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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 546 out of 10,317

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VAERS ID: 1891623 (history)  
Form: Version 2.0  
Age: 42.0  
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 066F21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dysgeusia, Parosmia, Throat irritation
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: bee stings, spiders, fleas, eggs, fructose, potatoes, nuts, peppers, morphine, opiates, anti-nausea medications
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received 2nd Moderna COVID vaccine at 1:12 pm in left deltoid, while sitting in zero gravity chair. At 1:15 pm, client reports to EMT she has an itchy feeling in throat, with a metallic taste in her mouth. Client also reports she perceives a "sense of perfume smell in air" as another client passed by. Client reports she is allergic to perfume. Client denies shortness of breath, no trouble breathing, no trouble swallowing, or chest tightening. RN offers client Benadryl IM, client declines, states Benadryl is not for itchy throat and is concerned it will interfere with the efficacy of COVID vaccine. Client states she would like to wait and see if symptoms resolve as she believes they are related to the perfume she smelled in the air. Vital signs are stable. EMT continues to maintain conversation with client, client reports sensation of "perfume smell" has gone away. At 1:35 pm, client reports throat itchiness is improving, declines Benadryl once again. At 1:38 pm, client reports no more throat itchiness. At 1:40 pm, Client reports throat sensation and itchiness have completely resolved, reports slight headache because of perfume noted earlier. Client educated on ER precautions. Client left observation area at 1:50 pm, walking with steady gait.


VAERS ID: 1892704 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-11-18
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hypoacusis, Muscle spasms, Tinnitus
SMQs:, Dystonia (broad), Hearing impairment (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: Comments: The patient had 2 beers and pizza for dinner around 5 pm that evening of 20-Nov-2021.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211146290

Write-up: SLIGHT LOSS OF HEARING IN RIGHT EAR; RINGING IN RIGHT EAR; LEFT LEG CRAMPING; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient had 2 beers and pizza for dinner around 5 pm that evening of 20-Nov-2021. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 18-NOV-2021 for prophylactic vaccination. Batch number was not reported and has been requested. No concomitant medications were reported. On 18-NOV-2021, the patient experienced left leg cramping. On 20-NOV-2021, the patient experienced slight loss of hearing in right ear. On 20-NOV-2021, the patient experienced ringing in right ear. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from left leg cramping on 18-NOV-2021, and slight loss of hearing in right ear, and ringing in right ear on 20-NOV-2021. This report was non-serious.


VAERS ID: 1892760 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: I randomly get itchy ever since I got the vaccine when I first got it I noticed it at night I decided to ignore it but it?s happening at work and when I?m at home I?m just icing my skin so it stops but regardless I?m still itchy it?s my arms that itchy my neck and face behind my head and stomach


VAERS ID: 1892821 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 - / -

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Periarthritis
SMQs:, Arthritis (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: Covid arm, fatigue, sore back
Other Medications: Montekulast, xyzal, famotidine, quetcetin, vitamin d, vitamin c, folic acid
Current Illness: MCAS Immune subclass deficiency Hashimoto?s
Preexisting Conditions: MCAS Immune subclass deficiency Hashimoto?s
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Painful shoulder, shoulder frozen for about 12 hours, then continued to be sore for a couple days before full function returned.


VAERS ID: 1893198 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-11-18
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, 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: USJNJFOC20211144972

Write-up: THE REFRIGERATOR WAS LEFT OPEN AND UNOPENED VIAL STORED FOR 15 MINUTES WHICH HAD A TEMPERATURE EXCURSION OF 47.44 DEGREES F; ADMINISTRATION OF VACCINE THAT WAS STORED OUTSIDE OF THE RECOMMENDED STORAGE CONDITIONS; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1855194, expiry: 09-APR-2022) dose was not reported, administered on 18-NOV-2021 15:20 for prophylactic vaccination. No concomitant medications were reported. On 18-NOV-2021, the patient experienced administration of vaccine that was stored outside of the recommended storage conditions. On an unspecified date, the patient experienced the refrigerator was left open and unopened vial stored for 15 minutes which had a temperature excursion of 47.44 degrees f.The action taken with covid-19 vaccine ad26.cov2.s was not applicable.The outcome of the administration of vaccine that was stored outside of the recommended storage conditions and the refrigerator was left open and unopened vial stored for 15 minutes which had a temperature excursion of 47.44 degrees f was not reported. This report was non-serious.


VAERS ID: 1893328 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101620710

Write-up: This is a spontaneous report from a contactable other healthcare professional, the patient. A 60-year-old male patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FF2589) via an intramuscular route of administration in the left arm on 17Nov2021 at 16:30 (at the age of 60-year-old), as a single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. On 18Nov2021, the patient experienced fever, chills, fatigue and nausea. The events did not result in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events fever, chills, fatigue and nausea was resolving at the time of this report.No follow-up attempts are possible. No further information is expected.


VAERS ID: 1893440 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Extra dose administered, Mobility decreased, Muscle tightness, Pain, Pain in extremity
SMQs:, Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: Received Booster COVID vaccine on 11/17/21, less than 12 hours developed symptoms. After receiving COVID booster developed left sided body pain and weakness. Difficulty moving the left arm due to pain and left arm tightness. Developed 99.9F Temp, treated with Tylenol and Motrin for 24 hours every 3-4 hours. Reports weakness. Reports symptoms lasted until Saturday 11/20/21. Reports all symptoms resolved.


VAERS ID: 1893442 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1893449 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Injection site pain, Interchange of vaccine products, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient was previously infected with COVID?19, November. 2020 and experienced heavy fatigue, skin pain, difficulty breathing and fever over 102 for 9 days. Patient was injected with Johnson and Johnson COVID vaccine in May 2021 and within hours following injection experienced severe injection site pain, lethargy, and fever over 101 for 3 days. Immediately following Pfizer booster in November. 2021, patient experienced injection site pain and fever over 101 for 36 hours. In each case patient experienced a full recovery. Patient is in above average physical condition with daily physical activity.


VAERS ID: 1893674 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

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

Write-up: Booster dose administered at 17 years old patient.


VAERS ID: 1893684 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

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

Write-up: Booster dose administered at 17 years.


VAERS ID: 1893731 (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: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 LA / IM

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

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

Write-up: Child''s mother brought him to an adult vaccine clinic. Child received Pfizer 0.3 ml. Vaccinator reported to coordinator that she asked child''s age after vaccine was administered. Child''s mother made aware that her son received an adult dose of Pfizer. Child was observed for 15-20 minutes and did not experience an adverse reaction to adult dose. Vaccine coordinator advised mother to report incident to child''s pediatrician. Understanding verbalized and child and mother left the clinic. HCP made aware.


VAERS ID: 1893739 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, 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: Client, 32 Yrs Old, 3rd shot in 6 shot series resulted in painful welt down my arm below the injection site. Welt disappeared af
Other Medications: Got Flu shot at same time
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None; not bad enough to need care
CDC Split Type:

Write-up: Swollen lymph nodes, mild-moderate fatigue, slight chills when tired. Nothing bad, reporting for your stats.


VAERS ID: 1893767 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-07
Onset:2021-11-18
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 RA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angioedema, Headache, Pain, Pain in extremity, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Unexplained urticaria, angioedema of face and hands 11 days post injection Sore arm, fever of 100. 8 F, severe headache body aches within 2- 12 hours of administration


VAERS ID: 1893811 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Influenza like illness, Loss of consciousness, Pain
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Chills, achy, flu like symptoms, passed out


VAERS ID: 1893905 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21B / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Fluid retention, Hyperhidrosis, Injection site pain, Lymph node pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: injection site sore, arm pit lymph node became sore, swelling in armpit, fatigue, chills, next day more fluid built up on side of body and moved down to the belly, last two nights woke up in sweats


VAERS ID: 1893943 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: My son had severe eye swelling after his first shot. They swelled shut and we gave him adult benadryl every 6 hours for 24 hours.


