetite, Injection site erythema, Mobility decreased, Pain, Pain in extremity, Poor quality sleep, Product administered at inappropriate site, Vomiting
SMQs:, Acute pancreatitis (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: covid19 Pfizer 2nd shot
Other Medications: Calcium, multi vitamins
Current Illness: none
Preexisting Conditions: IBS, Diverticulitis, osteoporosis
Allergies: penicillin, fomax
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hurt, ache all over body - weakness, low energy to get around walking, 1st night threw up arm hurt into back of shoulder 1.5" round pink at injection site - which seemed higher up on arm than usual...closer to shoulder Got booster on Thursday at 1:00 p.m...fine until early hours of next day with throwing up and painful aches....then sleep on and off all next 3 days with body aches all over. Little appetite or energy to make any food...but then mostly only wanted fruit. Today Tuesday, 4th day after feeling more like self...ache arm, some weakness.


VAERS ID: 1761676 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Fatigue, Lymph node pain, Lymphadenopathy, Pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes, 20 mg celexa, bupropion Topamax 100mg, low estrogen birth control pill
Current Illness: Mild cold
Preexisting Conditions: IBS
Allergies: Yellow 5, yellow 6, penicillin, sulfa
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: By the night of receiving the vaccine, my armpit lymph node got very large and swollen. It was sore and the size of a baseball. It kept growing for the next 3 days. The pain radiated from my breast to my shoulder joints. My armpit node is going down but now I have one on my collar bone that has appeared. It has been 5 days. The collar bone bulge is not as big as the one under my armpit. It hurt to move my arms, wear a bra, put my arms down. After a few days of taking Motrin and it not helping, I called the advice nurse and they suggested icing it. They told me to check for any streaking due to infection. The lump was only red. My armpit node has gone down since but now the one on my collar bone seems to have gotten larger. I was also very exhausted while the armpit lump was present.


VAERS ID: 1761685 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-10-01
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

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

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

Write-up: Tested NAAT positive for COVID 10/1/21 after being fully vaccinated.


VAERS ID: 1761699 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 3 LA / IM

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

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

Write-up: Patient broke out in hives on the legs, arms, and neck. Patient was given Benadryl, she is getting better now. Was taken to Urgent care on 10/4/21


VAERS ID: 1761709 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Biliary catheter insertion, Condition aggravated
SMQs:, Biliary tract disorders (narrow)

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

Write-up: Patient admitted for biliary drain leakage (per notes pre-existed vaccine dose)


VAERS ID: 1761716 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-10-01
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

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

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

Write-up: Tested positive for COVID 10/1/21 after being fully vaccinated.


VAERS ID: 1761739 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dizziness, Loss of consciousness, Migraine, Pyrexia, Rash, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), 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:
Other Medications: Vitamins
Current Illness: Barrets
Preexisting Conditions: Barrets
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 103,migraine,passed out twice,throwing up,diareeah, rash,chills,dizzy,


VAERS ID: 1761749 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Pain in extremity, Peripheral swelling, Skin discolouration, Thrombosis, Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim, ceclor, codeine
Diagnostic Lab Data: Blood work. vitals and sonogram and cat scan
CDC Split Type:

Write-up: I am a 35 year old healthy young woman . I received the first dose of the Pfizer vaccination on September 29, 2021 in by my house. By October 1, 2021 I had excruciating pain in my right arm. I didn''t think it was anything. The pain had gotten worse and I noticed that it was all black and blue and very swollen. I went to an urgent care on October 3, 2021 and they sent me to the hospital. When I got to the hospital they did a sonogram on my right arm and found that I had a blood clot. How is it that I have been very healthy with no health issues, but after I received the first dose of the vaccine I developed a blood clot?


