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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 545 out of 10,317

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VAERS ID: 1888442 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-10
Onset:2021-11-18
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Not a vaccine, anaphylaxis from rituxan 20 years ago
Other Medications: None
Current Illness: None
Preexisting Conditions: Achalasia Subcutaneous b cell NHL in remission
Allergies: Erythromycin rituxan
Diagnostic Lab Data: None
CDC Split Type:

Write-up: angioedema - lips and eyes urticaria - arms, chest, scalp, back


VAERS ID: 1888579 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ? / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Coma
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Backlifen tolteridin metoprolol
Current Illness: Multiple sclerosis
Preexisting Conditions: Multple sclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 36 hrs nearly comatose


VAERS ID: 1888597 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-24
Onset:2021-11-18
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Work       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: 11/19/2021 SARS-CoV-2, NAAT, positive.
CDC Split Type:

Write-up: Breakthrough COVID-19.


VAERS ID: 1888604 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 30 minutes after receiving the vaccine, client reported feeling dizzy and itchy on his left leg. One subtle slightly red smooth circle was seen on his right upper back and then it quickly disappeared. Five minutes later after reporting the symptoms, the client reported that the symptoms subsided and client denied any symptoms at all. Mother of client declined offer of Benadryl and stated that she would give it at home. After observing client another 30 minutes, he went home. Vital signs stable with slightly elevated blood pressure.


VAERS ID: 1888607 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-11-18
   Days after vaccination:296
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/19 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1888615 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Contusion, Dizziness, Extra dose administered, Flushing, Headache, Hyperhidrosis, Interchange of vaccine products, Lymphadenopathy, Nausea, Pain in extremity, Rash, Vertigo
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: May 5th, 2nd dose pfizer, headache, fever, nausea, sore arm, tired
Other Medications: After shot took ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: Sensitive to latex and adhesives, vicadin, soma.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 20 minutes later face became flush and felt chills. Arm became sore about an hr in. Started having small pumps on face, neck , chest and upper stomach. Friday afternoon at lunch got dizzy, experienced vertigo, sweating, arm felt badly bruised. Saturday left armpit lymph node was very swollen. Continued to sweat and feel slightly nauseous. Today, Sunday lymph node still swollen but less than Saturday. Headache started Thursday, lessened Saturday evening.


VAERS ID: 1888636 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Fatigue, Feeling of body temperature change, Headache, Heart rate increased, Inflammation, Injection site pain, Insomnia, Muscle fatigue, Myalgia, Nausea, Palpitations, Paranasal sinus discomfort, Photophobia, Retching, Toothache
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious meningitis (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Overnight, starting November 18th around 8 pm, I experienced full body muscle fatigue and achiness. I could not sleep due to severe headache, a racing/pounding heart rate, and generalized inflammation (my sinuses felt so swollen that my teeth hurt). I woke up to take my temperature around 2:45 am and it was 100.8. I was freezing the whole night and couldn''t stop having muscle tremors ( I am normally always hot, so being this cold is very unusual for me). The following day, November 19th, I still had the raging headache, which seemed to get worse with light (I was very light-sensitive the whole day). I showed a temperature of 99.6 by 5:45 am. I could still not control my body temperature. I would swing from so cold that I was shivering to so hot I''m sweating in an instant. I kept getting waves of nausea and gagging. I was so fatigued that I could barely function. My symptoms finally subsided Saturday, November 20. The only lasting effects were mild soreness at the injection site, mild fatigue, and a slightly increased heart rate.


VAERS ID: 1888641 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (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: L upper arm redness, warmth, tender, itching


VAERS ID: 1888648 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Fatigue, Headache, Nervousness, Pain
SMQs:, Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (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: Fish Oil, Multi-vitamin, low dose aspirin, D3, B-12, C, Levothyroxine, Testosterone, Omeprazole
Current Illness: Thyroid, GERD, Low Testosterone.
Preexisting Conditions: Thyroid, GERD, Low Testosterone.
Allergies: Oral Antibiotics aggravate GERD
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Very next day Shaky, unfocused, headache, body aches, exhaustion,.... Once home, took two(2) Advil PM tablets and got roughly 8 good hours of sleep. Much better next morning.


VAERS ID: 1888689 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7376NA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Headache, Malaise, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I received the second dose of Moderna, Feb. 19, 2021, the next day (2/20/21) I had a fever over 101, lethargic, painful injecti
Other Medications: None
Current Illness: None
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My arms became sore in the evening. Around 3:00 am the next morning, I started to become chilled, headache, not well. I took my oral temp, it read 100.5. I took Tylenol. I was not able to rest comfortably. I had similar symptoms after the second dose. The only thing different was that my temp was higher, I believe it was a little over 101. I continued to take Tylenol for the remainder of the day. I felt much better the next day, Saturday. My arms, both, are still a little sore, but not raging like the evening I received both injections.


VAERS ID: 1888690 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 2 LA / UN

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

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

Write-up: My hands and feet fall asleep and I feel pins and needles. No treatment. What could possibly relieve this? A doctor cannot do anything for me.


VAERS ID: 1888740 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ovulation delayed
SMQs:, Fertility 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Ovulation was late after receiving second dose during fertile window.


