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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 56 out of 8,010

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VAERS ID: 1771526 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-10-01
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Cough, Fatigue, Headache, Nasal congestion, Oropharyngeal pain, Productive cough, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The weekend post 2nd dose I felt fatigue, runny nose and cough from Saturday to Monday. However, Friday October 1st, I began having sore throat, nasal congestion and runny nose. These progressed Saturday and Sunday. On Monday I also felt fatigue and chills, no fever. On Tuesday and Wednesday I began to develop a productive cough in addition to all previously mentioned symptoms. On Thursday I began to feel a slight improvement in my energy but cough continued. Today is Friday and I still have cough and congestion headaches. It seems as though these must be related to a delayed response to my 2nd vaccine because I tested negative for Covid-19 and none of my immediate family members have "caught" anything from me.


VAERS ID: 1771553 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-27
Onset:2021-10-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: timolol, latanoprost, levothyroid, B12
Current Illness: no
Preexisting Conditions: osteoporosis, gerd, hyperlipidemia, CKD, glaucoma, hypothyroid, pacemaker for sinus node dysfunction
Allergies: sulfa, pcn
Diagnostic Lab Data: CT
CDC Split Type:

Write-up: PE


VAERS ID: 1771589 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-17
Onset:2021-10-01
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 AR / 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough Covid case. Went to ER and got monoclonal infusion.


VAERS ID: 1771636 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-10-01
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: plavxi, lipitor, ASA, metoprolol, metformin, famotidine
Current Illness: none
Preexisting Conditions: DM, MI with stents, HLD, HTN
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash, 10/2021. does not feel right since the vaccine


VAERS ID: 1771668 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-03-13
Onset:2021-10-01
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Eye pain, Ophthalmological examination abnormal, Vision blurred, Visual impairment, Vitreous detachment, Vitreous floaters, Vitritis
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (narrow), Ocular infections (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: Livalo, Losartan, Yuvafem, Vit D and E, Fish Oil, CoQ10, Aspirin, Percocet, Rozerem, Dayvigo,
Current Illness: None
Preexisting Conditions: HTN, CHD/CVD
Allergies: Demerol (?)
Diagnostic Lab Data: Many Oct 7, 2021 no results yet
CDC Split Type:

Write-up: August 12, 2021 sudden large increase in visual floaters. Oct 1, 2021 exceptional increase in visual floaters followed by decreased clouded vision left eye. Oct 2, 2021 sudden onset eyeball pain left eye with listed visual decline and floaters. Oct 2, 2021 Diagnosis Posterior Vitreous Detachment with increased vitreous debris/Vitritis left eye. Referral to specialist Oct 6, 2021 Eye specialist verified unusual viritis left eye and referred to retinal specialist. Oct 7, 2021 Retinal specialist confirmed vitritis but also asked many autoimmune questions and ordered many such tests as this condition is unusual in a person of my age.


VAERS ID: 1771673 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Maryland  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Incorrect route of product administration, Injection site pain, Pain in extremity
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), 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: Sertraline 50mg Lisinopril Multivitamin Probiotics
Current Illness: None
Preexisting Conditions: Anxiety HBP
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was injected (possibly too) high on arm-Injection itself was very painful and radiated down to elbow and wrist. Seems like the nurse hit a nerve. Pain in elbow and wrist was temporary. Pain resolved in upper arm with in 3 days, however, today- 7 days later- achey pain in upper arm, elbow and forearm has returned.


VAERS ID: 1771723 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-06
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 2588 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Headache, Lethargy, Myalgia, Nausea, Pyrexia, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Crestor Lopressor Vit D, C baby ASA
Current Illness: None
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: none I''m an MD retired Surgeon
CDC Split Type:

Write-up: Headache, fever 100.2, myalgias, tachycardia (120 resting), extreme lethargy (slept 20 hr.) anorexia and stomach queziness


VAERS ID: 1771739 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
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 - / 2 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Atrial fibrillation, Dizziness, Dyspnoea, Electrocardiogram ambulatory, Sleep apnoea syndrome, Sleep study abnormal
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes, Diltiazem CD 20mg, Eliquis 5mg, Lisinopril 2.5mg, Clopidol 75mg, Metformin 500mg
Current Illness: No
Preexisting Conditions: Diabetes, a-fib (controlled by medication; has
Allergies: No
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: I had some lightheadedness. I went to my GP and they told me I was in afib. They told me since I was on medications, it was controlled afib. I made an appointment with the cardiologists PA. I wore a heart monitor for 7 days. They said I had an issue where I would stop breathing for periods of time. I was suggested a pacemaker but that is not something I want at this point in my life. I had a sleep study done and was diagnosed with sleep apnea. I slept with a CPAP machine and am working on getting one.


VAERS ID: 1771787 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-08
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Seizure, Thirst, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: none
Preexisting Conditions: noe
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Immediately after the IM injection, patient asked for water. When I asked him if he would wait in the room while I got the water, there was no response from patient. I then called his name and no response. Within a minute, he started seizing and his face turned bright red. He remained in chair and came out of it in about 10-15 seconds. Patient had no idea that he had a seizure but was extremely thirsty. We gave him 3 bottled waters. Management alerted police and ambulance.


VAERS ID: 1771822 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-23
Onset:2021-10-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Electrocardiogram abnormal, Ventricular extrasystoles
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control pills
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: EKG done on 10/2/21 showed PVCs.
CDC Split Type:

Write-up: Premature ventricular contractions very frequently (less than 1 min apart). Began on 10/1/21 at 6pm and continued until 10/2/21 all day. Fewer on 10/3/21 and 10/4/21. Disappeared by 10/5/21.


VAERS ID: 1771886 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-24
Onset:2021-10-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthritis, X-ray
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prescription Diclofenac Sodium, prescription Lisinopril and Prescription Estradiol
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to Bactrim
Diagnostic Lab Data: X-ray on the foot in A-P with weight baring.
CDC Split Type:

Write-up: Arthritis in the mid-foot, left foot.


VAERS ID: 1771941 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Missouri  
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 30145BA / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, Hypoxia, Pulseless electrical activity, Respiratory failure, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Atrial Fibrillation
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized for acute respiratory distress with hypoxia. Diagnosed with septic shock and respiratory failure, acute renal failure and PEA arrest.


VAERS ID: 1771986 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-10-01
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Dyspnoea, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet Aluminum Chloride (DRYSOL) 20 % topical solution aspirin low dose 81 MG chew tablet atorvastatin (LIPITOR) 10 MG tablet bisacodyl (DULCOLAX) 10 MG suppository ceFAZolin Sodium (ANCEF IV) dexamethasone (
Current Illness: None known
Preexisting Conditions: Malignant neoplasm of left humerus (HCC) Essential hypertension Hyperlipidemia Non-insulin dependent type 2 diabetes mellitus (HCC) Pathological fracture in neoplastic disease, left humerus, initial encounter for fracture
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to emergency department from skilled nursing facility for shortness of breath and hypoxia. Patient also reported shoulder pain. Patient reported she tested positive for COVID-19 on 10/1/2021. Due to patient''s current treatment for osteosarcoma, she was transferred to a different facility to be cared for by her current care team.


VAERS ID: 1772024 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Headache, Injection site pain, Pain, 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? 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 reports that she received COVID Booster on 9/29/2021. States low grade temp (99) for a few days, mild pain at injection site of left deltoid, body aches and headaches for last 3 days. Advised to call PCP for appointment. Patient verbalized understanding.


VAERS ID: 1772081 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maine  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dextroamphetamine, fluoxetine, guanfacine, hydroxyzine
Current Illness: none
Preexisting Conditions: ADHD, asthma, eczema, depressive disorder, mild intellectual disabilty
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt was inadvertently administered an expired dose of covid vaccine. Pt was fine, did not experience any untoward effects.