VAERS ID: 1893984 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EF8734 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330068D / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Maternal exposure during pregnancy, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Probiotics, prenatal vitamin
Current Illness: Crohn''s disease, 21 weeks gestation
Preexisting Conditions: Crohn''s disease
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: 21 week pregnancy, uncomplicated. Patient had COVID booster then developed urticarial rash 2 days later that did not respond to Benadryl or Zyrtec


VAERS ID: 1893996 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 2 LA / IM

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

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

Write-up: 13yr old patient recieved moderna, no adverse effect reported


VAERS ID: 1894002 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-02-21
Onset:2021-11-18
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Cough, Incontinence, Infusion, Musculoskeletal chest pain, Nausea, Pain, Pulse absent, Resuscitation, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: HISTORY OF PRESENT ILLNESS: Patient is a 84 y.o. female with history of paroxysmal atrial fibrillation on Eliquis, T2DM, hypothyroidism, hyperlipidemia, aortic valve replacement HFpEF, OSA, CKD 3, and iron deficiency anemia who presents as a transfer from another hospital after a cardiac arrest. Patient was in the outpatient surgery clinic receiving an iron infusion today when she suddenly began to feel nauseous. She then became unresponsive. A respiratory therapist checked for pulse and could not find 1 so CPR was started. After roughly 1 minute of CPR, she started yelling, her pulse was checked and heart rates were in the 60s. She remained alert and oriented since this incident. Per report she was incontinent during the episode. She has been awake and alert since this incident. She continues to feel nauseous. Prior to the event she denies any chest pain but since CPR she has external musculoskeletal chest pain with any sort of movement of her upper body. Of note she tested positive for COVID-19. Per outside records her daughter presumed she had COVID around November 2nd and her symptoms, including a slight cough resolved about a week later. She was never tested at that time.


VAERS ID: 1894005 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-15
Onset:2021-11-18
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: BACTRIM, INSULIN LISPRO
Diagnostic Lab Data: COVID-19 TEST POSITIVE
CDC Split Type:

Write-up: COVID-19 POST COVID-19 VACCINATION


VAERS ID: 1894033 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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:
Other Medications: Rx: estradiol transdermal 0.1 mg/day; progesterone 100 mg/day; NP Thyroid 30 mg/day OTC: Vit. D3 1500 IU/day, Mg Glycinate 200 mg/day; Calcium 600 mg/day; Probiotic daily, Inulin Fiber 4 tsp/day
Current Illness: No illness in month prior
Preexisting Conditions: Hypothyroid & Lichen sclerosus
Allergies: Anaphalyxis to buckwheat & rhubarb; Seasonal Rhinitis to oak & birch pollen; Rhinitis - dust mites
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Hives on chest appeared appx. 8 hours after booster vaccination. By 11/22 the hives present on chest, left wrist and back. 11/22 took 25 mg benadryl at 11:30 p.m. followed by second dose at 2:40 a.m. 11/23. Used Bioron Calendula gel topical for itchiness and Eucerine Intensive Repair Lotion and Biossance 100% plant derived squalene oil.


VAERS ID: 1894114 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-11-18
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Ear discomfort, Headache, Nasal congestion, Oropharyngeal pain, Sinus congestion, Sneezing, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Immune-mediated/autoimmune 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: Taking Atorvastatin Calcium 10 MG Tablet 1 tablet Orally Once a day, Taking Levothyroxine Sodium 137 MCG Tablet 1
Current Illness: none
Preexisting Conditions: high cholestrol, hyperthyroid
Allergies: Aspirin: hives - Allergy, Tetracaine: hives - Allergy, NSAIDs: hives - Allergy.
Diagnostic Lab Data:
CDC Split Type:

Write-up: sore throat, headache, chills, loss of taste, loss of smell, , post nasal drainage, sinus congestion, nasal congestion, sneezing, ear fullness starting 11/18/21


VAERS ID: 1894188 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-11-18
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Sepsis
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Sepsis (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe sepsis; NSTEMI


VAERS ID: 1894231 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest discomfort, Cold sweat, Cyanosis, Disorientation, Dysarthria, Electrocardiogram, Eye movement disorder, Feeling abnormal, Injection site rash, Loss of consciousness, Pallor, Paraesthesia, Pyrexia, Seizure, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Standard immunization appointment when he was 2 years old to Dtap/DT/Td/Tdap4, HIB4 and MMR 1. After standard vaccination he we
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, lactose
Diagnostic Lab Data: Vitals; EKG, Chest X-ray, bloodwork, observation
CDC Split Type:

Write-up: Walk-in basis, vaccine administered around 4:40. As getting into car, noticed my son pale and clammy, asked if he was ok and he slurred his answer that he didn''t feel right, passed out, toppled over in seat, eyes rolled and started convulsions. He had a history of Febrile seizures so I was concerned when he was unresponsive. Called emergency. EMT stated I was closer to hospital where I was driving towards- than he could get to us. Son came to but was disoriented, eyes unfocused, asked me to call emergency mumbling his chest felt tight and reported a tingling sensation all over his body, passed out again, shaking violently, lips were bluish. Was unable to get out of car and wheeled in still pale, disoriented and unfocused. Vitals taken at ER and went into observation. Followed up with PCP next day. Recommended allergist. Fever of 101.8 that night and rash around injection site.


VAERS ID: 1894298 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, 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: We were conducting a booster clinic. We were told by medical staff that everyone showing up to the clinic was eligible for a booster, per their Medical Director. Individuals receiving boosters did not have access to their Covid-19 record cards for nurses to verify before giving the vaccine. Afterwards, when inputting doses , it was discovered that this individual had received their booster dose too early per CDC guidelines. Patient was monitored afterward per CDC guidelines and no adverse events occurred. This individual was eligible to receive a booster on 12/06/2021, but received it on 11/18/2021.


VAERS ID: 1894310 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-11-18
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Pulmonary congestion, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: s/p hip replacement
Allergies:
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) by NAA, Micro detected 11/22/21 Chest xray 11/22: IMPRESSION: Question possibility of a right lower lobe infiltrate and mild congestion. Follow-up recommended
CDC Split Type:

Write-up: short of breath, cough beginning around 11/18/21, then presented to ER and tested positive for covid


VAERS ID: 1894316 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-26
Onset:2021-11-18
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Pneumonia, SARS-CoV-2 test positive
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: POS on admission 11.18.21
CDC Split Type:

Write-up: CAP


VAERS ID: 1894319 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Incorrect 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 received full 0.5 ml dose for booster in series after Janssen vaccine where 00.25ml half dose was indicated. No adverse event reported.


VAERS ID: 1894343 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 - / -

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: We were conducting a booster clinic at a facility. We were told by medical staff that everyone showing up to the clinic was eligible for a booster, per their Medical Director. Individuals receiving boosters did not have access to their Covid-19 record cards for nurses to verify before giving the vaccine. Afterwards, when inputting doses into the database, it was discovered that this individual had received their booster dose too early per CDC guidelines, they were eligible to receive their booster on 12/06/21 but received it on 11/18/21. They were monitored afterwards per CDC guidelines and no adverse events occurred.


