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

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



Case Details (Reverse Sorted by Onset Date)

This is page 55 out of 8,010

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VAERS ID: 1764559 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Unknown  
Location: Delaware  
Vaccinated:2005-05-02
Onset:2021-10-01
   Days after vaccination:5996
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blindness, Blood glucose normal, Blood test, Chest X-ray, Electrocardiogram, Full blood count, Hyperhidrosis, Loss of consciousness, Metabolic function test, Pregnancy test urine, Syncope, Urine analysis, Vision blurred
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), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetiriziine
Current Illness: None
Preexisting Conditions: None
Allergies: Milk, apple, blue crab tomato green beans celery cherry broccoli cabbage cucumbers cranberry
Diagnostic Lab Data: Chest X-ray , blood work ,blood sugar, blood pressure, CBC,Comprehensive Metabolic Panel,POCT GLucose, Urinalysis,Urine Pregnancy , ECG12 lead two Glucose preformed 2 times
CDC Split Type:

Write-up: Stated couldn?t see blurred vision sweaty fainted was out for 15 minutes didn?t wake up until got to the hospital had just left pharmacy at 11:25 arrived at the hospital daughter woke up didn?t realize she passed out they check her sugar it was 70.


VAERS ID: 1764560 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
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: ATORVASTSTIN 40 MG
Current Illness: NONE
Preexisting Conditions: HYPERTENSION, ENLARGED PROSTATE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: WAS ADMINISTERED AN UNDILUTED PFIZER COVID-19 VACCINE IN THE AMOUNT OF 0.3 ML


VAERS ID: 1764566 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-06
Onset:2021-10-01
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

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

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1764599 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #EW0169 / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Fatigue, Full blood count, Injection site pain, Injection site swelling, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastin,Metformin,Gabapentin, Celecoxib, losartan-hydrochlorothiazide, Latanoprost, Zyrtec, Vitamin D andTylenol
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CBC W/ Auto Differential
CDC Split Type:

Write-up: Lymph node swollen on left side of neck, temperature was 100.5, muscle ache, swollen & pain at injection and fatigue


VAERS ID: 1764601 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Lymphadenopathy, Muscle spasms, Pain
SMQs:, Dystonia (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: Daily Multivitamin, hair, skin and nails vitamin, collagen supplement.
Current Illness: None other than seasonal allergies.
Preexisting Conditions: Seasonal Allergies
Allergies: Penicillin, Levaquin, Aleve, MSG, BHT, Sulfites.
Diagnostic Lab Data: None, did not visit Dr.
CDC Split Type:

Write-up: Swollen Lymph nodes in armpits ,arms, groin, legs, neck. Fatigue, aches and pains no fever. Lasted 5 days then today 10/6/21 muscle cramping.


VAERS ID: 1764616 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-10-01
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: breakthrough COVID-19


VAERS ID: 1764651 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-01
Onset:2021-10-01
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: MD Notes: Past Medical History - HTN - Hyperlipidemia - Hypothyroidism - GERD
Allergies: iodine, sulfa antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: MD Notes: History of Present Illness 77-year-old female with past medical history hypertension, hyperlipidemia presenting with weakness. Patient reports about 4 days of generalized weakness associated with mild shortness of breath. Also with decreased appetite. No chest pain. No fevers. No abdominal pain, nausea, vomiting. Patient reports to be fully vaccinated Covid.


VAERS ID: 1764707 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN J9J1822809 / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Dyspnoea, Hypoacusis, Sleep disorder, Tremor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Finesteride Tamsulosin
Current Illness: None
Preexisting Conditions: Enlarged Prostate
Allergies: Cipro Wheat Gluten
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dizziness, vomiting, partial loss of hearing starting around 5:00 pm. Uncontrollable shaking around 9:00 pm until around 10 pm. Tried to sleep but would wake up gasping for air which continued all night. Periodic vomiting, confusion until around 8:00 am. Still weak at this time.


VAERS ID: 1764728 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Costochondritis, Dyspnoea, Muscle spasms, Musculoskeletal chest pain, Pain, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: Diagnosis/Assessment/Plan 1. Costochondritis, acute 2. Vaccine reaction Orders: albuterol, 2 puffs, Inhale, every 4 hrs, PRN as needed for SOB/wheezing, # 8.5 g, 0 Refill(s), Supply cyclobenzaprine, 10 mg 1 tab, Oral, TID, PRN as needed for muscle spasm, X 3 days, # 10 tab, 0 Refill(s), 10/09/21 1:36:00 PDT, Supply ibuprofen, 600 mg 1 tab, Oral, every 6 hrs, PRN as needed for pain, X 7 days, # 30 tab, 0 Refill(s), 10/13/21 1:36:00 PDT, Supply Discharge Patient
CDC Split Type:

Write-up: HPI: This is a 33 Years old Male presenting with chest wall pain for 5 days s/p moderna covid vaccine. Patient indicates that he has felt short of breath at times. Patient is able to reproduce pain to right lower rib area. Pain started gradually. It is described as dull and aching, radiating into nowhere. Pain is described as moderate upon onset and is currently mild. No history of the same. Pain is not worse with exercise. Patient has no decrease in exercise tolerance recently.


VAERS ID: 1764730 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 310458A / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dyspnoea, Productive cough
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness:
Preexisting Conditions: Asthma, Heart condition, stage 3 kidney failure.
Allergies: Metformin.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Elevated blood pressure, shortness of breath, coughing of mucous.


VAERS ID: 1764775 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen 1000 mg TID Aspirin 81mg daily Ativan 0.5mg QID Atorvastatin 40mg daily in the morning Bisacodyl Suppository once every 3 days Cimetidine 300mg BID Donepezil 10mg at bedtime Fleet enema every 24 hrs PRN Losartan 25 mg daily
Current Illness: Dementia Constipation Hypercholesterolemia Insomnia Major depressive disorder Anxiety Joint pain Hypertension Affective Mood disorder
Preexisting Conditions: Dementia Constipation Hypercholesterolemia Insomnia Major depressive disorder Anxiety Joint pain Hypertension Affective Mood disorder
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented requesting a Pfizer vaccine, after administering the vaccine it was discovered that he had previously received a Janssen on 05/05/2021. RN, ADM of Health Dept, discussed with nursing staff at rehab center about whether client had had any adverse effects, and that he will not need a second dose of the Pfizer vaccine.


VAERS ID: 1764914 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: intermittent heart palpitations; intermittent slight chest pain; both occurred several times over the course of a week


VAERS ID: 1764957 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-09-26
Onset:2021-10-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination complication
SMQs:

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

Write-up: After the second Vacc i got Problems


VAERS ID: 1765003 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-10-01
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

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

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

Write-up: Tested PCR positive for COVID 10/3121 after being fully vaccinated.