VAERS ID: 1772244 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: D.C.  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Chest exam, chest x-ray, blood panel, blood marker for clot, EKG.
CDC Split Type:

Write-up: 30 minutes after injection, began feeling strange sensation in left side of chest (12 pm Friday). Sensation continued and became mildly painful Friday evening. Mild pain began Saturday, with shortness of breath developing Saturday afternoon. Serious difficulty breathing onset Saturday night. Car was broken so considered calling 911 for ambulance, but hesitated due to $5k health insurance deductible. Quickly researched myocarditis, saw treatment included NSAIDs, and took two Advil. Within one hour, breathing returned to near-normal and went to bed. Stayed on Advil through Sunday night when symptoms seemed to resolve. On Monday did telehealth consult with Medstar doctor who confirmed suspected Myocarditis and recommended ER consult to rule out other causes or permanent damage. Went to ER on Tuesday for chest exam, x-ray, blood panel, EKG, blood marker to rule out blood clot in lung. ER Dr interpreted all tests as normal and discharged with diagnosis of strange reaction to COVID vaccine and recommended to watch for worsening or resolution of symptoms. Symptoms returned Thursday, so began taking Advil regularly (1 pill every 4 hours). Present (10/8/21): Normal breathing can only be maintained by taking 1 Advil every four hours. If medication stops, breathing difficulty returns, along with chest pain.


VAERS ID: 1772270 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Illinois  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Hypertension, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fluzone Hi-Dose flu vaccine, 10/31/16, 75 yrs. old, vomiting, diarrhea, ears hurt, muscles hurt, headache after 1 hour of receiv
Other Medications: Centrum Silver vitamins, 1x a day, Vitamin D, 1000IU, 1x a day.
Current Illness: Slight scratchy throat from allergies. No fever present.
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None so far.
CDC Split Type:

Write-up: Two hours after receiving the Covid 19 booster vaccine, my heart experienced a rapid beating with palpitations. My blood/pressure was up and down as high as 171/96 when I usually have a normal blood/pressure. This continued for 8 hours. I called my family doctor at 11:00 pm and he said not to worry about a stroke or heart attack as this was a reaction to the vaccine. He advised to push fluids and in the morning to call if worse. I went to doctor''s office 3 days later to be checked out. He couldn''t hear anything wrong. He said to give it a couple of days and rest and push fluids. Eight days later I am still experiencing a faster heartbeat than normal. I''m not sure what to do next.


VAERS ID: 1772276 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-08
Onset:2021-10-01
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xeljanz (held for 7 days following booster vaccine) Celebrex Effexor prednisone omeprazole myrbetriq lipitor flaxseed oil lutein vit B 12 vit D Mg citrate folexin adult MVI
Current Illness: none
Preexisting Conditions: psoriatic arthritis hypercholesterolemia GERD
Allergies: Wellbutrin - hives
Diagnostic Lab Data: CTA 10/1/21
CDC Split Type:

Write-up: On 10/1 I developed an occlusion of left ulnar artery and partial occlusion of left radial artery. I presented to the ER with an ischemic index finger and thumb. Diagnosis was made by CTA. Per vascular surgery I was on a heparin drip overnight. The next morning circulation was documented via doppler and I was discharged on plavix, xerelto, and nifedipine. It is now one week out and I am still being treated. The thought is vasculitis and vasospasm and not thrombosis but they aren''t sure.


VAERS ID: 1772290 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-17
Onset:2021-10-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Site: Pain at Injection Site-Medium


VAERS ID: 1772333 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-15
Onset:2021-10-01
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Bone lesion, COVID-19, COVID-19 pneumonia, Chest pain, Condition aggravated, Cough, Dyspnoea, Dyspnoea exertional, Hypoxia, Lung opacity, Magnetic resonance imaging head abnormal, Malaise, Pulmonary imaging procedure abnormal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amoxicillin (AMOXIL) 500 MG capsule aspirin 325 MG tablet beclomethasone diprop HFA (QVAR REDIHALER) 40 MCG/ACT inhaler cevimeline (EVOXAC) 30 MG capsule Cholecalciferol (VITAMIN D) 2000 UNITS CAPS cycloSPORINE (RESTASIS) 0.05 % ophthalmic
Current Illness: 9.7.21: Office Visit - Other osteoporosis without current pathological fracture (Primary Dx); Hypothyroidism, unspecified type; MGUS (monoclonal gammopathy of unknown significance husband + with COVID
Preexisting Conditions: Narcolepsy with cataplexy Arthralgia Sjogren''s syndrome (HCC) Anemia of chronic disease Depression Fibromyalgia Blepharospasm Gout DVT of deep femoral vein 2005 Osteoporosis Back pain Hypogammaglobulinemia (HCC) Unspecified essential hypertension OSA (obstructive sleep apnea) H/O bilateral breast implants History of bilateral NS mastectomies - 1975 Anxiety Rheumatoid arthritis (HCC) MGUS (monoclonal gammopathy of unknown significance) IgG deficiency (HCC) Avascular necrosis of bone of right hip (HCC) CAD (coronary artery disease) Esophageal candidiasis (HCC) Stage 2 chronic kidney disease Peptic ulcer without hemorrhage or perforation but with obstruction (HCC) Leukopenia Hypercalcemia History of seronegative inflammatory arthritis Generalized osteoarthritis Atrophy of kidney Pneumonia due to COVID-19 virus
Allergies: CompazineAnaphylaxis, Nausea Only, Throat swelling Hylan G-f 20Edema Torecan [Thiethylperazine]Throat swelling LatexHives, Rash Atenolol [Beta Adrenergic Blockers]Other AtorvastatinMyalgia Coreg [Carvedilol]Other Dust Infed [Dextrans]Other IronOther Iron DextranOther MoldNausea Only, Sneezing Polyoxyethylene 40 Sorbitol Septaoleate [Sorbitan] Statins [Hmg-coa-r Inhibitors]Myalgia
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.2.21); COVID-19 positive (10.1.21); fully vaccinated Discharge Provider: MD Primary Care Provider: MD Admission Date: 10/2/2021 Discharge Date: Oct 5, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Precordial chest pain [R07.2] Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient is a 73-year-old female with history of MGUS, essential hypertension, hypothyroidism, history of prior DVT, no longer on anticoagulation, who presented to the ED with complaints of shortness of breath, cough, and malaise. Patient reported symptoms began on 09/26. Her husband was recently hospitalized for COVID-19 pneumonia and just discharged the day prior. Patient also tested positive for COVID. She is vaccinated. In the ER, CTA showed minimal scattered peripheral ground-glass opacities bilaterally as well as interval development of sclerotic bone lesion in the manubrium. She became mildly hypoxic with ambulation. Patient was admitted to the hospital for further workup and management. Patient was treated with remdesivir and Decadron as well as supportive care for viral illness. Patient was weaned off all oxygen. She is to remain on isolation for 20 days from 9/26/21 per our infection control due to immune compromised status, MRI was performed to further evaluate sclerotic bone lesion which revealed "No marrow replacing process in the manubrium or soft tissue mass. The area of sclerosis seen on the comparison CT is nonspecific but does not have an aggressive appearance". Biopsy deferred due to hypercoaguability after COVID infection. She follows with Hematology in the past. Can be done on routine basis once far removed from Covid infection. Please note MRI in-house done without contrast, unclear reason. If reimaged, would use contrast if no contraindication. Patinet currently ambulatory and not requiring oxygen. Pain controlled on home regimen. Discharged in stable condition.


VAERS ID: 1772764 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Fatigue, Headache, Influenza, Myalgia, Nasopharyngitis, Pyrexia, Respiratory tract congestion, Sinus pain, Ventricular extrasystoles
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad)

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

Write-up: Fever, severe muscle soreness, cold/flu symptoms (sinus pain/congestion), headaches, fatigue, dizziness, shortness of breath, premature ventricular contractions.


VAERS ID: 1772786 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-23
Onset:2021-10-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pt received a covid vaccine on 9-23-21. Injection was at the right deltoid. Pt noted a small bump at his right bicep on 10-1-21. Unclear if it is related. Appears consistent with a small lymph node. Doubt clinically significant, but will monitor over time.


VAERS ID: 1772979 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-10-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Contusion, Injection site erythema, Injection site reaction, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Bruising (Fri- Wed.), welts (Fri - Wed), itching arm (Thurs), pain in shoulder (Thurs - Sat.), and a blotch of redness (Fri 1 Oct - Sun) at site. Treatment was antihistamines and zyrtec.