VAERS ID: 1888773 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Symbicort: is the only medication I take (daily)
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: I am asking for direction on HOW to proceed, so I can take necessary precautions, and be aware of other (potential) side effects in the future. I AM WORRIED ABOUT THE POISON IN THIS BOOSTER THAT WAS INJECTED IN MY BODY.
CDC Split Type:

Write-up: Reporting issue with the Pfizer Booster I received on 11/17/2021. Side effects: body aches that lasted 3 days. Skin blotched/breakout on right side of face. 1. I had the original Phizer vaccines in March/April 2;021. NO SIDE EFFECTS. 2. I had the Phizer booser on Nov 17 and experienced unexpected side effects. (I am in good health and have not been sick for many years). Besides Body aches, a rash or skin blotches appeared on the right side of my face. I have NEVER in my life had this type of skin reaction (except for Measles and Chicken Pox). I AM CONCERNED ABOUT WHAT TYPE OF POISON IS IN THIS BOOSTER. Certainly something that my body rejected. I AM CONCERNED ABOUT MORE LONGER TERM SIDE EFFECTS.


VAERS ID: 1888785 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Erythema, Injection site nodule, Pain, Pruritus, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol 50 mg, Co Q-10, Probiotic, Loratadine
Current Illness: Arthritis, Neuropathy
Preexisting Conditions: Arthritis, Neuropathy, Sciatica
Allergies: None that I know of
Diagnostic Lab Data: None
CDC Split Type:

Write-up: large knot at injection point. Red and itches and swelling does not seems to be going down and a little painful. Looks somewhat like a rash. I got the shot on a Thursday night got chills and aches and pain by Friday, Saturday my symptom was better. Had no problems with the othe two shots. I''m having some kind of reaction because its itching like crazy.


VAERS ID: 1888825 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anal incontinence, Blood test, Dehydration, Headache, Lymph node pain, Lymphadenopathy, Muscular weakness, Nausea, Urethral spasm, Urinary incontinence, Urine analysis, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Fatigue, difficulty walking,74 yeast, 3/27/21 Pfizer shot #2
Other Medications: diltiazem, flacanide, Protonix, Digoxin, Effexor, Vit D3
Current Illness: Partial gastric outlet obstruction at site
Preexisting Conditions: Atrial fibrillation
Allergies: Contrast dye
Diagnostic Lab Data: Standard blood tests, urinanalysis
CDC Split Type:

Write-up: Urinary inconsonance ; dehydration, left neck lymph node swelling and pain, nausea, headache; ,fecal incontinences. pain at vaccine site. muscle weakness; spasms of urethra


VAERS ID: 1888869 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Headache, Nausea, Pain, Pyrexia, Troponin I increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: 11/21/21 Troponina I: 12.9
CDC Split Type:

Write-up: fever, headache, body pain, nauseas. Since yesterday start Chest pain. Today evaluated at Cidra hospital. Transfer to HIMA PICU.


VAERS ID: 1888885 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Gingival bleeding, Gingival pain, Gingival swelling, Mastication disorder
SMQs:, Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal allergic conditions (narrow), Gingival disorders (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Two days after on lower left side of mouth gums became swollen and would bleed when brushed. Has been like that since 11/18 and is now 11/21. Yesterday night 11/20, upper left side of gums is swollen and whenever brushed bleed and are sore. Soreness lingers even without being brushed. Salt water rinses do some initial aid in relieving pain, but overall has not reduced the soreness or swelling. Condition also makes eating difficult as food and jaw movements disrupt the gums.


VAERS ID: 1888949 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Movement disorder, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Could not move
Other Medications: Losartan, Levothyroxine, Famotidine, Levocetirizine, Perphenazine, Pregabalin, Amlodipine, Citalopram, Hydroxyzine, and Tylenol
Current Illness: None
Preexisting Conditions: Depression
Allergies: Shell fish, pineapple, Cipro, tramadol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: My arm swell up to the elbow. Also, I could not move for a day and a half


VAERS ID: 1888954 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F22A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cellulitis, Erythema, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta, Tylenol PM
Current Illness: None- did receive flu shot in right arm 11/10-/21
Preexisting Conditions: Fibromyalgia
Allergies: Sulfar
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cellulitis on left upper arm approx 1 inch to the right of injection site on Sun 11/21/21 area red warm approx 6x7 in size. Started abx. Nausea and rash Thurs evening 11/18/21 that resolved with Tylenol pm (50mg of Benadryl)


VAERS ID: 1888983 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Visual impairment, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Visual Changes/Disturbances-Medium, Systemic: Vomiting-Severe


VAERS ID: 1889022 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-02
Onset:2021-11-18
   Days after vaccination:289
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/19 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1889026 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-15
Onset:2021-11-18
   Days after vaccination:307
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/19 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1889028 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH COVID19 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Feeling abnormal, Full blood count, Hypoaesthesia, Limb discomfort
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D 1000 IU daily Atarax 25mg PO every 8 hrs PRN
Current Illness: depression
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data: electrolytes and cbc obtained while in the ED. Evaluated by Neurology given family concern for adverse reaction to vaccine.
CDC Split Type:

Write-up: Pt developed numbness in her face while driving home from receiving her second vaccine. She then developed unusual feelings all over her body and her mother describes her as "being out of it at times". She presented to the ED on 11/21/2021 for on-going symptoms since time of vaccination on the 18th. Pt is able to relate a full history of events and has a normal neurologic exam except for a perception of unusual sensations on her limbs. Family concern because aunt reportedly developed myocarditis and stroke after vaccination.


VAERS ID: 1889033 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

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

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

Write-up: PATIENT RECEIVED COVID PFIZER VACCINE DESIGNATED FOR PATIENTS AGED 5-11.