VAERS ID: 1765028 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-26
Onset:2021-10-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Pruritus, Skin burning sensation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (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: Olmesartan 40 mg Raloxifene 60mg Pantoproprazole 20 mg Atorvastatin 10 mg Fish oil Niacinamide Zioptan eye drops Vitamin D Vitamin B 12
Current Illness: None
Preexisting Conditions: Osteoporosis Glaucoma Laryngeal reflux Hypertension High cholesterol
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 10/01/2021- 8:30 am. Sudden onset of ?burning? sensation of skin over entire body, skin redness, not hot to touch. Burning sensation lasted 20 minutes and then itching over entire body for another 25 min. Entire Initial episode lasted 45 minutes and was relieved by 25 mg Benadryl. 10/4/2021 - 10:00 pm . Sudden onset of ?burning? sensation of skin over entire body, redness of skin, not hot to touch. Burning sensation lasted 15 minutes, entire body began itching which lasted another 20 minutes. Episode only relieved with 50 mg Benadryl. 10/6/2021-12:00 pm sudden onset of burning sensation and redness of skin for 15 minutes on head, face & torso with onset of itching on arms, & neck. Subsided without Benadryl within 20 minutes.


VAERS ID: 1765052 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-29
Onset:2021-10-01
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Inappropriate schedule of product administration, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
SMQs:, Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Atrial fibrillation, GERD, hypertension, hyperlipidemia, multiple sclerosis, restless legs syndrome, seizures, history of stroke, kidney tumor, hypothyroidism, obstructive sleep apnea, BPH.
Allergies: No known allergies
Diagnostic Lab Data: FLUVID test from 10/1/2021 indicates positive COVID-19 RNA (of note, test showed negative results for influenza A, influenza B, and RSV).
CDC Split Type:

Write-up: Patient received their second dose of the Moderna COVID vaccine on 6/29/2021 (of note, their first dose of Moderna COVID vaccine was given on 5/22/2021, Lot #027C21A). The patient was admitted to the hospital on 10/1/2021 with COVID infection. As of 10/6/2021, the patient remains admitted to the hospital for treatment of COVID-19 infection.


VAERS ID: 1765081 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Hypoaesthesia, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Increasing pain, numbness and tingling in left arm and left hand.


VAERS ID: 1765112 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRN TYELNOL OR IBUPROFEN FOR ANALGESIA
Current Illness: NONE
Preexisting Conditions: HSV1
Allergies: LORTAB
Diagnostic Lab Data:
CDC Split Type:

Write-up: JOINT PAIN BILATERALLY: SHOULDERS, ELBOWS, WRIST, HIPS, KNEES AND FEET


VAERS ID: 1765221 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of personal independence in daily activities, Muscle spasms
SMQs:, Dementia (broad), Dystonia (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: unaware of any at this time
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: DAY AFTER VACCINE PATIENT HAD SEVERE CRAMPING DOWN LEFT SIDE OF ARM AND BACK. SAID IT FELT LIKE SOMEONE HAD BEAT THEM WITH A SLEDGE HAMMER ON HIS LEFT SIDE. LASTED FOR 2 DAYS WHERE PATIENT COULD NOT DO ANY NORMAL DAILY ACTIVITY.


VAERS ID: 1765270 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Diarrhoea, Influenza like illness, Malaise, Night sweats
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient states that she received her 1st covid vaccine on Wednesday, September 29th and felt fine until Friday, October 1st when she began to have flu like symptoms. Symptoms include chills, night sweats diarrhea and general malaise. She no longer has diarrhea. She states that today is the first day she is starting to feel better, one week post vaccination.


VAERS ID: 1765278 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: terazosin, finasteride, atorvastatin, lisinopril, fluricasone, omeprazole
Current Illness: None
Preexisting Conditions: BPH
Allergies: celebrex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy rash on torso (front and back) appeared about 4 hours later. Still have it- 5 days later.


VAERS ID: 1765297 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Product storage error, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Systemic: Fever-Mild, Error: Improper Storage (temperature)-


VAERS ID: 1765303 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Product storage error, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Systemic: Fever-Mild, Error: Improper Storage (temperature)-


VAERS ID: 1765305 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

Administered by: Work       Purchased by: ?
Symptoms: Lymphadenopathy, Mass, Pain, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Potassium Citrate Lipitor Wellbutrin HCTZ Vivelle Dot patch Zyrtec Vitamin D
Current Illness: none
Preexisting Conditions: mild asthma
Allergies: MSG Erythromcin Doxycycline
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Swollen gland under arm that had injection 24 hours later. Swelling was visibly noticable lump. Underarm slightly tender 7 days later. A lot of body aches and pains, hurt to roll over from 24-48 hours post-injection.


VAERS ID: 1765318 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC8134 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Pruritus, 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: Site: Redness at Injection Site-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Additional Details: Rash started 3 days after vaccination. Started in both upper extremities and spread to chest. Patient states severe itching that did improve slightly with hydrocortisone. On the 5th day rash is starting to recede.


VAERS ID: 1765339 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / -

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

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

Write-up: administration error - shot given 7 days too early.


VAERS ID: 1765365 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1765387 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Extra dose administered, Hypoaesthesia oral, Injection site pain, Pain, Pharyngeal swelling, Pyrexia, Rash, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu Vaccine
Other Medications: Benadryl, Ibuprofen, Pepcid
Current Illness: none
Preexisting Conditions: none
Allergies: Bee Stings, spider
Diagnostic Lab Data: none
CDC Split Type:

Write-up: left arm pain and skin rash, bodyaches, fever 101.5 F, tongue numbness, tongue and throat swelling, mild shortness of breath. Treated with oral prednisone QD for 5 days and PO benadryl daily Symptoms appeared within 12 hours of receiving the shot, i.e. on 10/1 (but not within the first 4-6 hours), intensified after 24 hours (on 10/2) and resolved after starting on oral prednisone (by 10/4).


VAERS ID: 1765439 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-20
Onset:2021-10-01
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Covid PCR test confirmed positive
CDC Split Type:

Write-up: EE developed Covid months after completing 2 dose series. She actually received her 3rd "booster" on 9/30/21. She turned Covid positive on 10/5/21 after symptoms developed on 10/1/21


VAERS ID: 1765441 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oropharyngeal pain, Pharyngeal swelling, Swelling, Swelling face, Tenderness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling of face, throat, and neck, pain in throat, hurt to the touch


VAERS ID: 1765465 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-10
Onset:2021-10-01
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Fatigue, Influenza like illness, Laboratory test abnormal, Myalgia, Oropharyngeal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatinl Finasteride; Tamsulosin; Bactrim DS; Acyclovir; Acalabrutinib
Current Illness: none
Preexisting Conditions: hyperlipidemia; diverticulitis; BPH; mantel cell lymphoma; obesity, immunosuppressed
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: First symptoms started on Friday Oct 1st, test on Sunday the 3rd at park given results today that he is positive. Symptoms are flu like- cough, sore throat and muscle aches, tired all the time. Rec''d 3rd Pfizer dose in September


VAERS ID: 1765483 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Mouth ulceration, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Ulcers and sores in mouth Joint pain Headache Fatigue


VAERS ID: 1765506 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (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: N/A
Current Illness: NO
Preexisting Conditions: NO
Allergies: NSAIDS
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: SYNCOPE AND FELL TO THE FLOOR AFTER 5 MINS WAITING IN THE SEATING AREA . WOKE UP WITH IN A MINUTE.