VAERS ID: 1894358 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 - / -

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: We were conducting a booster clinic. We were told by medical staff that everyone showing up to the clinic was eligible for a booster, per their Medical Director. Individuals receiving boosters did not have access to their Covid-19 record cards for nurses to verify before giving the vaccine. Afterwards, when inputting doses , it was discovered that this individual had received their booster dose too early per CDC guidelines. They were monitored afterwards per CDC guidelines and no adverse events occurred. They were eligible to receive their booster on 1/30/2022, but received it on 11/18/21.


VAERS ID: 1894364 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-15
Onset:2021-11-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, ibuprofen
Current Illness:
Preexisting Conditions: hypertension
Allergies: seasonal allergies (pollen)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received COVID-19 vaccine on Monday - had grade 3 reactions (fevers, chills) through Wednesday, and developed redness/swelling at injection site thursday/friday. Evaluated by urgent treatment clinic, who determined to be allergy and dispensed benadryl, however per patient interview the reaction was localized and improved overnight after 1 dose of PO benadryl and a cold compress. No generalized hives, difficulty breathing, itchiness or swelling. This provider does not think this is an allergy or contraindication to future vaccination with the mRNA vaccines.


VAERS ID: 1894366 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 - / -

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: We were conducting a booster clinic.. We were told by medical staff that everyone showing up to the clinic was eligible for a booster, per their Medical Director. Individuals receiving boosters did not have access to their Covid-19 record cards for nurses to verify before giving the vaccine. Afterwards, when inputting doses into the database, it was discovered that this individual had received their booster dose too early per CDC guidelines. They were monitored afterwards per CDC guidelines and no adverse events occurred. They were eligible to receive their booster on 12/23/21, but received it on 11/18/21.


VAERS ID: 1894369 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster, Lymphadenopathy
SMQs:, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Herpes Zoster and groin lymph node swelling


VAERS ID: 1894376 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Fatigue, Loss of personal independence in daily activities, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Severe body aches Dizziness Nausea Fatigue Diarrhea Lasting for more than 1 week and debilitating to daily life


VAERS ID: 1894386 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 1 LA / IM

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

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

Write-up: imz was given 7hrs20mins after dilution. pfizer was called about dilution expiration time was identified.


VAERS ID: 1894395 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chest discomfort, Chest pain, Electrocardiogram normal
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Chest pain and tightness. EKG and blood work done to check the condition on the heart. All tests came back good.


VAERS ID: 1894409 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Diarrhoea, Dizziness, Fatigue, Headache, Nausea, Neck pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (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: PCN
Other Medications: Ozempic, Metformin, Levothyroxine, Metoprolol, Furosemide, Klor-Con, Advair, Montelukast, Zolpidem, Omeprazole, Methotrexate, Folic acid, Vitamin E, & D, Calcium, Magnesium, Lumigan and multivitamin. Xyzal. I''ve been taking Tylenol for pai
Current Illness: Nothing prior to vaccine
Preexisting Conditions: Asthma, Diabetes type 2, Hypothyroidism, high blood pressure, sleep apnea, hiatal hernia and arthritis.
Allergies: Pcn, Prednisone, Keflex, Bactrim, Cipro, Aspirin, Cymbalta, Meridia, Levaquin, Doxycycline, Cortosteroid, and Ominicef. Also allergies to eggs.
Diagnostic Lab Data: Non
CDC Split Type:

Write-up: Fatigue, dizziness, neck pain, chest pain, nausea, diarrhea, chills and headaches.


VAERS ID: 1894448 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-06
Onset:2021-11-18
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse reaction, Affect lability, Anxiety, Asthenia, Depression, Emotional distress, Fatigue, Fear, Feelings of worthlessness, Immediate post-injection reaction, Impaired work ability, Stress, Suicidal ideation
SMQs:, Suicide/self-injury (narrow), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: THC + CBD As needed for pain relief Progesterone Micro 100mg twice daily Estradiol Valerate 5mg weekly Spironolactone 100mg twice daily Seroquel 50 or 100mg nightly Bupropion 150mg each morning Adderall 15mg twice daily
Current Illness: No illnesses (other than chronic) leading up to the vaccine or at the time of vaccine
Preexisting Conditions: Ehlers Danlos Syndrome, Postural Orthostatic Tachycardia Syndrome, ADHD, ASD, PTSD.
Allergies: No allergies known.
Diagnostic Lab Data: I do not have any medical records of these adverse effects, however I was in constant contact with my mother through both of these events - We have the Text logs and call logs, as well as banking records that could potentially be used as proof.
CDC Split Type:

Write-up: For two weeks following the initial Covid Vaccine, I experienced extreme emotional distress and an inability to regulate those emotions, I was unable to work for several days due to the amount of anxiety I was experiencing. I was incredibly anxious, depressed, and generally overwhelmed. I had many thoughts that were passively suicidal, and many emotions of self-hate and deprecation. I was able to gradually cope with these emotions and after nearly two weeks, the symptoms were gone. I thought that this was due to stress buildup until i got my booster shot last Thursday (11/18/2021), Immediately after, my energy was completely drained, and the next day I was even more exhausted and started to feel incredibly anxious, and I decided to go to sleep as i was likely just tired. The next morning, I woke up to extreme fears of my friends leaving me along with a deep feeling of depression. The thoughts of self hate returned, but they only lasted a few days... I am still dealing with these symptoms but they have gotten better the last two days.


VAERS ID: 1894449 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chest discomfort, Dizziness, Dyspnoea, Dystonia, Electrocardiogram normal, Gait disturbance, Hypoaesthesia, Injection site pain, Muscle spasms, Muscular weakness, Pain, Pain in extremity, Palpitations, Pyrexia, Vertigo, Vomiting, X-ray normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccines
Other Medications: Escitalopram 20mg daily, LamoTRigine 100mg daily, Topiramate 150mg PM daily, Gabapetin 100mg PRN, Sumatriptin 100mg x2 PRN, Ferrous gluconate 225mg daily, magnesium 200mg daily, lansoprazole 30mg daily, dicylomine 10mg AM daily PM PRN, Yaz
Current Illness: no
Preexisting Conditions: GERD, Chronic migraines with aura, Major depressive disorder, PTSD, Anxiety, Anemic, Acute Cholecystic,
Allergies: Azithromycin, Citalopram, Hydrocodone. phentermine, flu vaccines, Gluten, Eggs,
Diagnostic Lab Data: EKG-Normal X-ray-Normal Bloodwork-normal
CDC Split Type:

Write-up: Right after I left the vaccine site my right arm began to hurt underneath. After a few minutes the site where I received the vaccine began to burn and I had shooting pain in my arm. As I continued to drive my arm began to spasm and my whole right side began to hurt. Suddenly after a spasm my hand closed and I could not get it to stay open. Soon after I could not feel my right foot. When I got home and got out of my vehicle I felt very dizzy and light headed and walking to my apartment was difficult. Once inside everything was spinning, my heart was racing and my chest felt tight, like I couldn''t get a good breath. I then began vomiting. I had a temp of 99.8 later that evening. The next evening when I woke up, I still had the same symptoms. I called my Dr office and they told me I needed to go to the ER right away because of the extremity weakness. At the ER they did EKG, X-ray, and blood work. all came back fine. They gave me Benadryl and a medication they said was like ibuprofen. After several hours they said they didn''t know why it happened but they couldn''t find anything and to wait a few days and call my PCP if it worsens or goes away. Since then everything comes and goes. for the most part i know can keep my hand open, sometimes it close, chest tightness is intermittent, as well as the fever. I still can not feel my toes in my right foot and still have right arm pain.