VAERS ID: 1889034 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Bradykinesia, Fall, Fatigue, Vertigo
SMQs:, Anticholinergic syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Vestibular 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: losartan-hydrochlorothiazide, alendronate. calcium, d3, probiotic
Current Illness:
Preexisting Conditions: hypertension, osteopenia
Allergies: biaxin
Diagnostic Lab Data: None. Seeing my primary November 22
CDC Split Type:

Write-up: On November 17 felt exhausted. On November 18 woke up with vertigo. Lasted about fifteen minutes. Moved slowly for several hour and seemed better. about 2:30 I went for a walk with a neighbor . After fifteen minutes the same feeling of vertigo started. told my friend as I stopped walking. Could not keep my balance and fell backwards in the road, Called a friend to give me a ride home because I didn''t feel comfortable walking.


VAERS ID: 1889042 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-30
Onset:2021-11-18
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Work       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: 11/19 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1889055 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-14
Onset:2021-11-18
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Work       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: 11/19 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1889067 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-18
Onset:2021-11-18
   Days after vaccination:304
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

Administered by: Work       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: 12/19 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1889098 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 was scheduled to receive a flu shot but instead received another dose of the pediatric Pfizer Covid 19 vaccine in error. First dose was on 11/10/21. No side effects reported.


VAERS ID: 1889113 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-11-18
   Days after vaccination:296
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 RA / IM

Administered by: Work       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: 11/20 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1889128 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, SARS-CoV-2 test, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 6 mg Prednisone
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid test
CDC Split Type:

Write-up: Vomiting, unresponsive in the morning with fever


VAERS ID: 1889131 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-03
Onset:2021-11-18
   Days after vaccination:288
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Work       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: 11/19 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1889179 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Tinnitus after 2nd shot. Worse after booster
Other Medications: Xarelto 20 mg once daily
Current Illness: None
Preexisting Conditions: Previous A-fib.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Almost immediately had increased high level ringing in both ears. Has gotten worse in past three days. It is constant.


VAERS ID: 1889205 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Hypersomnia, Myalgia, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine, 150 mg/day B2, 1000 mg per day Multivitamin
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: Vancomycin Ceftriaxone
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Felt fine the evening of the shot, though my arm hurt more than it did when I got the first two. Next morning, I was tired when I awoke. By 9 am, I was back in bed and slept most of the day. Severe fatigue, muscle ache, fever, chills. When I woke up on the second morning after the shot, I felt fine. Roughly 24 hours of symptoms.


VAERS ID: 1889464 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 RA / 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? 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: Upon review, booster given at 4.5 months instead of the approved 6 month interval. Pt tolerated booster well and left after 15 minutes.


VAERS ID: 1889481 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Gait disturbance, Injection site erythema, Injection site pain, Injection site swelling, Pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre 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), 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: Baclofen 20 mg. , Nuedexta 20-10 mg., generic Claritin, Vyvanse 70 mg., Alendronate 70 mg. once a week, Pantoprazole 40 mg., Vitamin D3 2000 IU QD, Multivitamin QD, Vitamin B 12 2000 IU QD, Digestive Enzymes 2 gummies QD.
Current Illness: None.
Preexisting Conditions: I have PPMS. Not on any medications due have had reaction to every one they tried me on.
Allergies: Pencillin, E-my in, All mycins, Flagyl.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and swelling at the site and swelled up 2-3 times it?s normal size, pain , achiness all over my body more so than usual, fever through today, extremely weakened my immune system 10 times more so than normal. Couldn?t even walk to the bathroom by myself without help from family. I normally work a 40 hour job without any issues until I took this vaccine against my will. I just want to start feeling better again.


VAERS ID: 1889483 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Feeling of body temperature change
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: lamictal , prilosec , wellbutrin,depakote,ambien , seroquel, ibuprophen
Current Illness: none
Preexisting Conditions: depression arthritis
Allergies: PCN Cephalosporins Sulfa , Kiwi
Diagnostic Lab Data: none
CDC Split Type:

Write-up: on 11/20/21 at 10pm at work i became confused to my surrounding as far as i thought i was on the west side of the building but i was on the east side the confusion lasted about 15min. the same occurance happened at 0700 have been having hot and cold flashes since receiving the vaccine . For the first 2 days i had a low grade fever of 99.8 - 100


VAERS ID: 1889497 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-12
Onset:2021-11-18
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna COVID-19 2/6/21, itching/heat/swollen lump localized to injection site approx. 1 week after injection, persisted 2-3 day
Other Medications: Blisovi birth control
Current Illness:
Preexisting Conditions: recurring iron deficiency, ovarian cysts
Allergies: lanolin
Diagnostic Lab Data:
CDC Split Type:

Write-up: itchy red hives around arm from shoulder to elbow beginning approx. 6 days after injection. itching temporarily alleviated with hydrocortisone cream. hives persisting for 5th day at time of report


VAERS ID: 1889498 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Appendicectomy, Asthenia, Chills, Confusional state, Hyperhidrosis, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre 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? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: colonoscopy
Preexisting Conditions: none
Allergies: penn
Diagnostic Lab Data: surgery possibly related
CDC Split Type:

Write-up: 5-6 hours after vaccine sever chronic vomiting, weakness, confusion began. Dry heaving or retching continued for the next 4-5-6 hours. Sweating and chills along with extreme sever stomach pain continued until morning. Went to Er and had tests done. Was told that appendix was needing removal and it was done. Vaccine was Moderna labeled lot 939905. Maybe this was a coincidence or maybe not, but since the appendix has recently been linked to the immune system as possibly part of it purpose for existence it seemed prudent to make this report.


VAERS ID: 1889505 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: na
CDC Split Type:

Write-up: Health department went to Nursing Home on 11/18/21 to vaccinate employees/residents as needed. Client received 1st pfizer vaccine. Client called and left message 11/19/21; tried to call back; no answer left message. Made contact with client 11/22/21. Client reported after vaccination on 11/18/21 developed numbness and tingling of the right side of her face, neck, down to shoulder. She reports started shortly after vaccination and resolved midday 11/19/21. Reports she has notified her PCP. Denies any issues at this time. As of our conversation on 11/22/21, client reports feels fine with no issues.


