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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 562 out of 10,317

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VAERS ID: 1888328 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1620 / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Arthralgia, Formication, Insomnia, Neuralgia, Pain
SMQs:, Peripheral neuropathy (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81mg, spironolactone 25mg, atorvastatin 5mg, once daily carvedilol 3mg twice a day
Current Illness:
Preexisting Conditions: obesity, heart disease
Allergies: lisinopril and it''s cousin bpm whose name I forgot almond milk, pistachios
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Next day body pain and joint pain; 3rd day joint pain more localized to my injured knee; but severe; that night insomnia with nerve pain in legs and feeling insect bites over my body (no insects)


VAERS ID: 1888451 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-15
Onset:2021-11-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

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

Write-up: Very swollen and sore lymph node in left underarm; started two days after injection and had continued for three days (so far). Also experienced fatigue and headache the day after the injection, lasting one day.


VAERS ID: 1888491 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bradycardia, Dyspnoea, Extrasystoles, Tachycardia, Tremor, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Tachyarrhythmia terms, nonspecific (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:
Other Medications: None before time of vaccination
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None performed
CDC Split Type:

Write-up: Heart became tachycardic ( 140 - 160 beats/min) then It would become bradycardic (50 beats/min) and sometimes skip a beat. During this time, I was short of breath and had blurry vision. I also experienced tremors of both hands. This lasted approximately 15 minutes before bedtime at 10:30pm the SAME day I received the shot. Heart rate and SpO2 was measured by pulse oximetry and palpitating pulses. SpO2 would go from about 85% to 100% on room air.


VAERS ID: 1888600 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8029 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cellulitis, Computerised tomogram, Injection site induration, Injection site swelling, Lymphadenopathy
SMQs:, 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: tetanus many years ago, left arm swelled from injection site to the wrist
Other Medications: levothyroxin, famotidine, Preservision AREDS2, krill fish oil, losarton, zenpep, aspirin, multi-vitamin, vitamin D3, alpha lipoic acid, atorvastatin, albuterol, retaine drops, humalog, tylenol
Current Illness: Type I diabetes mellitus, osteoarthritis, mixed hyperlipidimia, asplenia, asthma, gastro-esophageal reflux disease without esophagitis, chronic pancreatitis, stage 3 kidney disease, fatty liver
Preexisting Conditions: Type I diabetes mellitus, osteoarthritis, mixed hyperlipidimia, asplenia, asthma, gastro-esophageal reflux disease without esophagitis, chronic pancreatitis, stage 3 kidney disease, fatty liver
Allergies: tramadol, naprosyn, tetanus toxoid, erythromycin, sulfamethoxazole, levaquin, vancomycin, minocycline, ultram, promethazine, heparin, codeine, morphine, warfarin, omeprazole, penicillin, nortriptyline, lisinopril
Diagnostic Lab Data: CT Scan blood tests -waiting for results of the lab cultures
CDC Split Type:

Write-up: On Friday, Nov. 19, 2021 I was sent by my ARNP to the medical center. They diagnosed cellulitis, adult lymphadenopathy, due to severe swelling under and to the front of the right arm (and above right breast) and hardness and swelling at the injection site.


VAERS ID: 1888643 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-08
Onset:2021-11-17
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash erythematous, Rash macular
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: red and splotchy rash on feet, hands, stomach, chest appeared 9 days after moderna vaccine


VAERS ID: 1888649 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Swollen lower lip 4 days after booster Began selling soon after waking up. Had also taken a number of medications that morning
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lower lip. Benedril reversed swelling within 2 hours


VAERS ID: 1888659 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-11-15
Onset:2021-11-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3302680 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Injection site rash, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium, Vitamin D, Curcurmin, Cod Liver Oil
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash started at injection site and spread to 4 inches wide. Sore lymph nodes under arm. Sore muscles from hand to armpit.


VAERS ID: 1888686 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Moderate stomach pain over the pancreas and gall bladder region that lasted for 2 days and then reduced to mild level.


VAERS ID: 1888745 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065-F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Condition aggravated, Dizziness, Headache, Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Moderna dose (also reported in VAERS) - dizziness, light-headed, nausea, fatigue
Other Medications: Flonase Zyrtec Imipramine Iron
Current Illness: Tinnitus
Preexisting Conditions: Sarcoidosis Reflux
Allergies: Allegra
Diagnostic Lab Data:
CDC Split Type:

Write-up: 17th - dizzy, joints ached, headache, nausea 18th - headache; burning/tingling sensation in back of head, neck, top of ears (not bottoms), and sides of face 19th - light prickly sensation in arm, face, very temporary and sporadic (for instance, one minute my arm, next minute my cheek) 20th - everything else gone, just a little fatigued


VAERS ID: 1888816 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site bruising, Pain in extremity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Restasis, folic acid, norvasc, leucovorin, febuxostat, methotrexate, gabapentin, atorvastatin, prednisone, aspirin
Current Illness:
Preexisting Conditions: Arthritis, hypertension
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came back to pharmacy on 11/21/21 and showed a large bruise on the right arm near the site of injection. Bruise looked to be 2 inches tall and 4 inches wide, spanning across the upper right arm. Pt reports feeling a prick during the shot and then having a sore arm and noticing the bruise the night of. Reports some swelling that day. Bruise is still present today and there is a small area of redness that appeared. Reports no pain today. Patient counseled to see doctor if worsening of symptoms or increase in pain.


VAERS ID: 1889046 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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)

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: Swelling and redness in arm.


VAERS ID: 1919941 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 - / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 4L97X / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Not sure
Current Illness:
Preexisting Conditions:
Allergies: NONE Known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated day after vaccines she developed very heavy bleeding vaginally. She had her period 1 week prior. her doctor put her on high dose birth control pills and said if did not work to go to hospital bleeding did eventually stop


VAERS ID: 1889466 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram normal, Echocardiogram normal, Electrocardiogram normal, Gaze palsy, Hyperhidrosis, Scan with contrast normal, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), 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? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cheflex antibiotic Fish oil Cholest off Multivitamin one a day Focus factor
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Ekg Ct Scan with contrast on heart Echo cardio Blood test
CDC Split Type:

Write-up: Recieved vaccine at 4pm At 408 pm Bystanders witnessed while seated in recovery room chair my arms fall to my side, head went back against the wall, eyes rolled back in my head but remained open, they said it looked like I hade a seizure. I was instantly profusely sweating from head to toe and had no real sense of where I was for 5-10 min. I was taken to the ER. And received a full cardiovascular checkup while I was held over night for observation. I was released from the hospital woth a clean bill of health cardiovascular wise with no answers on why I had a seizure at pharmacy. I contacted pharmacy a d they were uncooperative in completing this form or providing anything in writing.


VAERS ID: 1889511 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-05
Onset:2021-11-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Appendicectomy, Appendicitis perforated, Asthma, Condition aggravated, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Gastrointestinal perforation (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), COVID-19 (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dietary Supplements, Esomperazole, Wellbutrin
Current Illness: none
Preexisting Conditions: Mild Asthma
Allergies: Seasonal Allergies
Diagnostic Lab Data: COIVD swab performed on 11/12 and 11/16 - both negative
CDC Split Type:

Write-up: Received 3rd vaccine on 11/5. Mild to moderate asthma attack began on 11/11. Stated 20 mg of prednisone on 11/14. On 11/17, had ruptured appendix requiring emergency surgery.