VAERS ID: 1761758 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-05
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: The individual was given the dose without the vaccine being diluted. The patient has been informed and will watch for any adverse reactions


VAERS ID: 1761761 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3A9ZG / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypersomnia, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: naltrexone, vitamin d, iron, zyrtec
Current Illness: MS, iron deficiency
Preexisting Conditions: MS
Allergies: bee venom, cipro, septra,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Around 8:15/8:30p on 10/1/21 first 3 bumps seen on arm 6a 3 on leg and just kept coming, 10/2/21 3 bumps on stomach and upper back, around noon had fever 100.9, slept for 20 hours between noon and Sunday evening, 10/3/21 found 3 more on lower back and 3 on face, 10/4/21 7 new ones just on hands, 10/5/21 6a found 3 on face 1 on neck, 1 on right upper arm.


VAERS ID: 1761776 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-16
Onset:2021-10-01
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthritis bacterial, Incisional drainage, Pyrexia, Staphylococcal bacteraemia, Tachycardia, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sepsis (broad), Opportunistic infections (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? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zoloft, remeron, Seroquel, flexeryl
Current Illness: None
Preexisting Conditions: PTSD, chronic hip pain
Allergies: None known
Diagnostic Lab Data: WBC = 25, febrile, tachycardic. Admitted on 10/2, I&D of the wrist on 10/5
CDC Split Type:

Write-up: Approximately 2 weeks after dose 1 of Moderna the patient developed septic arthritis in his left wrist leading to staph bacteremia requiring hospitalization and incision and drainage of the wrist.


VAERS ID: 1761777 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-10-01
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/01- tested PCR positive
CDC Split Type:

Write-up: patient tested positive for COVID-19 $g 14 days after vaccine series


VAERS ID: 1761800 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-10
Onset:2021-10-01
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: 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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough case


VAERS ID: 1761837 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Losartan, and Primirone , Restasis Eye Drops
Current Illness: NA
Preexisting Conditions: Thyroid Disease and Hypertension
Allergies: NKDA
Diagnostic Lab Data: NA
CDC Split Type: Unknown

Write-up: "Overwhelming sensation of dizziness, feeling off balance, and feeling feverish" since date of vaccine


VAERS ID: 1761847 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra OTC, Singulair, Albuterol inhaler PRN
Current Illness:
Preexisting Conditions: Asthma
Allergies: Stated had an allergic reaction of wheezing, SOB, hives to an "allergy shot" against dust mites, trees and grasses about 2 months ago.
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 12:39 pm (while under post vaccination observation), staff asked the observer if her neck was red as it was itching. No erythema noted in the neck. Denied difficulty of breathing or swallowing. Remained verbally responsive, with no other symptoms noted.


VAERS ID: 1761854 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0101 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenopia, Discomfort, Eye irritation, Eye pain, Fatigue, Feeling abnormal, Headache, Injection site pain, Pain
SMQs:, Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Corneal 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: metoprolol 25 mg night before Cymbalta 80 mg Vit D3 2000 IU Vitamin B Complex
Current Illness: none
Preexisting Conditions: fibromyalgia dry eyes intermittent depression PACs
Allergies: macrolide antibiotics, e-mycin, chloroprep, Levoquin, ethrane
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 10/1/21 Pain at injection site within an hour after administration R Deltoid going into back of neck and shoulders. 10/1/21 About 4 hrs post injection - fatigue, body feeling heavy and feeling like need to lie in bed, headache. 10/2/21 Next day the symptoms continued with some pain in eyes and burning in eyes, eyes feeling heavy, felt fuzzy in head. 10/3/21 They following day, all symptoms gone. I had no reaction after 1st and 2nd Pfizer vaccine other than arm pain at injection site.


VAERS ID: 1761866 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-05
Onset:2021-10-01
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Dyspnoea, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: asthma, anemia, OA, hypothyroidism, IBS, HTN
Allergies:
Diagnostic Lab Data: Covid-19 positive test on 09/30
CDC Split Type:

Write-up: Positive for COVID-19 infection - fever, myalgias, chills, cough and SOA. Received monoclonal antibody infusion


VAERS ID: 1761891 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Paraesthesia, Respiration abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Respiratory failure (broad), Hypoglycaemia (broad)

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

Write-up: Pt expressed apprehension about receiving vaccine, but was doing so because required by employer. While waiting in observation pt expressed a desire to lie down. Once pt was let back into immunization room and allowed to lay down he started to suffer an anxiety attack. Pt complained of tingling in extremities and lightheaded when moving from sitting to laying down. Paramedics were called and tested pt. All was good, pt just couldn''t relax and get breathing under control. Ultimately pt was taken out side on gurney and paramedics observed him until anxiety subsided. Pt''s spouse ultimately picked up pt. I phoned pt later that evening and he stated that he was feeling fine.