VAERS ID: 1889529 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-21
Onset:2021-11-18
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21-2A / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1889538 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-08
Onset:2021-11-18
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1889566 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015F21A / 3 LA / IM

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

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

Write-up: Pain in left arm, redness, warmth and swelling at and below injection site, headache


VAERS ID: 1889588 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram 20mg PO daily Dextroamphetamine-amphetamine 30mg PO daily Atrovent 42 mcg nasal spray daily Loratidine 10mg PO daily
Current Illness: None
Preexisting Conditions: ADHA Seasonal Allergies Herpes Labialis
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt started to experience erythematous papular eruption that is tender to touch around the lips and chin and diffuse papular eruption with surrounding erythema tender rash on the right lower forearm Treatment: Continue loratidine, pt does not like to take benadry Prednisone taper prescribed


VAERS ID: 1889604 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cyanosis, Dysphagia, Dyspnoea, Pallor, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient complained of not being able to swallow, shortness of breath, and feeling like throat was closing. He became extremely pale and his lips turned blue. He was given Epinephrine Injection .3 mg. His symptoms improved. He was able to walk and talk after injection and never lost consciousness. He was transferred by ambulance to ER for further evaluation and monitoring. His twin brother suffered the same symptoms about 5 minutes later- as he had received the shot about 5 min after his brother.


VAERS ID: 1889613 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 RA / IM

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

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

Write-up: Patient started having small rash in area of shot the night of/day after vaccination and since then has started spreading across her body. She has started using benadryl but does not improve the reaction. Today is day 5 of symptom course. She is going to see urgent care for assistance.


VAERS ID: 1889614 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA Q11F21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Chills, Ear pain, Fatigue, Headache, Hyperhidrosis, Lymphadenopathy, Pain, Pyrexia, Rash, Tongue discolouration, Tongue ulceration, Tooth disorder
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid First and Second Moderna
Other Medications: Synthroid Nurtec Adderall
Current Illness: N/A
Preexisting Conditions: Hashimotos
Allergies: PCN
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Purple tongue, Purple teeth, Ulcers on tongue, Headache, swollen lymph node under left arm, burning rash on and off on lower back on both sides, left sharp ear pain, body aches, chills/sweats but no fevers, fatigue, No treatment gradual resolution of sx''s.


VAERS ID: 1889622 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cyanosis, Dysphagia, Dyspnoea, Pallor, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient complained of not being able to swallow, shortness of breath, and feeling like throat was closing. He became extremely pale and his lips turned blue. He was given Epinephrine Injection .3 mg. His symptoms improved. He was able to walk and talk after injection and never lost consciousness. He was transferred by ambulance to ER for further evaluation and monitoring. His twin brother suffered the same symptoms about 5 minutes later- as he had received the shot about 5 min after his brother.


VAERS ID: 1889710 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 213D21A / 3 RA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril Atorvastatin famotidine HCTZ jardiance mobic trulicity
Current Illness:
Preexisting Conditions: HTN hyperlipidemia dyspepsia obesity DM osteoarthritis vitamin d deficiency
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. given Moderna booster at 5 months instead of 6 months from last vaccine.


VAERS ID: 1889714 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SC
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: Subcutaneous administration of both vaccines leading to possible vaccine failure and need to repeat at least the flu vaccine.


VAERS ID: 1889744 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-11-18
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-11-22
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer on 2/20 and 3/12. Positive on 11/17


VAERS ID: 1889746 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-11-18
   Days after vaccination:295
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NOT LISTED / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NOT LISTED / 2 - / -

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

Write-up: Fully vaccinated, breakthrough COVID infection with inpatient stay on a medical unit


VAERS ID: 1889772 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / UNK RA / IM

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

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

Write-up: Pt is poor historian. Pt called Covid hotline and requested a booster dose of Moderna. Upon arrival, pt could not locate his vaccine card or dates of vaccine. Pt stated that his vaccines were at the same time as his mother''s (1/21/21 & 2/18/21). Pt given Moderna dose of .25 into right deltoid. Pt''s mother then stated that he did not receive it at the same time and recalled that he received it in the hospital. Pt looked up on TennIIS and only one dose of Pfizer is documented on 8/24/21. Pt informed of this information. Pt stated he "went to get one vaccine but got scared and didn''t follow through". Pt educated that he can mix/match doses but that he received a half dose of Moderna, when a full dose of Moderna would have been the correct dosage if he only received one vaccination and that pt did not qualify for a booster if he did, indeed receive two doses. Pt declined receiving another .25 dose to make a full second dose. Pt educated on booster dose in 6 months. Pt repeated back education. During the initial encounter, before vaccination, pt ran to the other side of the room and stated "You guys are making me nervous. Step back." I attempted to follow up with the pt at the pt''s home but pt declined.


VAERS ID: 1889809 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-02
Onset:2021-11-18
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Bicytopenia, Bradycardia, COVID-19, Chronic kidney disease, Myocardial infarction, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Acute hypoxemic respiratory failure secondary to COVID-19; AKI on CKD4; Braydcardia; elevated troponin; bicytopenia in the setting of COVID-19; type 2 myocardial infarction


VAERS ID: 1889825 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Diarrhoea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: AMPHETAMINE/DEXTROAMPHET 40MG SA CAP; OMALIZUMAB 300MG/VIL INJ; AZELASTINE 137MCG/SPRAY 200D NASAL INHL; KETOTIFEN 0.025% OPH SOLN; CETIRIZINE HCL 10MG TAB
Current Illness: None
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA. Stomach pain, cramping, discomfort and diarrhea for over 5 days. Over the counter medications have helped, but not resolved the issue.