VAERS ID: 1894464 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: DEVELOPED RASH 24 HOURS AFTER PFIZER BOOSTER, REDNESS FROM INJECTION SITE TRAVELING DOWN TO ELBOW AND TURNING INWARD.


VAERS ID: 1894474 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS GC5NG / N/A RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 325mg po qid
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: NKA
Diagnostic Lab Data: None reported
CDC Split Type:

Write-up: Patient reports nosebleeds from the left nostril starting the day after vaccination that has became more frequent as the days has went by.


VAERS ID: 1894480 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PH8025 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysstasia, Fall, Gait disturbance, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness:
Preexisting Conditions: RSDS,Diabetes,Hypertension,hyperlipidemia,Osteoarthritis
Allergies: Lobster, ativan,Nsaids,Sulphur,
Diagnostic Lab Data: Non
CDC Split Type:

Write-up: Extreme weakness in arms and legs? difficulty walking due to the weakness? an episode of unable to stand on legs .. forced to fall to floor due to weakness? unable to get up to walk .. arms very weak Called for help to get off floor?.Legs unable to hold body wait.. no walking for 3 hours then strength back some able to walk very cautiously


VAERS ID: 1894485 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-11-15
Onset:2021-11-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Agitation, Schizoaffective disorder
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Geodon, Gabapentin, Paroxetine, LINZESS, Lunesta, lamotrigine
Current Illness: N/A
Preexisting Conditions: Bipolar, depression, anxiety, OCD
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: Beginning to have symptoms on 18th of November mental agitation, easily upset at things, suicidal thoughts and outbursts. experiencing schizoaffective disorder, which progressively got worse until worst episode was the 22nd of November.


VAERS ID: 1894518 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-08
Onset:2021-11-18
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 3183 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Postmenopausal haemorrhage, Postmenopause
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: Omega 3 fish oil Lutein. Turmeric. Vitamin D. Vitamin B
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Have been 2 years post menopause. Full hormonal/menstrual cycle has come back.


VAERS ID: 1894561 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 1 RA / IM

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

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

Write-up: imz was given 7hrs58mins after dilution. pfizer was called about stability & pt was informed


VAERS ID: 1894650 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fatigue, Feeling abnormal, Injection site pain, Musculoskeletal chest pain, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Hearing impairment (narrow), Vestibular disorders (broad)

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

Write-up: Fatigue, pain, burning at injection site, dizziness, felt a bit off, rib cage area pain and tinnitus worsened. Within hours, immediate pain. It felt like I was punched with a bee for 2 hours straight.


VAERS ID: 1894656 (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: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / SYR

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

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

Write-up: Patient came to the COVID-19 vaccine clinic and inadvertently received a 22 mcg dose of the Pfizer COVID-19 vaccine. I spoke to mom who tells me she completed the 15 min observation period without any unusual symptoms. Mom was counseled to monitor patients symptoms over the next 7 days and report any concerns to her pediatrician or if more serious to go to the ED.


VAERS ID: 1894666 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-15
Onset:2021-11-18
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN C28161 / 1 AR / 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: 11/22 SARS/COV-2, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1894670 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK1527 / 1 LA / IM

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

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

Write-up: Patient came to the vaccine clinic today and inadvertently received a 22 mcg dose of the Pfizer COVID-19 vaccine. I spoke to dad via phone who did not report any unusual symptoms during the 15 min observation period. I counseled them to monitor patient for the next 7 days and report any unusual symptoms to her pediatrician or if more serious to go to the ED.


VAERS ID: 1894682 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK1527 / 1 LA / IM

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

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

Write-up: Patient came to the vaccine clinic today and inadvertently received a 22 mcg dose of the Pfizer COVID-19 vaccine. I spoke to dad who said he completed the observation period without any unusual symptoms. I counseled dad to monitor his symptoms over the next 7 days and to report any concerns to his pediatrician or if more serious to go to the ED. I called back the next day and spoke to mom - he is doing well and no symptoms.


VAERS ID: 1894695 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK1527 / 1 LA / IM

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

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

Write-up: Patient attended the vaccine clinic and was inadvertently given a 22 mcg dose of Pfizer''s COVID-19 vaccine (pediatric dose is 10 mcg). She was with her dad and completed the 15 min observation period without any unusual symptoms. I spoke to her dad via telephone about what happened and advised them to monitor her symptoms over the next 7 days. If she exhibits any unusual or persistent symptoms or they have any concerns they should reach out to the pediatrician/family doc, or go to the ED. I spoke to her dad the next day and he reported that patient was doing well.


VAERS ID: 1894703 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK1527 / 1 LA / IM

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

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

Write-up: came to the clinic tonight and was inadvertently given a 22 mcg dose of vaccine. I spoke to mom while they were at the clinic, and she did not exhibit any unusual symptoms during the 15 min observation period. I explained what happened and that she should be watched closely over the next several days. If she exhibits any unusual symptoms, she was counseled to see her family doctor, urgent care, or the ED. Later that night I also received request at 1712 from father for a call back. I spoke to him and answered all his questions. Father sent me a text message the next day (11/19) to report she was doing well. I answered his text and all questions.


VAERS ID: 1894736 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 OT / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dysstasia, Headache, Incorrect route of product administration, Injection site discolouration, Injection site induration, Injection site pain, Injection site warmth, Nausea, Pyrexia, Retching, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), 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: 2nd Pfizer shot on 05/09/2021, splitting headache, 102 fever for 1 day. Same injection site: right upper buttock
Other Medications: amitriptyline 25 mg, 1 nightly metoprolol 25 mg, 1 nightly clonazepam 0.5 mg, 1 nightly multivitamin, 1 daily fish oil, 1 daily
Current Illness: None
Preexisting Conditions: Irritable Bowel Syndrome-Diarrhea PAC/PVCs Difficulty sleeping
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8 hours after vaccine administration, at 6 pm, I started to get a headache. Took Tylenol. Took repeat Tylenol at 10 pm and fell asleep. Woke up about 2 am, needing to pee. Went to stand up from bed and fell to my knees. I had no pain but could not hold myself up. Pushed on table and got myself back up to bed. Did not feel weak or tired. Just could not stand. Waited a few moments and shakily made it to the bathroom. At 5 am got up to pee again. Standing ok. Got done, and my whole abdomen started trembling. I felt like I was going to vomit and had dry heaves. The rest of the day I had diarrhea and the loudest GI sounds ever. I tried Gas-X. No help. Splitting headache. Fever of 102.1 with Tylenol taken every 4 hours. Fever seemed to break once with sweats, down to 99.8; but returned to 102.1. This lasted thru Friday and Saturday. I started to feel better Saturday evening and fever resolved. The injection site in my right upper buttock had been rock hard, sore, about 1" in diameter. On Sunday, the reaction at the injection site was 5" in diameter, hard in the center 3", pink, warm, and very sore. Could not sit. Still sore on Monday. Today, Tuesday, it is down to 1" diameter and is much less sore.