VAERS ID: 1889537 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-11-17
   Days after vaccination:293
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 000000 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 000000 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2, Nasopharyngitis
SMQs:, COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Glucosamine 500 MG Capsule 1 capsule Orally once a day ?Centrum . Tablet 1 tablet Orally once a day ?Fish Oil 1000 MG Capsule 1 capsule with a meal Orally Once a day ?Aspir-81 81 MG Tablet Delayed Release 1 tablet Orally Once a da
Current Illness: none
Preexisting Conditions: HTN. Hyperlipidemia. Gout. CHF systolic,echo in 3/15 EF 30% and on spironolactone and lisinopril ---showed thrombus in left ventricle and on coumadin . Diverticulosis. DJD. Bronchospasm. Benign prostatic hypertrophy. Shingles. Shots are Pneumovax in 92'', Tetanus in 99'', Flu shot in 03''. Consulting on his case is Dr. Chronic Renal Failure. Epididymitis. 3/06 MI angioplasty 2 stent LAD. Pericarditis. ATN Renal failure. UTI. IDA. Gout. A Fib,his last INR was 6/6/15 . Borderline blood sugar. maintenance ---annual 12/16, no skin moles concern 2016 and goes to derm every 1 year, colonoscopy in 2012 and hemorrhoid, polyp and no more due to age, no need for PSA 12/16. Hearing loss and wears hearing aid. Polst from ----he wants to be full code but no prolongation of life unnecessarily if no good chance of recovery 12/16.
Allergies: Sulfa: pain and swelling; Inderal: Rash; Iodine: Contract Dye; Propofol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received dose #1 and #2 at outside facility, unable to access lot #. Cold symptoms starting on 11/17/21. Exposure to grandson who was COVID positive on 11/15


VAERS ID: 1889691 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysphagia, Dyspnoea, Headache, Muscular weakness, Nausea, Pain in extremity, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever, Hives, Diarrhea, Head/Body Aches, Muscle Weakness
Other Medications: Levothyroxine 75mg
Current Illness: None
Preexisting Conditions: Hashimotos
Allergies: Pork, Biaxin, Chocolate
Diagnostic Lab Data:
CDC Split Type:

Write-up: I broke out into hives within 1.5 hours from my stomach to the top of my head, including bumps on throat and possibly nasal passage because it was difficult to breath normally and swallow. Similar instance after 2nd vaccine but was told it was most likely due to the high temp I reached of 102.9. This time the reaction occurred minutes after I arrived at my home after waiting the suggested time. Aside from this, I have had debilitating soreness and weakness of my extremities, nausea and headaches.


VAERS ID: 1889700 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: fever 104, extreme fatigue


VAERS ID: 1889732 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-11-17
   Days after vaccination:293
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 - / -

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

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

Write-up: Fully vaccinated, COVID breakthrough in an oncology patient. Admit to general medical ward


VAERS ID: 1889795 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-15
Onset:2021-11-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: HTN, DM II, Hypothyroidism, Afib, GERD, systolic murmur, psoriasis.
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Hives, itching throughout the patient''s body


VAERS ID: 1889852 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ataxia, Chills, Thinking abnormal
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)

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

Write-up: Case reports severe rigors, ataxia, normal thought disruption for approximately 48 hours after injection


VAERS ID: 1889900 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain, Muscle spasms, Pain
SMQs:, Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: well-butrin, Adderall, zinc, vit d
Current Illness: na
Preexisting Conditions: na
Allergies: latex
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Extreme tenderness to injection site. Radiating pain down to right hand. Joint pain. Lasting fatigue. Back spasm. Delayed severe headache lasting Saturday and Sunday(4&5 days after shot).


VAERS ID: 1889933 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-25
Onset:2021-11-17
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + 11/17/21
CDC Split Type:

Write-up: Covid breakthrough case


VAERS ID: 1889967 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-28
Onset:2021-11-17
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, Pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Taste disorder, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE, MELOXICAM, LO/OVRAL, EXCITALOPRAM, CYCLOBENZAPRINE
Current Illness: NONE
Preexisting Conditions: HYPOTHYROIDISM, HX GESTATIONAL DIABETES, DEPRESSION, ANXIETY
Allergies: LATEX
Diagnostic Lab Data: 11/17/21: POSITIVE SARS-COV-2 RNA
CDC Split Type:

Write-up: 11/17/21: BODY ACHES, FEVER, NASAL CONGESTION, CHEST CONGESTION, COUGH, CHANGE IN TASTE, RUNNY NOSE, SINUS DRAINAGE


VAERS ID: 1890037 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bronchospasm, Chest discomfort, Electrocardiogram, Pleuritic pain
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE WITHIN A MONTH DID HAVE FLU SHOT ON 10/12/2021
Preexisting Conditions: SEIZURES
Allergies: SHELLFISH
Diagnostic Lab Data: ON 11/17/2021 AT 0440 PM--INMATE WAS SEEN IN MEDICAL, EKG DONE, VITATS TAKEN AND SEEN BY PROVIDER
CDC Split Type:

Write-up: Per provider note of 11/17/2021 at 4:35 PM-- patient had non-cardiac chest discomfort/reproducible chest discomfort for nursing and pleuritic chest pain for the PA--- was given 25 mg of Benadryl and 600 mg of ibuprofen both orally-- vitals are stable RR14-16, cardiovascular regular without ectopy, lungs mildly diminished throughout, clear, no wheezes or rhonchi, abdomen soft, nontender, bowel sounds present times four, extremities unremarkable 1) noncardiac chest discomfort secondary to bronchospasm 2) mild non-cardiac chest discomfort from reproducible chest myalgia 3) mild bilateral pleuritic discomfort all of the above occurred after receiving the Covid booster earlier today-- he denies any shortness of breath or chest tightness currently


VAERS ID: 1890045 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
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: 13 year old patient administered 10 mcg dose of pediatric formulation 5-11 years.


VAERS ID: 1890047 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-08
Onset:2021-11-17
   Days after vaccination:313
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 Case: Patient was fully vaccinated, first dose on 1/8/21 and second dose on 2/4/21. Tested positive for COVID-19 on 11/20/21.


VAERS ID: 1890200 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-22
Onset:2021-11-17
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes simplex test negative, Herpes simplex test positive, Herpes zoster
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamins
Current Illness:
Preexisting Conditions: asthma
Allergies: augmentum, iodine, grass, trees
Diagnostic Lab Data: Herpes Zoster PCR test (positive) & HSV PCR test (negative)
CDC Split Type:

Write-up: I was recently diagnosed with shingles which began on Wednesday November 17th, and I was seen by the OB Triage and dermatology departments on Friday the 19th.


