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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)

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VAERS ID: 1906005 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 AR / IM

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

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

Write-up: It was reported to us approx a week later, that one day post vaccination with moderna booster, Patient has severe lymph node swelling in neck area. Sought care at primary care MD and prescribed steroids.


VAERS ID: 1906058 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Nausea
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt reported feeling nauseous and tired. She had missed school breakfast. Offered water and snack, symptoms resolved. Returned to class at 1050am. Parent was notified .


VAERS ID: 1906226 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Breast cyst, Breast mass, Breast pain, Ear congestion, Ear discomfort, Ear swelling, Haemorrhage, Herpes virus infection, Hypersensitivity, Induration, Oral discomfort, Oral mucosal blistering, Oropharyngeal pain, Palpitations, Paraesthesia oral, Pruritus, Tinnitus
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Lipodystrophy (broad), Hypersensitivity (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ASSESSMENT and PLAN Visit Diagnoses and Orders: 1. Herpes (Primary) 2. Adverse effect of COVID-19 vaccine 3. Breast pain in female Other orders - valACYclovir (VALTREX) 500 mg tablet; TAKE 4 TABLETS BY MOUTH AT FIRST SIGN OF ATTACK (BURNING,TINGLING ON EDGE OF LIP) AND TAKE 4 BY MOUTH 12 HOURS LATER. Dispense: 14 tablet; Refill: 1 Discussion: File VAERS report REfill of valtrex, Use vasline inside right nares Questions answered and patient demonstrated understanding and instructions. Medication Management: Patient''s Medications New Prescriptions No medications on file Modified Medications Modified Medication Previous Medication VALACYCLOVIR (VALTREX) 500 MG TABLET valACYclovir (VALTREX) 500 mg tablet TAKE 4 TABLETS BY MOUTH AT FIRST SIGN OF ATTACK (BURNING,TINGLING ON EDGE OF LIP) AND TAKE 4 BY MOUTH 12 HOURS LATER. TAKE 4 TABLETS BY MOUTH AT FIRST SIGN OF ATTACK (BURNING,TINGLING ON EDGE OF LIP) AND TAKE 4 BY MOUTH 12 HOURS LATER Discontinued Medications FLUTICASONE (FLONASE) 50 MCG/NASAL SPRAY 2 sprays by Nasal route Daily. Follow-up: No follow-ups on file. SUBJECTIVE HPI: Allergic reaction to pfizer COVID vaccine. Having mouth blisters, sore throat, bleeding blister in nose, heart palpitations, left ear swelling and itching, ear congestion and ringing. Right lateral Breast lump, sore & change in feel. right breast cyst, centrally at 9oclock, hard, painful $g associates with start of HRT Has follow up with clinic Recent mammogram 3/9/2021. COVID vaccine side effects Blister inside right nares Blisters at back of mouth (not typical allergy rxn) $g painful, swollen Left ear plugs and then develops tinnitus Heart palpitations - constant - pounding, rapid $g no sob or chest pain with episodes. Since vaccine all typical "allergy" symptoms are "off the charts" Dentist prescribed Valtrex 2,000mg BID x1 $g for possible herpes flare, possibly helpful. No relief with benadryl


VAERS ID: 1906271 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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

Write-up: Developed hives and itching of left arm at site of injection. Family returned to the office. Patient was stable, no swelling of face or lips, no difficulty breathing, no nausea or vomiting. He received Diphenhydramine in the office and continued Loratadine for 2 days with improvement of symptoms.


VAERS ID: 1906301 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
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: Atorvastatin 80 mg PO QHS Hyperlipidemia Diltiazem CD 180 mg PO QAM Atrial fibrillation X Famotidine 20mg PO daily GERD with Esophagitis Fluoxetine 80 mg PO daily Schizoaffective disorder, social anxiety, OCD X Levetiracetam XR 2000 mg
Current Illness: Hemiplegia and hemiparesis following cerebral infarction, dysphagia, schizophrenia, OCD, social anxiety disorder, hyperparathyroidism, hypercalcemia, hypophosphatemia, atrial fibrillation, HTN, hyperlipidemia, depression, hx of alcohol abuse, seizure disorder, latent TB.
Preexisting Conditions: Hemiplegia and hemiparesis following cerebral infarction, dysphagia, schizophrenia, OCD, social anxiety disorder, hyperparathyroidism, hypercalcemia, hypophosphatemia, atrial fibrillation, HTN, hyperlipidemia, depression, hx of alcohol abuse, seizure disorder, latent TB.
Allergies: bariumNKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse events, vaccine reconstituted with 1.2ml of NS vs 1.8ml


VAERS ID: 1906420 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
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: Alzheimer''s dementia, prediabetes, hyperlipidemia, insomnia, hypertension, urinary incontinence, COPD, GERD, Hx of alcohol and tobacco use. Alendronate 70 mg PO weekly Osteoporosis Calcium 500mg/Vit D 400mg PO BID Osteoporosis Donepezil
Current Illness: see below
Preexisting Conditions: see below
Allergies: Ibuprofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse events, vaccine reconstituted with 1.2ml of NS vs 1.8ml


VAERS ID: 1906422 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
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: Medications and diagnosis Amlodipine 5 mg PO daily Essential HTN X Azithromycin 250 mg PO 3 times weekly Bronchiectasis Docusate 100 mg PO BID Constipation Losartan 100 mg PO daily Essential HTN X Mometasone/formoterol 200/5 mcg 2 inh.
Current Illness: none
Preexisting Conditions: Medications and diagnosis Amlodipine 5 mg PO daily Essential HTN X Azithromycin 250 mg PO 3 times weekly Bronchiectasis Docusate 100 mg PO BID Constipation Losartan 100 mg PO daily Essential HTN X Mometasone/formoterol 200/5 mcg 2 inh. BID Bronchiectasis Refresh Plus 0.5% 2 drops to each eye BID Xerophthalmia Montelukast 10 mg PO daily COPD Tramadol 50 mg PO BID Pain X PRN Medication Indication Increased Fall Risk Acetaminophen 650 mg PO/PR Q4H prn Fever, headache or other minor aches Albuterol 2.5 mg SVN Q2H prn Shortness of breath / COPD Alum/mag/simeth Susp 30 ml Q2H prn Epigastric upset Artificial tears 1-2 drops to eyes Q2H prn Dry eyes Benzonatate 100 mg PO TID prn Cough Bisacodyl 10 mg PO/PR daily prn Constipation Calmoseptine topically up to 6 times daily Skin barrier Carbamide peroxide 2 drops each ear prn Cerumen Duoneb SVN Q4H prn (use albuterol 1rst) Shortness of breath / COPD Hydrocortisone 1% cr topically bid prn Mild rash Morphine 10 mg PO / sublingual Q1H prn Air hunger X Polyethylene Glycol 3350 17 g PO daily prn Constipation
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse events, vaccine reconstituted with 1.2ml of NS vs 1.8ml


VAERS ID: 1906424 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: No adverse events, vaccine reconstituted with 1.2ml of NS vs 1.8ml Hemiplegia and hemiparesis following cerebral infarction, dysphagia, schizophrenia, OCD, social anxiety disorder, hyperparathyroidism, hypercalcemia, hypophosphatemia, atrial fibrillation, HTN, hyperlipidemia, depression, hx of alcohol abuse, seizure disorder, latent TB. Atorvastatin 80 mg PO QHS Hyperlipidemia Diltiazem CD 180 mg PO QAM Atrial fibrillation X Famotidine 20mg PO daily GERD with Esophagitis Fluoxetine 80 mg PO daily Schizoaffective disorder, social anxiety, OCD X Levetiracetam XR 2000 mg PO daily Seizures X Magnesium chloride ER 128 mg PO BID Hypomagnesemia Potassium chloride ER 20 mEq PO BID Hypokalemia Rivaroxaban 15 mg PO daily Paroxysmal atrial fibrillation Risperidone 1.5 mg PO daily Schizoaffective disorder, social anxiety, OCD X PRN Medication Indication Increased Fall Risk Acetaminophen 650 mg PO/PR Q6H prn Headache, fever, minor aches Alum,mag,simeth 30 ml Q2H prn Mild epigastric upset Bisacodyl 10 mg PO / PR prn Bowel regimen Calmoseptine ointment prn Barrier cream for fecal & urinary incontinence Carbamide peroxide ear drops prn Cerumen impaction Diazepam 20 mg intranasal prn Seizures Hydrocortisone 1% cream BID prn Rash MOM 30 ml PO daily prn Bowel regimen (second line) Ondansetron ODT 8 mg PO Q6H prn Nausea Promethazine 12.5 mg PO/PR Q6H prn Nausea, if ondansetron ineffective X Senna 17.2 mg PO BID prn Constipation (first line)


VAERS ID: 1906946 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

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

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

Write-up: Moderna dose was drawn up and administered after recommended 12-hour punctured Beyond Use Date (BUD) but before recommended 24-hour room temperature unpunctured BUD.