VAERS ID: 1894754 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hyperhidrosis, Pallor, Skin warm, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received his vaccine and sat down for his 15 minute observation period. After approx 5 min of sitting, staff noticed patient was sweating profusely. patient skin pale and clammy, very sweaty. Patient stated he felt dizzy and his vision was blurry and he felt like he was going to pass out. staff used an ammonia inhalant under patient''s nose. Cool papertowels applied to head. Patient''s mask and jacket were removed. Patient given cold beverage. Patient declined to lie on the floor. BP 110/82, pulse 76 and regular. Breathing normal, non labored. staff sat next to patient for 15 minutes until patient stated he no longer felt he had to pass out. Patient sat for an additional 15 minutes. After 40 minutes of sitting, patient''s color of face was no longer pale, skin warm to touch, no longer clammy and sweaty. staff stood next to patient as he stood from sitting position. patient stated he felt fine, no dizziness. Patient stated he was fine to drive himself home and he was going to go home and rest.


VAERS ID: 1894766 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-30
Onset:2021-11-18
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Hypoxia, Malaise, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, depression, osteoporosis, dyslipidemia
Allergies: No known drug allergy
Diagnostic Lab Data: 11/22/2021 Positive COVID-19 NAA
CDC Split Type:

Write-up: Patient admitted with worsening shortness of breath. The patient was sick for about a week with sore throat, cough, shortness of breath, and hypoxia.


VAERS ID: 1894772 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Angiogram, Blood test, Chest X-ray, Chest pain, Chills, Dizziness, Electrocardiogram, Fatigue, Feeling abnormal, Headache, Hypertension, Malaise, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ib profen, meclizine, women''s multi-vitamin, calcium supplement, probiotic, zyrtec, birth control (seasonique)
Current Illness: Seasonal allergies
Preexisting Conditions: Environmental allergies
Allergies: penicillin
Diagnostic Lab Data: BW, chest x-rays, check CT angiogram, EKG - all 11/18/21
CDC Split Type:

Write-up: After vaccination felt fine other than sore arm. At bedtime had mild chills and body aches. Next morning I felt ok, had a headache, went to my physical therapy appt and couldn''t do the exercises. I tired very quickly. I could do those exercises easily 2 days prior. I went to work, felt malaise overall. Felt better the next morning, mild headache - went to work. I had been working on my feet all day for about 4 hours when I started to feel chest pain on the left side. It was mild so kept working for about an hour or two. I started to feel it on the left side of my back as well. It started to get worse and I was starting to feel dizzy - I left work and went to ER. They did a bunch of tests to rule out all the bad stuff (heart attack, stroke, clots, etc). All tests came back negative. My blood pressure was higher than 180 when I presented at the ER and returned to normal after 3 hours at the ER. Felt nauseated after the ER visit (assuming it was from the contrast dye injected during ER visit for CT scan). Next day had overall malaise. Still had chest pain but it was lessening. Felt like the aftermath of something exploding in your chest and I was sore from the inside/out (vs outside/in when you workout - if that makes sense). Minimally sore on day 4 and overall malaise - went to urgent care because I felt I should feel better by now. Had a mild low grade fever of 99.4 (I normally run 98 or below and my 2nd covid vax elevated to 99.4 as well). They tested me for covid (neg) and told me to give it a couple more days and come back if I still wasn''t feeling well. Day 5 felt more normal - was trying to check my blood pressure at home, but was consistently getting high readings - went to ER next day (urgent care refused to see me for high bp) - BP was only slightly elevated (127/92) - so suspect the high readings were false - as I felt normal that day. I have history of mildly elevated bp in which I have controlled with diet/exercise last 2 years - no meds for it.


VAERS ID: 1894865 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       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: none
CDC Split Type:

Write-up: accidently gave the 5-11 dose instead of the 12+ dose


VAERS ID: 1894873 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-11-16
Onset:2021-11-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Bradycardia, C-reactive protein, Echocardiogram normal, Electrocardiogram normal, Full blood count abnormal, Hypotension, Red blood cell sedimentation rate normal, SARS-CoV-2 test negative, Streptococcus test negative, Syncope, Viral infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: covid negative, strep negative, echo negative, ekg normal, crp, esr negative, CBC- indicative of viral illness.
CDC Split Type:

Write-up: Pt had a syncopal event with hypotension and subsequent bradycardia after venipuncture.


VAERS ID: 1894894 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Chills, Decreased appetite, Eating disorder, Fatigue, Feeling abnormal, Headache, Hypotension, Pain in extremity, Rash, Sleep disorder
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Yes to the 1st and 2nd Moderna COVID vaccinations - leg pain Flu vaccination one time - sick after vaccination
Other Medications: Topiramate Synthroid Tramadol Gabapentin Nifedipine Mirtazapine Restasis Biotin Vitamin C Vitamin D3 Magnesium Red Yeast Rice Multivitamin Fish Oil Super B Complex Calcium Citrate Magnesium & Zinc Refresh Plus Eye drops Refresh Celluvisc N
Current Illness: None
Preexisting Conditions: Peripheral Neuropathy in left calf, Benign tumor on thyroid, Seizure disorder, Hypertension, history of ankle injury, Psoriasis
Allergies: Codeine, Demerol, Lisinopril, sick after a flu vaccination (one time),
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: I woke up in the middle of the night shivering with bad chills. I also had the sore arm but that was nothing. During the night, the chills were bad and the leg pain. When I got up to go to the bathroom, I could tell my blood pressure was low. But I had a normal temperature in the morning which was 98.3. My BP was 76/56 when my husband took my blood pressure in the morning. So that?s when I called the doctor?s office. I also had a really terrible stomachache and a headache. I just felt horrible, but it was the chills that knocked me. The next day, the chills were starting to go away, the headache as well. But I had a rash from just below my chin all the way down to my hips. All over my entire torso and under my arms and all over my breasts and under. Front sides, back, everywhere. It was a worst rash than when I had vaccine 1 & 2. I was just really wiped out and super tired. By the end of that day, I was beginning to feel better. I also had no appetite this entire time. I could hardly eat anything, I was able to eat something because I needed to, especially since I needed my blood pressure to go back up. I knew that it was dangerous for me to have low BP because it can cause you to fall. The first night, I thought I was gonna fall over that night going to the bathroom, but I never took my BP. I never felt that bad with the first two vaccinations. The pain of the leg ? that decided to stick around. The day after that, the rash started fading. The other symptoms, by that day, I only had a little bit of a rash and leg pain but the rest of the symptoms went away and the BP went back to normal. Leg pain still persists.


VAERS ID: 1895074 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Malaise, Presyncope
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: Medications: albuterol sulfate (PROVENTIL HFA;VENTOLIN HFA) 90 mcg/actuation HFA inhaler Inhale 1 Inhalation by mouth every 6 (six) hours as needed for Wheezing or Shortness of Breath. aluminum-mag hydroxide-simethicone (MINTOX MAXIMUM STRE
Current Illness:
Preexisting Conditions: PMH: CAD s/p stent, COPD, HTN, OSA, HLD, GERD, Diverticulosis, Diverticulitis, anxiety, chronic CP
Allergies: Allergies: Pfizer COVID Vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received Janssen Booster. Pt previously received Pfizer Covid Vaccine x1 and Janssen Covid Vaccine x1 30mins post vaccination pt was observed to be dizzy by observation RN. Pt had a near syncopal event. Pt escorted by w/c to triage area and assess by provider. Pt denies SOB, chest pain. Provider recommended to call 911 for further evaluation at the ER @11:30. Vitals: 160/101, 83, 18, 100% A&O x4, dizzy upon standing -- $g 155/94, 83, 18. Pt d/c to ER via EMS w/ family member In ED: Pt reports that he noticed he was feeling "weird" and generally unwell Described as pre-syncope States similar s/s w/receipt of prev covid vax. However, endorses mild CP w/onset of s/s States s/s ongoing but gradually improving. NO further information available. Pt appears to have been discharged from ED without intervention.