VAERS ID: 1890227 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-07
Onset:2021-11-17
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Please contact primary care provider APRN-CNP for further history.
Current Illness: Please contact primary care provider APRN-CNP for further history.
Preexisting Conditions: Please contact primary care provider APRN-CNP for further history.
Allergies: Please contact primary care provider APRN-CNP for further history.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated against and then tested positive for COVID-19


VAERS ID: 1890324 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: The pediatric dose of Pfizer was given to a 15 year old patient. There are no adverse outcomes


VAERS ID: 1890329 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fall, Feeling abnormal, Laboratory test, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient was "not feeling right" when walking back to chair in waiting room, patient lost consciousness and fell backwards. Patient then was transported by family to the emergency room.


VAERS ID: 1890371 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Cold sweat, Fatigue, Hyperhidrosis, Hyperpyrexia, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Chills; high fever; dripping wet; clammy white skin; nausea; extremely fatigued. Symptoms have improved.


VAERS ID: 1890389 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 033030BD / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Dental paraesthesia, Flushing, Lip oedema, Paraesthesia oral, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: at 9:50, patient reported upper lip edema, tingling to teeth and inside of mouth, tightness of chest, blurred vision, and facial flushing. BP 163-92, P 75, R 22, Pulse Ox 98% on room air, lungs clear, patient anxious. Water and 25mg of po Benadryl administered. No dyspnea noted. 1003 BP 122/78; 1015 patient feeling better, no dyspnea, alert, oriented, stated she lives close and is going to drive straight home. 1102 Called patient at home, she stated she was doing well, her brother is going to sit with her for the afternoon. I advised patient to inform her PCP of today''s reaction, patient voiced understanding.


VAERS ID: 1890402 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Auscultation, Chest X-ray, Cough, Full blood count, Hypophagia, Lethargy, Mechanical ventilation, Oxygen saturation decreased, Productive cough, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Reflux, hearing loss, dementia, parkinsons, mitral valve disorder,
Allergies: NKDA
Diagnostic Lab Data: STAT Chest X-ray on 11/18/21 STAT CBC on 11/18/21
CDC Split Type:

Write-up: Pt received booster vaccine from DPH on 11/16/21. Next day pt is coughing and running a fever of 100. Having episodes of vomiting''. 11/18/21 Lethargic, not eating very productive cough noted /lung clear to auscultations with increased fever of 100.8. Chest x-ray ordered. Evening with decreased 02 sats requiring breathing treatments and 02. Started on Levaquin daily. 11/19/21 Continued issue with fever and coughing requiring O2. Coughing event during mealtime that required non-breather mask and transfer by EMS to outside hospital. Now on ventilator at other Hospital


VAERS ID: 1890423 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Abdominal pain, Headache, Heavy menstrual bleeding, Impaired work ability, Menstrual disorder
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Migraines
Allergies: No
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: The morning of 11/17/2021, the day after vaccine, I had a light headache and abdominal cramping. The cramping kind of progressed. The period started abnormal and throughout the day it became excessively heavy. I had to use multiple sanitary pads through out the day. I do have fibroids, and I read, if you have fibroids the vaccine can make your menstrual heavy. I bled all over my brand new car seats and I had excessive bleeding al over my bed sheet. The puddle was like a 1 foot puddle on my side the following morning. I did not go to work the next day because I was constantly changing. I had a headache for a total of 4 days and I tried to take everything I can before I take Imitrex. I finally had to take Imitrex and slept the following day and my headache was finally gone. Today, 11/22/2021 I finally woke up with no headache. I contacted my clinic and had a telephone conference regarding my symptoms. They told me to stay home because it was a side effect of the vaccine.


VAERS ID: 1890478 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Diarrhoea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Tylenol, ibuprofen, vit d & vit c
Current Illness: None
Preexisting Conditions: None
Allergies: Nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever/chills, abdominal cramping, diarrhea, body aches. Started at 930pm & lasted 2 days


VAERS ID: 1890483 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA IX109588 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Diarrhoea, Erythema, Headache, Oral herpes, Pyrexia, Swelling, Swelling face, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none at time of vaccination
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: None- referred to her medical provider
CDC Split Type:

Write-up: Client called 11-22-2021 and stated that after receiving the injection and left the clinic started having some redness on her face with swelling in her face and neck. She had a headache the next day and fever and chills for about 48 hours. She felt better over the weekend and then at 3 am this morning she had vomiting and diarrhea. She also stated that she has multiple cold sores in her mouth.


VAERS ID: 1890569 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #FH8020 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Deafness, Immediate post-injection reaction, Tinnitus
SMQs:, Hearing impairment (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: After initial Covid-19 vaccination series in April/May of 2021 had fullness in ears, eustachian tube dysfunction in left ear, ve
Other Medications: Crestor 10 mg
Current Illness: None
Preexisting Conditions: High cholesterol, osteoarthritis
Allergies: amoxycillan, adhesive tape.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Persistent low frequency tinnitus and hearing loss immediately following vaccination. Every day, ongoing since vaccination booster was received.


VAERS ID: 1890590 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Product administered at inappropriate site, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Drug abuse and dependence (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Medication errors (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: daily birth control pills
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Tomorrow have appointment with orthopedic surgeon for ultrasound diagnostic with likely cortisone injection into bursa to reduce inflammatory response.
CDC Split Type:

Write-up: Covid booster shot was given in shoulder joint (bursa) instead of deltoid muscle. Obviously high injection site 1/2 finger width below acromion process. Pain, heat, swelling to shoulder joint progressively getting worse over past 5 days, no pain in deltoid muscle.


VAERS ID: 1890646 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-11-14
Onset:2021-11-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F48028 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dizziness, Dyspnoea, Fatigue, Muscular weakness, Nausea, Pain in extremity, Pyrexia, SARS-CoV-2 test negative, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 150 mg - Effexor 600 IU - Vitamin D Nature''s Bounty - Hair, Skin, & Nail Vitamins
Current Illness: None
Preexisting Conditions: History of asthma
Allergies: Buspar, augmentin, skin allergy to certain metals such as nickel
Diagnostic Lab Data: I received a COVID-19 test this morning, Monday, November 22nd at 9:30AM and received a negative result at approximately 4PM.
CDC Split Type:

Write-up: I received the Pfizer booster vaccine at approximately 4:30PM on Sunday, November 14th. I awoke with a sore arm Monday, November 15th and Tuesday, November 16th. It was not until Wednesday, November 17th I began to feel dizzy and nauseas. By Friday, November 19th I was experiencing dizziness, chills, exhaustion/fatigue, muscle weakness, trouble sleeping, and diarrhea. By Sunday, November 21st, I noticed a fever of 100 and was still experiencing all of the previous symptoms listed as well as vomiting. Today, Monday, November 22nd, I still feel the previous symptoms. I have let my PCP know of this experience and I will likely have to be seen and have further intervention tomorrow unless I miraculously feel better.