VAERS ID: 1761921 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-31
Onset:2021-10-01
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Tested positive for COVID 10/1/21 after being fully vaccinated.


VAERS ID: 1761940 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Chest pain, Dizziness, Dyspnoea, Ear pain, Haematemesis, Injection site pain, Neck pain, Pain, Pyrexia, Toothache, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 30, Atenolol 50, Acetaminophen 500, Asacol 800
Current Illness: High blood pressure, Idiopathic aplastic anemia, Crohn''s disease
Preexisting Conditions: High blood pressure, Idiopathic aplastic anemia, Crohn''s disease
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, abdominal cramps, vomiting with blood, diarrhea with blood, chest pain, shortness of breath, blurred vision, constant dizziness, dental pain, severe pain at injection site radiating to the neck and ear left side.


VAERS ID: 1761951 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-08-27
Onset:2021-10-01
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3180 AND FE35 / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Over the past week I have developed severe shortness of breath, pounding heart with slight physical exertion. I?m also experiencing extreme tiredness and fatigue.


VAERS ID: 1761953 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Vaccine positive rechallenge
SMQs:, Taste and smell disorders (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: 6 months earlier on 3/8/2021 at age 37 I had the same reaction to my first Pfizer covid shot. That was also reported it was lot
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies: Hazelnuts Tree pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: A metallic taste in my mouth that began approx 5 minutes after the injection and was gone within 15 minutes. I had the same or similar reaction with my first Pfizer covid vaccine (also reported) but not on the second shot. This was my third shot, a booster 6 months later, and I experienced the metallic taste again.


VAERS ID: 1761974 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Fatigue, Headache, Pain in extremity, Pruritus, Pyrexia, X-ray
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot
Other Medications: Flecanide Diltiazem Vitamin D Calcium Fish oil L-lysine
Current Illness: none
Preexisting Conditions: A fib
Allergies: Keflex sulfa drugs
Diagnostic Lab Data: Took a picture of my arm and sent it to my doctor. He called immediately.
CDC Split Type:

Write-up: First shot was fine. Second shot on 09/29/2021 I got the reaction. My doctor prescribed an antibiotic. The redness is all the way down my arm and was raised. Had a low grade fever, face was red, headache for two days, Tired, Arm was sore and itched. Bright red. This is the 5th day of reaction and my second day on antibiotics. When I got the flu shot, I couldn''t walk. Had GBS. I can walk now but couldn''t walk for many months.


VAERS ID: 1761990 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: Major headaches, chest and muscle pain.


VAERS ID: 1762002 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-27
Onset:2021-10-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Flushing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Nifedipine, Lasix, clonidine, clonazepam, prozac
Current Illness: none
Preexisting Conditions: High blood pressure, clinical depression
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 4 days after vaccine 8 am mild confusion, flushing, dizziness. Cleared till approx 6 pm with new dizziness, flushing, no fever. Lasted about 1 hour. Cleared then flushing no fever at approx 11pm. Some flushing the following am which cleared by 10:00 am. Nothing since then. All the reports I heard were that the side effects occurred on day 1-2. Thought you might want to know. I am a physician and have not had any of these symptoms previously. BP was normal to slightly elevated during event.


VAERS ID: 1762027 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dysarthria, Fatigue, Hyperhidrosis, Lethargy, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: probiotic, Advair, atorvastatin, escitalopram, lisinopril, albuterol, zyrtec
Current Illness: none
Preexisting Conditions: htn, hypertriglyceridemia, asthma, elevated glucose, hernia
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: LAB went into the room to draw blood and the patient said she was very tired and she had just had a shot. The patient started slurring her words, became sweaty, lethargic, and stated her chest was heavy, and her throat was tight. Provider Dr. was brought to the room to evaluate the patient and he ordered 50 mg of injectable Benadryl, IM which was administered. Dr. also called a rapid response through our hospital system and that team came as well. The rapid response team decided to also administer an epi pen 0.3mg IM. After this medication the patient said her throat and chest felt less tight and she started to feel better and the team decided she did not need another dose of epi.The patient was observed for 1 hour in the clinic per rapid response team and left on her own after that.