VAERS ID: 1895083 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: North Dakota  
Vaccinated:2021-11-22
Onset:2021-11-18
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039721A / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Chills, Dyspnoea, Feeling hot, Hypoaesthesia, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Non
Current Illness: No im.healthy till I got.my vaccine. I start feeling numbness.my.right.side of.my.neck High fever 103.0 then I get chill. Body ach.xontenue having fever muscles pain
Preexisting Conditions: Non
Allergies: Non
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbness. On the Neck pain right side. Body ach Chill fever 103.0. My body very hot exiety Breathing problem.during vaccine went away the next day


VAERS ID: 1895098 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling jittery
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: No Known Medications
Current Illness:
Preexisting Conditions: PMH: Eczema, Fibromyalgia
Allergies: Allergies: "Paba"
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12mins post vaccination pt reported feeling internally jittery (shoulder, arms and torso) Vitals: 16:00 115/64, 86, 18, 100%, 97.2F -- $g 16:22 126/67, 74, 100%, 97.8F After ~15 additional minutes, pt stated that she was feeling better. Pt denied lightheadedness with ambulation. Pt waited in general observation area to be pick up by husband. Pt advised not to drive. Pt stable and released from the vaccination site. Recommended pt f/u w/ PCP.


VAERS ID: 1895319 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 had booster dose on 11/18/21 and complained of area being puffy and red. resolved now 11/23/21.


VAERS ID: 1895328 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 3 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Erythema, Fatigue, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MODERNA dose 1 on 2/11/21, age 41, redness and itching with tingling down arm to fingers
Other Medications: NONE
Current Illness: none
Preexisting Conditions: CHRONIC MIGRAINE
Allergies: ALLERGIC TO PECANS, ALMONDS, COCUNUTS, MILD REACTION TO BANANAS. ALLERGIC TO PCN and ALL CILLIN CLASS DRUGS.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4 hours after receiving booster dose of Moderna, pt reports feeling intense itching all over her body. Denies any visible rash at this time. Pt was seen by telehealth provider who prescribed Hydroxyzine HCl 25mg. Pt has had previous reaction to Moderna dose 1 on 2/11/21, unclear if VAERs report was generated. 17 days after dose 1 (lot #024M20A ) pt had feeling of intense itching and redness of left arm, with tingling all the way down to all of her fingers and extreme fatigue.


VAERS ID: 1895727 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Injection site rash, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: THE PATIENT''S MOTHER CALLED ON 11/23/21 TO REPORT THAT HER SON HAD A REACTION TO THE PFIZER VACCINE HE RECEIVED. HE FAINTED OUTSIDE THE PHARMACY IN THE PARKING LOT MINUTES AFTER RECEIVING THE VACCINE. THE PATIENT DID NOT WAIT FOR 15 MINUTES OBSERVATION AS REQUESTED BY THE VACCINATING PHARMACIST. PATIENT WAS TAKING TO THE EMERGENCY ROOM AND THEN DISCHARGED AFTER SERIES OF TEST AND OBSERVATION PER MOTHER. PATIENT ALSO COMPLAINED OF CHEST TIGHTNESS, DROWNING SENSATION, RASH AT THE INJECTION SITE AND FEVER FOR 5 DAYS.


VAERS ID: 1896522 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Heart rate decreased, Nausea
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea and pulse decreased to 40''s . Symptoms started as patient was discharged. Patient rested, heart rate increased with oxygen and. Patient observed for 45 minutes, paramedics called and patient stable, no further complications.


VAERS ID: 1958453 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site mass, 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: Allopurinol, budesonide-formoterol inhaler, Allegra, hydrochlorothiazide, ibuprofen, ipratropium-albuterol nebulizer, levothyroxine, lisinopril, magnesium chloride, metformin ER, metoprolol succinate ER, montelukast, multiple vitamin, omepr
Current Illness: Chronic-no acute visits
Preexisting Conditions: Diabetes type 2, asthma, hypothyroid, obstructive sleep apnea, gastroesophageal reflux disease, goat, menieres disease, hyperlipidemia, hypertension
Allergies: Sulfonamide antibiotics, clarithromycin, doxycycline, penicillins, propranolol HCL, pseudoephedrine, hydrocodone bitartrate, loratadine, morphine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hard lump, red warm area 4-5 cm at upper arm injection site. Skin is now itching. Size and pain have started to decrease.


VAERS ID: 1896315 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-11-18
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, 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: Test Date: 20211118; Test Name: COVID-19 PCR test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20211144964

Write-up: COVID-19 TEST POSITIVE; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on MAR-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 18-NOV-2021, the patient experienced covid-19 test positive. Laboratory data included: COVID-19 PCR test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of covid-19 test positive was not reported. This report was non-serious. This report was associated with product quality complaint: 90000203158. .; Sender''s Comments: V0: Medical assessment comments not required as per standard procedure as the case is considered non serious.


VAERS ID: 1896526 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling abnormal, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Patient reported feeling "fuzzy". Pallor in appearance. She vomitted once. This lasted 30 minutes.


VAERS ID: 1896974 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: Extreme fever,body aches, chills and rash. Could not use the left arm the shot was given in too sore then rash spread around and down arm. Angry red and increased itching has continued and as of today is still badly sore and itchy.


VAERS ID: 1896986 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Abnormal dreams, Condition aggravated, Fatigue, Insomnia, Middle insomnia, Nausea, Taste disorder
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (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: Similar but less intense reaction to the second shot of the Pfizer COVID vaccine. No nausea, changes to sense of taste, or repea
Other Medications: Multivitamin
Current Illness:
Preexisting Conditions:
Allergies: Penicillin and derivatives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue started 3-4 hours after injection for~2 days. Starting early the next morning: - Headache for ~3.5 days, less intense after ~2. Treated with ibuprofen. - Fever/chills for ~1.5 days. Treated with ibuprofen. - Altered sense of taste for ~2 days. Treated we''re less intense but also shifted somehow. - Nausea after eating/drinking, even if it was just a few swallows of water. Did not actually vomit, just felt like I might each time. - Difficulty sleeping, frequent waking, and intense dreams for the first two nights (and the day in between). I would wake up, change positions, and fall back into the same dream repeatedly.


VAERS ID: 1897039 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B(# / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Chills, Cold sweat, Contusion, Dizziness, Fatigue, Feeling abnormal, Injection site pain, Insomnia, Pain in extremity, Ultrasound Doppler normal
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Presented to ED on 11/23. reports that 4 hrs post-vaccine had LUE pain at injection site, fatigue and generalized weakness. That night had difficulty sleeping w/ abdominal pain, cold sweats/shivering. The day after vaccine felt dizzy, fatigued and had left leg pain. On 11/20, 2 days after vaccine, continued to have left leg pain which then later developed into multiple bruises. Pt reports no fall or injury. In ED pt continued to have left leg pain and occasional brain fog. LLE Doppler performed and was negative for deep vein thrombosis. Patient discharged home from ED.


VAERS ID: 1897106 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: urticarial rash on upper extremities, resolved with benadryl


VAERS ID: 1897111 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / IM

Administered by: School       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: Client presented to clinic. Parent requested both pediatric Pfizer dose 1 and pediatric flu. Client received pediatric Pfizer dose 1 at first station, and was asked to move to the next station for pediatric flu dose. At next station client also received a second dose of Pediatric pfizer instead of pediatric flu. Client and parent notified. Client monitored for 30 minutes. No initial adverse reactions noted. Parent instructed to monitor child at home. Parent informed of follow up for next day - RN would call parent next day to check on client. No further concerns noted on follow up call. RN instructed parent that per guidelines, client may receive "second" dose in 21 days. Parent in agreement. Denies any further questions.