VAERS ID: 1890732 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injected limb mobility decreased, Injection site pain, Injection site paraesthesia, Injection site reaction, Neuralgia, Product administered at inappropriate site
SMQs:, Peripheral neuropathy (narrow), Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KNOWN
Current Illness: ARTHRITIS
Preexisting Conditions: ARTHRITIS
Allergies: ARTHRITIS, IODIDES
Diagnostic Lab Data: NOT DONE
CDC Split Type:

Write-up: PATIENT CAME NEXT DAY ON THURDAY AT 3:47 PM COMPLAINING OF PAIN AT THE SITE OF INJECTIONS STARTED THE NIGHT OF THE VACCINATION, THE PAIN WAS DESCRIBED AS TINGLING, NERVE PAIN AND PAIN AT THE SHOULDER, SHE TOOK SOME TYLENOL, WHICH MADE IT BETTER, HOW EVER, THE PAIN GOT WORSE THE NEXT DAY THAT SHE COULD NOT MOVE THE ARM AROUND, SHE HAD TO GO TO URGENET CARE AND SHE WAS TOLD AT THE URGENT CARE OFFICE THAT THE SITE OF INJECTIONS WAS VERY HIGH. IF THE PAIN CONTINUES MORE THAN A WEEK, PATIENT SHOULD SEEK MEDICAL HELP. THE PATIENT KEPT TAKING TYLENOL WHICH HLEPS LESSEN THE PAIN. UPON COMING TO THE PHARMACY, I OBSERVED THE SITE OF INJUECTION AND IT WAS VERY HIGH CLOSE TO SHOULDER AND FAR AWAY FROM DELTIOD MUSCLE


VAERS ID: 1890935 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Myalgia, Nausea, Presyncope
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: About 12 hours after receiving the booster I felt normal side effects of fatigue, muscle aches and chills. These continued and close to 24 hours after receiving the booster, I started to fell nauseous, light headed., and then I nearly passed out twice during the span of about 30 minutes. I spoke to a RN with my doctor''s office, described all symptoms. After the consultation, I was told to drink plenty of liquids and try to snack lightly; and if I experienced it again to contact them. While I felt a little light-headed for the next 12 hours, I seemed to be improving and did not have another episode.


VAERS ID: 1890986 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Pyrexia, Sinus congestion, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chills, wheezing, sinus congestion


VAERS ID: 1891450 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ 1611 / 3 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Erythema, Feeling hot, Flushing, Injection site erythema, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 100mcg, Allegra-D, Trulance, montelukast, methylprednisolone, generic Sudafed, antihistamine nose spray, antihistamine eye drops, allergy shots
Current Illness: Inflammation of sinuses and throat leading to excessive post nasal drip and increased environmental response
Preexisting Conditions: Post total thyroidectomy for previous thyroid cancer; allergy shots on a weekly basis working up to a maintenance dosage (last shot was 8am on 11/16); chronic constipation
Allergies: No medication or food allergies; environmental and pet allergies only
Diagnostic Lab Data: No tests done, epi pen was administered in the ER.
CDC Split Type:

Write-up: About 20 minutes after shot face was feeling very flush and left cheek was tingling. I was driving home and noticed the red flush and extreme warmth on cheeks spreading down toward neck. 15 minutes later at home noticed the red had covered my neck, chest, and injection site as well, had also moved up face toward forehead. At which time I went to the ER and the injection site has closed right after my shot and my primary care office was unable to assist.


VAERS ID: 1892689 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-11-17
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Polyethylene glycol allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211142178

Write-up: SHORTNESS OF BREATH; CHEST TIGHTNESS AS OF LAST NIGHT AND THIS MORNING; TINGLING; This spontaneous report received from a pharmacist concerned a 45 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: allergy to peg (poly ethylene glycol). The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 213D21A and expiry: 11-APR-2022) dose was not reported, administered on 17-NOV-2021 17:45 for prophylactic vaccination. No concomitant medications were reported. On 17-NOV-2021, the patient experienced shortness of breath. On 17-NOV-2021, the patient experienced chest tightness as of last night and this morning. On 17-NOV-2021, the patient experienced tingling. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from tingling, chest tightness as of last night and this morning, and shortness of breath. This report was non-serious.


VAERS ID: 1892693 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-11-17
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Fatigue, Swelling face, 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: Medical History/Concurrent Conditions: COVID-19 (COVID-19 positive); Comments: Patient had no known allergies and no medical history otherwise healthy.
Allergies:
Diagnostic Lab Data: Test Name: Blood test; Result Unstructured Data: Normal
CDC Split Type: USJNJFOC20211143073

Write-up: HIVES/ WELTS ALL OVER BODY/ LIMBS; FATIGUE/ TIRED; FACIAL DROOPING/ SWELLING FROM EAR TO MOUTH; This spontaneous report received from a parent via a company representative concerned a 26 year old female. The patient''s weight was 125 pounds, and height was 70 inches. The patient''s past medical history included: covid-19 infection, and other pre-existing medical conditions included: Patient had no known allergies and no medical history otherwise healthy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043A21A and expiry: 19-SEP-2021) dose was not reported, administered on 24-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-NOV-2021, the patient experienced facial drooping/ swelling from ear to mouth. On an unspecified date, the patient experienced hives/ welts all over body/ limbs, and fatigue/ tired. Laboratory data (dates unspecified) included: Blood test (NR: not provided) Normal. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from facial drooping/ swelling from ear to mouth on 17-NOV-2021, and had not recovered from hives/ welts all over body/ limbs, and fatigue/ tired. This report was non-serious.


VAERS ID: 1892781 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Headache, Lymph node pain, Lymphadenopathy, Muscular weakness, Musculoskeletal stiffness, Neck pain, Pain, Tenderness, Tunnel vision
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Retinal disorders (narrow), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Mild flu-like symptoms 2 weeks prior but clinic COVID PCR type test negative, resolved in few days
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Same day tunnel vision and light headed, muscle weakness. 24h after, body aches and headache, low energy. Swollen lymph nodes in left armpit to size of grapefruit hemisphere and right armpit to lesser degree day 2-5 after injection, tender to pressure and weight of arm against armpit. Swollen mid jawline at submandibular glands, bilateral, equal size, tender to touch day 4-5. Left more pronounced. Tender pain and stiffness at base of skull uppermost vertebrae of neck.


VAERS ID: 1893323 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FM8027 / 3 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Immunisation, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Prior to vaccination, was the patient diagnosed with COVID-19?:Yes); Discoid lupus erythematosis (Discoid Lupus); Penicillin allergy (Known allergies: Penicillin.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101617174

Write-up: This is a spontaneous report from a contactable consumer, the patient. A 44-year-old non-pregnant female patient received the third (booster) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FM8027) via an unspecified route of administration in the left arm on 17Nov2021 at 12:00 (at the age of 44-years-old) as a single dose for COVID-19 immunisation. Medical history included discoid lupus, penicillin allergy and COVID-19. Prior to the vaccination, the patient was diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. The patient received unspecified medication within two weeks of vaccination. The patient previously received codeine (MANUFACTURER UNKNOWN) and morphine (MANUFACTURER UNKNOWN) and experienced drug allergy. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EN6198) via an unspecified route of administration in the right arm on 15Mar2021 at 14:00 (at the age of 43-years-old) and the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EN6208) via an unspecified route of administration in the right arm on 05Apr2021 at 14:00 (at the age of 43-years-old) as a single dose for COVID-19 immunisation. On 18Nov2021 at 03:00, the patient experienced fever, chills, headache, extreme body aches, shaking and sweating. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events fever, chills, headache, extreme body aches, shaking and sweating was not resolved at the time of this report.