VAERS ID: 1907135 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

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

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

Write-up: Moderna dose was drawn up and administered after recommended 12-hour punctured Beyond Use Date (BUD) but before recommended 24-hour room temperature unpunctured BUD.


VAERS ID: 1907141 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

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

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

Write-up: Moderna dose was drawn up and administered after recommended 12-hour punctured Beyond Use Date (BUD) but before recommended 24-hour room temperature unpunctured BUD.


VAERS ID: 1907147 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

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

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

Write-up: Moderna dose was drawn up and administered after recommended 12-hour punctured Beyond Use Date but before recommended 24-hour room temperature unpunctured Beyond Use Date.


VAERS ID: 1907151 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

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

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

Write-up: Moderna dose was drawn up and administered after recommended 12-hour punctured Beyond Use Date (BUD) but before recommended 24-hour room temperature unpunctured BUD.


VAERS ID: 1907155 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

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

Write-up: Moderna dose was drawn up and administered after recommended 12-hour punctured Beyond Use Date (BUD) but before recommended 24-hour room temperature unpunctured BUD.


VAERS ID: 1907161 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

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

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

Write-up: Moderna dose was drawn up and administered after recommended 12-hour punctured Beyond Use Date (BUD) but before recommended 24-hour room temperature unpunctured BUD.


VAERS ID: 1958410 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Headache, Nausea, Pain, Somnolence, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MODERNA COVID VACCINES FEB AND MAR, 2021. ALSO FLU SHOT EACH YEAR
Other Medications: METFORMIN, ROSUVASTATIN LOSARTIN, AMLOPHERINE, HYDROCHLOROTHIAZIDE
Current Illness: SINUS - SINUS DRAINAGE
Preexisting Conditions: ALLERGIES, SINUS
Allergies: NONE KNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: CHILLS, TOTAL BODY SHAKES, NAUSEA, DRY COUGH, ACHY BODY, TIRED, SLEEPY, HEADACHE, LASTED ALL OF NEXT DAY. COUGH LASTED SEVERAL DAYS.


VAERS ID: 1907573 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-30
Onset:2021-11-17
   Days after vaccination:291
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, Cold sweat, Feeling hot, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), 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: PREDNISONE
Current Illness: Headache; Lung disease (taking prednisone for lung disease); Penicillin allergy; Sore throat
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211118; Test Name: pulse rate went up; Result Unstructured Data: Increased
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: warm feeling; breaking out in cold sweat/cold sweat having from Saturday and today; had atrial fibrillation; This spontaneous case was reported by a consumer and describes the occurrence of ATRIAL FIBRILLATION (had atrial fibrillation) in an 87-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 004FZ1A, 031M20A and 038k20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Penicillin allergy, Lung disease (taking prednisone for lung disease), Sore throat and Headache. Concomitant products included PREDNISONE for Lung disease. On 30-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Nov-2021, the patient experienced ATRIAL FIBRILLATION (had atrial fibrillation) (seriousness criterion medically significant). On 20-Nov-2021, the patient experienced FEELING HOT (warm feeling) and COLD SWEAT (breaking out in cold sweat/cold sweat having from Saturday and today). The patient was treated with DIGOXIN ongoing from 17-Nov-2021 for Atrial fibrillation and Pulse rate increased, at a dose of 0.025 milligram. On 17-Nov-2021, ATRIAL FIBRILLATION (had atrial fibrillation) had resolved. At the time of the report, FEELING HOT (warm feeling) and COLD SWEAT (breaking out in cold sweat/cold sweat having from Saturday and today) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 18-Nov-2021, Heart rate increased: increased (High) Increased. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient was concerned about the cold sweat she was having from Saturday and today. Stated she always have constant sore throat and headache prior the vaccines. Haven''t contacted her doctor yet, would talk to him on Monday. On Thursday, her pulse rate went up, nurse advised her to get hydrated, rest and also took Digoxin to lower pulse rate. On Friday she was fine. This case concerns an 87-year-old, female patient with a history of Lung disease, who experienced the unexpected serious AESI event of Atrial fibrillation. The event occurred approximately 4 days after booster dose of mRNA-1273 vaccine. Patient was treated with digoxin. The rechallenge was not applicable since the events happened after the booster dose and no information on additional dosing is expected. The medical history Lung disease and patient�s age remain as confounders. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. Case was assessed as serious due to important medical event and medical judgement.; Sender''s Comments: This case concerns an 87-year-old, female patient with a history of Lung disease, who experienced the unexpected serious AESI event of Atrial fibrillation. The event occurred approximately 4 days after booster dose of mRNA-1273 vaccine. Patient was treated with digoxin. The rechallenge was not applicable since the events happened after the booster dose and no information on additional dosing is expected. The medical history Lung disease and patient�s age remain as confounders. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. Case was assessed as serious due to important medical event and medical judgement.


VAERS ID: 1908397 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-27
Onset:2021-11-17
   Days after vaccination:294
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Influenza like illness, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: flu-like symptoms; very drowsy; chills; very tired; This spontaneous case was reported by a consumer and describes the occurrence of INFLUENZA LIKE ILLNESS (flu-like symptoms), SOMNOLENCE (very drowsy), CHILLS (chills) and FATIGUE (very tired) in a 75-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 014F21A, 013M20A and 012M20A) for COVID-19 vaccination. No Medical History information was reported. On 27-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 24-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Nov-2021 at 9:00 AM, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 17-Nov-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu-like symptoms), SOMNOLENCE (very drowsy), CHILLS (chills) and FATIGUE (very tired). At the time of the report, INFLUENZA LIKE ILLNESS (flu-like symptoms), SOMNOLENCE (very drowsy), CHILLS (chills) and FATIGUE (very tired) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications was reported. Patients symptoms started 12 hours after the booster dose administration and stated his symptoms are cleared up at the time of this report. No treatment drug details was reported. This case was linked to MOD-2021-395665, MOD-2021-395666 (Patient Link).


VAERS ID: 1908559 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-15
Onset:2021-11-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Swollen, painful lymph node in armpit of arm that was injected. Pain lasted about 4 days.


VAERS ID: 1908836 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-24
Onset:2021-11-17
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Breast discomfort, Breast pain, Chills, Dermatitis, Influenza like illness, Lacrimation increased, Lymphadenopathy, Malaise, Myalgia, Rash macular, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Lacrimal disorders (narrow), Lipodystrophy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Felt her breast is very full./The circle around is all stretched out as if full of milk./. It felt heavy; Sore breast; Big red blotch on the left breast; Glands on her left under arm is very sore; Arm very sore; Achy; Chills; Not feeling well; Eyes are watery; Flu like symptoms; Skin was inflamed; This spontaneous case was reported by a consumer and describes the occurrence of BREAST DISCOMFORT (Felt her breast is very full./The circle around is all stretched out as if full of milk./. It felt heavy), BREAST PAIN (Sore breast), RASH MACULAR (Big red blotch on the left breast), MALAISE (Not feeling well) and LACRIMATION INCREASED (Eyes are watery) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 033F21A, 039B21A and 006B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported.On 24-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form.On 17-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Nov-2021, the patient experienced MALAISE (Not feeling well), LACRIMATION INCREASED (Eyes are watery), INFLUENZA LIKE ILLNESS (Flu like symptoms), DERMATITIS (Skin was inflamed), VACCINATION SITE PAIN (Arm very sore), MYALGIA (Achy) and CHILLS (Chills). On 20-Nov-2021, the patient experienced BREAST DISCOMFORT (Felt her breast is very full./The circle around is all stretched out as if full of milk./. It felt heavy), BREAST PAIN (Sore breast), RASH MACULAR (Big red blotch on the left breast) and LYMPHADENOPATHY (Glands on her left under arm is very sore). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) for Adverse event, at an unspecified dose and frequency. On 20-Nov-2021, MALAISE (Not feeling well), LACRIMATION INCREASED (Eyes are watery), INFLUENZA LIKE ILLNESS (Flu like symptoms), DERMATITIS (Skin was inflamed), VACCINATION SITE PAIN (Arm very sore), MYALGIA (Achy) and CHILLS (Chills) had resolved. At the time of the report, BREAST DISCOMFORT (Felt her breast is very full./The circle around is all stretched out as if full of milk./. It felt heavy), BREAST PAIN (Sore breast), RASH MACULAR (Big red blotch on the left breast) and LYMPHADENOPATHY (Glands on her left under arm is very sore) outcome was unknown. Concomitant medication information was not provided by the reporter.This case was linked to MOD-2021-395698 (Patient Link).