VAERS ID: 1765514 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-23
Onset:2021-10-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abortion spontaneous, Back pain, Exposure during pregnancy, Haemorrhage, Muscle spasms, Pregnancy test positive, Ultrasound scan abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Dystonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Morphine and amoxicillin
Diagnostic Lab Data: I had a positive pregnancy test 09/29. On 10/4 the pregnancy test showed 2 HCG level and also an ultra sound showed no gestational sac. I had the miscarriage over the weekend.
CDC Split Type:

Write-up: I received the vaccine on 09/23/21. I started getting back pain and cramps 09/30-10/1, and started bleeding on 10/2-4. It was confirmed that I had a miscarriage.


VAERS ID: 1765538 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-01
Onset:2021-10-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid on 10/1/2021
CDC Split Type:

Write-up: Client was vaccinated with Pfizer vaccines for Covid in beginning and end of June, 2021. Mother not exactly sure of dates but states it was beginning and end of June. Client was tested on 10/1 because she had contact with + family member. She tested PCR + on 10/1 and is asymptomatic.


VAERS ID: 1765543 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Condition aggravated, Diarrhoea, Dizziness, Fall, Headache, Loss of consciousness, Nausea, Syncope, Tremor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (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: Atorvastatin, chlorthalidone, fish oil
Current Illness: None
Preexisting Conditions: High cholesterol, prehypertension
Allergies: Levaquin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dizziness and lightheadedness beginning 12 hours after injection, lasting for total of 12 hours. Chills and shaking beginning 12 hours after injection and lasting two hours. Nausea and vomiting, diarrhea, beginning 14 hours after injection and lasting 10 hours. Fainted and fell three times, not sure how long was out before regaining consciousness. Symptoms were similar after 2nd shot but significantly milder (no vomiting, fainted once). Headache and low energy the next day.


VAERS ID: 1765553 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Condition aggravated, Fatigue, Headache, Nausea, Pain, Pain in extremity, Pyrexia, Visual impairment
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: covid Pfizer shot 1 3/8/21 and shot 23/29/21 both times I sore arm and deep fatigue.
Other Medications: lopresser, multi vitamins, fish oil, vit D
Current Illness: none
Preexisting Conditions: High BP
Allergies: codeine, pennicillian
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Sore arm, 6;30pm 10/1/21, Nausea, 10:00pm 10/1/21, body aches 10:00pm Took 1.5 aspirin 10:00pm 10/1/21. Chills 9:30am 10/2/21, Fatigue 10/2/21 9:30am, took 1 Advil 10:00am 10/2/21 for deep body aches. chills 2:00pm 10/2/21, fever of 102.7 6:00pm. took 2 aspirin for fever, considered ER decided to wait. checked fever every hour. fever remained between 100 and 102.3 until 10:00pm. Deep fatigue and body aches 10/2/21 and 10/3/21, with on off chills then fever of 100.5 along with vision focusing issues and headaches. 10/4/21 and 10/5/21 a bit better with a lessening of all symptoms but all still present. 10/6/21 still fatigued with chills then slight fever and on and off headaches and vision issues.


VAERS ID: 1765555 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-10-01
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

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


VAERS ID: 1765584 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Breast swelling, Chills, Headache, Hypoaesthesia, Lymphatic disorder, Pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Sexual dysfunction (broad)

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

Write-up: I had expected chills, body aches and headaches, received on 10/01/2021. I also had swelling under my armpit the next day and it got worse, extending to the lateral aspect of my breast. It was swollen so big and my arm, ring finger were numb and that is when I sought care. I went to urgent care and they told me it was a lymphatic reaction. I am still swollen, significantly reduced than on Monday. I still am taking Ibuprofen and warm compresses as suggested.


VAERS ID: 1765643 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-01
Onset:2021-10-01
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Headache, Malaise, Muscle spasms, Oropharyngeal pain, Pain in extremity
SMQs:, Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi vitamin, vit d, k, elderberry, Claritin d, Flonase
Current Illness: allergies
Preexisting Conditions: allergies asthma
Allergies: Hay fever, shellfish, sea food
Diagnostic Lab Data: none
CDC Split Type:

Write-up: immediately headache, chest pain, arm pain followed by sore throat and felt sick 3 days 10/1 stabbing left arm pain, left leg cramp and left upper side chest pain


VAERS ID: 1765721 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Reporting a vaccine administration error. Patient was given a dose of Moderna vaccine that was expired at the time of administration. Vial that dose was drawn from was moved from freezer to fridge on 8/30/2021 at 8:45pm, starting a 30 day expiration per manufacturer. Error was discovered on 10/5/2021 after a subsequent vial from the same box was identified as being expired. Manufacturer was contacted on 10/6/2021 for guidance. Manufacturer indicated on 10/6/2021 that they will "conduct an analysis to determine if the vaccine administered past 30 days provided the necessary protection against a COVID-19 infection". Patient was contacted and informed of the vaccine administration error. Patient reports no AE''s and is awaiting follow up guidance from manufacturer.


VAERS ID: 1765736 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

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

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

Write-up: Reporting a vaccine administration error. Patient was given a dose of Moderna vaccine that was expired at the time of administration. Vial that dose was drawn from was moved from freezer to fridge on 8/30/2021 at 8:45pm, starting a 30 day expiration per manufacturer. Error was discovered on 10/5/2021 after a subsequent vial from the same box was identified as being expired. Manufacturer was contacted on 10/6/2021 for guidance. Manufacturer indicated on 10/6/2021 that they will "conduct an analysis to determine if the vaccine administered past 30 days provided the necessary protection against a COVID-19 infection". Patient was contacted and informed of the vaccine administration error. Patient reported mild AE''s consistent with common Covid-19 vaccine AE''s (arm pain, low grade fever) that have resolved. Patient is awaiting follow up guidance from manufacturer.


VAERS ID: 1765886 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product administered at inappropriate site
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: Injection was administered somewhat posteriorly and high up in the arm, most likely missing the majority of the deltoid muscle. No pain occurred, however concern over the effectiveness of the vaccine was a concern.


VAERS ID: 1766158 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-31
Onset:2021-10-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Menstrual disorder
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: Lo Loestrin
Current Illness: None.
Preexisting Conditions: Menstrual cycle changed, got menstruation three times since the vaccination. I never had an adnormal/unpredictable menstrual cycle like this before.
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: After getting the vaccine, I had three unpredictable menstruation cycles in one month. This is not common for me, nor have I ever had more than one period in one month.


VAERS ID: 1766849 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (The patient occasionally consume alcohol.); Hypertension; Non-smoker
Preexisting Conditions: Comments: The patient does not have any no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20211001; Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20211006677

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION (BREAKTHROUGH); This spontaneous report received from a patient concerned a 46 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: hypertension, non smoker, and alcohol user. The patient had no known allergies. The patient was not pregnant at the time of this report. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A expiry: unknown) dose was not reported,1 total, administered on 10-APR-2021 to left arm for prophylactic vaccination. No concomitant medications were reported. On 01-OCT-2021, the patient experienced breakthrough (suspected covid-19 infection) and the patient tested positive for Covid-19 with mild symptoms (suspected clinical vaccination failure). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected covid-19 infection (breakthrough) and suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint.; Sender''s Comments: V0: 20211006677-covid-19 vaccine ad26.cov2.s-suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1766855 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211008756

Write-up: SEVERE CHILLS; FEVER OF 101; This spontaneous report received from a patient via a company representative 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, and batch number were not reported) dose was not reported, administered on 01-OCT-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 01-OCT-2021, the patient experienced severe chills. On 01-OCT-2021, the patient experienced fever of 101. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the severe chills and fever of 101 was not reported. This report was non-serious.