VAERS ID: 1893669 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Injection site pain, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Additional Details: Patient called on 11/22, states that starting the night after his Moderna booster (11/17) that his heart was racing and chest was painful "like an elephant was sitting on his chest". It is now feeling somewhat better, reduced pain but still painful during the day and racing heart. Pt states he is not the picture of his and that night of vaccination 11/17 he spoke to friend said they knew someone had this happen and it lasted 3 months. He has not gotten any F/u, I recc calling dr or going to ER


VAERS ID: 1893697 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-09
Onset:2021-11-17
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Pyrexia, SARS-CoV-2 test positive, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: He has a past medical history significant for diabetes mellitus type 2 (inusulin dependent), ESRD 2/2 glomerulonephritis s/p kidney transplant (2000; immunocompromised), hypertension, chronic hepatitis B on tenofovir prophylaxis, and left renal carcinoma s/p radical nephrectomy (5/2021).
Allergies:
Diagnostic Lab Data: COVID-19 positive PCR 11/22/21
CDC Split Type:

Write-up: Worsening dyspnea and cough since 11/17/21. Tested positive 11/22. Presented with fever of 102.9 and tachycardic to 126 BPM.


VAERS ID: 1893720 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-03-04
Onset:2021-11-17
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

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

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

Write-up: Patient hospitalized after testing positive of COVID19


VAERS ID: 1893734 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-23
Onset:2021-11-17
   Days after vaccination:267
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1893740 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-04
Onset:2021-11-17
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1893754 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-17
Onset:2021-11-17
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Culture, Mastitis
SMQs:, Functional lactation disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blocked Ducts
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Breast milk culture 11/22/21 - result = sterile Breast exam
CDC Split Type:

Write-up: Mastitis in right breast, treated with antibiotics, improving but not completely recovered yet.


VAERS ID: 1893851 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-12
Onset:2021-11-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain lower, Abdominal tenderness, Headache
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Monistat 3 [Miconazole Nitrate], Doxycycline, Nortriptyline
Diagnostic Lab Data:
CDC Split Type:

Write-up: a 59 YOF admitted on 11/17/21 with a history of morbid obesity, recurrent panniculitis, OSA, HTN, DM2 who presents with a two day history of HA and pain/tenderness of her lower abdomen.


VAERS ID: 1893881 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-11-17
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 00ZB21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID Positive test date 11/21/2021
CDC Split Type:

Write-up: COVID vaccine breakthrough case


VAERS ID: 1893952 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 52SA4 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: benztropine (Cogentin) 1 MG tablet guanFACINE (Intuniv ER) 4 mg Tb24 loxapine (Loxitane) 5 MG capsule methylphenidate (Concerta) 36 MG extended release tablet QUEtiapine (SEROquel) 100 MG tablet
Current Illness:
Preexisting Conditions: Seizure disorder (HCC-CMS) Chromosomal abnormality
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse effect. Patient was given Pfizer Covid Vaccine Booster dose and patient did not meet the required age for booster at time and date of administration.


VAERS ID: 1893954 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 2 RA / IM

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

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

Write-up: Patient originally received Pfizer as her primary dose and thought she had gotten Moderna. So when she came to us for her 2nd dose she filled out consent with all Moderna, wishing to receive Moderna. When looked up in database after administration it was noticed that persons actually received Pfizer. Spoke to persons she is made aware. Spoke with Representative at health facility and she is not to do anything further she is considered fully vaccinated and may get whichever she would like as her booster 6 months after her 2nd dose which ended up being the Moderna. Verbiage of this clarification was also emailed to me. Patient called and notified. She is doing well and has had no adverse reaction.


VAERS ID: 1893997 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angioedema, Facial discomfort, Facial pain, Pain in jaw, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: tongue tingling, tightness in face, right side of face droopy, smile crooked, and jaw and chin sore


VAERS ID: 1894087 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-11-17
   Days after vaccination:267
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Hemiparesis, Intensive care, Thrombectomy
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Significant CVA landing patient in ICU (hemiparesis). tPA and and thrombectomy required.


VAERS ID: 1894103 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-11-17
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Catheter directed thrombolysis, Cor pulmonale, Pulmonary embolism
SMQs:, Cardiac failure (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PE, cor-pulomonale requiring catheter directed thrombolysis and remains critically ill.


VAERS ID: 1894129 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Tongue pruritus, Vaccine positive rechallenge
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Status: Sign when Signing Visit Cosign Required: Yes Patient had reaction to COVID-19 vaccine. Patient was monitored after COVID-19 vaccine as recommended per guidelines. The following reaction signs/symptoms were observed: difficulty swallowing and other tounge itching She had previus similar reaction to initial 1st dose did not for 2nd dose. Provider had advised to get booster. VS stable, no visual distress,no SOB, lungs sound clear, denies n/v,dizziness. Emergency response notified: vitals taken and Dr came and assessed. Symptoms improved. EpiPen administered by RN as per standing order?: No Report given to Dr


VAERS ID: 1894239 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-14
Onset:2021-11-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bilirubin urine, Blood urine absent, Condition aggravated, Glucose urine absent, Nephrotic syndrome, Nitrite urine absent, Protein urine present, Specific gravity urine normal, Urine ketone body absent, Urine leukocyte esterase, Urine protein/creatinine ratio increased, pH urine normal
SMQs:, Acute renal failure (broad), Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Proteinuria (narrow), Tubulointerstitial diseases (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: Idiopathic Childhood Nephrotic Syndrome
Allergies:
Diagnostic Lab Data: Urine pro/cr ratio (11//18/21): 13.0 UA (11/18/21): sp grav 1.030, pH 6.0, $g 500 mg/dL pro, negative for blood, glucose, ketones, bilirubin, leukocytes, nitrites
CDC Split Type:

Write-up: Pt developed relapse of nephrotic syndrome which had been in remission within 3 days of receiving immunization. Confirmed by labs on day 3 post injection although home urine dipstick protein levels trending up prior to this.


VAERS ID: 1894272 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 4 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 4th dose given in error as consent form documentation listed as 1st dose , facility administrator notified once identified, stated resident showing no signs of an adverse reaction


VAERS ID: 1894302 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Headache, Nasopharyngitis, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Mild symptoms: headache, fever, body stiffness
Other Medications: Attended kickboxing class
Current Illness: None
Preexisting Conditions: None
Allergies: Tramadol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, vomit, nausea, cold


VAERS ID: 1894328 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-27
Onset:2021-11-17
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NA / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/17/2021- SARS Coronavirus-2, PCR Detected
CDC Split Type:

Write-up: pt was admitted to the hospital for s/s consistent with COVID 19. Tested positive on admission


VAERS ID: 1894396 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065721A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt. states that after receiving the 3rd Booster of Moderna 11/16/2021, started experiencing symptoms 11/17/2021 of pain at the injection site, chills (self-treated with Flexaril), fever, and fatigue. Symptoms subsided 11/18/2021. No noted Primary visit/communications.