VAERS ID: 1773159 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
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 - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse, clonazepam, nuvaring
Current Illness: None
Preexisting Conditions: Thyroid nodule, low PTH, low vit D, depression/anxiety
Allergies: None
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Left ancillary lymph node swelling


VAERS ID: 1773406 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: South Carolina  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Dizziness, Headache, Hypertension, Injection site pruritus, Injection site reaction, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202110; Test Name: Blood pressure; Result Unstructured Data: high
CDC Split Type: USJNJFOC20211014251

Write-up: ITCHING AT SITE OF INJECTION; OOZING SITE OF INJECTION; DIZZINESS; HIGH BLOOD PRESSURE; NAUSEA; HEADACHES; This spontaneous report received from a patient concerned a 34 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1822809, and expiry: UNKNOWN) dose was not reported, administered on 05-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On OCT-2021, the patient experienced itching at site of injection. On OCT-2021, the patient experienced oozing site of injection. On OCT-2021, the patient experienced dizziness. On OCT-2021, the patient experienced high blood pressure. On OCT-2021, the patient experienced nausea. On OCT-2021, the patient experienced headaches. Laboratory data included: Blood pressure (NR: not provided) high. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from itching at site of injection, oozing site of injection, nausea, dizziness, headaches, and high blood pressure. This report was non-serious. This case, from the same reporter is linked to 20211014731.


VAERS ID: 1773417 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: South Carolina  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Dizziness, Headache, Hypersomnia, Hypertension, Hypoaesthesia, Injection site pruritus, Injection site reaction, Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202110; Test Name: Blood pressure; Result Unstructured Data: High
CDC Split Type: USJNJFOC20211014731

Write-up: ITCHING AT SITE OF INJECTION; OOZING AT SITE OF INJECTION; EXCESSIVE SLEEP; HIGH BLOOD PRESSURE; DIZZINESS; HEADACHE; NUMBNESS OF FACE AND ARM; NAUSEA; This spontaneous report received from a consumer concerned a 35 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 1822809 expiry: UNKNOWN) dose was not reported, administered on 05-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On OCT-2021, the patient experienced itching at site of injection. On OCT-2021, the patient experienced oozing at site of injection. On OCT-2021, the patient experienced excessive sleep. On OCT-2021, the patient experienced high blood pressure. On OCT-2021, the patient experienced dizziness. On OCT-2021, the patient experienced headache. On OCT-2021, the patient experienced numbness of face and arm. On OCT-2021, the patient experienced nausea. Laboratory data included: Blood pressure (NR: not provided) High. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, itching at site of injection, oozing at site of injection, high blood pressure, dizziness, and nausea, and the outcome of numbness of face and arm and excessive sleep was not reported. This report was non-serious. This case, from the same reporter is linked to 20211014251.


VAERS ID: 1773455 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30458A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Lymphadenopathy, Magnetic resonance imaging abnormal, Nipple pain, Peripheral swelling, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? 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: MRI- Reactive Lymphadenopathy
CDC Split Type:

Write-up: Reactive lymphadenopathy/diagnosed 10/5/2021 10/1/2021-Swelling in neck/ Underarm wasn''t notice until doctors visit on 10/5/2021 10/4/2021- swelling of feet that went away the next day 10/8/2021-nipples hurting9Not diagnose or treated


VAERS ID: 1773465 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Feeding disorder, Nausea, Parosmia, Retching, Taste disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I was unable to eat or drink because everything smelled and tasted rotten. The sight and smell of food or drink besides water made me gag or vomit. It took me more than three days to transition to liquids besides water, and five for solid foods. I still cannot eat or drink foods with strong smell without feeling nauseous, is had been at least eight days.


VAERS ID: 1773525 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dehydration, Feeling hot, Illness, Insomnia, Maternal exposure during pregnancy, Nausea, Pain in extremity, SARS-CoV-2 test, Vaccination site pain, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament disorders (broad), Dehydration (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PRENATAL VITAMINS [MINERALS NOS;VITAMINS NOS]; UNISOM 2
Current Illness: Asthma; Drug allergy (allergic to oxycodone)
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Hospitalization due to COVID-19: No, sick for about a week Treatment received was Tylenol)
Allergies:
Diagnostic Lab Data: Test Date: 20210915; Test Name: COVID 19 test; Test Result: Positive ; Result Unstructured Data: positive
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dehydration; She was vomiting during the phone call to report the AE; Felling like she was burning up/hot/felling very very hot; Felling sick; Chest pain; Not been available to sleep; Severe pain in the arm, she cannot move it; Nausea; Vaccination site pain; chest pain; Pregnancy; This spontaneous prospective pregnancy case was reported by a consumer and describes the occurrence of INSOMNIA (Not been available to sleep), PAIN IN EXTREMITY (Severe pain in the arm, she cannot move it), FEELING HOT (Felling like she was burning up/hot/felling very very hot), ILLNESS (Felling sick) and CHEST PAIN (Chest pain) in a 21-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 020f21a) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 (Hospitalization due to COVID-19: No, sick for about a week Treatment received was Tylenol) on 12-Sep-2021. Concurrent medical conditions included Drug allergy (allergic to oxycodone) and Asthma. Concomitant products included MINERALS NOS, VITAMINS NOS (PRENATAL VITAMINS [MINERALS NOS;VITAMINS NOS]) and DOXYLAMINE SUCCINATE (UNISOM 2) for an unknown indication. On 01-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. The patient''s last menstrual period was in June 2021 and the estimated date of delivery was 08-Apr-2022. On 01-Oct-2021, the patient experienced INSOMNIA (Not been available to sleep), PAIN IN EXTREMITY (Severe pain in the arm, she cannot move it), CHEST PAIN (chest pain), MATERNAL EXPOSURE DURING PREGNANCY (Pregnancy), NAUSEA (Nausea) and VACCINATION SITE PAIN (Vaccination site pain). On 02-Oct-2021, the patient experienced FEELING HOT (Felling like she was burning up/hot/felling very very hot), ILLNESS (Felling sick), CHEST PAIN (Chest pain) and VOMITING (She was vomiting during the phone call to report the AE). On an unknown date, the patient experienced DEHYDRATION (Dehydration). The patient received mRNA-1273 (Moderna COVID-19 Vaccine) beginning around the thirteenth week of the pregnancy. At the time of the report, INSOMNIA (Not been available to sleep), PAIN IN EXTREMITY (Severe pain in the arm, she cannot move it), FEELING HOT (Felling like she was burning up/hot/felling very very hot), ILLNESS (Felling sick), CHEST PAIN (Chest pain), DEHYDRATION (Dehydration), VOMITING (She was vomiting during the phone call to report the AE), NAUSEA (Nausea) and VACCINATION SITE PAIN (Vaccination site pain) outcome was unknown, CHEST PAIN (chest pain) had not resolved and MATERNAL EXPOSURE DURING PREGNANCY (Pregnancy) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 15-Sep-2021, SARS-CoV-2 test: positive (Positive) positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No treatment medication was provided. Ultrasound and EKG were performed on patient for myo/pericarditis but did not find either and it also included fluids as treatment. Patient did not had history of myocarditis/pericarditis. Most recent FOLLOW-UP information incorporated above includes: On 05-Oct-2021: Live followup received on 05-OCT-2021 included: added patient history and lab data and events and updated narrative accordingly.; Sender''s Comments: This case concerns a 21 year old pregnant female at 13 weeks gestation with an LMP of end of June 2021 and an EDC of 08 April 2022 with a history of COVID-19 infection 12 Sep 2021 that resolved prior to vaccination and experienced the AESI of Maternal exposure during pregnancy and other non-serious listed and unlisted events occurring the day of the first dose of mRNA-1273 vaccine. Re-challenge is unknow as the second is not yet indicated. The history of COVID-19 infection remains a confounder as this could have enhanced the reaction and severity of events. Benefit-risk relationship of mRNA-1273 is not affected by this report.