VAERS ID: 1767124 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-06
Onset:2021-10-01
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/04/2021-Tested PCR positive @ HCF
CDC Split Type:

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


VAERS ID: 1767134 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-10-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Vaccine positive rechallenge
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same reaction with first and second dose of Pfizer vaccine as I am reporting now
Other Medications: lisinopril, amlodipine, finasteride, Repatha, biotin, B12, D3, baby ASA, fish oil, tumeric, multivitamin, CoQ10, probiotics.
Current Illness: none
Preexisting Conditions: hypertension, chronic kidney disease, neuropathy in both legs and feet, high cholesterol, chronic back pain
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Five days after receiving my Pfizer booster, I developed a herpes zoster lesion on my left upper arm approximately the size of a silver dollar; symptoms of itching, redness, swelling, and blisters. I applied acyclovir ointment 5% topically and it is slowly getting better. This has been a chronic site of herpes zoster in the past and usually only erupts about once per year. This lesion has now erupted after my first, second, and third dose of Pfizer so know that there must be a connection to the Pfizer vaccine. Also, this third dose reaction appears worse in size and intensity even though I have received both doses of Shingrix in 2019. I would like to know what the health implications are? Is the Pfizer vaccine making my Shingrix vaccine null and void? Do I need to get vaccinated again with Shingrix? How is this affecting my immunity against Covid-19? Is my body able to produce antibodies against Covid-19 as it is supposed to do?


VAERS ID: 1767136 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-10-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Herpes zoster, Injection site erythema, Injection site pruritus, Injection site swelling, Injection site vesicles, Vaccine positive rechallenge
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
Previous Vaccinations: same reaction with first and second dose of Pfizer vaccine as I am reporting now
Other Medications: lisinopril, amlodipine, finasteride, Repatha, biotin, B12, D3, baby ASA, fish oil, tumeric, multivitamin, CoQ10, probiotics
Current Illness: none
Preexisting Conditions: hypertension, chronic kidney disease, neuropathy in both legs and feet, high cholesterol, chronic back pain
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Five days after receiving my Pfizer booster, I developed a herpes zoster lesion on my left upper arm approximately the size of a silver dollar; symptoms of itching, redness, swelling, and blisters. I applied acyclovir ointment 5% topically and it is slowly getting better. This has been a chronic site of herpes zoster in the past and usually only erupts about once per year. This lesion has now erupted after my first, second, and third dose of Pfizer so know that there must be a connection to the Pfizer vaccine. Also, this third dose reaction appears worse in size and intensity even though I have received both doses of Shingrix in 2019. I would like to know what the health implications are? Is the Pfizer vaccine making my Shingrix vaccine null and void? Do I need to get vaccinated again with Shingrix? How is this affecting my immunity against Covid-19? Is my body able to produce antibodies against Covid-19 as it is supposed to do?


VAERS ID: 1767773 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Fluid intake reduced, Gait disturbance, Headache, Hypophagia, Maternal exposure during breast feeding, Pyrexia, Suppressed lactation, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Functional lactation disorders (narrow), Neonatal exposures via breast milk (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Diarrhea, vomiting and headache started at 9:45pm on Friday night. Couldn''t keep any food or fluids down. Then a fever started at around 1am. By the time 6am rolled around I could barely walk. Really bad joint pains. I continued to have diarrhea, vomiting, headaches and joint pain all throughout Saturday and Sunday. By Sunday night my milk supply (I''m a breastfeeding mom) had dropped to 1/3 my usual supply.


VAERS ID: 1767961 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-13
Onset:2021-10-01
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O25821A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Head injury, Headache, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt is a 43 y/o F w/ PMH of RCC s/p kidney removal, NIDDM type 2 who is presenting due to syncope episode. A rapid response had occurred due to pt arriving in ER valet due to syncope. Pt reports hitting the right side of her head. Syncope witnessed by her husband. Pt reports she feels much better now and back to her baseline. States she is vaccinated w/ moderna. Denies sob, cough, fever, chills. Reports right shoulder pain. No complaints otherwise. Review of Systems CONSTITUTIONAL: Denies weight loss, fever and chills. HEENT: Denies changes in vision and hearing. RESPIRATORY: Denies SOB and cough. CV: Denies palpitations and CP. GI: Denies abdominal pain, nausea, vomiting and diarrhea. GU: Denies dysuria and urinary frequency. MSK: Denies myalgia and joint pain. SKIN: Denies rash and pruritus. NEUROLOGICAL: +headache and syncope


VAERS ID: 1768007 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, Burning sensation, Extra dose administered, Eye irritation, Feeling cold, Feeling hot, Injection site pain, Pain
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Corneal disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: diclofenac, desloratadine, mometasone, azalastine, vit d, vit e, nystatin powder, suprax
Current Illness: end stages of a candida intertrego infection
Preexisting Conditions: neutropenia
Allergies: bactrim-rash, levaquin-pain, mylan brand estradiol patch-rash
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 12 hours after receiving the vaccine I became very cold. I took 2 extra strength tylenol and a diclofenac and went to bed. I awoke in the night hot from all the blankets I had on me, I thought everything was ok. I was ok until evening of the following day when I was freezing cold again. I could not get warm. I took my temperature. It was 100.4, normal is 97.3. I took a hot shower to try to get warm. I had a feeling of burning throughout my body, even my eyes. It seemed like the pain I had from shingles. I took 2 extra strenght tylenol and diclofenac and went to bed. The next morning I slightly had the burning feeling. My temperature was 99 something. I took another 2 extra strength tylenol and diclofenac. The symptoms disappeared. I continued with the tylenol and diclofenac until the third night when I stopped and everything was ok. My arm hurt at the injection site too but that was not a problem for me. I had no side effects at all from the first 2 doses, nothing at all.


VAERS ID: 1768022 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, Pharyngeal swelling, Rash, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Baby Aspirin, Losartan, vitamin D, C, Magnesium, Zinc
Current Illness: none
Preexisting Conditions: Fibromuscular Dysplasia, Hypothyroidism
Allergies: latex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Face/lips throat swelling and rash.


VAERS ID: 1768090 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-23
Onset:2021-10-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Heavy period following injection. I was 2 weeks early for my cycle and I am experiencing extreme bleeding. More than normal.


VAERS ID: 1768112 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 3 RA / SYR
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Extra dose administered, Fatigue, Nasal congestion, Pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd shot of shingles - tight muscle cramping
Other Medications: Otezla, aspirin, losartan, presser vision, fish oil , Lipitor
Current Illness: scratchy throat
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: Covid - positive
CDC Split Type: vsafe

Write-up: Booster on Friday, I had a slight scratchy throat. After the vaccine on the same day aches and pains, chills started. I was under my blanket and my arms felt cold. I changed into long sleeves. Sat & Sunday and Monday- fatigue, chill, stuffy congestive coughing, aches and pains. hips and everything hurts. Not much of the fever. Monday - I saw the doctor, I worked at the hospital. Sent ER for covid test was positive. Tuesday texted doctor through my chart. Drug infusion/ IV therapy tomorrow. A Tuesday positive.