VAERS ID: 1894476 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-11-12
Onset:2021-11-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Biopsy endometrium, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (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
Current Illness: endometrial polyp diagnosed
Preexisting Conditions: perimenapausal
Allergies: none
Diagnostic Lab Data: doctor visit on 11/18/21 with endometrial biopsy
CDC Split Type:

Write-up: significant vaginal bleeding with large orange size clots for 12hrs. stopped by taking megace 40mg bid.


VAERS ID: 1894512 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ear pain, Head discomfort, Headache, Hypersomnia, Musculoskeletal pain, Pain, Pain in extremity, Pain in jaw
SMQs:, Rhabdomyolysis/myopathy (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Osteonecrosis (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None. I''m debating calling my doctor tomorrow. I''ve been complaining and taking advil and tylenol for 6 days.
CDC Split Type:

Write-up: 6 days later, I''ve had a headache that feels like pressure all over my head, jaw, and ears. Also, I have 1 step from my back room to my kitchen that is usually easily maneuvered but my thighs hurt. My buttocks hurt. I feel achy and slept 11 hours 4 nights after my vaccine. I usually sleep 7.


VAERS ID: 1894543 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Product preparation issue
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: Fish oil, cranberry extract, red yeast rice, CO Q-10, Vitamin D 3Vitamin B-12
Current Illness: None
Preexisting Conditions: Pre-diabetes, Postmenopausal Hormone Replacement Therapy
Allergies: NKDA, NKFA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Used 0.8 cc of diluent instead of 1.8


VAERS ID: 1894552 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Osteoarthritis; radiculopathy; glaucoma; shingles; HTN; hypothyroid
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling to left arm. No erythema or cellulitis. Just swelling.


VAERS ID: 1894587 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
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: Lamictal, Zoloft, Provigil, Retin-A
Current Illness: None
Preexisting Conditions: Mood Disorder Unspecified Type, Adult OSA, Menstrual migraine, Generalized anxiety disorder, PTSD, Eczema, IBS, Hypersomnia w/sleep apnea, H/O Lyme disease
Allergies: Ciprofloxacin-dexamethasone
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Used 0.8 cc of diluent instead of 1.8


VAERS ID: 1894644 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
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: Imitrex, Celexa, Inderal Prilosec, Lasix
Current Illness: None
Preexisting Conditions: Depression Unspecified, HTN, Anxiety, GERD, Hemangioma, Mixed sleep apnea, Mixed urinary incontinence
Allergies: Lisinopril
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Used 0.8 cc of diluent instead of 1.8


VAERS ID: 1894688 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013H21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Disorientation, Disturbance in attention, Dizziness, Dysphagia, Dyspnoea, Feeling abnormal, Headache, Miliaria, Myalgia, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Evekeo 5MG, Levothyroxine 75MCG, Duloxetine 60MG, Buspirone
Current Illness: none
Preexisting Conditions: Fibromyalgia/CFS
Allergies: Penicillin
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: First 36 hours after shot: Persistent headache, difficulty swallowing and difficulty breathing, prickly heat, chills, joint pain, muscle aches, dizziness, Brain fog and disorientation. Woke up the next day 11/18/2021 and I my whole body was swollen. As of 11/23/2021 joint & muscle pain has abated to my normal level, still have a constant headache, dizziness, difficulty concentrating and focusing.


VAERS ID: 1894739 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 1 LA / IM

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

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

Write-up: Swelling and redness circumference of a baseball at injection site. Painful and warm to touch. Finally abating now.


VAERS ID: 1894811 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pristiq, Levocetirizine
Current Illness:
Preexisting Conditions: Asthma, Ehlers Danlos Syndrome, suspected Seronegative Rheumatoid Arthritis, Hay Fever, Vestibular Dysfunction, Anxiety, Depression
Allergies: Sun exposure
Diagnostic Lab Data: Doctor looked at my arm on Nov 22nd around 4:40pm.
CDC Split Type:

Write-up: Around 11pm (same day I got the vaccine, which was around 2pm) I noticed a rash forming that was probably around an inch or so big at the time. The injection site had a firm lump under the skin, and hot to the touch. When I woke up the next morning, I noticed multiple lumps (all under the skin) that were spread away from the initial injection site in addition to the original injection site. It gave me the impression the injection may have moved due to gravity (side sleeper). All of the lumps were painful, very red, and hot to the touch. My skin around the lumps was also red, and hot but less so. The redness continued to get bigger until Sunday (Nov 21st), which is when it started to show signs of fading. Currently my rash has faded some, but is still visible. It covers a large portion of my upper arm, and is around 6 inches around. It is still warm to the touch, itches, and feels similar to having a carpet burn. The lumps are still there, and are by far the most itchy. They also feel like a bad bruise when pressed on. I went to see the doctor on Nov 22nd, and was given a cream to put on my arm, but I have yet to start using it (need to pick it up).


VAERS ID: 1894815 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: 8mins post vaccination pt reported nausea and dizziness. Vitals: 109/66, 53, 20 Pt stable and released from the vaccination site @15:10.


VAERS ID: 1894836 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: 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? 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: 4-year-old patient received Pfizer COVID-19 instead of influenza vaccine.


VAERS ID: 1894876 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Injection site pain, Peripheral coldness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PMH and Medications unknown to this writer
Current Illness:
Preexisting Conditions: PMH and Medications unknown to this writer
Allergies: Allergies: lotion (rash)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10mins post vaccination pt had a syncopal event with associated headache, L arm feels coldm and injection site soreness Pt was put in the the trendelenburg position @18:20 Vitals: 18:20 127/58, 72, 14, 100% -- $g 18:35 (sitting) 119/59, 73, 16, 100% -- $g 18:40 (sitting) 131/61, 61, 14, 100% Pt given water and advised to f/u w/ doctor. S/S improved. Pt ambulatory and d/c w/ mother @18:45. Instructed to increase PO intake x3days to 8-10 cupps each day. Pt is 5''2" ~120-130lbs


VAERS ID: 1894895 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medications: Nortriptyline 30mg po QHS HCTZ 25mg PO daily Temazepam 15mg PO PRN Anxiety Gabapentin 600mg PO QHS
Current Illness:
Preexisting Conditions: PMH: HTN, anxiety, GERD, Migraine w/ Aura, fatty liver
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 15mins post vaccination pt c/o numbness to L cheek which self resolved w/ 30mins of observation. Vitals: 170/92 -- $g 160/82 -- $g 152/88


VAERS ID: 1894901 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 2 RA / IM

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

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

Write-up: A 7th dose removed from a Pfizer vial of 6 doses.