VAERS ID: 1909370 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Anion gap, Biopsy kidney abnormal, Blood albumin decreased, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood glucose increased, Blood potassium increased, Blood sodium decreased, Blood urea increased, Carbon dioxide decreased, Condition aggravated, Glomerular filtration rate decreased, Haematuria, Kidney transplant rejection, Transplant rejection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: - aspirin (ECOTRIN LOW STRENGTH) 81 mg delayed release tablet Take 1 tablet (81 mg) by mouth once daily. 12/20/19 - atorvastatin (LIPITOR) 20 mg tablet Take 1 tablet (20 mg) by mouth at bedtime. 10/5/21 - cholecalciferol (VITAMIN D3
Current Illness: - CMV viremia - BKV viremia
Preexisting Conditions: Patient had end-stage kidney disease secondary to diabetic nephropathy, now status post a deceased unrelated donor kidney transplant on 10/31/2020. Diabetes mellitus (CMS/HCC) ? GERD (gastroesophageal reflux disease) ? Hyperlipidemia ? Hypertension ? Obesity ? Polycythemia ? Sleep apnea
Allergies: - Simvastatin Not Specified Other (See Comments) - Sevelamer Carbonate Low GI Distress, Unknown
Diagnostic Lab Data: Full kidney biopsy report and DSA are pending at this time. Results for patient 11/26/2021 08:34 Sodium: 135 (L) Potassium: 5.9 (H) Chloride: 107 CO2: 18 (L) Urea Nitrogen: 66 (H) Creatinine: 4.81 (H) Glucose: 126 (H) Calcium: 8.8 Albumin: 3.5 EGFR, Black: 16 (L) EGFR, Non-Black: 13 (L) Anion Gap: 10 11/27/2021 05:41 Sodium: 131 (L) Potassium: 5.6 (H) Chloride: 102 CO2: 16 (L) Urea Nitrogen: 80 (H) Creatinine: 4.72 (H) Glucose: 269 (H) Calcium: 8.7 Albumin: 3.4 (L) EGFR, Black: 16 (L) EGFR, Non-Black: 14 (L) Anion Gap: 13 (H) 11/28/2021 07:26 Sodium: 135 (L) Potassium: 5.4 (H) Chloride: 107 CO2: 19 (L) Urea Nitrogen: 84 (H) Creatinine: 4.39 (H) Glucose: 235 (H) Calcium: 9.1 Albumin: 3.5 EGFR, Black: 17 (L) EGFR, Non-Black: 15 (L) Anion Gap: 9 11/29/2021 07:10 Sodium: 137 Potassium: 5.6 (H) Chloride: 111 (H) CO2: 20 (L) Urea Nitrogen: 83 (H) Creatinine: 3.76 (H) Glucose: 191 (H) Calcium: 8.9 Albumin: 3.3 (L) EGFR, Black: 21 (L) EGFR, Non-Black: 18 (L) Anion Gap: 6 11/30/2021 07:27 Sodium: 137 Potassium: 4.9 Chloride: 110 (H) CO2: 20 (L) Urea Nitrogen: 81 (H) Creatinine: 3.22 (H) Glucose: 108 (H) Calcium: 8.8 Albumin: 3.2 (L) EGFR, Black: 25 (L) EGFR, Non-Black: 22 (L) Anion Gap: 8
CDC Split Type:

Write-up: Patient was admitted with acute renal failure, kidney biopsy showed Banff III TCMR in transplanted kidney. He is just over a year post kidney transplant. Patient got J&J 2nd vaccine on 16th and symptom of hematuria started on 11/17/21. Had received 1st dose in 3/2021 without any issues. Notably, one of his immunosuppression meds (cellcept) dose was reduced to 250mg BID recently for BKV viremia. There was no evidence of BKV in kidney biopsy. He had several triggers for rejection including CMV viremia few months back, BKV viremia, slightly decreased cellcept dose. But given temporal relation with vaccination with J&J, and the resultant severity of the rejection despite being on 2 other immunosuppression agents at good doses and no preceding DSA, raises the concern of if the vaccine had any role to play in triggering his immune system facilitating this degree of rejection. He is being treated for TCMR at this time.


VAERS ID: 1909384 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Pyrexia, Vaccination site erythema, Vaccination site swelling
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: Pradaxa, Potassium, Torsemide, Diltiazem, Lovastatin, Levothyroxin
Current Illness: None
Preexisting Conditions: Congestive heart failure, A-fib, HYPOTHYROIDISM, CORONARY ARTERY DISEASE
Allergies: Tylenol, Beta Adrenergic Blockers, Amiodarone Hydrochloride
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever - <101 degrees (more than 24 hours), swelling and redness at vaccination site (for 1 week), no appetite for 2 days. Treatment aspirin


VAERS ID: 1909539 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: She takes 2 vitamin gummies a day, occasionally a chewable grape kids melatonin at bedtime
Current Illness: Had a cold several weeks earlier
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I took her to the doctor on Friday, November 19th, there were no tests just a visual inspection.
CDC Split Type:

Write-up: Rash started chest, then spread front torso, neck, chin, ears, cheek. It appeared very similar to a scarlet fever rash, small red bumps, extremely itchy. It moves around her body in different places, flares up in water. I started with hydrocortisone cream, zyrtec and benadryl, that did not help, then she was given a topical steroid cream I don''t know which one, and now she is starting an oral steroid for 5 days. It is finally starting to dissipate, but she has itched herself so badly in places that it is now scabbing.


VAERS ID: 1909627 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-11-17
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Brain natriuretic peptide normal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Dyspnoea, Hypoxia, Lung disorder, Procalcitonin normal, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG tablet benzonatate (TESSALON) 100 MG capsule Calcium Carb
Current Illness:
Preexisting Conditions: Asthma Chronic obstructive pulmonary disease with acute exacerbation (HCC) Pneumonia due to COVID-19 virus Acute hypoxemic respiratory failure due to COVID-19 (HCC) Coronary artery disease Thoracic aneurysm without mention of rupture Hypertension CHF (congestive heart failure), HA class I, chronic, diastolic (HCC) Stenosis of left carotid artery Drug-induced constipation-opiate Class 2 obesity with body mass index (BMI) of 37.0 to 37.9 in adult Gastroesophageal reflux disease without esophagitis MRSA infection Pernicious anemia Fibromyalgia Chronic back pain Lumbar radiculopathy Type 2 diabetes mellitus with neurologic complication, without long-term current use of insulin (HCC) Hip pain, left Dry eye syndrome of both eyes Chronic abdominal pain Diabetic nephropathy associated with type 2 diabetes mellitus (HCC) Unspecified hypothyroidism Hyperlipidemia Diabetes mellitus (HCC)
Allergies: Penicillins Codeine Contrast Dye [Ivp Dye, Iodine Containing] Sulfa Drugs Celebrex [Celecoxib] Ciprofloxacin Dobutamine Doxepin Iodides Steroids Tylenol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 11/17/2021; COVID-19 positive 11/17/2021; fully vaccinated Discharge Physician: MD, MPH Primary Care Physician: MD Date of Admission: 11/17/2021, Hospital Day: 5 Discharge Date: 11/21/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19 HOSPITAL COURSE: 67-year-old female past medical history coronary artery disease s/p CABG, chronic obstructive pulmonary disease, chronic diastolic CHF presents with cough and shortness of breath. In the ER patient was 88% on room air and required 3L NC. She had fairly stable vitals and labs other than her hypoxia. BNP and procalcitonin were WNL. She had CXR showing Mild peripherally predominant bilateral airspace disease concerning for pneumonitis. She was wheezing in the ER and started on solumedrol and albuterol for her breathing. She will be admitted to the hospitalist service for further treatment of COVID pneumonia and COPD exacerbation. She was continued on dexamethasone and Remdesivir. Supplemental oxygen was continued and weaned as tolerated. Patient was continued on chronic obstructive pulmonary disease inhalers and other medications. Patient''s oxygen was weaned and home oxygen evaluation was performed by respiratory therapy. Patient qualified for 3 L supplemental oxygen with exertion. Inhalers were adjusted for chronic obstructive pulmonary disease. PT OT evaluated advised home with assist home health PT/OT. Case manager consulted to arrange for outpatient services and discharge planning. Patient clinically improved and hemodynamically stable for discharge. Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. She will continue 5 additional days of dexamethasone and antitussives as well as mucolytics. She will continue Lasix low-dose twice daily oral. Patient will continue adjusted inhaler regimen for chronic obstructive pulmonary disease. Patient voiced understanding was agreeable with plan of care discharge.