VAERS ID: 1773532 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-24
Onset:2021-10-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 - / 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: PROTONIX [PANTOPRAZOLE SODIUM SESQUIHYDRATE]; HYDROXYZINE; FLOMAX [TAMSULOSIN HYDROCHLORIDE]; FERROUS SULFATE; TYLENOL; CARAFATE
Current Illness:
Preexisting Conditions: Comments: No medical history information were reported.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: received too soon the 2nd dose by mistake/Second dose administered at <21 days after the first dose; This spontaneous case was reported by a nurse and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received too soon the 2nd dose by mistake/Second dose administered at <21 days after the first dose) in a 90-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039d21a and 039d21a) for COVID-19 vaccination. No medical history information were reported. Concomitant products included PANTOPRAZOLE SODIUM SESQUIHYDRATE (PROTONIX [PANTOPRAZOLE SODIUM SESQUIHYDRATE]), HYDROXYZINE, TAMSULOSIN HYDROCHLORIDE (FLOMAX [TAMSULOSIN HYDROCHLORIDE]), FERROUS SULFATE, PARACETAMOL (TYLENOL) and SUCRALFATE (CARAFATE) for an unknown indication. On 24-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 INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received too soon the 2nd dose by mistake/Second dose administered at <21 days after the first dose). On 01-Oct-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received too soon the 2nd dose by mistake/Second dose administered at <21 days after the first dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No treatment medication use was reported.


VAERS ID: 1774962 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-01
Onset:2021-10-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Memory impairment, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Questran Premarin
Current Illness:
Preexisting Conditions: Malabsorption bile salts due small bowel resection after reversal of ileostomy
Allergies: Ampicillin none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm next day with redness. About 5 days later memory problems. Can''t find things I just had in my hand or forgot where I put it. Go to get something and totally forget what I was looking for. Being asked to do something. Then being asked if I had done it. And can''t remember that I was even asked. Left one item in food cart after shopping. Continue to have small episodes of forgetfulness . But have not seen doctor yet.


VAERS ID: 1774965 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-01
Onset:2021-10-01
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral venous thrombosis, Computerised tomogram head, Headache, Magnetic resonance imaging head, Venogram, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: CT BRAIN, MRI BRAIN, CT VENOGRAM BRAIN
CDC Split Type:

Write-up: PATIENT WAS ADMITTED TO HOSPITAL WITH HEADACHE AND VISUAL IMPAIRMENT, ULTIMATELY DIAGNOSED WITH CEREBRAL VENOUS THROMBOSIS


VAERS ID: 1775005 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA165969 / 1 - / -

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

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

Write-up: This gentleman did not disclose that he had a prior dose of Pfizer, and in fact denied that he had any previous doses


VAERS ID: 1775010 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Lip swelling, Muscle spasms, Nasal congestion, Swelling face, Ultrasound Doppler normal
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dystonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ? acetaminophen (AKA TYLENOL EXTRA STRENGTH) 500 MG tablet Take 1,000 mg by mouth every 6 hours as needed for Pain. Maximum 4000mg per 24 hours ? Ascorbic Acid (VITAMIN C OR) 1,000 mg daily. 1 tablet daily. ? atorvastatin (LIPITOR) 10 M
Current Illness: No preceding illness
Preexisting Conditions: Diagnosis Vitamin D deficiency Secondary hyperparathyroidism ANA positive Hypercalciuria Chronic hepatitis C without hepatic coma Numbness and tingling of right face Vitamin B 12 deficiency Cerebrovascular disease History of whiplash injury to neck Cervical spondylosis without myelopathy Hip impingement syndrome, left hysterectomy Iron deficiency anemia Overweight (BMI 25.0-29.9) Osteoporosis Patella, chondromalacia Neck pain GERD (gastroesophageal reflux disease) S/P gastric bypas Migraine
Allergies: Albuterol Respiratory Distress High Allergy 8/10/2010 hyperventilation Amoxicillin Hives, Other, see comments High Allergy 1/18/2007 yeast infection Other Cough, Respiratory Distress High Allergy 12/19/2011 Bleach cleaning supplies=cough & RT distress, , Cat Gut Suture= Do NOT dissolve in pt per pt statement Adhesive Rash Not Specified 6/10/2015 Doxycycline Rash Not Specified Allergy 11/6/2002 Ibuprofen Gastrointestinal Not Specified Allergy 10/15/2008 Can''t take due to gastric bypass Metronidazole Not Specified 9/28/2012 aching Nitrofurantoin Other, see comments Not Specified Allergy 9/28/2009 UTI, yeast infection Wound Dressing Adhesive Rash Not Specified Allergy 12/19/2011 Paper tape=Localized rash to application site Drug Intolerances Dicyclomine Dizziness Medium Intolerance 2/14/2012 dizzy, mental status changes Pantoprazole Gastrointestinal Not Specified Intolerance 3/17/2015 Ciprofloxacin Confusion Low Intolerance 2/4/2014 Berries Facial swelling 2019 Energy Drink Facial swelling, cyanosis 2019
Diagnostic Lab Data: US doppler to rule out DVT of bilateral lower extremities was negative. No further testing done at this time Allergy/Immunology referral is pending
CDC Split Type:

Write-up: Received Pfizer COVID 19 vaccine booster on 9/30/2021 at 11:50. 2 hours later, she noticed a HA. She took Tylenol with partial relief and was able to work the rest of the day. When she woke up the next day at 6:20 AM, she noticed swelling on both sides of her face in the maxillary area with the right side being more swollen than the left. She also noticed swelling in her lips and her nose feeling congested. Denies any throat tightness, dysphagia, SOB or wheezing. No lightheadedness or dizziness. The facial/lip swelling and nasal congestion gradually resolved over the following 1-2 days. 4 days later (10/5/2021) she woke up with an intense cramp in her left calf. The following day, she noticed a cramp in her right calf. The cramping has continued and is worse on the left side. She has also noted some mild swelling in both calves, left $g$g right. She denies any redness in her legs or pallor in her feet. Reports prior h/o cramps in her feet that were much milder but no prior leg cramps. US doppler to rule out DVT of bilateral lower extremities was negative.


VAERS ID: 1775024 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 2 - / IM

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

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

Write-up: This patient had the series of Moderna. He did not inform that he had a previous dose of Janssen on 3/12/21 at another facility.


VAERS ID: 1775172 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sinus infection
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intermittent chest pain beginning 10/1 and continues to present


VAERS ID: 1775221 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Conjunctival haemorrhage, Fatigue, Influenza like illness, Panic attack
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Conjunctival disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: Penecillian
Diagnostic Lab Data: Eye visit and medical doctor visit on Saturday 10/02/2021 and again 10/04/2021
CDC Split Type:

Write-up: I got the normal flu like symptoms became very fatigue and woke up to a conjunctival hemorrhage in my right eye . Eye showing signs of a stroke . Blood pressure has since been elevated since the vaccine was given . Suffer from panic attacks .


VAERS ID: 1775289 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fear of injection, Feeling hot, Muscle rigidity, Nervousness, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Husband stated she usually faints when she gets vaccinations. The rigidity and seizing, he stated was not normal.
Other Medications: Unknown.
Current Illness: No other illnesses disclosed at time of vaccination
Preexisting Conditions: No disclosed at time of vaccination.
Allergies: None disclosed by patient.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was nervous about getting this vaccination specifically and additionally did not like needles. Husband reported that it was normal for patient to faint with vaccinations. Vaccine was administered and patient remained sitting in chair with husband and myself by her side. She stated that she was getting very warm so I provided her with some air (by opening door). Patiently fainted momentarily in chair and then recovered quickly. This happened twice with approximately 1-2 minutes in between fainting episodes. Patient was alert upon recovery. Patient fainted a third time (approximately 1-3 minutes after episode 2) however when she fainted a third time, the patient went rigid in the chair and seemed to seize a few times. Emergency services were contacted and arrived on scene. Patient was alert and had recovered. Patient did not remember the events that had occurred other than the fact that she told her husband and I that she was getting very warm. Patient was taken via ambulance to ensure stable status.