VAERS ID: 1895317 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain upper, Asthenia, Chest pain, Decreased appetite, Electrocardiogram normal, Hyperhidrosis, Hypertension, Lethargy, Oedema, Pain in extremity, Swelling, Tenderness, Troponin
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 2nd dose of Pfizer/Biontech in March, 2021. Lethargy, significant arm pain, pain in joints, exhaustion for 2 days after vaccinat
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: local Medical Center ER to evaluate chest pain on 11/18. ER staff did an EKG (normal) and a blood test for troponin came back normal (<5). Blood pressure was 135/95 which is elevated. We were not given the results from the blood panel when discharged.
CDC Split Type:

Write-up: Severe swelling to arm, chest, armpit, shoulder and back on left side. Most of these were also point tender. Extreme pain in left arm, general weakness throughout arm. Pain in joints. Lethargy and diminished appetite. Stomach pain. High blood pressure (150/95) and excessive sweating. I usually have blood pressure of 106/60. Significant edema and bloating. Swelling after exercise and point tenderness in left chest 7 days after vaccination.


VAERS ID: 1895365 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 75FZ7 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Cough, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: albuterol inhaler, azelastine 0.05% nasal spray, spiriva inhaler, wixela inhaler, montelukast, cetirizine
Current Illness:
Preexisting Conditions: asthma, allergic rhinitis
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt developed coughing , vomiting one time , abdominal pain and wheezing


VAERS ID: 1895547 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-03
Onset:2021-11-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Antibody test, Aspartate aminotransferase increased, Bacterial test, Blood alkaline phosphatase increased, Blood bilirubin normal, Blood lactate dehydrogenase normal, C-reactive protein normal, Coagulation test normal, Conjunctivitis, Culture, Culture urine, Echocardiogram normal, Epstein-Barr virus antibody, Full blood count abnormal, Haemoglobin decreased, Hepatic enzyme increased, Inflammatory marker test, Influenza virus test negative, Liver function test abnormal, Mononucleosis heterophile test negative, Murine typhus, Mycoplasma test, Platelet count normal, Procalcitonin, Pyrexia, Pyuria, Rash erythematous, Rash maculo-papular, Red blood cell sedimentation rate increased, Respiratory viral panel, SARS-CoV-2 antibody test, Scarlet fever, Staphylococcus test negative, Streptococcus test, Troponin normal, Urine analysis abnormal, White blood cell count normal, White blood cells urine positive
SMQs:, Liver related investigations, signs and symptoms (narrow), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Biliary system related investigations, signs and symptoms (broad), Conjunctival disorders (narrow), Ocular infections (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Patient was taking oral doxycycline for eczema
Current Illness:
Preexisting Conditions: None
Allergies: Azithromycin - rash
Diagnostic Lab Data: 11/21 - WBC 7.9, Hgb 13.6, Platelet 236, T bili. 1.2, D. Bili 0.8, AST 55, ALT 135, Alk Phos 245, UA WBC "too numerous to count" UCX: 50-100K Coag Neg Staph 11/22 - WBC 8.8, Hgb 12.6, Platelet 232, T. bili 1.0, AST 25, ALT 78, Alk Phos 222, ESR 27, CRP 0.651, Troponin <0.02, LDH 176, UA 3 WBCs, UCX <10K CFU, few contaminants 11/23 - WBC 5.9, Hgb 11.8, Platelet 224, T. bili0.4, AST 15, ALT 57, Alk Phos 170, CRP 0.478, Procalcitonin 0.13 NEGATIVE; MONOSCREEN, RAPID STREP, INFLUENZA, RESPIRATORY VIRAL PANEL, ASO PENDING: RICKETTSIAL FEVER AB PANEL, MYCOPLASMA AB, EBV AB, COVID AB
CDC Split Type:

Write-up: Patient became febrile on 11/17/21 and developed bright erythematous rash that was worse at creases. She was treated with PO amoxicillin due to presumed scarlet fever. She continued to be febrile and rash became maculopapular throughout body. She was seen in ED on 11/21 and had labs that showed slightly elevated liver enzymes and UA showed pyuria without any UTI symptoms. She was tested for mononucleosis and negative. She was given Rocephin IM in ED and switched to cephalexin as physician concerned rash was from mononucleosis. She then continued to fever and developed conjunctivitis. Patient was admitted to Pediatric Floor on 11/23 to rule out MIS-C but on day of admission CBC and inflammatory markers were nearly normal with downtrending LFTs. She was started on doxycycline to treat murine typhus as it is endemic in the region and Rocephin empirically while awaiting cultures. She has been afebrile since admission on 11/23 and had a normal ECHO by cardiology.


VAERS ID: 1896425 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Confusional state, Immunisation, Neurological symptom
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: FINASTERIDE; TAMSULOSIN; OXYBUTYNIN; AMLODIPINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes; Heart disorder (Heart disease); Penicillin allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101626028

Write-up: Confusion - thought my phone was the TV remote; Neurological symptoms; Could not sit up - had no control over upper body, balance severely affected, could not place body where I intended; Administration date 17Nov2021 at 14:30, dose received=3; This is a spontaneous report from a contactable consumer, the patient. A 73-year-old male patient received the third dose (booster) of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FG3527) via an unspecified route of administration in the right arm on 17Nov2021 at 14:30 (at the age of 73-years-old) as a single dose for COVID-19 immunisation. Medical history included heart disorder, diabetes and penicillin allergy. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications included finasteride (MANUFACTURER UNKNOWN), tamsulosin (MANUFACTURER UNKNOWN), oxybutynin (MANUFACTURER UNKNOWN) and amlodipine (MANUFACTURER UNKNOWN); all for unknown indications from unknown dates and unknown if on going. The patient previously took sulfur (MANUFACTURER UNKNOWN) for unknown indication and had drug allergy. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the right arm on 26Jan2021 (at the age of 73-years-old) and also received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 16Feb2021 (at the age of 73-years-old) as a single dose for COVID-19 immunisation. On 18Nov2021 at 13:15, the patient experienced confusion- he thought that his phone was the TV remote, neurological symptoms, could not sit up-had no control over upper body, balance severely affected, could not place body where he intended. The patient was very concerned over those affects. He had no effects with first and second dose of Pfizer, but only with the booster on 17Nov2021. The events resulted in doctor or other healthcare professional office/clinic visit. Since the vaccination, the patient had not been tested for COVID-19. No therapeutic measures were taken as a result of the events confusion- thought his phone was the TV remote, neurological symptoms and could not sit up - had no control over upper body, balance severely affected, could not place body where he intended. The clinical outcome of the events confusion- thought his phone was the TV remote, neurological symptoms and could not sit up - had no control over upper body, balance severely affected, could not place body where he intended was recovering at the time of report.


VAERS ID: 1896805 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-05
Onset:2021-11-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fall, Fracture debridement, Open fracture, Open reduction of fracture, Pain in extremity, Suture insertion, Ulna fracture, Wound treatment
SMQs:, Accidents and injuries (narrow), Osteoporosis/osteopenia (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: APAP 650mg tablet q6h bupropion 300mg tablet daily mutivitamin tablet daily omeprazole 40mg daily oxycodone ir 5mg tablet q4h sertraline 100mg tablet daily vitamin d 1,000 u QAM
Current Illness:
Preexisting Conditions: depression, gerd,
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Husband fell landing on her right arm with sudden onset of right arm pain. Admitted for Acute compound midshaft radial ulnar fracture. Underwent open reduction and internal fixation right both bone foramen fractures with irrigation debridement of grade 1 open ulna fracture 11/17/2021. Pain was well controlled overnight without complications postoperatively. Felt stable for discharge to home 11/18. Will follow up with orthopedic surgery clinic in 2 weeks for wound check and suture removal as well as x-rays. Nonweightbearing to the right upper extremity. Cleared to start digit range of motion immediately. Strict elevation of the right upper extremity. Received 24 hours of postoperative antibiotics for treatment and discontinue thereafter. Adverse event not related to vaccine but reported as required per EUA for hospital admission, irrespective of attribution to vaccine.