VAERS ID: 1889875 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Feeling hot, Pain, Sleep disorder, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: Non displaced fracture left wrist: 10/21/21
Preexisting Conditions: No
Allergies: Shrimp, albuterol
Diagnostic Lab Data: 11/20/21: ECG (unknown if other tests performed)
CDC Split Type:

Write-up: Swelling, pain, slight warmth of left axillae, left chest reported to our clinic~2:00PM 11/19/21; unable to sleep previous night due to pain. Instructed to take acetaminophen 650mg and apply ice to area and recheck at 7:30pm. Provider unable to reach mother 11/19/21 @7:30pm-no answer. Follow-up 11/20/21: mother states she took child to church evening of 11/19/21; later that night child was getting worse with chest pain-took pt to ED-given ECG-normal per mother, ibuprofen- child able to fall asleep in ED and discharged early morning 11/20/21. Child starting to feel better 11/20/21. Unable to reach mother today, 11/22/21-left message


VAERS ID: 1889877 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram, Chills, Computerised tomogram abnormal, Dyspnoea, Lung disorder, Pulmonary oedema, Pyrexia, Tremor
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, doxepin, esomeprazole, lamictal, quetiapine fumarate, triumeq, Vitamin C, Xanax
Current Illness: HIV+, chronic GERD, depression, dyslipidemia, insomnia, lumbar radiculopathy, obesity, vitamin B12 and D deficiency
Preexisting Conditions: Same.
Allergies: None
Diagnostic Lab Data: CTA 11/22/2021: No Pulmonary Emboli but consistent with widespread interstitial pulmonary edema with differential being allergic lung disease, autoimmune lung disease or exposure related lung disease.
CDC Split Type:

Write-up: Shortness of breath, fever, shaking, chills that started the day after receiving Moderna and influenza vaccine.


VAERS ID: 1889915 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-11-12
Onset:2021-11-18
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

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

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

Write-up: Vascuularitis in both feet, worse in left. Steroid and antibiotic were prescribed 11/22/21


VAERS ID: 1889932 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-26
Onset:2021-11-18
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/18/2021- SARS-CoV-2 PCR Rapid Detected
CDC Split Type:

Write-up: Pt was admitted to the hospital for reasons unrelated to COVID. Admission screening yielded positive results. Pt is asymptomatic for COVID. Due to pt being high risk monoclonal antibodies and remdesivir were given.


VAERS ID: 1889949 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Feeling hot, Headache, Injection site erythema, Injection site pain, Injection site warmth, Pain, Pyrexia, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin with iron
Current Illness: none
Preexisting Conditions: migraines
Allergies: sulfa, pcn, wellbutrin, artificial strawberry
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within an hour- hives, painful, and hot to touch. That night- Wheezing, fever 104.3, body aches, and headache. Still as of 4 days later- injection site red, hot and painful


VAERS ID: 1889951 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Peripheral swelling, Polymenorrhoea
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: I was on my menstrual cycle day 2 and my cycle suddenly stopped. Normal cycle is 7 days. Swelling of my arm with bruising.


VAERS ID: 1889977 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-25
Onset:2021-11-18
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: DM, CAD, HTN,CABG, back surgery
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization with covid after being fully vaccinated


VAERS ID: 1889989 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-05
Onset:2021-11-18
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 RA / IM

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

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

Write-up: hospitalization with covid after being fully vaccinated


VAERS ID: 1889993 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F48020 / 3 - / -

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

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

Write-up: Body aches, chills, fever, swollen lymph node in right arm (side of injection)


VAERS ID: 1890005 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-09
Onset:2021-11-18
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Glycosylated haemoglobin normal
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zyrtec, effexor, crestor, atenolol, losartin, amlodapine, estadiol, metformin, synthroid
Current Illness: none
Preexisting Conditions: hypertension high cholesterol asthma pre diabetic
Allergies: aloe vera
Diagnostic Lab Data: A1C taken at my doctors office 11/18/21
CDC Split Type:

Write-up: my A1C has been hanging around 5.8-6.0 for a couple of years. my A1C has suddenly jumped to 6.8. my doctor is starting me on a new medication to bring my sugar down.


VAERS ID: 1890031 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-04-20
Onset:2021-11-18
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03/23/2021 / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04/20/2021 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, Oropharyngeal pain, Pain, Paranasal sinus hypersecretion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NIACIN, METFORMIN, VERAPAMIL, LOSARTAN/HCTZ, ALOGLIPTIN, LEVOTHYROXINE, ATORVASTATIN
Current Illness: NONE
Preexisting Conditions: DM TYPE 2, HYPOTHYROIDISM, HTN, HYPERLIPIDEMIA, ASHTHMA, OBESITY, MICROALBUMINURIA, OSA, ALLERGIC RHINITIS, DYSPHAGIA
Allergies: ALBENDAZOLE
Diagnostic Lab Data: 11/18/21: POSITIVE POC SARS COVID RAPID ANTIGEN
CDC Split Type:

Write-up: 11/18/21: NASAL CONGESTION, COUGH, ST, BODY ACHES, RUNNY NOSE, SINUS DRAINAGE


VAERS ID: 1890067 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Flushing, 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: fluticasone nasal spray
Current Illness: None known
Preexisting Conditions: Autism
Allergies: NKA
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Flushing and itching occurred after ~10 minutes. Nonverbal, so unable to ask about further s/s, but erythema to hands, chest, and face (brightest on cheeks). Scratching self. Given benadryl.