VAERS ID: 1762031 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-07
Onset:2021-10-01
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM

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

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

Write-up: Pt received Pfizer x2. Pt tested COVID + on 10/1/21 and admitted to hospital for COVID on 10/1/2021. Pt receiving remdesivir and dexamethasone.


VAERS ID: 1762091 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-04-02
Onset:2021-10-01
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Dyspnoea, Fatigue, Laboratory test, Memory impairment
SMQs:, Anaphylactic reaction (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: A-fib
Allergies: NKDA
Diagnostic Lab Data: all kinds of tests, lab work
CDC Split Type: vsafe

Write-up: I ended up with mild stroke and a hospital stay, could not drive for three months. I also had to see a neurologist. I have trouble remembering things. I also feel tired and winded all the time. I had all kinds of tests done at the hospital. I think it is coincidental, I do not feel like myself at all since the vaccine.


VAERS ID: 1762186 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hypertension, Angioedema, Hyperlipidemia, GERD,
Allergies: Acetaminophen, Aspirin, Ibuprofen, Shellfish, Gadolinium, Iron Sucrose. IV Contrast with Dye
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient states after waiting 30 minutes after receiving vaccine she start to experience a headache and tingling to her lips. Patient states did is how she feels when she is about to have a reaction. APRN notified and informed LPN Nurse, to administer Diphenhydramine 25 mg capsule PO and to observe patient for 30 minutes more. After observing patient for 30 minutes, patient states tingling to lips subsided and only have a slight headache but is feeling better and is ok. APRN discharged patient and to follow up if needed. Patient verbalized understanding.


VAERS ID: 1762196 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-10-01
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 UN / IM

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

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

Write-up: Employee Health Services was notified that employee was Positive for COVID-19 10/02/2021, MDH requires us to report to VAERS breakthrough cases.


VAERS ID: 1762212 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carvedilol, isosorbide, losartan, 80 mg aspirin, vitamin D,
Current Illness: none
Preexisting Conditions: heart disease high blood pressure obesity
Allergies: egg yolk
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Soreness in arm where shot given. The next day, extreme fatigue that lasted throughout the day.


VAERS ID: 1762274 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blindness, Blood glucose normal, Dyspnoea, Hyperhidrosis, Hypotension, Pupillary reflex impaired, Pupils unequal
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
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: multivitamin, probiotic, magnesium
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: blood sugar : 85 bp 66/40 pulse 88
CDC Split Type:

Write-up: Lost vision completely for 20 minutes diaphoretic hypotension left pupil 4 x larger than right not responsive to light short of breath


VAERS ID: 1762364 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Extra dose administered, Malaise, Migraine, Myalgia, Nausea, Vaccine positive rechallenge, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Pfizer covid vaccine on 2-17-2021. Twelve hours post vaccine, I started nausea/vomiting, migraine, general ill feeling but
Other Medications: Candesartan Metoprolol Chlorthalidone Synthroid
Current Illness: No illnesses
Preexisting Conditions: High Blood Pressure
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 12 hours post vaccine I started with nausea/vomiting. A migraine headache developed which continued along with general ill feeling. Migraine was very strong (I have a history of migraines and the only relief was sumatriptain). Ice packs and cold wet cloth only provided minimal relief. In the early morning hours all my muscles started quivering similar to the chills but I didn''t FEEL cold. The quivering lasted for 2.5 hours and then stopped. After that all my muscles hurt like I''d exercised too hard. All symptoms lasted about 36 hours and then went away.