VAERS ID: 1768122 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-11
Onset:2021-10-01
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M02A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Endotracheal intubation, Septic shock
SMQs:, Angioedema (broad), Toxic-septic shock conditions (narrow), Respiratory failure (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Pt has a history of CHF, COPD, hypertension, and diabetes was transferred here from a local hospital after admission there since 10/1. He has COVID pneumonia and septic shock and is intubated.


VAERS ID: 1768130 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Constant tinnitus and occasional head aches after the second dose. Tinnitus never stops and was never a problem before injections. Headaches were never a problem before the injections.


VAERS ID: 1768144 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-14
Onset:2021-10-01
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Explorative laparotomy, Intestinal anastomosis, Large intestinal obstruction reduction, Large intestine anastomosis, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol, bisacodyL, cyanocobalamin, diphenhyd rAMINE, famotidine, gabapentin, heparin
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin, Bactrim, Biaxin, Carafate, Codeine, Darvocet-n 1000, Erythromycin Base, Metronidazole, Naprosyn , Nsaids ,Percocet , Propoxyphene-acetaminophen, Provigil , Serevent Diskus , Toprol Xl , Tramadol, Zaroxolyn , Zithromax , Doxycycline, Hydrocodone, Levaquin [Levofloxacin], Penicillins, Toradol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to inpatient level of care on 10-1 with complaints of abdominal pain. Patient noted to have tested positive for covid on 10-1. Patient had surgery on 10-1 with exploratory lap, reduction of intussusception, reseciton of J and J anastomosis with reanastomosis x2. Patient noted to have a history of a TBI.


VAERS ID: 1768245 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-01
Onset:2021-10-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation delayed
SMQs:, Fertility disorders (broad)

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

Write-up: Delayed menstrual cycle. Never more than 26-28 days. After receiving both vaccinations, menstrual cycle was delayed 6 days that month.


VAERS ID: 1768263 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-23
Onset:2021-10-01
   Days after vaccination:282
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Cough, Diarrhoea, Myalgia, Pain, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram, Bubroprion HCL, Simvastatin, Multivitamin, D3, Biotin, Vitamin E, Estrogen supplement.
Current Illness: None
Preexisting Conditions: None
Allergies: Nickel allergy
Diagnostic Lab Data: Rapid test at Pharmacy on 10.4 11:15 am resulted positive. PCR spit test at Clinic on 10.4 3:15pm resulted positive.
CDC Split Type:

Write-up: Body/muscle aches, chills, diarrhea, cough, loss of sense of taste and smell


VAERS ID: 1768305 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-31
Onset:2021-10-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Appendicectomy, Appendix disorder, Blood test, Computerised tomogram abdomen abnormal, Inflammation, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Depression
Allergies: Soy Hay fever Seasonal allergies
Diagnostic Lab Data: CT scan Blood work
CDC Split Type: vsafe

Write-up: On 10/01/2021, I woke up with intense abdominal pain that got progressively worse. I went to the ER. They did a CT scan and blood work. They determined that I had an inflammation of my appendix. On 10/02/2021 in the evening, they removed the appendix. On 10/03/2021, I returned home - where I am still recovering.


VAERS ID: 1768323 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-10-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstrual disorder, Muscle spasms
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (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: Junell birth Control
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Menstrual cycle occurred twice in one month. Excessive bleeding and more days than normal. Intense cramping.


VAERS ID: 1768356 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-08
Onset:2021-10-01
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

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

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

Write-up: Patient admitted to hospital with COVID. Patient is fully vaccinated.


VAERS ID: 1768395 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-10-01
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, simvastatin, oxycodone, fingolimod, carisoprodol, Metamucil metronidazole
Current Illness: morbid obesity, anxiety, hypertension
Preexisting Conditions: morbid obesity, anxiety, hypertension
Allergies: vancomycin
Diagnostic Lab Data: rapid test
CDC Split Type:

Write-up: SOB and hospitalization


VAERS ID: 1768425 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / UNK LA / IM

Administered by: Pharmacy       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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Previously tested for Reynaud''s
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had possible reaction to Pfizer COVID19 immunization on 10/01/21. Followup with Parent on Monday following she said that daughter was doing fine and that they had gone to an urgent clinic and had been given benadryl which seemed to help.


VAERS ID: 1768443 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 LA / IM

Administered by: Public       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 15 year old patient given a Moderna dose (0.5 cc) instead of a Pfizer dose.


VAERS ID: 1768477 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Platelet count decreased, Pyrexia, Red blood cell count normal, White blood cell count increased
SMQs:, Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: high WBC count (15.98) RBC was slightly low at 4.26 platelets were *very* low at 24 (normal 150-450) PCP called at 10:00 PM last night (Wednesday) and urged to go to the ED immediately One thing the ED doc said was to monitor, especially in light of the low platelet count, is if have developed secondary immune thrombocytopenia
CDC Split Type:

Write-up: very high fever of 103.4.


VAERS ID: 1768480 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-20
Onset:2021-10-01
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30235BA / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Cardiac stress test, Chest pain, Computerised tomogram, Dyspnoea, Echocardiogram, Electrocardiogram, Fibrin D dimer normal, Full blood count, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: multi vitamin, vicodin, losartan, abilify, celexa, levothyroxine, pantoprazole,
Current Illness: none
Preexisting Conditions: throat neck cancer 2018 in remission hypothyroid hypertension
Allergies: none
Diagnostic Lab Data: ekg x 2, cbc, chem, 10 d-dimer, tsh, ctscan, echo, stress test
CDC Split Type:

Write-up: on day 11 after the second vaccine purple fingers and toes started with some shortness of breath, by day 14 worsening shortness of breath worsening extremities discoloration and chest pain with breathing


VAERS ID: 1768606 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-03
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Gait disturbance, Loss of personal independence in daily activities, Pyrexia, Tremor, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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 dose very similar to third booster
Other Medications: ibupropen
Current Illness: none
Preexisting Conditions: -taking thyroid meds
Allergies: bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: 101.8 fever, vertigo, shaking for hours, vomiting on myself, couldn''t walk to bathroom wthout -assistance husband had to help me


VAERS ID: 1768618 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-10-01
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 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: Patient had a positive COVID test


VAERS ID: 1768637 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-26
Onset:2021-10-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Communication disorder, Confusional state, Disorientation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Per patient''s sister, starting 10/1, confused, disoriented, and not communicating. He was then transported to Medical Center via EMS where he is still hospitalized.