VAERS ID: 1890099 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 3 LA / IM

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

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

Write-up: Patient was mistakenly given the pediatric formulation of this vaccine instead of the intended adult formulation. No adverse effects or issues; reporting this on the basis of a vaccine error specifically involving the COVID-19 vaccine.


VAERS ID: 1890113 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-11
Onset:2021-11-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O47C21A / 3 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW6207 / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood test, Computerised tomogram, Painful respiration, Pulmonary thrombosis, Thrombosis, Ultrasound Doppler normal, X-ray
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: oral birth control, zoloft, calcium, vitamin d, prenatals
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: multiple blood panels, x-ray, CT scan, doppler
CDC Split Type:

Write-up: A week after the booster, I experienced severe pain when breathing. I went to the ER the next day and was diagnosed with multiple blood clots in my lungs (a subsequent doppler of my legs showed no clots there). They immediately started blood thinners. I was admitted to the hospital and stayed one night.


VAERS ID: 1890139 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Underdose
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 was given 3rd Moderna vaccine. Vaccine was #21 out of a vial that should only have had #20 drawn out of it.


VAERS ID: 1890150 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-11-18
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Diarrhoea, SARS-CoV-2 test positive
SMQs:, Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes , Hypertension
Allergies: Soy, Sulfadiazine, Ceclor, Celebrex, Epinepherine, Gluten, con
Diagnostic Lab Data: C-19 Posisitve
CDC Split Type:

Write-up: Pt was admitted to hospital on 11/15/2021 presenting with weakness Pt was tested for c-19 on 11/18/2021. Pt has been treated with Vatiamin c , Setrezine, Vitamin B-12, Ferra sulfate.


VAERS ID: 1890154 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-15
Onset:2021-11-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Chills, Computerised tomogram normal, Electrocardiogram normal, Gait disturbance, Laboratory test, Mobility decreased, Myalgia, Nausea, Pain, Physical examination, Pyrexia, Vertigo, Vestibular neuronitis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour Thyroid for hypothyroidism
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: None
Diagnostic Lab Data: Emergency department - EKG, labs, CT and chest X-Ray were all normal. Physical exam was performed and diagnosed with vestibular neuritis.
CDC Split Type:

Write-up: I received the Moderna booster on 11/15 at 3:30pm. On the evening of 11/16 I experienced muscle aches, fever and chills which lasted 8 hrs. I took ibuprofen on 11/17 to help with the muscled aches and pain that I was still having. On the morning of 11/18 I could not get out of bed due to severe vertigo and nausea. Stayed in bed all day as I could not walk and could barely function. I have never experienced anything like this and I''m certain it is related to the vaccine. The following morning, 11/19, I was taken to an urgent care facility and upon exam there, was directed to the emergency department. I was experiencing symptoms of a stroke. I am a healthy, active 64 year and this is frustrating. The medications are not working and I am still struggling to walk.


VAERS ID: 1890170 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 was administered 3rd dose of moderna vaccine. The vaccine was #22 drawn out of a vial. Should not have been any more than 20 drawn from vial


VAERS ID: 1890175 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-15
Onset:2021-11-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head discomfort, Nausea, Peripheral swelling, Rash, Rash pruritic, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Other Medications: Gabapentin; metformin, metropolol, fluoxetine, cetirizine, multi vitamin, calcium, baby aspirin
Current Illness: N/A
Preexisting Conditions: Charcot Marie Tooth Diabetes Auto-immune disease
Allergies: Bacitracin, salmon, blue fish, chicken (? ), chamomile, arnica, eucalyptus
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling in face, jaw and lips & hands (worse on left hand), itchy rash welts on torso, front & back. Nausea and slight head discomfort.


VAERS ID: 1890189 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-03
Onset:2021-11-18
   Days after vaccination:260
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Respiratory tract congestion
SMQs:, Anaphylactic reaction (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: Accu-Chek FastClix Lancets - Miscellaneous as directed - 1x/day Accu-Chek Guide - Strip as directed - 1x/day Aspirin Adult Low Dose 81 MG Tablet Delayed Release 1 tablet Orally Once a day Losartan Potassium 50 MG Tablet 1 tablet Or
Current Illness: none
Preexisting Conditions: Labile hypertension. New right bundle branch block diagnosed 1/30/2003 with subsequent negative stress cardiolite. BPH. Shortness of breath with negative evaluation. Hyperlipidemia. Right shoulder rotator cuff repair. 12/19/2018. Normal colonoscopy. Benign biopsy of normal tissue. Next one due in 10 years..
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: xs; congestions, chills, cough starting on 11/18/21


VAERS ID: 1890271 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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)

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

Write-up: Fever, body chills, joint and muscle pain, mild nausea - 4 days. Headache - 5 days and counting.


VAERS ID: 1890345 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 - / IM

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

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

Write-up: Child received pediatric dose instead of normal dose


VAERS ID: 1890353 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Incorrect dose administered, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: Mom took son with her to a Pfizer clinic. PT went through screening process and was administered an adult Pfizer as this was a booster clinic. Mom made aware of med error while waiting to be discharged from the clinic. Clinic educated parents to follow up with PCP, PCP encouraged parents to follow up with DOH. Dad called into DOH to inquire what to do next with dosing. Dad reports that patients experienced typical side effects of fatigue, HA, and sore arm. Dad asking questions of what to look and what to be concerned about because child was administered the wrong formulation. DOH physician followed up with education with family. 11/22/2021: Spoke with clinic, Recommended that they complete a VAERS form and educated on how to do that, verbalized understanding. She reported that patient''s mom signed him up for the clinic and he was administered the dose by a new nurse who asked his age after administration.