VAERS ID: 1762368 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Oropharyngeal pain, Pyrexia, Rhinorrhoea, Upper-airway cough syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the vaccine on 09/30/21 and developed a fever the following day on 10/01/21 which caused profuse sweating. EMS was called to the home on 10/02/21 and the fever broke that following evening. Since the fever has resolved, patient has now been experiencing a constant runny nose and post-nasal drip causing a sore throat.


VAERS ID: 1762374 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cellulitis, Headache, Influenza like illness, Injection site erythema, Injection site swelling, Injection site warmth, Pyrexia, Ultrasound scan, X-ray
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nexium; Hydrochlorothiazide; Enoxaparin; Famotidine; Iron; Alprazolam; Fluticasone
Current Illness: None
Preexisting Conditions: Hypercoagulable State; Breast Cancer; Acid Reflux; Migraine; Varicose Vein
Allergies: Augmentin; Pradaxa; Lortab; Tylenol w/Codeine; Levaquin; Lactose; Environmental Allergy; Seasonal Allergy
Diagnostic Lab Data: 10/04/2021 Ultrasound, blood work, X-ray.
CDC Split Type: vsafe

Write-up: 10/01/2021: Warm red, swollen about 2-inches from injection site.Headache, body, joint and fever and flu-like symptoms. 10/4/2021: Sought care from ER and they gave treatment as for cellulitis. Antibiotics, cephalexin for course. Ongoing.


VAERS ID: 1762489 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-09
Onset:2021-10-01
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac stress test, Echocardiogram, Electrocardiogram, Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Migraines, fibromyalgia, asthma
Allergies: None
Diagnostic Lab Data: EKG, echocardiogram, stress test 10/5/2021
CDC Split Type:

Write-up: First dose- fevers, chills for 24 hours Second dose less than a month later myocarditis


VAERS ID: 1762492 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: TD vaccine. Sick for months, erratic BP, palpitations, neuropathy, insomnia, anxiety, stomach, bladder pain, food sensitivities.
Other Medications: Armour Thyroid, progesterone, ldn
Current Illness: Lyme Disease
Preexisting Conditions: Lyme disease
Allergies: TD vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shoulder pain 1st day. Widespread severe joint/ muscle pain 2nd day. Was unable to report on checkin. Received the text to checkin 4 days after. Checked in , left page to get verification code, went back to page and got message that I had already completed the check-in . I had not done so.


VAERS ID: 1762496 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Blood glucose, Chest pain, Dyspnoea, Fibrin D dimer, Troponin, Ultrasound scan normal
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Hospitalized? No
Previous Vaccinations: Allergic reactions to flu shots (multiple prior occasions)
Other Medications:
Current Illness: None
Preexisting Conditions: IGA Nephritis
Allergies: Penicillin, Sulfa medications
Diagnostic Lab Data: D-Dimer negative, Troponin negative (2X), Ultrasound of heart unremarkable, Other blood tests in range with exception elevated glucose.
CDC Split Type:

Write-up: Shortness of breath (early morning of 10/1), Chest Pain (noon of 10/1), Lower Back Pain ( 10/2-4).


VAERS ID: 1762514 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Throat irritation
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad)

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

Write-up: Lightheaded, severe itchy throat


VAERS ID: 1762695 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Oral herpes
SMQs:, Oropharyngeal infections (narrow), Opportunistic infections (broad)

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

Write-up: 3-4 days after vaccine dose reported, patient developed a primary oral herpes outbreak to the right side of his mouth.


VAERS ID: 1762719 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Pain
SMQs:, Arthritis (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: Acute sharp pain in the left shoulder joint. Pain is worst when lifting to the outside while applying pressure to the arm (think of a lateral dumbbell raise). Started a couple days after injection and pain has steadily increased each day since.


VAERS ID: 1762725 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-24
Onset:2021-10-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility 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: Paroxetine 10 mg, Adhansia XR 55 mg
Current Illness:
Preexisting Conditions: asthma
Allergies: Avelox, Mucinex, theraflu
Diagnostic Lab Data:
CDC Split Type:

Write-up: Abnormal menses for 1 month.