VAERS ID: 1775312 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-06
Onset:2021-10-01
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6023 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aldactone,lasix,synthroid, aciphex Ursodiol, celexa
Current Illness: Chirrhosis, T cell lymphoma, depression, poly cystic kidney
Preexisting Conditions: see above
Allergies: asa, PCN
Diagnostic Lab Data: +covid
CDC Split Type:

Write-up: none


VAERS ID: 1775380 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Cardiac pacemaker insertion, Dialysis, Dizziness, Feeling abnormal, Hypopnoea, Mechanical ventilation, Nausea, Septic shock, Somnolence
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Toxic-septic shock conditions (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Chronic kidney disease (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations: Pfizer
Other Medications: Tylenol Amlodipine Pantoprazole Advair
Current Illness: None
Preexisting Conditions: Mild MVP Mild COPD
Allergies: None
Diagnostic Lab Data: Cardiac Arrest Ventilator Transducer Pacemaker Septic Shock Dialysis
CDC Split Type:

Write-up: Dizziness, Nauseous, Unstable, Sleepy within 4 hours of shot. Symptoms persisted through the night. Respiratory and breathing diminished Resulted in Cardiac Arrest


VAERS ID: 1775495 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Balance disorder, Chest pain, Cough, Decreased appetite, Dyspnoea, Migraine, Nausea, Pain, Pruritus, Pyrexia, Swelling, Upper-airway cough syndrome, Visual impairment
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nausea medication, antihistamine, anti anxiety.
Current Illness: Chronic sinus infection, migraines.
Preexisting Conditions: Lupus, asthma.
Allergies: Shellfish supposedly.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain, swelling, itchiness, fever, migraine, dots in vision, lack of appetite, nausea, lost in balance, chest pain, cough, difficulty breathing at times, lots of mucus and post nasal drip.


VAERS ID: 1775509 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Chills, Disturbance in attention, Dizziness, Echocardiogram, Electrocardiogram, Electrocardiogram ambulatory, Fatigue, Full blood count, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prazosin,effexor
Current Illness: denies
Preexisting Conditions: ptsd
Allergies: nkda
Diagnostic Lab Data: -EKG -CBC -TSH -holter -TTE -CARDS consult
CDC Split Type:

Write-up: 42-year-old patient presented on 10/8/21 for follow-up first coronavirus vaccine complaints. Most symptoms were resolved within 3 days of getting the vaccine last Thursday include fatigue upstairs, chills, headache, dizziness, decreased concentration. one that hasn''t resolved as of his shot 8 days ago are 30 seconds to 1 minute nightly palpitations spontaneously resolve when lying in bed. Denies muscle pain, sore throat, new rash cough vision problems chest pain shortness of breath GI symptoms or loss of taste or smell.


VAERS ID: 1775601 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-23
Onset:2021-10-01
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076D21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Lip blister, Oral herpes
SMQs:, Oropharyngeal infections (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:
Other Medications: Abreva and peroxide
Current Illness:
Preexisting Conditions:
Allergies: Sulfa antibiotic
Diagnostic Lab Data: Feeling of being very tired and Visuals of blisters on my lips
CDC Split Type:

Write-up: I''m still verrrrrry tired all the time and have reoccurring cold sores on lips.


VAERS ID: 1775640 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-26
Onset:2021-10-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Feeling abnormal, Headache
SMQs:, Taste and smell disorders (narrow), Dementia (broad), Immune-mediated/autoimmune 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: Birth Control
Current Illness: None
Preexisting Conditions: PCOS
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loss of taste and smell for two weeks, "brain fog", persistent headache


VAERS ID: 1775647 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-18
Onset:2021-10-01
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Nausea, Rash, Respiratory tract oedema, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 0100 (am): nausea, vomiting 0200: hives, body rash Within hours, hives had completely engulfed my body, to include perineal areas and chest. 0500-0600: Airway swelling, hives on neck. Required shot to decrease airway swelling.


VAERS ID: 1775648 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Decreased appetite, Dizziness, Feeling abnormal, Headache, Insomnia, Limb discomfort, Nausea, Pain, Pain in extremity, Pollakiuria, Urinary incontinence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer #1 02/26/2021 and Pfizer #2 03/19/2021
Other Medications: Levoxyl, Cytomel.
Current Illness:
Preexisting Conditions: Fibromyalgia, arthritis, migraines, post-surgical hypothyroidism, depression.
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: nausea, dizziness, felt like an explosion in my arm, achy, teeth chattering and severe shivering, chills, in too much pain from aches to sleep, feel like I got hit by a truck, brain fog, headache, urinary incontinence, peeing after not drinking, lack of appetite, sore arm.


VAERS ID: 1775672 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-10
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 RA / SYR

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

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

Write-up: No reaction. Patient was observed for approximately 15 minutes.


VAERS ID: 1775740 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185H / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Dehydration, Dyslipidaemia, Headache, Hyperglycaemia, Hyponatraemia, Hypovolaemia, Influenza like illness, Liver function test increased, Nausea, Pain, Renal failure, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Lipodystrophy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingles
Other Medications: Carvedilol Vitamin D-3 CoQ-10 Colesevelam Ezetimibe Levothyroxine Rosuvastatin Triamterene-hydrochlorothiazide
Current Illness:
Preexisting Conditions: Very healthy. Hypertension and high cholesterol under control for years.
Allergies: Codeine Meloxicam Nitrofurantoin Oxycodone Secobarbital
Diagnostic Lab Data: Diagnosis included ?volume depletion, elevated Lfts, HyponatRemix, dyslipidemia and hyperglycemia.?
CDC Split Type:

Write-up: By 7:00 the night of injection ( 10/1)I had lost my appetite. By 10:00 PM I started getting the chills. Chills off and on throughout the night. The next morning (10/02)I had flu-like symptoms??.achy body, bad headache, chills, no appetite and nausea. Started vomiting. couldn?t even keep water down. All symptoms continued the next day ( 10/03). Knew I was dehydrated so husband took me to the ER. At ER I was diagnosed with extreme dehydration and renal failure. Admitted to the hospital 10/03. In hospital until late 10/05 when discharged.


VAERS ID: 1775789 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 127421168 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (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: Prostate Cancer 10 months since having prostate removed
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore shoulder


VAERS ID: 1775872 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-13
Onset:2021-10-01
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Blood magnesium, Chest X-ray, Echocardiogram, Electrocardiogram, Full blood count, Heart rate increased, Heart rate irregular, Laboratory test, Metabolic function test, Troponin
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fosamax
Current Illness: None
Preexisting Conditions: Lymphedema
Allergies: None
Diagnostic Lab Data: EKG, lab draw (CBC, CMP, MAGNESIUM, TROPONIN), chest x-ray. All done on 10/3/21 Echocardiogram done on 10/5/21. Follow up with PCP on 10/7/21. Still waiting to see a cardiologist
CDC Split Type:

Write-up: Rapid, irregular heart rate, diagnosed as atrial fibrillation. Unresolved.


VAERS ID: 1775877 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Diarrhoea, Diarrhoea haemorrhagic, Faeces discoloured, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Diarrhea progressing to Black and bloody diarrhea starting within 6h post injection and resolving 48h-72h later. Additionally fevers, chills and body aches were present 12h post injection and lasted for ~24h duration.


VAERS ID: 1775935 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: South Dakota  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211016220

Write-up: NOSE BLEEDS; NORMAL BODY ACHING; This spontaneous report received from a patient via a company representative concerned an adult male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 30-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On OCT-2021, the patient experienced nose bleeds. On OCT-2021, the patient experienced normal body aching. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the nose bleeds and normal body aching was not reported. This report was non-serious.


VAERS ID: 1775970 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Lymphadenopathy, Pyrexia, Vaccination site erythema
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: Test Date: 20211001; Test Name: Body temperature; Result Unstructured Data: 100.5-100.7 Deg. F
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Fever of 100.5-100.7 Deg. F; Swollen axillary adenopathy that is 5cm; Redness of injection site of 4cm.; This spontaneous case was reported by an other health care professional and describes the occurrence of PYREXIA (Fever of 100.5-100.7 Deg. F), LYMPHADENOPATHY (Swollen axillary adenopathy that is 5cm) and VACCINATION SITE ERYTHEMA (Redness of injection site of 4cm.) in a 56-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 third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Oct-2021, the patient experienced PYREXIA (Fever of 100.5-100.7 Deg. F), LYMPHADENOPATHY (Swollen axillary adenopathy that is 5cm) and VACCINATION SITE ERYTHEMA (Redness of injection site of 4cm.). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. On 03-Oct-2021, PYREXIA (Fever of 100.5-100.7 Deg. F) had resolved. At the time of the report, LYMPHADENOPATHY (Swollen axillary adenopathy that is 5cm) and VACCINATION SITE ERYTHEMA (Redness of injection site of 4cm.) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 01-Oct-2021, Body temperature: 100.5-100.7 (High) 100.5-100.7 Deg. F. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was provided.