VAERS ID: 1909655 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: potassium chloride ER 10mEq (one daily) simvastatin tablets 20 mg (one daily) hydrochlorothiazide 25mg ( one-half tablet daily) vitamin D3 1,000 IU (two capsules daily)
Current Illness: none
Preexisting Conditions: high blood pressure high serum cholesterol
Allergies: penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Lymph node in my neck by my collar bone (left side) enlarged and very tender. (supraclavicular lymphadenopathy) Began the day following administration of COVID-19 booster at Pharmacy. Tenderness in lymph node and swelling lasted for several days. Back to normal in about one week from onset. No treatment administered. Did not contact pharmacy or doctor.


VAERS ID: 1909803 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Fatigue, Muscular weakness, Pain, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal 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: blood pressure meds; aspirin 81mg
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: no allergies
Diagnostic Lab Data: none so far
CDC Split Type:

Write-up: Shortness of breath, weakness, blurred vision, tiredness, generalized aches and pains, legs are tired


VAERS ID: 1909832 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: PT received her first dose of Pfizer covid 19 vaccine. While sitting in the lobby for her 15 minute observation period, she started to faint. Her mother was sitting next to her and immediately got our attention. We took her into the consultation room, put a fan on her and put cold compresses on her forehead and neck. She drank some orange juice and some water. She was feeling better after 10 minutes and was able to walk out on her own after 20 minutes. She had never fully lost consciousness. She had never fainted after receiving a vaccine in the past.


VAERS ID: 1909900 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-25
Onset:2021-11-17
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Neck pain, Oropharyngeal pain, Streptococcus test
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Arthritis (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: daily vitamins, levothyroxine, advir and zyrtec
Current Illness:
Preexisting Conditions: Asthma and history of thyroid cancer
Allergies: Soy, Gluten, Citrus, E-mycin, and adhesive
Diagnostic Lab Data: a rapid strep test
CDC Split Type:

Write-up: 2 and 1/2 weeks after getting the booster, I was super tired and had throat and neck pain. I went to my doctor. He tested me for strep throat.


VAERS ID: 1909965 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-15
Onset:2021-11-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cognitive disorder, Confusional state, Disorientation, Headache, Impaired driving ability, Mobility decreased, Mouth haemorrhage, Nausea, Visual impairment
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), 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: valtrex, fish oil, multivitamin,
Current Illness: none
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SEVERE HEADACH AND NAUSEA THAT MOVED TO COGNITIVE EFFECTS OF DISORIENTATION, VISUAL PROCESSING ISSUES, INABILITY TO DRIVE, DECREASE REACTION TIME, CONFUSION, BLEEDING ORAL MUCOSA. PATIENT DID NOT GO TO THE DOCTOR BUT DID TAKE ASPIRIN 81MG ONCE DAILY.


VAERS ID: 1909973 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: slight loss of hands with flu vaccine 3 years ago
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received booster dose at 3:37pm when should have received first dose in series. We identified and corrected by administering a second booster dose (i.e. qs to full first dose) at 5pm. Patient did not have any adverse events from this.


VAERS ID: 1910017 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-11-10
Onset:2021-11-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood glucose increased, Dehydration, Enuresis, Lethargy, Pollakiuria, Polydipsia, Type 1 diabetes mellitus, Vomiting, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Dehydration (narrow), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim
Diagnostic Lab Data: Poct glucose 600+
CDC Split Type:

Write-up: My son soon after getting the covid vaccine started loosing weight looking ill unhealthy has no preexisting illnesses. Started drinking nonstop and urinating way too often even wet the bed at 14 that?s very unusual and unusual for him? then on Monday the 22nd he started getting lethargic, vomiting, weak, dehydrated.. rushed him to hospital. He had a blood sugar of 800 and was diagnosed with type 1 diabetes.


VAERS ID: 1910236 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FN8030 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Back pain, Balance disorder, Blood fibrinogen, Blood lactate dehydrogenase, Burning sensation, C-reactive protein, Chest pain, Confusional state, Cough, Decreased activity, Decreased appetite, Diarrhoea, Differential white blood cell count, Dizziness, Fatigue, Fibrin D dimer, Full blood count, Headache, Hyperacusis, Hypersomnia, Influenza virus test negative, International normalised ratio, Irritability, Lethargy, Livedo reticularis, Loss of personal independence in daily activities, Metabolic function test, Mononucleosis heterophile test negative, Nasal congestion, Nausea, Neck pain, New daily persistent headache, Ocular hyperaemia, Oropharyngeal pain, Peripheral swelling, Photophobia, Prothrombin time, Red blood cell sedimentation rate, SARS-CoV-2 test negative, Serum ferritin, Thinking abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (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: 5mg Lexapro once daily 3mg Intuniv Q AM
Current Illness: None
Preexisting Conditions: Anxiety, ADD
Allergies: NKA
Diagnostic Lab Data: 11/24/21 Covid negative 11/30/21 Covid negative 11/30/21 Flu negative 11/30/21 mononucleosis negative 11/30/21 Labs drawn- CBC with diff, CMP, PT/INR, fibrinogen, d-dimer, CRP, ESR, ferritin, LDH. Results pending. There may have been additional labs drawn that MD office can provide information on.
CDC Split Type:

Write-up: Approximately 24 hours after vaccine On 11/-7/21, onset of debilitating headaches, extreme fatigue, dry non productive cough, sore throat, blood shot eyes, chest pain, lightheadedness, sensation of ?head feeling like it?s on fire?, mild confusion and decreased processing time, nausea, diarrhea, lethargy, back and neck pain , nasal confection? Irritability, Mottling and swelling in bilateral lower extremities, decreased appetite sensitivity to light and noise, decreased balance. Symptoms have progressively gotten worse. Daily headaches have become debilitation, sleeping excessive amounts of time and very limited tolerance to activity. Patient has been home from school and had abstained from sports since 11/18/21. 14 day course prophylactic Amoxicillin started 11/30/21. Referral to neurologist pending for imaging.


VAERS ID: 1910250 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Per mother hives on torso and neck started approximately 4 hours after Covid-19 vaccine. Mother gave oral benadryl. Hives continued off and on for 48 hours. Mother contacted pediatrician 48 hours after the hives started and physician advised to contiune oral benadryl. Hives subsided 72 hours after Covid 19 vaccine.


VAERS ID: 1910261 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-07
Onset:2021-11-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Rash, Urticaria, Viral infection
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: Prozac, Montelukast, Guanfacine, Concerta, Allertec
Current Illness: none
Preexisting Conditions: Asthma, ADHD, Anxiety
Allergies: NKA
Diagnostic Lab Data: Physical Only as of 11/30
CDC Split Type: vsafe

Write-up: 11/17 She broke out in hives and rashes. Was given Benadryl cream for 2 days and after the rash seem to reverse and come back in increasing time and severity. 11/19 Seen Pediatrician about rash and hives. After a physical exam it was determined to be a viral situation like chicken pox. Was advised to continue Zyrtec and Hydrocortisone cream. Will see pediatrician in a month if shows no signs of clearing up. Ongoing issue.


VAERS ID: 1910433 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 611F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Dizziness, Fatigue, Headache, Hypoaesthesia, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Fever 102 Severe body aches Tiredness Anorexia Nausea and vomiting Severe headache Dizziness Left arm numbness


VAERS ID: 1912134 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-21
Onset:2021-11-17
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013513A / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood iron, Full blood count, Heavy menstrual bleeding, Metabolic function test, Serum ferritin
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: Multivitamins daily
Current Illness: None
Preexisting Conditions: Low iron
Allergies: Penicillin (hives)
Diagnostic Lab Data: CBC, BMP, ferritin/iron labs 11/18/21
CDC Split Type:

Write-up: Noted with prolonged menstruation of over 10 days. Menstruation started on 11/7/21 and continued with moderate to heavy flow until provider visit on 11/18/21. Menstruation is usually regular (approximately 4-5 days total), occurs around the same time of the month (between 6th-8th of month). This is first time patient?s menstruation was longer than 5 days.


VAERS ID: 1912663 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-11-17
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0124 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

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

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

Write-up: positive covid test


VAERS ID: 1912665 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-14
Onset:2021-11-17
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METOPROLOL, HCTZ, LOSARTAN, OMEPRAZOLE, METFORMIN ASPIRIN, ATORVASTATIN
Current Illness:
Preexisting Conditions: CAD, HYPERTENSION, HYPERLIPIDEMIA,
Allergies: DEMEROL
Diagnostic Lab Data: POSITIVE COIVD AFTER FULLY VACCINATED
CDC Split Type:

Write-up: SORE THROAT, COUGH, HEADACHE,


VAERS ID: 1912680 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-25
Onset:2021-11-17
   Days after vaccination:296
Submitted: 0000-00-00
Entered: 2021-12-01
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


VAERS ID: 1912719 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-15
Onset:2021-11-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Ear pain, Extra dose administered, Eye irritation, Ocular discomfort, Ocular hyperaemia, Oropharyngeal pain, Sleep disorder, Vision blurred
SMQs:, Anaphylactic reaction (broad), 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), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nature thyroid, D3 with k2, magnesium glycenate, dhea 10mg, biest, testosterone, vitamin c, probiotics, b complex
Current Illness:
Preexisting Conditions: Scoliosis
Allergies:
Diagnostic Lab Data: Went to urgent care one week after receiving vaccine, before I realized this was a vaccine side effect. No diagnosis there outside of telling me I had a virus. Called my doctor to tell him I was having diverse reaction and was told to drink plenty of fluids and wait it out.
CDC Split Type:

Write-up: Two days after booster, I had a terrible earache and sore throat with difficulty swallowing. This was all on my left side. Three days later my eyes became red and irritated. I had terrible pressure in my eye along with blurred vision. I am now sixteen days post vaccine booster and my eye is still red and irritated with blurred vision. My earache comes and goes, but last night, I couldn?t sleep due to pain in left ear. I am concerned about my eyesight and long term effects. Also, I don?t know what to do about future boosters.