VAERS ID: 1897137 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Dyspnoea, Echocardiogram, Echocardiogram abnormal, Electrocardiogram, Laboratory test, Myocardial necrosis marker normal, Pericardial effusion, Pericarditis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirena 20 mcg/24 hours (6 yrs) 52 mg IUD Generic drug: levonorgestreL
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKDA
Diagnostic Lab Data: 11/22/21- CRP 6.76 11/23/21- Transthoracic Echocardiogram- small circumferential pericardial effusion, more focal at the base
CDC Split Type:

Write-up: Acute midsternal chest pain and dyspnea, within 24hours of injection 11/18/21, she presented to the ED the following day, EKG, labs and cardiac enzymes normal, she started on NSAIDs (ibuprofen), fluids and rest, symptoms did not improve. I saw her in my clinic 11/22/21 her symptoms were persistent, her EKG remained unremarkable, I sent her for repeat labs and echocardiogram, she has mildly elevated high sensitivity CRP and small pericardial effusion w/o evidence of tamponade. I have started her on medical therapy for pericarditis of continued NSAIDs and Colchicine as well as exercise restriction, she will follow up with me in my clinic


VAERS ID: 1897141 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-11-18
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 36B21A / UNK LA / IM

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

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

Write-up: COVID


VAERS ID: 1897187 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-11-18
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Fatigue, Respiratory tract congestion
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?amLODIPine Besylate 2.5 MG Tablet 1 tablet Orally Once a day ?Melatonin 5 MG Tablet 1 tablet in the evening Orally Once a day ?Jobst For Men 15-20mmHg Lg - Miscellaneous as directed wear daily ?Triamterene-HCTZ 37.5-25 MG Tablet 1
Current Illness: none
Preexisting Conditions: cardiac evaluation spring 2018, stress echocardiogram with no evident ischemic changes, negative troponins. Essential hypertension. Mild anemia. Chronic back pain. GERD. Headache. BPH. Adenomatous colon polyps 1/07 (recheck 2012).
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: chest congestion, chills, fatigue, diarrhea.starting 11/18/21


VAERS ID: 1897202 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-15
Onset:2021-11-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fosinopril 10MG, Atorvastatin 20MG, D3 10,000 iu, K2-mK7 100mcg, Quercetin 250MG, Zinc 7.5MG, B complex, Glucosamine & MSN 1500MG, CO-Q10 100MG, A - 500MG
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Scheduled for MRI before 12/31/21
CDC Split Type:

Write-up: Bi-lateral joint pain in shoulders, elbows, wrists, thumbs, and knees. More pronounced at night. Ibuprofen 500MG before bed.


VAERS ID: 1897230 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-11-18
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 RA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1897260 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Fatigue, Lymphadenopathy, Muscle spasms, Musculoskeletal stiffness, Pain, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Contraceptive birth control, beta blocker, daily multivitamins.
Current Illness: None
Preexisting Conditions: Polycystic ovarian syndrome, allergy induced asthma
Allergies: Sudafed
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: I had the vaccine at 5pm on the 17th and went home, made dinner, and relaxed when I noticed stiffness in my arm which is pretty normal around 7/8 PM. I then began to feel tired and went to bed at 9:30 PM and woke up at 3 AM 11/18 with excruciating under arm pain and full body pain that was unlike anything I''ve ever experienced. I have had the flu viruses in the past with body aches and it was nothing like that. I got up and took Aleve to try and alleviate the pain, and that''s when I noticed I had severe swelling on underside of my arm on the opposite side of where I had been injected with the vaccine, and I had swelling up into armpit and around the side of my chest and into my breast and up into my collar bone around my neck to the point you couldn''t see my collar bone through the skin anymore. It still is somewhat puffy and we are a week into having the vaccine. I then proceeded to get ready for work and try to go to work because I could with 2nd dose, but by the time I got to work the Aleve had worn off around 8:30 AM and my body just hurt so bad that I had to go home. I called my Doctor and asked if I needed to come in but because we''re overflowed with Covid patients right now I was told to go home and rest and that is what I did. The body aches didn''t pass until morning on the 19th. The best way that I could describe the body pain that I felt was that if needles pushed into my joints all the way back up my neck, back, fingers, toes, and had them be pulled out and pushed back in and set on fire. It was even in my jaw and I could feel all my teeth and the swelling in my underarm especially in my armpit felt like a water balloon in it because there was so much fluid built up from the swelling. My chest was bruised from the swelling. It''s finally starting to go down and I''m able to see my collar bone through my skin again. The fever and everything else was pretty typical with the first two. The 2 days in recovery on the 19th and 20th, I was experienced muscle spasms following the body pain, specifically in my back and abdomen. Today is the best I''ve felt since last Wednesday.


VAERS ID: 1897277 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Pain in extremity, Peripheral swelling, Pruritus, Skin discolouration, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna 2nd dose (body aches no arm swelling)
Other Medications: Losartan, Levothyroxine
Current Illness: No
Preexisting Conditions: Osteoarthritis, High Blood Pressure, Erb''s Palsy (left arm)
Allergies: No
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: The following day my left arm felt so hot, really red and started to swell. It started off like a patch it was becoming bigger and bigger. The part of my of my left arm that I do have feeling in it could feel pressure and was really inflamed. I took pictures of my left arm and went to the clinic it was infected. I was told of my arm was ok it would go away give antibiotic three times a day and cortisone cream. My arm is discolored in the area slowly clearing up and the part that I do have feeling is still hot, itchy and pain is going away.


VAERS ID: 1897327 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injection site induration, Injection site pruritus, Injection site rash, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Also Moderna vaccine, but typical body aches and body soreness. Recovered after 12 hours of cold/flu like symptoms (no fever).
Other Medications: None
Current Illness: Seasonal colds, not COVID (according to PCR test). No symptoms on day of, or at least 48 hours prior to, day of vaccine.
Preexisting Conditions: None
Allergies: Allergic to penicillin and sulfa antibioltics
Diagnostic Lab Data: None
CDC Split Type:

Write-up: COVID arm. Rash around injection site, warm to the touch, itchy, hard to the touch (but not painful).