VAERS ID: 1775971 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Feeding disorder, Feeling abnormal, Feeling of body temperature change, Mobility decreased, Nausea, Pain in extremity, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: a little clammy; I slept all day probably for about 18 hours; l was hot and cold; I couldn''t eat; couldn''t get up; felt like I am going to fall down; A little nauseated; pain in my arm; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (pain in my arm), COLD SWEAT (a little clammy), SOMNOLENCE (I slept all day probably for about 18 hours), FEELING OF BODY TEMPERATURE CHANGE (l was hot and cold) and FEEDING DISORDER (I couldn''t eat) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 088D21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 01-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 01-Oct-2021, the patient experienced PAIN IN EXTREMITY (pain in my arm). On 02-Oct-2021, the patient experienced SOMNOLENCE (I slept all day probably for about 18 hours), FEELING OF BODY TEMPERATURE CHANGE (l was hot and cold), FEEDING DISORDER (I couldn''t eat), MOBILITY DECREASED (couldn''t get up ), FEELING ABNORMAL (felt like I am going to fall down) and NAUSEA (A little nauseated). On 03-Oct-2021, the patient experienced COLD SWEAT (a little clammy). The patient was treated with IBUPROFEN for Adverse event, at a dose of 2 Tab every six hours. At the time of the report, PAIN IN EXTREMITY (pain in my arm) and COLD SWEAT (a little clammy) had not resolved and SOMNOLENCE (I slept all day probably for about 18 hours), FEELING OF BODY TEMPERATURE CHANGE (l was hot and cold), FEEDING DISORDER (I couldn''t eat), MOBILITY DECREASED (couldn''t get up ), FEELING ABNORMAL (felt like I am going to fall down) and NAUSEA (A little nauseated) was resolving. Concomitant medication information was not provided by the reporter.


VAERS ID: 1776006 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Decreased appetite, Diarrhoea, Fatigue, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (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: Progesterone Vitamin c, d3, b complex, glutamine, l-theanine, fish oil, magnesium citrate, 5htp
Current Illness: Diarrhea
Preexisting Conditions: Unresolved megaloblastic anemia
Allergies: Amoxicillin, sulfa drugs, almonds
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, muscle aches, chills, diarrhea, nausea, loss of appetite, fatigue lasting for over 10 days and continuing. Treated with Tylenol, ibuprofen and rest.


VAERS ID: 1776027 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 RA / 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: Administration of expired vaccine/vaccine vial that was in the fridge for more than 30 days; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine/vaccine vial that was in the fridge for more than 30 days) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 045C21A) for COVID-19 vaccination. No Medical History information was reported. On 01-Oct-2021 at 2:30 PM, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine/vaccine vial that was in the fridge for more than 30 days). On 01-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine/vaccine vial that was in the fridge for more than 30 days) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication were reported. No treatment information was provided by the reporter. The patient was monitored after Moderna COVID vaccine was administered for 15 min. Pt was ok and left home after 15 min observation. Most recent FOLLOW-UP information incorporated above includes: On 07-Oct-2021: Non- Significant Follow-up received on 07-OCT-2021 contains patient condition (patient was monitored after Moderna Covid vaccine was administered for 15 min. Pt was ok and left home after 15 min observation).


VAERS ID: 1776351 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-25
Onset:2021-10-01
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Diarrhoea, Fatigue, SARS-CoV-2 test positive
SMQs:, Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: History of Present Illness Patient is a 64-year-old male tested positive for COVID-19. He came into the ER with diarrhea for 3 days. He has 2 roommates who are also sick. 1 is vaccinated 1 is not. The patient is fully vaccinated. Denies any chest pain or shortness of breath. Denies any nausea vomiting. Denies any fevers or chills. Denies any dizziness lightheadedness. He is a nonsmoker. He is complaining of weakness, tiredness, and fatigue. No other active complaints at this time.


VAERS ID: 1776385 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-27
Onset:2021-10-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Blood test, Computerised tomogram
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis 5mg bid, Lisinopril 10mg qpm, Allopurinol 300mg qpm, Rosuvastatin Calcium 10mg qam, Testosterone 40mg qw, vitamin D3 2000IU qd, multivitamin/multimineral qd.
Current Illness: None
Preexisting Conditions: History of DVT, History of pulmonary embolism, Dyslipidemia, Essential hypertension, Chronic idiopathic gout of multiple sites, Severe obesity (BMI 35.0-39.9) with comorbidity (HCC), Prediabetes, Thrombophilia (HCC), Stage 3a chronic kidney disease.
Allergies: None
Diagnostic Lab Data: Blood tests and CT. No cause of abdominal pain determined.
CDC Split Type:

Write-up: Abdominal pain, centered and slightly left side. Intermittent beginning afternoon of 10/1/21. Continuous and increasing afternoon of 10/2/21 and severe from 11pm 10/2/21 though time of visit to ER on 10/3/2021. Treated with Dilaudid for pain. Given prescription for Ondansetron, 4mg tid. Symptoms did not reoccur after discharge.


VAERS ID: 1776405 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-24
Onset:2021-10-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Electromyogram, Fatigue, Hypoaesthesia, Hypoaesthesia eye, Hypoaesthesia oral, Magnetic resonance imaging, Muscle twitching, Myalgia, Pain in extremity, Paraesthesia, Paraesthesia oral, Pyrexia, Sensory disturbance
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness: No
Preexisting Conditions: Fibromyalgia
Allergies: Sudo
Diagnostic Lab Data: Blood work EMG -nerve test MRI
CDC Split Type: vsafe

Write-up: I had a very low grade fever, muscle aches, fatigue, sore arm. About a week later I experienced a small fiber nerve tapping. Numbness and tingling and twitching around my eyes, nose, mouth and forehead. Also, have tingling in feet, legs, arms and hands. He prescribed Gabapentin for the nerve tapping. Still under doctors care.


VAERS ID: 1776430 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

Administered by: Work       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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient has not presented an adverse reaction patient had vaccine Moderna and was administered third dose pfizer by mistake patient did not bring in vaccination card at the moment and refers she had pfizer.


VAERS ID: 1776475 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-17
Onset:2021-10-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Mass, Pain
SMQs:

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

Write-up: Patient experienced chills, body aches, and headache for the first 48 hours after vaccination. Lump developed over left clavicle and plans to see provider for evaluation.


VAERS ID: 1776480 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 LA / IM

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

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

Write-up: Received moderna dose after getting Johnson/Johnson in March


VAERS ID: 1776538 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (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: Sharp back pain while sitting, BP 106/84 (according to patient this is baseline for her BP) Patient complaints of sharp back pain while sitting in observation area. Advised patient to lay down but she refused and said that she is more comfortable standing and walking. Patient stated she has epidural in back 7months ago during delivery. Advised her to take pain medicine OTC Patient stayed 30 minutes in observation area. Patient had jaw pain with 1st dose of covid pfizer vaccine. Advised to talk to PCP in case pain stays longer. Patient states she felt better and left for home .


VAERS ID: 1776541 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. - / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Maternal exposure during breast feeding, Suppressed lactation
SMQs:, Functional lactation disorders (narrow), Neonatal exposures via breast milk (narrow)

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

Write-up: Decreased milk supply in lactating mother


VAERS ID: 1776646 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide Acebutolol Paroxetine
Current Illness: none
Preexisting Conditions: diverticulitis hypertension
Allergies: penicillin sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Swollen lymph nodes arm pit, clavicle and neck. Have been icing/heat and alternating with acetaminophen and ibuprofen.


VAERS ID: 1776764 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: "she has had allergic reactions with shots before " follows with an allergist losartan PPIs
Diagnostic Lab Data:
CDC Split Type:

Write-up: "I received the first Pfizer dose of the COVID-19 Vaccine today and developed hives on my lower legs" Called in the report approx 1 hour after shot. PCP Rx''d Benadryl, stroids, and EPIPEN (if needed). Patient took Bendryl with plans to follow-up with allergist. She declined need for ER.


VAERS ID: 1776766 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-17
Onset:2021-10-01
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No physical reaction. Patient was given a dose of Moderna after having received Janssen previously. Patient had stated they needed their second dose of Moderna but forgot their card. A look up in state database showed no first dose given so Moderna was given to patient. In October, patient presented vaccine card which showed Janssen as first dose.