VAERS ID: 1912892 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not applicable. Dose administered too soon and medications at time of vaccination not necessary.
Current Illness: Not applicable. Dose administered too soon.
Preexisting Conditions: Not applicable. Dose administered too soon and chronic health conditions are not relevant.
Allergies: Not applicable. Dose administered too soon and previous ADRs do not add to assessment.
Diagnostic Lab Data: not applicable ? dose given too soon therefore no medical tests/lab results indicated
CDC Split Type:

Write-up: For unknown reason (not documented in chart) patient received the first Moderna COVID-19 Vaccine dose on 10/28/21 and the second dose of Moderna COVID-19 Vaccine on 11/17/21 which is earlier than 28 days and outside of the 4-day grace period. There were no adverse events associated with administration of the vaccine. Per CDC guidance, doses inadvertently administered earlier than the grace period should not be repeated.


VAERS ID: 1912944 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not applicable. Dose administered too soon and medications at time of vaccination not necessary.
Current Illness: Not applicable. Dose administered too soon.
Preexisting Conditions: Not applicable. Dose administered too soon and chronic health conditions are not relevant.
Allergies: Not applicable. Dose administered too soon and previous ADRs do not add to assessment.
Diagnostic Lab Data: not applicable ? dose given too soon therefore no medical tests/lab results indicated
CDC Split Type:

Write-up: Patient received the first Moderna COVID-19 Vaccine dose on 6/25/21 and the second dose of Moderna COVID-19 Vaccine on 7/23/21. For unknown reason (not documented in chart) patient also received a third booster dose on 11/17/21 which is 117 days after the second dose. The recommended waiting period between booster and second dose is 168 days (7 days/week x 4 weeks/month x 6 months). There were no adverse events associated with administration of the vaccine. Per CDC guidance, doses inadvertently administered earlier than the grace period should not be repeated.


VAERS ID: 1912962 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not applicable. Dose administered too soon and medications at time of vaccination not necessary.
Current Illness: Not applicable. Dose administered too soon
Preexisting Conditions: Not applicable. Dose administered too soon and chronic health conditions are not relevant.
Allergies: Not applicable. Dose administered too soon and previous ADRs do not add to assessment.
Diagnostic Lab Data: not applicable ? dose given too soon therefore no medical tests/lab results indicated
CDC Split Type:

Write-up: Patient received the first Pfizer COVID-19 Vaccine dose on 6/24/21 and the second dose of Pfizer COVID-19 Vaccine on 7/12/21. For unknown reason (not documented in chart) patient also received a third Moderna booster dose on 11/17/21 which is 128 days after the second dose. The recommended waiting period between booster and second dose is 168 days (7 days/week x 4 weeks/month x 6 months). There were no adverse events associated with administration of the vaccine. Per CDC guidance, doses inadvertently administered earlier than the grace period should not be repeated.


VAERS ID: 1912965 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Pityriasis rosea
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor 10mg, Vitamin D, Turmeric, MVI, Benadryl
Current Illness: none
Preexisting Conditions: hyperlipidemia
Allergies: NKDA, NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pityriasis Rosea


VAERS ID: 1912980 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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: imipramine, desmopressin
Current Illness:
Preexisting Conditions:
Allergies: Dust
Diagnostic Lab Data: none
CDC Split Type:

Write-up: wrong vaccine, patient was outside the age range for this vaccine


VAERS ID: 1913438 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-10-20
Onset:2021-11-17
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 7+ - / SYR

Administered by: Pharmacy       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No symptoms


VAERS ID: 1913457 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 LA / IM

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

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

Write-up: No adverse event. Booster dose was given too early. It was given 1 month after the second dose instead of 6 months after the second dose.


VAERS ID: 1913476 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: No Adverse event, Patient turned 12 on 11/01/2021 patient received a child dose of pfizer 5-11 instead of age appropriate dose


VAERS ID: 1913487 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-03
Onset:2021-11-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash, 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: trazodone zoloft
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: on and off rash, itching, hives


VAERS ID: 1913579 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Blood magnesium, Computerised tomogram, Differential white blood cell count, Facial paralysis, Full blood count, Magnetic resonance imaging, Metabolic function test, SARS-CoV-2 test, Troponin, Urine analysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: pantoprazole, famotidine, multi vitamin, CoQ10, bupropion, atorvastatin, Align probiotic, ASA 81mg, cetirizine, amlodipine-benazepril
Current Illness: GERD, seasonal allergies,
Preexisting Conditions: HTN, Sleep apnea, coronary atherosclerosis, hyperlipidemia, cardiac stent placement, osteopenia, venous insufficiency, myocardial infarction, lumbar stenosis, carotid artery disease
Allergies: Codeine, Ciprofloxacin, beta blockers
Diagnostic Lab Data: MRI 11/28/2021 CT Stroke protocol 11/28/2021 Labs: CMP, troponin, CBC with diff, urinalysis, magnesium, covid PCR
CDC Split Type:

Write-up: Facial paralysis, Bell''s palsy started the day after patient had her booster vaccine. She initially went to one Emergency Department and was worked up there, but not given steroids. She went to Emergency Department on 11/28/2021 and was placed in observation status. She was seen by a Hospitalist and a Neurologist. She had a MRI that was negative, so she was discharged home.


VAERS ID: 1913634 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 1 RA / IM

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

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

Write-up: Pt does not meet age requirement for Moderna vaccine. She should have received the Adult Pfizer.


VAERS ID: 1914227 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chills, Fatigue, Feeling abnormal, Fibrin D dimer normal, Insomnia, Laboratory test, Pain in extremity, Paraesthesia, Tremor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Just lab work - D-dimer test (results came back normal)
CDC Split Type:

Write-up: I feel off, not myself. I had chest pressure/heaviness. Hands shaking, tremors at times, internal trembling. Cold chills. Arm soreness. Insomnia. Lower body tingling. Extremely fatigued. Some issues are better some still continue.


VAERS ID: 1920021 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-11-17
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, Cough, Pyrexia, SARS-CoV-2 test positive, Viral infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 09/21 COVID-19 ANTIGEN BINAX result: not detected 09/21 COVID-19 MONT result: not detected 11/17 CXR impression: No acute disease is seen. Of note, plain radiography is insensitive for the detection of subtle groundglass opacities as can be seen in viral infection. 11/17 COVID swab, result: detected 11/17 SARS-COV-2 Variant Sequencing result: pending 11/26 COVID swab, result: detected
CDC Split Type:

Write-up: COVID infection following COVID vaccine series 04/12, Pfizer, dose #1 05/03, Pfizer, dose #2 09/21 COVID-19 ANTIGEN BINAX result: not detected 09/21 COVID-19 MONT result: not detected 11/17 pt cc: cough, fever exposure: unknown 11/17 CXR impression : No acute disease is seen. Of note, plain radiography is insensitive for the detection of subtle groundglass as can be seen in viral infection. 11/17 COVID swab, result: detected 11/17 SARS-COV-2 Variant Sequencing result: pending 11/26 COVID swab, result: detected


VAERS ID: 1920022 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-11-17
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Adrenal mass, Angiogram, Atelectasis, Blood fibrinogen increased, COVID-19, Chest X-ray abnormal, Confusional state, Fibrin D dimer increased, Lung consolidation, Lung opacity, Pleural effusion, Red blood cell sedimentation rate increased, SARS-CoV-2 test positive, Ultrasound Doppler normal
SMQs:, Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/17 pt admit medicine cc: confusion dx: LOS: 11/17 CXR impression Stable small right pleural effusion with increased right basilar opacity which may represent associated atelectasis or pneumonia. 11/17 COVID swab, result: detected 11/18 COVID swab, result: NOT detected 11/18 CTA PE impression: No pulmonary embolus. Small right pleural effusion with right basilar consolidation, likely compressive atelectasis. Left adrenal gland 3 cm nodule of indeterminate density. Consider comparison to prior outside imaging if available. Alternatively, recommend non urgent CT adrenal protocol. 11/19 FIBRINOGEN: 529 11/19 DDIMER: 1.34 11/19 ESR: 80 11/19 US DOPPLER impression: Bilateral lower extremity: patency and compressibility of the visualized portion of the deep venous system without evidence for thrombosis. Spectral waveform analysis: normal phasic flow and appropriate response to augmentation. Venous structures identified and cleared: Common femoral vein, femoral vein, and popliteal vein. No popliteal fossa cysts identified.
CDC Split Type:

Write-up: Narrative: COVID infection following COVID vaccine series 04/12, Moderna , dose #2 11/17 pt admit medicine cc: confusion dx: LOS: 11/17 CXR impression: Stable small right pleural effusion with increased right basilar opacity which may represent associated atelectasis or pneumonia. 11/17 pt cc: exposure: unknown 11/17 COVID swab, result: detected 11/18 COVID swab, result: NOT detected 11/18 CTA PE impression: No pulmonary embolus. Small right pleural effusion with right basilar consolidation, likely compressive atelectasis. Left adrenal gland 3 cm nodule of indeterminate density. Consider comparison to prior outside imaging if available. Alternatively, recommend non urgent CT adrenal protocol. 11/19 FIBRINOGEN: 529 11/19 DDIMER: 1.34 11/19 ESR: 80 11/19 US DOPPLER impression: Bilateral lower extremity: patency and compressibility of the visualized portion of the deep venous system without evidence for thrombosis. Spectral waveform analysis: normal phasic flow and appropriate response to augmentation. Venous structures identified and cleared: Common femoral vein, femoral vein, and popliteal vein. No popliteal fossa cysts identified.Bland


VAERS ID: 1915749 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-11-17
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Peripheral swelling, Vaccination site induration, Vaccination site pain, Vaccination site 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: her arm completely swelled up; the swelling has gone down but the circle with the fine bump is still there; headache that won''t go away; sensitive to the touch; formed another small swollen fine circle in that area; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (her arm completely swelled up), VACCINATION SITE INDURATION (the swelling has gone down but the circle with the fine bump is still there), HEADACHE (headache that won''t go away), VACCINATION SITE PAIN (sensitive to the touch) and VACCINATION SITE SWELLING (formed another small swollen fine circle in that area) in a 40-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 06-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 17-Nov-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Nov-2021, the patient experienced PERIPHERAL SWELLING (her arm completely swelled up), VACCINATION SITE INDURATION (the swelling has gone down but the circle with the fine bump is still there), HEADACHE (headache that won''t go away), VACCINATION SITE PAIN (sensitive to the touch) and VACCINATION SITE SWELLING (formed another small swollen fine circle in that area). In November 2021, PERIPHERAL SWELLING (her arm completely swelled up) and VACCINATION SITE SWELLING (formed another small swollen fine circle in that area) had resolved. At the time of the report, VACCINATION SITE INDURATION (the swelling has gone down but the circle with the fine bump is still there) and HEADACHE (headache that won''t go away) had not resolved and VACCINATION SITE PAIN (sensitive to the touch) outcome was unknown. No concomitant drugs were reported. No treatment drugs were reported.


VAERS ID: 1915936 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Axillary pain, Chills, Headache, Immunisation, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101621939

Write-up: This is a spontaneous report received from a non-contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 34 year-old female patient received bnt162b2 (BNT162B2), administered in arm right, administration date 17Nov2021 (Lot number: EW0196) at the age of 34 years as dose 3 (booster), single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Bnt162b2 (Dose Number: 1, Lot Number: EL3247), administration date: 03Mar2021, when the patient was 33 years old, for COVID-19 immunisation; Bnt162b2 (Dose Number: 2, Lot Number: EL3247), administration date: 24Mar2021, when the patient was 33 years old, for COVID-19 immunisation. The following information was reported: IMMUNISATION (non-serious) with onset 17Nov2021, outcome "unknown", described as "booster"; PAIN (non-serious), outcome "unknown", described as "Body aches"; ABDOMINAL PAIN UPPER (non-serious), outcome "unknown", described as "stomach pain"; PAIN IN EXTREMITY (non-serious), outcome "unknown", described as "sore arm"; AXILLARY PAIN (non-serious), outcome "unknown", described as "sore underarm"; HEADACHE (non-serious), outcome "unknown", described as "headache"; CHILLS (non-serious), outcome "unknown", described as "chills". No follow-up attempts are possible. No further information is expected.


VAERS ID: 1916438 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Child turned 12years old, 2 days before the school covid 19 vaccine clinic for 5-11 year olds. Child received the Pfizer 5-11 year old dose


VAERS ID: 1916585 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Mobility decreased, Pain, Pain in extremity
SMQs:, Parkinson-like events (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient stated that after receiving the vaccine, he had regular arm pain. The arm pain then radiated to his shoulder and eventually down to his elbow in the coming days. He is still experiencing pain from his shoulder to elbow and cannot lift his arm past his shoulder without severe pain.


VAERS ID: 1916596 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Fatigue, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None shared.
Current Illness: Did not disclose.
Preexisting Conditions: Did not disclose.
Allergies: None.
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Individual reported experiencing swelling to the left clavicle area 30 minutes after receiving the vaccination. She did not report it until today. She stated that the swelling subsided by Thanksgiving Day. She continues with lightheadness and fatigue.


VAERS ID: 1916818 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-11-17
   Days after vaccination:278
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patient was COVID positive on 11/17/2021. Because of this repeat COVID testing not obtain. She does not have respiratory symptoms, fever, or other symptoms suspicious for COVID-19. Patient was a transfer from a HCF. Vaccine Lot number not document in current EMR


VAERS ID: 1916893 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-30
Onset:2021-11-17
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site swelling, Laboratory test normal, Mechanical urticaria, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Climara Pro Patch for HRT
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin
Diagnostic Lab Data: multiple visits to urgent care, allergist, and primary care. Laborwork was done on 11/18/21 and all tests were negative.
CDC Split Type:

Write-up: 11 days after the vaccine I developed severe hives all over my body. Symptoms included swelling of site including inside ears, itching, redness, raised hives, and developed into dermatographia.


VAERS ID: 1917090 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-06
Onset:2021-11-17
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Urinary tract infection, Urine analysis abnormal
SMQs:

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: Multivitamins with omega 3
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to amoxicillin
Diagnostic Lab Data: Urine analysis
CDC Split Type: vsafe

Write-up: She suffered a UTI on the 17 of Nov and saw a physician on the 18th. They gave her nitrofurantoin 6mgs four times a day.


VAERS ID: 1917140 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 - / IM

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

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

Write-up: Administration error: Dose administered 11 days after the expiry date.


VAERS ID: 1917857 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-05
Onset:2021-11-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 1000mg twice a day Apri once a day Spinorolactone 50 mg once a day
Current Illness: PCOS
Preexisting Conditions: None
Allergies: Dust
Diagnostic Lab Data:
CDC Split Type:

Write-up: Urticaria 12 days following booster shot. Went to see an allergist today, possibly urticaria related to booster shot. Will start on prednisone and antihistamines.


VAERS ID: 1919333 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-06
Onset:2021-11-17
   Days after vaccination:315
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 - / OT

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

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

Write-up: itchy rash again in the same area as the second shot. At first it looked like welts and like mosquito bites. It was large but later flattened down.; This spontaneous case was reported by a consumer and describes the occurrence of RASH PRURITIC (itchy rash again in the same area as the second shot. At first it looked like welts and like mosquito bites. It was large but later flattened down.) in a 73-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 939905, 028L20A and 011J20A) for COVID-19 vaccination. No Medical History information was reported. On 06-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 10-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Nov-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced RASH PRURITIC (itchy rash again in the same area as the second shot. At first it looked like welts and like mosquito bites. It was large but later flattened down.). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) (topical) for Itchy rash, at an unspecified dose and frequency and HYDROCORTISONE at an unspecified dose and frequency. At the time of the report, RASH PRURITIC (itchy rash again in the same area as the second shot. At first it looked like welts and like mosquito bites. It was large but later flattened down.) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medication was reported. This case was linked to MOD-2021-395629 (Patient Link).