VAERS ID: 1897076 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dehydration, Diarrhoea, Nausea, Tachycardia, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), 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? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: She woke up immediately went to restroom to vomit. A couple hours later exp diarrhea felt weak and wanted to go to hospital . A year ago she had her appendix removed told me she felt like those symptoms. I checked her heart rate it was 145. I took her to the Urgent Care it took about hour to get there on the way she was fine. When we got there the doctor stated she was in Tachycardia. She was given Ondansetron for nausea and look dehydrated I was advised to get fluids in her.


VAERS ID: 1897123 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-11-17
   Days after vaccination:278
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / UNK RA / IM

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

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

Write-up: COVID


VAERS ID: 1897181 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-22
Onset:2021-11-17
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 OT / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 UN / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1897186 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-09
Onset:2021-11-17
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040F21A / 2 RA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1897208 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-01
Onset:2021-11-17
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhaler, Nasacort
Current Illness: NA
Preexisting Conditions: Asthma
Allergies: Wheat, pollen, dust, pet dander
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Extremely intense, progressing headache x2 - (11/17 & 11/23) creating nausea and the feeling to vomit (not normal for me).


VAERS ID: 1897214 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-08
Onset:2021-11-17
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1897217 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-01-26
Onset:2021-11-17
   Days after vaccination:295
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 - / -

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, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: 11/12/2021 positive COVID-19 test result
CDC Split Type:

Write-up: Hospitalization with COVID-19 following COVID-19 immunization. Immunized with Moderna COVID-19 vaccination on 1/26/2021 and 2/23/2021.


VAERS ID: 1897237 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-09
Onset:2021-11-17
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1897241 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprol tartrate 25 MG
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received the 1st dose Moderna lot # 016B21A - no reaction I received the 2nd dose Moderna lot #008C214 - adverse reaction - large red circle and swelling, pain in shoulder, intense itching I received the 3rd dose Moderna lot #021C21A - adverse reaction - large red circle and swelling, pain in shoulder, intense itching **I have taken photos to show proof


VAERS ID: 1897242 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Confusional state, Disorientation, Fatigue, Injection site pain, Injection site swelling, Myalgia, Nausea, Physical examination
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (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: Amphetamine Salts, Viibryd, Testosterone cream, Trazodone, Phentermine, Topamax
Current Illness: None
Preexisting Conditions: Depression, Clinically obese
Allergies: Dilaudid, Buspar, Medical adhesive
Diagnostic Lab Data: Physical exam only
CDC Split Type:

Write-up: Pain, swelling, looked like 2 injection sites for 5 days, joint/muscle aches, fatigue, nausea, chills. confusion/disorientation on day 3. Injection of Toradol on day 3. Finally better on day 6.


VAERS ID: 1897300 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta 30 mg daily MS Contin 30 mg twice a day Oxycodone 5 mg every 6 hours as needed Actos 15 mg daily Compazine 10 mg every 8 hours as needed Coreg 25 mg twice daily Dilantin 300 mg daily Glucophage 1000 mg twice daily Hytrin 5 mg d
Current Illness: None
Preexisting Conditions: squamous cell carcinoma, was treated with radiation and chemotherapy 2021 Major Depressive Disorder, recurrent episode, moderate Antisocial Personality Disorder DMII Hypertension Neuropathy Hyperlipidemia Constipation
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: This client was given a 4th dose of Moderna Vaccine


VAERS ID: 1897347 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-11-17
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Ataxia, Brain cancer metastatic, Brain neoplasm, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Feeling abnormal, Headache, Hypoxia, Lung infiltration, Lung opacity, SARS-CoV-2 test positive, Tumour excision
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Non-haematological tumours of unspecified malignancy (narrow), 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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet benzonatate (TESSALON) 100 MG capsule Calcium Carb-Cholecalciferol 600-200 MG-UNIT TABS cholecalciferol (VITAMIN D3) 25 MCG (1000 UT) tablet guaiFENesin (MUCINEX) 600 MG 12 hr tablet levETIRAcetam (KEPP
Current Illness: recently hospitalized from 9/27/2021 to 10/9/2021 due to metastatic cancer to brain, brain tumor s/p resection 11.10.21: Pt''s husband/son tested positive for covid today. Symptoms: coughing, fatigue, and headache. 11.13.21: Called nurse triage line inquiring about monoclonal AB infusion - Symptoms started 11/9/2021. Symptoms include: reason for call was related to questions about monoclonal antibody infusion and referral request Mild symptoms cough, fatigue, intermittent headache. Patient symptoms are mild, no shortness of breath or pain/pressure in her chest. Patient is undergoing targeted cancer therapy and does have metastasis to her brain. Her son denies any worsening confusion but does state that she has been "foggy" since diagnosis of Covid-19.
Preexisting Conditions: hilar mass, left Brain metastases Brain malignant neoplasm Intermittent confusion
Allergies: Erythromycin (macrolides) - rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (11.16.21); COVID-19 positive (11.17.21); Fully vaccinated PRESENTING PROBLEM: Pneumonia due to COVID-19 virus [U07.1, J12.82] Primary Care Physician at Discharge: NP Hematologist/Oncologist: Dr. Admission Date: 11/16/2021 Discharge Date: 11/21/2021 Patient''s Discharge Disposition: Home in stable condition. Hospital course: Patient is a 63 y.o. female with a past medical history significant for non-small cell lung cancer with multiple brain mets who has been on treatment with Entrectinib and completed SRS radiation to her brain. She has mild ataxia at baseline. She presented to ER from home per EMS after she was found on the floor by her family and helped back to bed. She was hypoxic in the 80''s when checked by EMS and placed on 4L/NC. She was diagnosed with COVID 11/5 when she was tested due to her husband and son testing positive. Pt''s CXR and CTA thorax both demonstrated patchy ground glass infiltrates consistent with COVID pneumonia. The patient was admitted for further evaluation and management. She was started on dexamethasone 6 mg and Remdesivir. She was also given compassionate use monoclonal antibodies on 11/18. She completed the course of remdesivir and 5 days of steroids. Her SOB resolved and she was weaned to RA. Her only remaining symptom at time of discharge was a cough. The patient was eating and ambulating at the time of discharge. Discharge medications and follow up as listed below. Answered all questions and the patient was comfortable with the discharge plan.


VAERS ID: 1897376 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / UNK - / IM

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

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

Write-up: Patient vaccinated before 5 years old, vaccine only approved for 5+.


VAERS ID: 1897391 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-11-17
   Days after vaccination:292
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM

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

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

Write-up: Positive COVID-19 test.


VAERS ID: 1897400 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-11-17
   Days after vaccination:275
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

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

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

Write-up: Positive COVID test


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