VAERS ID: 1776799 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30148A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, Pain, Wrong product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown, none on pharmacy record.
Current Illness: None at time of vaccination
Preexisting Conditions: Atopic Dermatitis, according to patient profile on record.
Allergies: None on file
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Came in for a routine flu vaccine, was inadvertently given the Pfizer COVID-19 vaccine instead. Patient had already received two doses of the Moderna vaccine in the past, however this dose *was* roughly six months after her second Moderna dose. Patient did not exhibit any unusual adverse effects for the shot (reported soreness), but we are reporting in an abundance of caution.


VAERS ID: 1776829 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-10-01
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Fatigue, Nasal congestion, Pyrexia
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), Immune-mediated/autoimmune disorders (broad)

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

Write-up: fever, loss of taste and smell; fatigue, cough and nasal congestion


VAERS ID: 1776835 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event, Wrong product administered
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: None on record at pharmacy.
Current Illness: None at time of vaccination.
Preexisting Conditions: None according to profile.
Allergies: None according to patient profile.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient came in to get a routine flu shot, and was instead given a third dose of Pfizer''s COVID-19 vaccine. Patient did not have any adverse reaction, however we''re filling this form out in an abundance of caution.


VAERS ID: 1776845 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age, Wrong product administered
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: None on record
Current Illness: None at time of vaccination
Preexisting Conditions: None on record.
Allergies: None on record
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient came in for a routine flu shot, and was inadvertently given the Pfizer COVID-19 vaccine. Patient is not old enough under current authorizations to receive this vaccine, but patient reported absolutely no adverse reactions. We are filling this form out in an abundance of caution and guidance from our superiors.


VAERS ID: 1776852 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-10-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18089980 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Headache, Pyrexia
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), Immune-mediated/autoimmune disorders (broad)

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

Write-up: fever, loss of taste and smell, headache, cough


VAERS ID: 1776912 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-23
Onset:2021-10-01
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bacterial infection, COVID-19, COVID-19 pneumonia, Productive cough, SARS-CoV-2 test positive, Sepsis
SMQs:, 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 had an incidental finding of COVID positivity on 10/1 prior to a procedure on 10/8. He came to the hospital on 10/7 with cough and mild sputum production, but developed sepsis secondary to COVID pneumonia with superimposed bacterial infection.


VAERS ID: 1776914 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-24
Onset:2021-10-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30125BA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine 20 mg
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None needed
CDC Split Type:

Write-up: Second vaccine inadvertently administered too early. Was given one week apart instead of 3 weeks, no adverse reactions noted.


VAERS ID: 1776926 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-24
Onset:2021-10-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine 150 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Second vaccine inadvertently administered too early. Was given one week apart instead of 4 weeks, no adverse reactions noted.


VAERS ID: 1776993 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
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: N/A
CDC Split Type:

Write-up: Chest tightness and pain


VAERS ID: 1777037 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-10-01
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, Muscular weakness, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN,
Allergies: Hydrocodone
Diagnostic Lab Data: Positive COVID test on admission, asymptomatic.
CDC Split Type:

Write-up: Hospitalized for 6 days with generalized bilateral extremity weakness. Asymptomatic for COVID


VAERS ID: 1777132 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-10-01
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Muscle spasms, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Dystonia (broad), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion - Generic for Wellbutrin XL 300 mg; Spironolactone - 100 mg; Adderall XR - 15 mg ER and booster of 7.5 mg regular release; Multivitamin; fish oil
Current Illness: no
Preexisting Conditions: ADHD - take medication for it
Allergies: no
Diagnostic Lab Data: 4th - Ultrasound (Radiological Associates) - Diagnosis: Acute Deep Vein thrombosis of lower left extremity and the clot was at popliteal and gastrocnemius vein
CDC Split Type: vsafe

Write-up: Note: lot number could also be 087B21A - difficult to read it. On the 1st of October, I noticed a weird feeling in my left calf. It felt Like I was going to get a cramp. It felt like a little stitch or pull. I wasn''t dehydrated. It didn''t seem like I had hurt it. It stayed that way over the weekend. I made a doctor''s appt 09:45 Monday, Urgent Care visit - Clinic - the 4th, they sent me for an ultrasound. It was a clot in my left calf. They prescribed Xarelto blood thinner - 15 mg twice a day for 21 days and then need to switch to 20 mg for 72 days after that. That stitch in my calf cleared after about four days on the blood thinner. I met with my doctor on the 6th.


VAERS ID: 1777144 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Headache, Injection site erythema, Injection site pain, Injection site swelling, Pyrexia, SARS-CoV-2 test negative, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2012-flu shot at work, I had the same reaction as my 3rd Dose of Pfizer. They suggested having flu shots 1/2 dose, 2 weeks apar
Other Medications: 1 Benadryl at the time of the vaccine singulair 10 mg od zyrtec 10 mg od Q-VAR 80 mcg on puff od
Current Illness: no
Preexisting Conditions: allergy asthma allergies obese lymphedema iron deficiency but not iron deficiency anemic
Allergies: latex penicillin sulfa quinolones amino glycosides lincosamides cephalosporins shell fish
Diagnostic Lab Data: PCR test- negative rapid test- negative
CDC Split Type: vsafe

Write-up: 10/01/2021 @ 03:00 AM, I woke up with a throbbing headache. I had the headache till 01:00 PM. On 10/01/2021, at night, I started with redness in my left arm in the injection site. It started the size of a nickel and started getting bigger. On 10/02/2021-I ran a fever of 99. I run a low body temp. I had a little bit of a flush face with it . Took Tylenol within 2 hours I had a normal body temperature. On 10/03/ 2021 -the injection site arm was getting bigger. It looked like a goose egg size where the injection went in along with the redness, and sore to the touch. I went to work on 10/04/2021- I work in healthcare and they looked at it and suggested I see my doctor. I went to my doctor at 2:30 pm that day , he thought it was a normal reaction, but because it was pretty red, and swollen , he gave me a prescription. I ran a fever that evening on 10/04/2021- 99.1, took Tylenol again, within 2 hours it came down. On 10/05/2021 I had marked it to make sure it wasn''t going outside the line. It was going a little outside the line by lunchtime. I went ahead and filled the prescription Tuesday night, 10/05/2021. Clarithromycin 500 mg 1 tablet bd. for 10 days. I took the 1st dose on 10/05/2021, I did 6 doses. I only took it for 3 days. I took the last dose on 10/08/2021. It started to resolve on 10/06/2021, whether the antibiotic helped it or not, I am not sure.


VAERS ID: 1777585 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312838 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose 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:

Write-up: THE PATIENT RECEIVED THE FLU VACCINE (FLUAD) TWICE. THE FIRST TIME ON 9/16/21 AND SECOND TIME 10/01/2021. PATIENT DID NOT REPORT ANY ADVERSE EVENTS AFTER THE SECOND VACCINE


VAERS ID: 1777958 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Gallbladder disorder
SMQs:, Acute pancreatitis (broad), Gallbladder related disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: RUQ abdominal pain, sharp stabbing consistent with gallbladder attack.


VAERS ID: 1778519 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1778570 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1778759 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: Tinnitus- still an issue.


VAERS ID: 1778785 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Headache, Injection site pain, Lymphadenopathy, Oedema peripheral, Pain, Sleep disorder
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: received my flu shot on Tuesday 10/5 at the POD. Received my 3rd Covid booster on 10/8 @11:30. Typical arm pain at injection site (received both vaccines in the right arm). Headache on Saturday and Sunday. Sunday morning woke up (actually so painful it woke me up) with underarm pain and a lot of swelling. Swelling can fit into the palm of my hand (baseball sized). Very sore today (under arm) when moving my arm. I know that it can swell but didn?t have this before and never had Lymph swelling under my arm from a vaccine. Headache now gone. No fever or anything. I am sure this will go away with time. Just wasn?t sure if I needed to report it or not. Haven?t had it before.