VAERS ID: 1919387 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-02
Onset:2021-11-17
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Diplopia, Hypoaesthesia, Strabismus, Vaccination complication
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Strabismus in here left eye; Seeing double vision; Numbness in her right side, her leg, her arm; The complications are also on the left side; This spontaneous case was reported by a consumer and describes the occurrence of DIPLOPIA (Seeing double vision), HYPOAESTHESIA (Numbness in her right side, her leg, her arm), VACCINATION COMPLICATION (The complications are also on the left side) and STRABISMUS (Strabismus in here left eye) in a 33-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 058E21A and 058E21A) for COVID-19 vaccination. No Medical History information was reported. On 02-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 04-Oct-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Nov-2021, the patient experienced DIPLOPIA (Seeing double vision), HYPOAESTHESIA (Numbness in her right side, her leg, her arm) and VACCINATION COMPLICATION (The complications are also on the left side). On 25-Nov-2021, the patient experienced STRABISMUS (Strabismus in here left eye). At the time of the report, DIPLOPIA (Seeing double vision), HYPOAESTHESIA (Numbness in her right side, her leg, her arm) and VACCINATION COMPLICATION (The complications are also on the left side) had not resolved and STRABISMUS (Strabismus in here left eye) outcome was unknown. No concomitant medications were provided. No treatment medications were reported. This case was linked to MOD-2021-396458 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 25-Nov-2021: follow up received on 25-nov-2021 contains significant information Event added.


VAERS ID: 1919450 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-08
Onset:2021-11-17
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 - / OT

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

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

Write-up: Hives all around the body; It is itchy; This spontaneous case was reported by a consumer and describes the occurrence of URTICARIA (Hives all around the body) and PRURITUS (It is itchy) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939906) for COVID-19 vaccination. Concurrent medical conditions included Anxiety. On 08-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Nov-2021, the patient experienced URTICARIA (Hives all around the body) and PRURITUS (It is itchy). At the time of the report, URTICARIA (Hives all around the body) and PRURITUS (It is itchy) outcome was unknown. Concomitant product use included medication for anxiety but not all the time. Treatment information included steroid and histamine.


VAERS ID: 1919645 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 2 RA / -

Administered by: Other       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101619288

Write-up: Major heart attack; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). A 43 year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), administered in arm right, administration date 16Nov2021 10:02 (Lot number: FH8027) at the age of 43 years as dose 2, single for covid-19 immunisation. The patient had no relevant medical history. There were no concomitant medications. Vaccination history included: Bnt162b2 (dose 1, Lot Number: FF2593), administration date: 26Oct2021, when the patient was 43 years old, for COVID-19 immunization, reaction(s): "pain in his arm", "carpal tunnel". The following information was reported: MYOCARDIAL INFARCTION (hospitalization, medically significant) with onset 17Nov2021, outcome "unknown", described as "Major heart attack". The patient was hospitalized for myocardial infarction (start date: 17Nov2021). The event "major heart attack" was evaluated at the emergency room visit. Follow-up attempts completed. No further information expected


VAERS ID: 1919659 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / OT

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Oropharyngeal pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Peanut allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101620883

Write-up: Right arm and leg pruritus; he was feeling hot; throat pain; dizziness; This is a spontaneous report received from a contactable reporter(s) (Other HCP). A 9- year-old male patient received Bnt162b2 (BNT162B2), intramuscular, administered in arm right, administration date 17Nov2021 14:29 (Lot number: FK5127) at the age of 9 years as dose 1, single for COVID-19 immunisation. Relevant medical history included: "known allergies: peanuts" (unspecified if ongoing). The patient''s concomitant medications were not reported. The following information was reported: pruritus (medically significant) with onset 17Nov2021 14:45, outcome "unknown", described as "Right arm and leg pruritus"; feeling hot (medically significant) with onset 17Nov2021 14:45, outcome "unknown", described as "he was feeling hot"; oropharyngeal pain (medically significant) with onset 17Nov2021 14:45, outcome "unknown", described as "throat pain"; dizziness (medically significant) with onset 17Nov2021 14:45, outcome "unknown", described as "dizziness". The events "right arm and leg pruritus", "he was feeling hot", "throat pain" and "dizziness" were evaluated at the emergency room visit. Therapeutic measures were taken as a result of pruritus, feeling hot, oropharyngeal pain, dizziness. Events details was reported as follow: The patient was vaccinated Pfizer-BionTech COVID-19 Vaccine at 14:29 17Nov2021. Around 14:40 the observation nurse noted that the patient was fanning himself. The patient complained that he was feeling hot, Right arm and leg pruritus, new "throat pain" and dizziness. The observation nurse and POD lead then called 9-1-1 at 14:45 and initiated the anaphylaxis protocol. An epipen JR was administered (Lot #LFN341) IM to right thigh at 14:51 and at 14:57 0.4ml of Diphenhydramine (lot # 080008) was administered IM to R Deltoid by Nurse withheld. EMS arrived at 14:58 and hand off occurred to the EMS crew at 14:59. Transport to the ER occured at 15:05. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: As per available information, the causal association between the reported events and the suspect drug BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1919696 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-15
Onset:2021-11-17
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211120; Test Name: SARS-Cov-2, RT-PCR; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101649129

Write-up: Positive COVID test; Positive COVID test; Headache; stuffy; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from product quality group. A 22 year-old male patient received bnt162b2 (BNT162B2), intramuscular, administered in arm left, administration date 15Apr2021 (Lot number: EP6955) at the age of 22 years as dose 2, single and intramuscular, administered in arm left, administration date 25Mar2021 (Lot number: EP6955) as dose 1, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: VACCINATION FAILURE (medically significant), COVID-19 (medically significant) all with onset 17Nov2021, outcome "recovering" and all described as "Positive COVID test"; HEADACHE (non-serious) with onset 17Nov2021, outcome "recovering", described as "Headache"; NASAL CONGESTION (non-serious) with onset 17Nov2021, outcome "recovering", described as "stuffy". The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (20Nov2021) positive, notes: Nasal Swab. The action taken for bnt162b2 was unknown. Therapeutic measures were not taken as a result of vaccination failure, covid-19, headache, nasal congestion. Clinical course: The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, was the patient was not diagnosed with COVID-19. Since the vaccination, the patient was tested for COVID-19.


VAERS ID: 1920215 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-10
Onset:2021-11-17
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, Computerised tomogram thorax, Cough, Hypoxia, Lung consolidation, Malaise, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, alendronate, bacitracin ointment PRN, Benadryl PRN, divalproex, docusate PRN, Hydrocortisone cream PRN, levothyroxine, loratadine, milk of mag PRN, risperidone, Trazodone
Current Illness:
Preexisting Conditions: seizures, developmental delay, hypothyroidism, nonverbal status, osteoporosis. Anemia, Anxiety disorder, Autism spectrum disorder, Cataracts, bilateral, Chronic periodontal disease, Hallux abducto valgus, bilateral, History of pica, Hypothyroid, Nonverbal, Osteoarthritis, Osteoporosis, Profound intellectual disabilities, and Seizures.
Allergies: Penicillins, zometa
Diagnostic Lab Data: 11/17/21 COVID 19: Positive 11/17/21 chest xray: normal 11/19/21 CT chest: Consolidated left lower lobe pneumonia new when compared to an April 24, 2015 study. The effusion seen on the prior study are now resolved.
CDC Split Type:

Write-up: Presented to ER on 11/17/21 with hypoxia noted at group home. Caretaker at the bedside provides all the history. Patient was diagnosed with COVID symptoms that have been present for approximately a week. He has been coughing, chest x-ray does not show any signs of infection. He presented to another hospital, did not have much of a workup. Diagnosed with COVID on 11/17/21. He drops down to below 90% on room air. The patient was treated with dexamethasone for COVID treatment protocols ( was outside the window for remdesivir therapy); empiric antibiotic therapy with ceftriaxone and azithromycin was also added to preclude a bacterial component to his disease. Patient improved over course of his hospital stay. He was ultimately discharged back to his group home residence on 11/23/2021.


VAERS ID: 1920251 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-11-17
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Dyspepsia, Fatigue, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg Oral TbEC Atenolol (TENORMIN) 50 mg Oral Tab Cholecalciferol, Vitamin D3, 1,000 unit Oral Tab GlipiZIDE (GLUCOTROL XL) 5 mg oral extended release tablet 24 HR Losartan (COZAAR) 50 mg
Current Illness:
Preexisting Conditions: Nephrolithiasis Hypertension Hypercholesteremia Type 2 diabetes mellitus Pancreatic lesion Choledocholithiasis Enlarged prostate Neurogenic bladder Trochanteric bursitis Cataract PVD of both eyes Hashimoto''s thyroiditis Pulmonary fibrosis Thrombocytopenia Primary hyperparathyroidism Parathyroid adenoma
Allergies: Lisinopril
Diagnostic Lab Data: POSITIVE COVID TEST 11/27/21
CDC Split Type:

Write-up: INGESTION, RHINORRHEA, AND COUGH, GENERALIZED WEAKNESS AND FATIGUE


VAERS ID: 1920326 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-15
Onset:2021-11-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Blister, Confusional state, Drug reaction with eosinophilia and systemic symptoms, Pain of skin, Pyrexia, Septic shock, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Toxic-septic shock conditions (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, cetirizine, dabigatran, levothyroxine, losartan, metformin, multivitamin, simvastatin, triamcinolone
Current Illness:
Preexisting Conditions: pulmonary embolism, type 2 diabetes mellitus, hypertension, hypothyroidism, mixed connective tissue disease, retinitis pigmentosa
Allergies: aspirin, hydrocodone, lisinopril, metoprolol, mushroom, naproxen, ondansetron, onion, oxycodone, sulfa, triamterene, hydrochlorothiazide
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: patient presented to another hospital two days after vaccination with confusion, word finding difficulties, and fever. Diagnosed with septic shock and started on antibiotics. Less than one day after initiation of antimicrobials patient was noted to have skin pain, large blisters, and sloughing. Patient transferred to current facility for diagnosis of DRESS syndrome.