VAERS ID: 1768638 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain, Injection site reaction, Muscle spasms, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Avalide; SINGULAIR; Dexamethasone; BREO
Current Illness: ASTHMA; HBP
Preexisting Conditions: ASTHMA; HBP
Allergies: Sulfa Ophthalmic
Diagnostic Lab Data: Oct 4 2021 Medical evaluation
CDC Split Type:

Write-up: Sep 29 I received the third dose of COVID-19 vaccine on the left arm. Oct 1 started to feel strong pain on the left shoulder with burning and cramps from the shoulder to the elbow and numbness from the elbow to the fingers left hand. I went to the clinic Oct 4 where I got the vaccine to report the symptoms that I''m having. After evaluation the doctor determines that I have spasm and prescribes me FLEXERIL HS. Panadol/ NEURONTIN 100mg HS/ FEXERIL does not relieve what I feel in my arm and the cramp in my left arm and the pain is worse at night.


VAERS ID: 1768667 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiomyopathy, Chest pain, Dyspnoea, Fatigue, Heart rate irregular, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Cardiac arrhythmia terms, nonspecific (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Pending
CDC Split Type:

Write-up: Symptoms of cardiomyopathy; Shortness of breath, tachycardia, irregular heart beat, chest pain, fatigue


VAERS ID: 1768672 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Profil XL, Aspirin, Xarelto, One A Day Vitamins, Vitamin C
Current Illness:
Preexisting Conditions: Atrial flutter, High cholesterol
Allergies:
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I experienced mild headaches, body aches, back aches and fever.


VAERS ID: 1768736 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-25
Onset:2021-10-01
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cellulitis, Erythema, Pain in extremity, Ultrasound Doppler
SMQs:, Anaphylactic reaction (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: MMR-age 6-passed out
Other Medications: I was taking insulin, Humulin R, Metoprolol, Eliquis, Glipizide, Gabapentin, and something for Gout (not sure of the name of it), Lipitor.
Current Illness: no
Preexisting Conditions: Diabetic, Sycosis of the liver, LEIDN Roman numeral five.
Allergies: I am allergic to Sulfa drugs, Penicillin, Lantus, Zosyn.
Diagnostic Lab Data: Right leg ultrasound- 10/04/2021-no clot
CDC Split Type: vsafe

Write-up: 10/01/2021-began with calf pain, like I was having a clot, when stepping on the right leg. My right leg was very red on Tuesday the 5th. On 10/04/2021 I went to the hospital and I was admitted. I am receiving antibiotics by IV to treat cellulitis in my right leg.


VAERS ID: 1768754 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse 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? No
Previous Vaccinations:
Other Medications:
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Sulfa, Keflex, Azithromycin, Clindamycin, Amoxicillin, penicillin, Z-Pack. Almonds, tree nuts, beef, milk, nuts, cheese, dairy products, red dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that she suffers severe anaphylactic response to multiple antibiotics. Food items as listed previously. Patient denies citrus sensitivity. Patient taken to EMS room at 12:25 PM. Lead RN notified. Benadryl 25 mg po given at 12:20 PM. Patient sat on cot with bottled water while injection of J&J vaccine administered at 12:30 without incident. Patient was closely monitored for adverse symptoms. Patient denies these symptoms at this time. 12:40 PM, patient is texting on phone without any problems breathing or otherwise.


VAERS ID: 1768784 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Paraesthesia oral, Pharyngeal paraesthesia
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer Covid 1st and second doses
Other Medications: Metformin, Singulair, Rosuvastatin, Levothyroxine, Calcium
Current Illness: no
Preexisting Conditions: Diabetes, hypoglycemic
Allergies: penicillin - rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports that with her 2 previous vaccines, she had a reaction of tingling in throat and tongue (felt like she was injected with lidocaine). Also stated that her Blood Pressure dropped at that time and she felt better after an hour. Booster dose of Pfizer given in EMS room at 3:51 PM after patient had received 25 mg of Benadryl PO @3:45 PM. @3:54 PM, patients complains of tingling in back of throat and tongue and feeling a little dizzy. Second individual called and came to EMS room for support. Patient refuses cot. After 30 mins, patient states she only has a little tingling in front half of tongue. States she feels like she can go home. Patient is with her parents and will go home with them, she states. Patient is drinking fluids well without difficulty. Left at 4:26 PM. Second individual accompanied her to the exit and to her car. Tingling was significantly less and patient wanted to leave.


VAERS ID: 1768859 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Unknown  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Loss of consciousness, Skin laceration, Swelling
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (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), Accidents and injuries (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: UNKNOWN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient lost consciousness (twice) while sitting in the lobby and hit her head on the blood pressure machine. Small laceration and minor swelling was seen at the time. 911 was called and paramedics took the patient out of the building after checking her BP and blood glucose. Unknown if patient went to the hospital afterwards.


VAERS ID: 1768867 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Back pain, Fatigue, Hypoaesthesia, Immediate post-injection reaction, Injection site pain, Pain, Palpitations, Paraesthesia, Product after taste, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Laytex
Diagnostic Lab Data: If I do not feel better within a day or so, will see my healthcare provider at Clinic.
CDC Split Type:

Write-up: Immediate pain in left arm Felt sinus opening up about 15 minutes in with ?medicine-like? taste in back of throat. 10:30 pm on day of vaccination began tingling sensation in extremities. Fingers were numb. 11:00 pm on day of vaccination I began to experience severe pain in knees, elbows, fingers, feet. Whole of body was achy. Began to have heart palpitations and fever shortly thereafter. Fever ran all night and next day at 101.4 degrees. Fever did not break until 6:00 pm next day. Feeling of tiredness and sore back muscles next day?like I was hit by a train.


VAERS ID: 1768943 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81
Current Illness:
Preexisting Conditions: yes
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: lt leg swollen and hurts, bruises on rt arm


VAERS ID: 1769052 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 is complaining of swollen injection site, pain, and inability to raise arm above shoulder level.


VAERS ID: 1769244 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-19
Onset:2021-10-01
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, Cough, Dyspnoea, SARS-CoV-2 test positive
SMQs:, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, aspirin, atenolol, Suboxone, fludrocortisone, lisinopril, quetiapine
Current Illness:
Preexisting Conditions: COPD, hypertension
Allergies: NKA
Diagnostic Lab Data: 10/7/21: COVID-19, rapid: positive X-ray chest: no acute process Alkaline phosphatase: 141 Potassium 3.5
CDC Split Type:

Write-up: Patient had began experiencing cough and shortness of breath approximately 1 week prior to evaluation in the ED. The patient was treated outpatient with steroids. In ED, patient had O2 sat of 96%. Patient was found to be positive for COVID-19 via rapid swab. Patient was evaluated as eligible for discharge home.