VAERS ID: 1897329 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-10
Onset:2021-11-18
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Blood glucose fluctuation, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Decreased appetite, Dehydration, Diarrhoea, Dyspnoea exertional, Hyponatraemia, Hypovolaemia, Hypoxia, Lung consolidation, Malaise, Nausea, Oxygen saturation decreased, Pain, Pneumonia, Procalcitonin increased, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (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), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (narrow), Sepsis (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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 MG tablet B Complex Vitamins (VITAMIN B COMPLEX) TABS cyclobenzaprine (FLEXERIL) 10 MG tablet dexamethasone (DECADRON) 6 MG tablet escitalopram (LEXAPRO) 10 MG tablet glucagon (BAQSIMI TWO PACK) 3 MG/DOSE nasal powde
Current Illness: NA
Preexisting Conditions: Type 2 diabetes mellitus with hyperglycemia, with long-term current use of insulin (HCC) Class 3 severe obesity wih serious comorbidity and body mass index (BMI) of 40.0 to 44.9 in adult, unspecified obesity type (HCC) Primary osteoarthritis of both knees Dyslipidemia HTN (hypertension), benign Acute kidney injury (HCC)
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (11.18.21); COVID-19 positive (11.18.21); Fully Vaccinated Admission Date: 11/18/2021 Discharge Date: Nov 23, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE:PT is a 65 year old female with a past medical history of type 2 diabetes, hypertension, and hyperlipidemia who had received a COVID vaccine who presented with 2 weeks of symptoms including body aches, anorexia, nausea, and diarrhea. She was found to be Covid-19 positive with hypoxia in the emergency department and was started on supplemental oxygen and dexamethasone. At time of admission, she was found to have mildly elevated procalcitonin with findings of lobar consolidation on chest x-ray consistent with a community-acquired pneumonia. After presenting with several days of diarrhea and poor appetite, she was noted to have an AKI with hypovolemic hyponatremia in the setting of dehydration and was treated with IV fluids. Her blood sugars were noted to be very labile while on steroids, her home Lantus dose was increased and she received corrective insulin while inpatient. She required up to 6L oxygen by NC and was weaned to room air prior to discharge. She was treated with ceftriaxone and azithromycin for a total course of 5 days. She did not qualify for remdesivir, but was treated with steroids, started on dexamethasone in hospital and discharged with instructions continue dexamethasone course as outpatient. Patient was discharged in stable condition, in no acute distress, afebrile, with O2Sat $g92% on room air. Pulmrehab evaluated the patient with ambulating desat to 88% but patient declined home oxygen. Patient will continue dexamethasone at discharge to complete 10 total days. Patient seen by regulatory authortity with home insulin and DM medication reccs at discharge as noted.


VAERS ID: 1897399 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-09
Onset:2021-11-18
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Appendicectomy, Appendicitis, Computerised tomogram abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin supplements, Omega 3, clopidogrel, atorvastatin
Current Illness: None
Preexisting Conditions: High closterol
Allergies: MSG
Diagnostic Lab Data: CT scan and emergency surgery 11/19/2021
CDC Split Type:

Write-up: Appendicitis


VAERS ID: 1897485 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-29
Onset:2021-11-18
   Days after vaccination:293
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Atrial fibrillation diabetes prostate cancer just finished 6 weeks of radiation congestive heart failure pulmonary hypertension gout
Preexisting Conditions: Atrial fibrillation diabetes prostate cancer just finished 6 weeks of radiation congestive heart failure pulmonary hypertension gout
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed active COVID disease after being fully vaccinated with 2 doses of Moderna (january and february 2021). Patient had to receive monoclonal antibodies on 11/23/21 at hospital.


VAERS ID: 1897505 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-26
Onset:2021-11-18
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, COVID-19, Chills, Cough, Dizziness, Fatigue, Headache, Pain, SARS-CoV-2 test positive, Sinus congestion, Thrombosis, Vaginal haemorrhage
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of anemia and hypothyroidism
Allergies: Penicillins
Diagnostic Lab Data: 11/23/2021 COVID-19 Positive
CDC Split Type:

Write-up: Patient states that her son tested positive over the weekend. Since Thursday prior to ED visit, the patient experienced symptoms of sinus congestion, headache, body aches, cough, dizziness, fatigue and chills. Patient with vaginal bleeding since October 4 with intermittent clots and lower abdominal cramps the last few days.


VAERS ID: 1897596 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-11-18
   Days after vaccination:294
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 LA / SYR

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

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

Write-up: positive covid test


VAERS ID: 1897605 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-11-18
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04721A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 LA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897616 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-11-18
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 LA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897621 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-11-18
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 RA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897628 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-14
Onset:2021-11-18
   Days after vaccination:308
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

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

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

Write-up: positive covid test


VAERS ID: 1897629 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-15
Onset:2021-11-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Chest pain, Electrocardiogram abnormal, Fatigue, Pain in extremity, Pyrexia, Sinus arrhythmia, Troponin normal, Ventricular extrasystoles
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Ventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Chest x-ray & standard cardiac injury panel: no significant findings (troponin I, high sens <3ng/L) EKG: Sinus arrhythmia (PVCs)
CDC Split Type:

Write-up: Day 1: Sore arm, mild fever, general fatigue Day 2: Sore arm Day 3: Sore arm Day 4: Chest pain (stabbing) Day 5: Chest pain (tightness) Day 6: Chest pain (tightness) Day 7: Chest pain (tightness) Day 8: Chest pain (tightness) Day 9: Chest pain (tightness)


VAERS ID: 1897644 (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: 2021-11-24
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. Child 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 child 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. 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: 1897648 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-12
Onset:2021-11-18
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Began spotting a week after receiving my Covid booster. My period was not due for another 2 weeks and is usually on a predictable schedule. Spotting lasted for 3 days.


VAERS ID: 1897735 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-11-18
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: CVA, AMS, Afib, CHF, PAD, high cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization


VAERS ID: 1897818 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-20
Onset:2021-11-18
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3812 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Fatigue, Feeling abnormal, Illness, Influenza like illness, Myalgia, Oropharyngeal pain, Pain, Rhinorrhoea, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole
Current Illness: None
Preexisting Conditions: None
Allergies: Seasonal allergies
Diagnostic Lab Data: 2 Covid tests 11/21/2021- negative
CDC Split Type: vsafe

Write-up: I had sore muscles almost like immediate flu like symptoms for 48 hours after the vaccine. Approximately on 10/24/2021 I started to feel with flu like symptoms, I had body aches, excess of tiredness, sore throat, cough, runny nose, allergy type symptoms, and that made me think I had Covid again. I had no fever but I did not take my temperature. We went to the doctor on 10/28/2021 and they diagnosed us with a virus and they gave us an antibiotic. I did the antibiotic for 10 days. Approximately on 11/18/2021 I started getting sick again with allergy and sinus issues and cough, I felt miserable pretty much. I have not been to the doctor for this yet. My employer made me take an at home Covid test on 11/21/2021 and took 2 of them and both were negative.


VAERS ID: 1897866 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-15
Onset:2021-11-18
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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: not known
Current Illness: none known
Preexisting Conditions: cardiac arrythmia
Allergies: not known
Diagnostic Lab Data: PCR + for Covid 11/18/2021
CDC Split Type:

Write-up: Client had Moderna vaccines for Covid in April and May 2021. Tested on 11/18 because son with who she lives was positive for Covid the week before. Client tested positive and has no symptoms.


VAERS ID: 1897959 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / N/A RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, 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: slight fever, chills and body aches about 24 hours after 2nd dose
Other Medications: Citalopram 10mg
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa Ketokonazol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: low grade fever, chills, body aches, headache and swollen lymph node by right clavicle


VAERS ID: 1898038 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Induration, Lymphadenopathy, Musculoskeletal stiffness, Swelling, Tenderness, Ultrasound scan abnormal
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), 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: Wegovy, metFORMIN 24Hr-XR 500mg Tab, Vitamin B, Zinc, Vitamin d, CALCIUM-MAGNESIUM PO, TURMERIC PO, MILK THISTLE PO, levonorgestrel 19.5mg IUD, losartan/hydrochlorothiazide 100mg/25mg Tab
Current Illness: none
Preexisting Conditions: hypertension
Allergies: none
Diagnostic Lab Data: ultrasound showed my supraclavicular lymph nodes were swollen and were what I was feeling
CDC Split Type:

Write-up: The day after I received the shot, I noticed the area between my clavicle and neck was swollen. My neck was already stiff but the swollen area was sensitive to touch and I noticed two hard lumps in the same area.


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