VAERS ID: 1778847 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA WILL UPDATE / 1 - / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7336KA / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Depressed level of consciousness, Hyperhidrosis, Hypotension, Hypotonia, Pallor, Slow response to stimuli
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: Unknown dates - Pt reported previous reaction in past
Other Medications: Currently, unable to access
Current Illness: none known
Preexisting Conditions: Currently, unable to access
Allergies: Currently, unable to access
Diagnostic Lab Data: BP was checked at the time of the incident 1st reading 78/58, 2nd 104/68, 3rd 148/78 (which per patient representative was normal).
CDC Split Type:

Write-up: Patient received 2 vaccines. She received flu shot and first COVID-19 vaccine. She had mentioned that she had a history of fainting with previous vaccines but patient said it had been awhile. Patient was also claustrophobic, but did not mention that prior to getting her vaccine. After the vaccinations (both), she was fine and talking, she jumped up to get out of the immunizing room, she made it to the outer seating and then slumped down in the seat. She did not appear to lose complete consciousness but was not completely alert either. She was not responding well but eyes were open. Pt turned pale and had a brief bluish tint to lips. We could not safely move patient to the floor. Patient was sweating . BP was checked and found to be low and was checked again about 5 minutes later given patient was talking again. Color returned to her cheeks and we continued to monitor.


VAERS ID: 1778849 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-23
Onset:2021-10-01
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Xeralto
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: I developed multiple blood clots in both lungs. Five in total. DVT was ruled out and there are is no other explanation. No travel, recent surgery, or family history.


VAERS ID: 1778856 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram, Headache, Heart rate increased, Laboratory test, Malaise, Pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant 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 (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No acute illness
Preexisting Conditions: no chronic illness
Allergies:
Diagnostic Lab Data: Lab tests, EKG, and ECHO Oct 4th, 2021
CDC Split Type:

Write-up: Patient received the Pfizer booster vaccine at our facility on Thursday 9/30/21. On Friday and Saturday the next two days was in bed with body aches, headache, felt " awful" both days. Sunday felt better but was winded and short of breath, had dull chest pain sternal area. Heart rate was 160''s. Heart rate through the day was 130-160''s. Monday, Dr. was seen and labs ordered and EKG and ECHO completed by cardiology Dr. Ordered Motrin for possible myocarditis 3 times a day. Still having 110-130''s heart rate when walking and 90-110 when sitting. Motrin has assisted the chest discomfort. Still awaiting ECHO results.


VAERS ID: 1778893 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

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

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

Write-up: Itching/pain at site of injection that continued for x3 weeks. Was seen by provider 10/2/21 and 10/13/21- no sign of infection. Given Benadryl/Zyrtec and symptom care.


VAERS ID: 1778910 (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: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, 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: Albuterol inhaler; 81 mg ASA; Clonazepam; Hydrocodone; Omeprazole; Ondansetron; Pantoprazole; Quentiapine; Simvastatin; Terbinafine HCL.
Current Illness:
Preexisting Conditions: generalized anxiety disorder
Allergies: Lamotrigine; methocarbamol; paroxetine; phenelzine; phenelzine sulfate; topiramate
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received vaccine at 22 days after dose #2 was administered. No physical adverse effects, denies any s/s post vaccine except fatigue . Patient declined office visit; he wanted to talk to someone about the error and make recommendations for improvement at future vaccine events.


VAERS ID: 1778919 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-01-20
Onset:2021-10-01
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / UNK - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Dyspnoea, Illness, Intensive care, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Admitted on 10/10/2021 to COVID ICU. COVID (+) detected on 10/9/2021
CDC Split Type:

Write-up: Chief Complaint co illness x 5-6 days with shortness of breath and increasing weakness. negative home covid test 3 days ago. arrives tachypneic, in RD, with O2 54% on RA. history per pt son. History of Present Illness Patient is a 74-year-old male presents to the ER complaining of shortness of breath which started 5-6 days ago. He took an in-home COVID test 3 days ago was negative. He tells me had 2 doses of earlier this year and had the pfizer booster 9-30-21. In the ED tested positive for COVID. In triage, patient''s room air O2 sat was 54% on room. He denies any fever chills or any known lung disease. He says he is a nonsmoker takes no medications and has no cough past medical problems that he is awa


VAERS ID: 1778935 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Burning sensation, Diarrhoea, Hot flush, Muscular weakness, Pain in extremity, Peripheral swelling, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Hx of sleep apnea and vitamin D deficiency
Allergies: Avocado food allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day following vaccination I experienced bilateral hand swelling along with drowsiness, hot flashes and diarrhea. Bilateral hand swelling was noted to have started on 10/1 and I am still experiencing it along with pain/weakness in entire right arm and burning sensation in right foot.


VAERS ID: 1778978 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-10-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Feeling abnormal, Impaired work ability, Limb discomfort, Mobility decreased, Pain, Pain in extremity, Scratch, Screaming
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Parkinson-like events (broad), Accidents and injuries (narrow), Hostility/aggression (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: None.
Current Illness: None.
Preexisting Conditions: Asthma.
Allergies: Levaquin, Penicillin, Dilaudid and contrast dye.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, just felt a little bit weirdness in the arm, and felt that she would just give it time. For the week it was completely sore to the point that she could not lift it up. She has never had a reaction to any vaccines. She was told that it was normal and she said OK. Then about 10/1/21, she noticed that all of a sudden she felt like something was being pulled inside her arm, burning sensation as if she was getting a flu shot. She started rubbing her arm and scratched it and was trying to feel to see if there was something, it just always pulls and burns now. She doesn''t know if it''s a cramp but just a burning sensation. She cannot carry her purse on her arm now, and swing her arm back as it triggers the pain to the point that she screams in pain. She took some anti-inflammatories three times (Ibuprofen 800 mg), and this has not relieved her symptoms. If she needs to use the arm she can''t and she works in the hospital and picks up patient''s and it''s affecting her job performance.


VAERS ID: 1778986 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-12
Onset:2021-10-01
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Appendicitis
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: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Appendicitis on 10/01. Was treated with antibiotics.


VAERS ID: 1779068 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (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: Morphine sulfate ER,Famotidine, Verapamil ER, Lamictal XR, Trokendi XR, Levetiracetam ER, Vitamin D, Calcium/vitamin D
Current Illness: None
Preexisting Conditions: Ehlers-danlos syndrome, Sjogren''s syndrome, Hashimoto''s, Chronic pain
Allergies: Keflax, tofranil
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Slight swelling, deep down itching at injection site. Still there on Oct 11


VAERS ID: 1779082 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, Photophobia
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril (blood pressure) 20 mg. Humera pen (psoriasis) Flomax (prostate)
Current Illness: None
Preexisting Conditions: Psoriasis, elevated blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: A few days following the 3rd dose (booster) of the Moderna vaccine, I experienced intense headache, nausea, light sensitivity, and lightheadedness. This lasted for approximately 3 days. I do not get headaches of this sort at any time. Following 3 days, the headache and other symptoms dissipated and have not returned. No other adverse events.


VAERS ID: 1779104 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-28
Onset:2021-10-01
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Cough, Dyspnoea, Endotracheal intubation, Fatigue, Hypoxia, Intensive care, Myalgia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (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: Imdur, lopressor, coumadin, tylenol, duoneb, lipitor, proscar, prinivil, miralax, flomax, multi-vitamin
Current Illness:
Preexisting Conditions: obesity, Rheumatoid arthritis, hypertension, hyperlipidemia, CAD, melanoma,
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received Moderna vaccines on 01/28/2021 and 02/25/2021. Pt presented to the ED on 10/04/2021 after testing positive for COVID-19 outpatient on 10/01/2021. Pt complained of fatigue, weakness, myalgias, cough, congestion, and SOB. He was diagnosed with COVID pneumonia and was started on Remesivir for 5 days. Pt was discharged back to his nursing home on 10/08/21. Pt presented back to the ED on 10/11/2021 with complaints of hypoxia. Pt was admitted to the ICU and was intubated secondary to hypoxia.


VAERS ID: 1779154 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-30
Onset:2021-10-01
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Balance disorder, Blood test, Muscular weakness, Platelet count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Haematopoietic thrombocytopenia (narrow), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: celecoxib/gabapentin/sertraline/metformin/amtriptiline
Current Illness: CIDP
Preexisting Conditions: CIDP
Allergies: codeine
Diagnostic Lab Data: blood test found platelet level critical at 14
CDC Split Type:

Write-up: weakness in legs, balance issues,


VAERS ID: 1779193 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-10-01
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Malaise
SMQs:

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

Write-up: Patient fully vaccinated for COVID presented to ED on day 7 of COVID-related symptoms and was admitted.


VAERS ID: 1779210 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-03-15
Onset:2021-10-01
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: Positive test for covid on 10/1/2021
CDC Split Type:

Write-up: Had covid


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