VAERS ID: 1769253 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Diarrhoea, Dizziness, Fatigue, Feeling cold, Headache, Insomnia, Nausea, Neck pain, Pyrexia, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE KNOWN
Diagnostic Lab Data: NONE HAVE NOT GONE TO HOSPITAL YET, HE DOES NOT WANT TO, DEPENDING ON HOW MUCH LONGER I WILL BE TAKING HIM IN
CDC Split Type:

Write-up: REACTIONS STARTED THE SAME DAY AS THE SHOT AND WE ARE ON DAY 6 WITH NO IMPROVEMENT. SEVERE HEAD PAIN, CHILLS, FEVER, WEAKNESS THROUGHOUT ENTIRE BODY, NASEAU, VOMITING (STARTED ON DY 3 LASTING FOR 3 DAYS, THAT SO FAR HAS STOPPED AS OF TODAY 10/7/21), DIARRHEA, NECK PAIN, SHOULDER PAIN, FATIGUE (CAN NOT STAY AWAKE, BUT DOES NOT SLEEP SOUNDLY), DIZZINESS


VAERS ID: 1769286 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Feeling cold, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Glipizide Hydrochlothiside Januvia Metoprolol Simvastatin Tamsulosin Losartan Sulfa Salazine Aspirin Mira lax
Current Illness: None
Preexisting Conditions: Diabetes Arthritis
Allergies: Levofloxacin
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: I experienced chills late at night. My teeth were chattering and I was shaking very hard. I felt cold and I was freezing. It lasted 8 hours. When I woke up, I was fine.


VAERS ID: 1769493 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ743AB / UNK LA / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, 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? 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: n/a
CDC Split Type:

Write-up: Pt described rash, redness and warmth to the area where he was vaccinated on last Fri. I advised pt to apply cold pack to area and to contact Dr to evaluate.


VAERS ID: 1770003 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-23
Onset:2021-10-01
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 RA / IM

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

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

Write-up: Pt admitted to hospital positive for COVID 10/7/21 s/p 2 doses of Pfizer (last dose was 2/23/21)


VAERS ID: 1770399 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Diplopia, Eye disorder, Fatigue, Lymphadenopathy, Myalgia, Ocular hyperaemia, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Ocular motility disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HYDROCHLOROTHIAZIDE; BIOTIN
Current Illness: Alcohol use (socially); Hypertension; Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies. The patient did not have any drug abuse/illicit drug use. Patient had taken multivitamin.
Allergies:
Diagnostic Lab Data: Test Name: SARS-CoV-2 PCR test; Result Unstructured Data: Unknown; Test Name: SARS-CoV-2 rapid POC test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20211011458

Write-up: DOUBLE VISION; BLOOD SHOT EYES; DROOPY EYES; BAD MUSCLE ACHES; BAD CHILLS; FATIGUE; SWOLLEN LYMPH NODES; This spontaneous report received from a patient concerned a 42 year old female. The patient''s weight was 100 pounds, and height was 62 inches. The patient''s concurrent conditions included: hypertension, alcohol user, and non smoker, and other pre-existing medical conditions included: The patient had no known allergies. The patient did not have any drug abuse/illicit drug use. Patient had taken multivitamin. 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 30-SEP-2021 for prophylactic vaccination. The Company is unable to perform follow-up to request batch/lot numbers. Concomitant medications included biotin for drug used for unknown indication, and hydrochlorothiazide for hypertension. On 01-OCT-2021, the patient experienced bad chills. On 01-OCT-2021, the patient experienced fatigue. On 01-OCT-2021, the patient experienced swollen lymph nodes. On 05-OCT-2021, the patient experienced blood shot eyes. On 05-OCT-2021, the patient experienced droopy eyes. On 05-OCT-2021, the patient experienced bad muscle aches. On 06-OCT-2021, the patient experienced double vision. Laboratory data (dates unspecified) included: SARS-CoV-2 PCR test (NR: not provided) Unknown, and SARS-CoV-2 rapid POC test (NR: not provided) Negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from double vision on 06-OCT-2021, and swollen lymph nodes on 03-OCT-2021, and had not recovered from bad chills, fatigue, bad muscle aches, blood shot eyes, and droopy eyes. This report was non-serious. This case, from the same reporter is linked to 20211011585.


VAERS ID: 1771120 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-27
Onset:2021-10-01
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Malaise, Musculoskeletal chest pain
SMQs:, Guillain-Barre 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: VITAMIN D3; FISH OIL
Current Illness:
Preexisting Conditions: Comments: No Medical History information was reported.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Today I''m not feeling well; Weakness; I have some headache; Little bit of chill that started yesterday afternoon; My ribs started feeling wrapped tight/compression on my ribs that got away; This spontaneous case was reported by a consumer and describes the occurrence of MALAISE (Today I''m not feeling well), MUSCULOSKELETAL CHEST PAIN (My ribs started feeling wrapped tight/compression on my ribs that got away), ASTHENIA (Weakness), HEADACHE (I have some headache) and CHILLS (Little bit of chill that started yesterday afternoon) in a 75-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 006C21A and 021B21A) for COVID-19 vaccination. No Medical History information was reported. Concomitant products included COLECALCIFEROL (VITAMIN D3) and FISH OIL for an unknown indication. On 27-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Oct-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 01-Oct-2021, the patient experienced MUSCULOSKELETAL CHEST PAIN (My ribs started feeling wrapped tight/compression on my ribs that got away) and CHILLS (Little bit of chill that started yesterday afternoon). On 02-Oct-2021, the patient experienced MALAISE (Today I''m not feeling well), ASTHENIA (Weakness) and HEADACHE (I have some headache). The patient was treated with OMEPRAZOLE (PROTONIX [OMEPRAZOLE]) for Adverse event, at a dose of 40 mg. At the time of the report, MALAISE (Today I''m not feeling well), ASTHENIA (Weakness), HEADACHE (I have some headache) and CHILLS (Little bit of chill that started yesterday afternoon) outcome was unknown and MUSCULOSKELETAL CHEST PAIN (My ribs started feeling wrapped tight/compression on my ribs that got away) had resolved.


VAERS ID: 1771126 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-03
Onset:2021-10-01
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 - / OT

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

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

Write-up: a patient received their 2nd dose of the Moderna Covid-19 Vaccine on 1Oct2021,from a previously opened (24Sep2021) vial that has been stored at room temperature since 24Sep2021; a patient received their 2nd dose of the Moderna Vaccine on 1Oct2021, from a previously opened (24Sep2021) vial that has been stored at room temperature since 24Sep2021; This spontaneous case was reported by a physician assistant and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (a patient received their 2nd dose of the Moderna Vaccine on 1Oct2021, from a previously opened (24Sep2021) vial that has been stored at room temperature since 24Sep2021) and PRODUCT STORAGE ERROR (a patient received their 2nd dose of the Moderna Covid-19 Vaccine on 1Oct2021,from a previously opened (24Sep2021) vial that has been stored at room temperature since 24Sep2021) in a 49-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 050E21A and 033B21A) for COVID-19 vaccination. No Medical History information was reported. On 03-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Oct-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 01-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (a patient received their 2nd dose of the Moderna Vaccine on 1Oct2021, from a previously opened (24Sep2021) vial that has been stored at room temperature since 24Sep2021). On an unknown date, the patient experienced PRODUCT STORAGE ERROR (a patient received their 2nd dose of the Moderna Covid-19 Vaccine on 1Oct2021,from a previously opened (24Sep2021) vial that has been stored at room temperature since 24Sep2021). On 01-Oct-2021, EXPIRED PRODUCT ADMINISTERED (a patient received their 2nd dose of the Moderna Vaccine on 1Oct2021, from a previously opened (24Sep2021) vial that has been stored at room temperature since 24Sep2021) had resolved. At the time of the report, PRODUCT STORAGE ERROR (a patient received their 2nd dose of the Moderna Covid-19 Vaccine on 1Oct2021,from a previously opened (24Sep2021) vial that has been stored at room temperature since 24Sep2021) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medication were reported. The patient was given accidentally a dose of vaccine that had been out of the fridge for multiple days Most recent FOLLOW-UP information incorporated above includes: On 01-Oct-2021: Follow-up received contains no new information.