VAERS ID: 1890358 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 Generalized-Mild, Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild


VAERS ID: 1890390 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Gait inability, Groin pain, Hypoaesthesia, Muscular weakness, Nausea, Pain, Pain in extremity, Ultrasound Doppler
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 1st & 2nd dose of Moderna
Other Medications: xyrem, concerta, provisual, paxil, Synthroid, lopatol , ventrin C
Current Illness: none
Preexisting Conditions: narcolepsy, hypothyroidism, restless leg syndrome
Allergies: aspirin sensitivity , stingy insects
Diagnostic Lab Data: Blood work- a few things off nothing of concern Doppler of right leg arterial and venial - possibility of lymph nodes inflamed
CDC Split Type: vsafe

Write-up: Nausea, arm pain, throbbing in my right femoral artery in groin area. I was sitting at my desk looking at my computer and when I got up from my groin to my toes of my right leg were completely numb and weak, I could not walk on it so I went to the Emergency room.


VAERS ID: 1890415 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache
SMQs:

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

Write-up: headache


VAERS ID: 1890420 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK OT / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ750AB / UNK OT / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Chest X-ray, Electrocardiogram, Headache, Laboratory test, Pain in jaw
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Osteonecrosis (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: multiple supplements, Vitamins Synthroid, Losartan, Effexor, Potassium, Protonix generic,
Current Illness: sinus drainage
Preexisting Conditions: Sharcot-marie-tooth Immune defieciency macular degeneration
Allergies: Tums, all antibiotics except Rocephin, All pain meds, and anything that processes through CNS
Diagnostic Lab Data: ER, lab test, chest x ray, ekg, 11/19/2021
CDC Split Type:

Write-up: Elevated BP, requiring ER visit Headache, Jaw pain


VAERS ID: 1890434 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018F21A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vial punctured at 12 pm 11/17/2021, and left overnight in the refrigerator. Staff member administered a dose from the punctured vial at around 10 am on 11/18/2021.


VAERS ID: 1890444 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018F21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vial punctured at 12 pm 11/17/2021, and left overnight in the refrigerator. Staff member administered a dose from the punctured vial at around 10 am on 11/18/2021.


VAERS ID: 1890454 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018F21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vial was punctured at 12pm 11/17/21 left out overnight in the refrigerator. Staff member drew and administered dose from punctured vial at around 10am on 11/18/21


VAERS ID: 1890459 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018F21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vial punctured at 12 pm 11/17/2021, and left overnight in the refrigerator. Staff member administered a dose from the punctured vial at around 10 am on 11/18/2021.


VAERS ID: 1890468 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018F21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vial was punctured at 12pm 11/17/21 left out overnight in the refrigerator. Staff member and administered dose from punctured vial at around 10am on 11/18/21


VAERS ID: 1890477 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018F21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vial was punctured at 12pm 11/17/21 left out overnight in the refrigerator. Staff member drew and administered dose from punctured vial at around 10am on 11/18/21


VAERS ID: 1890485 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Erythema, Headache, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Joint range of motion decreased, Lymphadenopathy, Malaise, Myalgia, Nausea, Neck pain, Pyrexia, Swelling, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza, redness and significant swelling at site, adult
Other Medications: Allegra-D, Ibuprofen, Acetaminophen
Current Illness: Strep Throat- resolved
Preexisting Conditions: PCOS
Allergies: Eggs, PCN, Stadol
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11/18/2021 AM :Pain, itching, redness and swelling at injection site. Headache, muscle aches, malaise, low grade temp, nausea. PM: Pain, redness and swelling at injection site extending to left shoulder, supraclavicular, ROM difficult. Headache, muscle aches, malaise, low grade temp, nausea, emesis. Notified nurse manager/FHS. Treatment: OTC Motrin, Tylenol, rest, elevate, ice pack or warm compress prn 11/19/2021 -11/21/2021 AM/PM Pain, redness and swelling at injection site. Increased pain and swelling left: shoulder, neck, and armpit. Significant swelling left supraclavicular. Treatment: OTC Motrin, Tylenol, rest, elevate, ice pack or warm compress prn 11/22/2021 AM/PM Continued Pain itching and tenderness, area firm, decreasing redness and swelling at injection site. Increased pain and swelling left: shoulder, neck, and armpit. Significant swelling left supraclavicular. Limited ROM left shoulder. Headache, malaise. Treatment: OTC Motrin, Tylenol, rest, elevate, ice pack or warm compress as needed.


VAERS ID: 1890506 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-12
Onset:2021-11-18
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abnormal behaviour, Blood pressure decreased, COVID-19, Dialysis, Hypoxia, Neuropathy peripheral, Procalcitonin increased, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinoL, atorvastatin, carbidopa-levodopa, nitroglycerin, pregabalin
Current Illness:
Preexisting Conditions:
Allergies: Adhesive Tape, Wellbutrin [Bupropion Hcl]
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient tells me that on Wednesday she presented to dialysis and tells me this was completed. She normally has Monday Wednesday Friday dialysis. States that after returning home she was thought to be acting differently in an ambulance was called which time she was brought in to the emergency department at an outside facility. Her patient is being seen in transfer from that outside facility. Per secondhand report for being found hypoxic in dialysis in the 70s. Of note the patient was diagnosed with COVID-19 11/16/2021 in her assisted living at what sounds to be a standard screening test. She is vaccinated. She states she has had some mild congestion but otherwise is asymptomatic. Tells me that 2 other resdents were also positive. Also has pertinent history of GI bleeding, renal artery stenosis, peripheral artery disease, diabetes mellitus, history of stroke, history of NSTEMI. Patient was on 2 L of nasal cannula at the outside facility and saturating in the mid 90s. Patient''s blood pressure initially was in the 140 systolic however dropped to 80s though asymptomatic. The patient was given normal saline boluses which her blood pressure was responsive. Due to elevated procalcitonin was started on 1 g of ceftriaxone and 500 mg of azithromycin. Was briefly on norepinephrine however this was weaned off without difficulty. Patient was initially to be transferred to the ICU however with improvement was transferred to General Medicine. On arrival the patient is 100% on 2 L. blood pressures are appropriate in the 120s to 130s. She is awake, alert, and pleasant. Denies chest pain, shortness of breath, dyspnea on exertion, pleuritic pain, abdominal pain, nausea, vomiting, diarrhea. States she has had some fevers at her facility. Tells me that she typically has low blood pressures. Her biggest complaint is the neuropathy in her feet.