VAERS ID: 1763100 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Hypoaesthesia, Injection site pain, Muscular weakness, Paraesthesia, Paraesthesia oral, Product administered at inappropriate site, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Drug abuse and dependence (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow), Sexual dysfunction (broad)

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

Write-up: My first two doses, I didn''t feel the injection. My booster 3rd dose I did feel it. Shortly afterward I felt tingling and a little numbness on the left side, including my face. I woke up with pain in my left arm at 2:00 a.m. and had difficulty going back to sleep. It was very sore for the first 3 days and hurt when I tried to raise it up high. Day 2 I noticed the injection site was higher than previous injections on my arm. I looked up proper injection site and it looks like it was too high up. I am on day 6 and still feel some soreness and weakness in my arm and some tingling in my face and lips. I can perform every day tasks and my face is not lopsided.


VAERS ID: 1763108 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 3 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Hyperacusis, Photophobia
SMQs:, Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (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: None
Current Illness: None
Preexisting Conditions: Asthma. Generalized anxiety disorder.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day after booster dose (3rd) had fever and fatigue and major headache. I?ve had a nighttime severe headache every night since. Headache is severe and painful, sensitivity to light and sound and dizziness are present. It?s been ever single day after my vaccine, i do not usually suffer from these headaches.


VAERS ID: 1763708 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-14
Onset:2021-10-01
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / SYR

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

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

Write-up: Super long and heavy period after second dose. Period also came 5 days early.


VAERS ID: 1763926 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac disorder, Chills, Feeling cold, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USJNJFOC20211004062

Write-up: SOMETHING BAD IN HEART, LIKE FEELING A BOOM BOOM; CHILLS; FEEL COOL; DONT FEEL GOOD; A LITTLE FEVER; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 01-OCT-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 01-OCT-2021, the patient experienced something bad in heart, like feeling a boom boom. On 01-OCT-2021, the patient experienced chills. On 01-OCT-2021, the patient experienced feel cool. On 01-OCT-2021, the patient experienced dont feel good. On 01-OCT-2021, the patient experienced a little fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from chills, feel cool, a little fever, something bad in heart, like feeling a boom boom, and dont feel good. This report was non-serious.


VAERS ID: 1763977 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Lacrimation increased, Nasopharyngitis, Respiratory tract congestion, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Lacrimal disorders (narrow), 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: Alcohol use (Twice a year); Non-smoker
Preexisting Conditions: Comments: The patient had no known drug allergies and no drug abuse or illicit drug usage
Allergies:
Diagnostic Lab Data: Test Date: 202110; Test Name: COVID-19 virus test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20211006390

Write-up: HEAD CONGESTION; CHEST CONGESTION; WATERY EYES; COUGH; This spontaneous report received from a patient concerned a 47 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: alcohol user, and non-smoker, and other pre-existing medical conditions included: The patient had no known drug allergies and no drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805022 expiry: UNKNOWN) dose was not reported, administered on 14-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On OCT-2021, Laboratory data included: COVID-19 virus test (NR: not provided) Negative. On 01-OCT-2021, the patient experienced head congestion. On 01-OCT-2021, the patient experienced chest congestion. On 01-OCT-2021, the patient experienced watery eyes. On 01-OCT-2021, the patient experienced cough. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the head congestion, chest congestion, watery eyes and cough was not reported. This report was non-serious.


VAERS ID: 1763979 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A31A / UNK - / -

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? 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: USJNJFOC20211006433

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a health care professional concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A31A, expiry: 21-SEP-2021) dose was not reported, administered on 01-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-OCT-2021, the patient experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious.


VAERS ID: 1764554 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, Injection site reaction, Injection site swelling, Migraine, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: vaers report submitted strong bee sting type spasm at left wrist site. a6, Feb11, 2021 Moderna 010M2)A
Other Medications: Corgard, Plavix, Diovan, Crestor
Current Illness: none
Preexisting Conditions: Cardiac condition and congestive heart failure
Allergies: Sulpha drugs, Iodine dye, adhesive products
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain and selling at injection site, red rash 4 inches down from injection site, strong migraine headaches - both lasting four days in duration


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