VAERS ID: 1771133 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: I believe we vaccinated an individual after the beyond use date of the vaccine.; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (I believe we vaccinated an individual after the beyond use date of the vaccine.) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (I believe we vaccinated an individual after the beyond use date of the vaccine.). At the time of the report, EXPIRED PRODUCT ADMINISTERED (I believe we vaccinated an individual after the beyond use date of the vaccine.) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant Medications were provided by the reporter No Treatment Information were provided by the reporter


VAERS ID: 1771151 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 3 - / OT

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

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

Write-up: Received a dose of the Moderna vaccine when he already had 2 doses of Pfizer; This spontaneous case was reported by a pharmacist and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received a dose of the Moderna vaccine when he already had 2 doses of Pfizer) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 051E21A) for COVID-19 vaccination. Previously administered products included for an unreported indication: PFIZER BIONTECH COVID-19 VACCINE (dose2) in May 2021 and PFIZER BIONTECH COVID-19 VACCINE (Dose 1). On 01-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Oct-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received a dose of the Moderna vaccine when he already had 2 doses of Pfizer). On 01-Oct-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received a dose of the Moderna vaccine when he already had 2 doses of Pfizer) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. On an unknown date , patient received first dose of Pfizer COVID-19 vaccine. On MAy2021, patient received second dose of Pfizer COVID-19 vaccine. No concomitant medications were provided by the reporter. No treatment information was provided by the reporter.


VAERS ID: 1771152 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: This spontaneous case reported by a nurse, describes the occurrence of polymenorrhea (my sister got the Moderna COVID-19 shot & it has shortened her menstrual cycle) in a female patient, of an unknown age, who received mRNA-1273 (Moderna COVID-19 vaccine) for COVID-19 immunization. No medical history reported. On an unknown date, patient received a dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On Oct 1, 2021, patient experienced polymenorrhea (my sister got the Moderna COVID-19 shot & it has shortened her menstrual cycle). At the time of the report, polymenorrhea (my sister got the Moderna COVID-19 shot & it has shortened her menstrual cycle) outcome: unknown. The action taken with mRNA-1273 (Moderna COVID-19 vaccine): unknown. The reporter did not provide any causality assessments, concomitant medication or treatment information.


VAERS ID: 1771156 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-13
Onset:2021-10-01
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 LA / OT

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

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

Write-up: Patient received a dose from an expired vial; Second dose given $g35 days from first dose; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient received a dose from an expired vial) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second dose given $g35 days from first dose) in a 54-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 019B21A and 003B21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Oct-2021 at 8:30 AM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 01-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient received a dose from an expired vial) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second dose given $g35 days from first dose). On 01-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Patient received a dose from an expired vial) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second dose given $g35 days from first dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided. Treatment information was not provided.


VAERS ID: 1771160 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202110; Test Name: EKG; Result Unstructured Data: normal
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Chest pain; This spontaneous case was reported by a consumer and describes the occurrence of CHEST PAIN (Chest pain) in a 26-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 01-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Oct-2021, the patient experienced CHEST PAIN (Chest pain). At the time of the report, CHEST PAIN (Chest pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In October 2021, Electrocardiogram: normal (normal) normal. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medication information was not provided by the reporter. Treatment information was not provided by the reporter.


VAERS ID: 1771410 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Feeling abnormal, Headache, Malaise, Myalgia, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderate headache day after receiving second dose of Pfizer vaccine in March.
Other Medications: Lumigan Prednisolone Acetate Ketorolac Thera Tears
Current Illness: None known
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever: up to 103.6 for three days Nausea, vomiting, diarrhea for three days Severe headache for two days Muscle aches and extreme fatigue for five days Mild aches and fatigue for additional two days General malaise and feeling yucky for total of six days


VAERS ID: 1771454 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C12A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: topiramate, warfarin, hydroxyurea, sertraline, cyanocobalamin
Current Illness: none
Preexisting Conditions: polycythemia vera, antiphospholipid, anemia
Allergies: honey, codeine
Diagnostic Lab Data: unknown. ask physician.
CDC Split Type:

Write-up: According to the patient, she had multiple temporal lobe seizures that rendered her unable to speak or communicate. These were more extreme and for longer duration than she has had before. Prior to this her seizures were controlled with her topiramate and the patient states she has not had a seizure in a "long time". Seizures are still occurring intermittently.


VAERS ID: 1771462 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-04-05
Onset:2021-10-01
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Pyrexia, SARS-CoV-2 test positive, Taste disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer 2021
Other Medications: ARMOUR THYROID; levothyroxine; fish oil; vitamin D; selenium; methyl folate; iodine; zinc
Current Illness: None
Preexisting Conditions: Hashimoto''s; high blood pressure; obesity
Allergies: Sulfa drugs
Diagnostic Lab Data: PCR
CDC Split Type: vsafe

Write-up: October 1 I woke up with a cough and my lunch had tasted weird and I didn''t think too much of it but I thought that was a ace in the hole for Covid. I took a home test and there was a faint positive. That night I was running fever that lasted 3 days. I had a PCR on 10/03/2021 that was positive, and had a regeneron infusion on 10/07/2021. I never had any O2 issues or anything like that. I''ve had loss of taste and smell, fever, and a cough. Symptoms are still ongoing.


VAERS ID: 1771469 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Heart rate decreased, Lethargy
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 5 years ago, Flu vaccine, sick for 3 days.
Other Medications: Bisoprolol; lisinopril; potassium; folic acid; vitamin D; vitamin B12; aspirin; melatonin
Current Illness: No
Preexisting Conditions: High blood pressure; 2 knee replacements
Allergies: Codeine; oxycodone; things with oxy
Diagnostic Lab Data: Yes, only thing detected was the low pulse rate.
CDC Split Type: vsafe

Write-up: Since receiving my 3rd dose, I have been very lethargic. No motivation to do anything. My blood pressure medication has been lowered because I am experiencing a low pulse rate. I was also given a medication for bladder control but it was not agreeing with me so I only took it for 3 days. My pulse rate has been around 50-57. I have not had issues like this prior to the 3rd dose.


VAERS ID: 1771500 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstrual disorder, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Adversely affected menstrual cycle. Started period early. Extremely heavy period bleeding. Still bleeding on 10/8/2021.


VAERS ID: 1771516 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling, Thrombosis, Ultrasound scan
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paparazzo (IV chemo) Carboplatin (IV chemo)
Current Illness:
Preexisting Conditions: Cancer, Lymphoma
Allergies: None
Diagnostic Lab Data: Ultra sound 10/01/2021
CDC Split Type:

Write-up: Pain and swelling left lower leg. US shows blood clots left thigh. Put on a blood thinner. Pain and swelling currently continues. Will be on blood thinner for at least 6 months.


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