VAERS ID: 1890516 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 LA / IM

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

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

Write-up: patient is age 17 , guardian reported client having a slight headache day after immunization which resolved itself, then no other side effects were encountered.


VAERS ID: 1890560 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-03
Onset:2021-11-18
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Atorvastatin, Fluticasone Furoate-Vilanterol, Omeprazole, Azole, Paroxetine HCL , Propranolol, Tamsulosin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted to hospital as inpatient on 11/18/21 due to abdominal pain. Patient was tested for COVID-19 at Pharmacy prior to admission and had COVID + result of that test which was 11/5/21.


VAERS ID: 1890709 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Lymph node pain, Myalgia, Oedema peripheral, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: severe chills, severe body and muscle aches, fever, severe headache for about 10 hours commencing 12 hours after vaccination. swollen and painful lymph nodes in armpit of injection arm (ongoing for 4 days)


VAERS ID: 1890769 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, 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)

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: as mentioned previously similar event with both other doses
Other Medications: Unknown
Current Illness: Known seizure disorder; pt reported that he had a seizure w/ both 1st and 2nd doses of Moderna COVID vaccines
Preexisting Conditions:
Allergies: Unknown
Diagnostic Lab Data: Blood glucose stable at 87 Blood pressure 167/82 initially; 118/80 upon discharge SpO2 95% on room air
CDC Split Type:

Write-up: Pt w/ ongoing seizure disorder for the past 2 yrs. Depending on the day/ week pt can have up to 3-4 seizures per day. Reports having had a seizure after both 1st and 2nd Moderna COVID vaccines. Pt had seizure at 3:22pm; rapid response called. No loss of consciousness. Pt was alert and oriented during seizure ? was speaking w/ wife and verbalizing his experience during seizure. Pt works closely w/ a neurologist. Has had his medications adjusted several times by neurologist but has not yet found one that can manage his seizures. Pt does not know names of his meds. Pt does not have a rescue medication for seizures. No fall or head trauma occurred. Pt was monitored in clinic for ~1 hr and was escorted to his car in a wheelchair in stable condition at 4:26pm.


VAERS ID: 1890980 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ezetimibe, simvastatin, sertraline, advair
Current Illness: asthma
Preexisting Conditions: asthma, high cholesterol, anxiety
Allergies: seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: several swollen/tender lymph nodes under left arm, left hand, left shoulder, left breast


VAERS ID: 1890999 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Nausea, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: PATIENT HAS STARTED TO BE NAUSEAUS 5 MINUTES AFTER VACCINATION AND THEN STARTED TO EXPERIENCE CHEST TIGHTNESS. MOM DECIDED TO BRING PATIENT TO THE EMERGENCY ROOM. SPOKE TO PATIENT 11/21/2021 AND SAID THAT THE ER SAID SHE HAD EXPERIENCE A VACCINE REACTIOPN AND NOT AN ALLERGIC REACTION.


VAERS ID: 1891011 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-11-18
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Consistent Headaches , extremely heavy bleeding during menstrual cycle.
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extremely heavy bleeding during menstrual cycles, consistent headaches (didn?t not have prior)


VAERS ID: 1891238 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Chills, Electrocardiogram, Palpitations, Supraventricular extrasystoles
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CLONIDINE, ATENOLOL,LISINOPRIL, GABAPENTIN, PROMETHAZINE
Current Illness:
Preexisting Conditions: IBS INTERSTITIAL CYSTITIS PVCS CHRONIC PANCREATITIS
Allergies:
Diagnostic Lab Data: ECGS, BLOOD TESTS,
CDC Split Type:

Write-up: WOKE UP SHIVERING UNCONTROLLABLY, MY HEART WENT INTO SOME WEIRD RYTHM, CALLED AMBULANCE AROUND 8AM. TAKEN TO ER FOR THE DAY, TOLD I HAVE PACS TO GO ALONG WITH MY PVCS. GIVEN FLECAINIDE WHICH REALLY HASN''T DONE MUCH, STILL HAVING WEIRD PALPATIONS NEARLY A WEEK LATER.


VAERS ID: 1891246 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 969909 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Herpes simplex, Lymphadenopathy, Oral herpes
SMQs:, Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: - 10mg of Adderall daily - 5mg of Melatonin daily - 500mg Psyllium Husk (fiber) daily
Current Illness: None
Preexisting Conditions: ADHD
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: A flare up of herpes simplex virus in the form of a cold sore on the middle/right side of my lip with a swollen lymph node on the right side as well. No fever, but felt tired and a little fluish for three days after the vaccine. Treating with Abreva. Not the first time I''ve had a cold sore, but its the first one I''ve had in about three years so the timing this soon after the booster (third) shot is suspicious. My other two shots were also Moderna.


VAERS ID: 1891446 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

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

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

Write-up: Finger numb and tingling


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