VAERS ID: 1920423 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram abdomen, Diarrhoea, Hyperaesthesia, Pruritus, Skin burning sensation, Skin exfoliation, Stool analysis, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Heart murmur Chronic Asthma/non smokers COPD
Allergies: Anything with sulfa, latex, hydrocodon
Diagnostic Lab Data: Stool labs-11242021 Blood tests-11242021 CT Scan of stomach area-11242021
CDC Split Type:

Write-up: Around 8:00 PM on 11172021, my wife noticed hives between the legs, buttocks, arms, face and hands. The hives caused the skin to itch and burn turning into scales and lost of skin. The hands still feel burning at times and sensitive to touching objects. Around the 29 of November an onset of diarrhea started and persists today.


VAERS ID: 1920611 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-15
Onset:2021-11-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Blood test, Borrelia test negative, C-reactive protein normal, Full blood count normal, Haematocrit normal, Haemoglobin normal, Hypotonia, Platelet count normal, Red blood cell sedimentation rate increased, Synovitis, X-ray of pelvis and hip abnormal
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Osteonecrosis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (narrow), Tendinopathies and ligament disorders (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: none
Diagnostic Lab Data: 11/18/21 XRAY hip CBC - normal (WBC 6.5, h/h 12.3/35.5; plts337) ESR 26 CRP <3 LYME negative
CDC Split Type:

Write-up: 2 days after vaccine began to limp Pain in L hip Had evaluation at our office - Xray, blood work (CBC, ESR, CRP, Lyme) - consistent with Transient Synovitis Ibuprofen and rest and symptoms improved over the next 5-7 days.


VAERS ID: 1920693 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-13
Onset:2021-11-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: 4 days after the injection of the COV-PFR 10 into the upper left arm patient had an itchy red rash around the injection site. It was a mild rash that eventually went away. The oddity was it started days after the injection. I googled it and read articles on a website and the CDC website that said this was normal and to use a warm compress and OTC pain reliever. I used a warm wash cloth, applied calamine lotion and gave her 2 children''s ibuprofen for swelling. This helped and she was able to sleep.


VAERS ID: 1920837 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-18
Onset:2021-11-17
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

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

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

Write-up: . This case meets criteria for vaccine breakthrough review. SxS started 11/17, tested positive 11/22 (unknown where). Cough, SOB.


VAERS ID: 1920864 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-07
Onset:2021-11-17
   Days after vaccination:255
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Hypophagia, Sick relative
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: SOB, decreased PO intake, multiple family members ill


VAERS ID: 1920966 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-11
Onset:2021-11-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain, Clostridium difficile colitis, Clostridium difficile infection, Clostridium test positive, Colitis, Colitis ulcerative, Computerised tomogram abdomen abnormal, Condition aggravated, Diarrhoea, Diverticulitis, Stool analysis abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal ulceration (narrow), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir (ZOVIRAX) 400 MG tablet amLODIPine (NORVASC) 10 MG tablet aspirin 325 MG tablet atorvastatin (LIPITOR) 80 MG tablet B Complex Vitamins (VITAMIN B COMPLEX PO) Calcium Carb-Cholecalciferol (CALCIUM 600 + D PO) diclofenac sodium 1 %
Current Illness: NA
Preexisting Conditions: C. difficile colitis Ulcerative colitis Type 2 diabetes mellitus with complication, with long-term current use of insulin Vitreous degeneration Myopia Coronary artery disease Left bundle branch block Dyslipidemia Essential hypertension Ulcerative colitis Non-ischemic cardiomyopathy Grade I diastolic dysfunction Encounter for hydration prior to CT scan ICD (implantable cardioverter-defibrillator) in place Acute diverticulitis
Allergies: Ace InhibitorsCough Bystolic [Nebivolol]Dizziness TricorMyalgia Vancocin [Vancomycin]Other
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (not for COVID, but for diverticulitis and C. diff - 11.17.21) within 7 days of receiving vaccination. Admission Date: 11/17/2021 Discharge Date: Nov 21, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute diverticulitis Acute on chronic colitis Ulcerative colitis with complication, unspecified location HOSPITAL COURSE: 79 year old female with a history of ulcerative colitis who presented with 12 days of worsening diarrhea and left lower quadrant abdominal discomfort. Symptoms began after taking Keflex for a skin biopsy. In the emergency department she had CT imaging of her abdomen and pelvis showing colitis beginning in the transverse colon and into the sigmoid colon and also some component of diverticulitis in the sigmoid colon. Stool for C difficile toxin was positive. She was treated with oral vancomycin 125 mg q.i.d., Rocephin, and IV Flagyl for the diverticulitis. She had excellent improvement in her abdominal pain although she still had some diarrhea by discharge. Medications at discharge: 1. For diverticulitis take Keflex 500 mg 4 times daily and Flagyl 500 mg 3 times daily for 7 days to complete treatment. 2. For Clostridium difficile colitis take vancomycin liquid 125 mg 4 times daily for 10 days.


VAERS ID: 1921050 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Malaise, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type: vsafe

Write-up: AFTER THE SHOT I HAD SEVERE CHILLS, AND SEVERE HEADACHE AND HIGH FEVER. I DID NOT CONTACT ANY DOCTOR AND I JUST WENT TO BED. IT WENT AWAY AFTER 20 HOURS.


VAERS ID: 1921446 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-09
Onset:2021-11-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cutaneous vasculitis, Headache, Induration, Joint swelling, Nausea, Pain, Peripheral swelling, Rash, Rash erythematous, Urine analysis
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vasculitis (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Latex
Diagnostic Lab Data: Blood and urine tests, 12/2/21 and 12/3/21
CDC Split Type:

Write-up: Appearance of red spots on knees and lower legs on 11/17. Slight progression of spots on calves. Seemed like it was an allergic reaction to a newly purchased body wash. Discontinued use of body wash. On 11/26, I received intravenous toradol and reglan with oral meclizine and Benadryl to address a severe headache and nausea that started on 11/24 and would not subside. The red spots increased on 11/28 to my trunk, thighs, and elbows. The dermatologist did a biopsy and the results were returned today, 12/3. The spots have spread to my ankles and feet as well. I have been diagnosed with leukocytoclastic vasculitis. I started a regiment of prednisone today which will be scheduled to end in 5 weeks. Overall symptoms include hard red spots which turn reddish purple with long bouts of sitting or standing. My legs, ankles, and feet have swelling and throb. The swelling subsides significantly after sleeping for the night.


VAERS ID: 1922878 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Mississippi  
Vaccinated:0000-00-00
Onset:2021-11-17
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Dysgeusia, Pain, Pain in extremity
SMQs:, Taste and smell disorders (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sulfonamide allergy
Preexisting Conditions: Comments: No medication
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211205587

Write-up: BITTER TASTE IN MOUTH; STARTED HURTING ON LEGS, FEET, HEELS AND MUSCLES; STINGING ON LEFT ARM; This spontaneous report received from a patient concerned a 54 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: sulfonamide allergy, and other pre-existing medical conditions included: No medication. The patient experienced drug allergy when treated with thiamine hydrochloride, and tramadol. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 17-NOV-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 17-NOV-2021, the patient experienced stinging on left arm. On 18-NOV-2021, the patient experienced bitter taste in mouth. On 18-NOV-2021, the patient experienced started hurting on legs, feet, heels and muscles. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from bitter taste in mouth, and had not recovered from stinging on left arm, and started hurting on legs, feet, heels and muscles. This report was non-serious.


VAERS ID: 1922895 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Body temperature increased, Chest discomfort, Chills, Diarrhoea, Fatigue, Hyperhidrosis, Monoplegia, Vaccination site lymphadenopathy, Vaccination site swelling
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211117; Test Name: temperature; Result Unstructured Data: high
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: arm was paralyzed for 24 hours; sweats; temperature; diarrhea; pressure on chest; chills; instant swelling on left arm; inflammation on lymph node (side of throat); fatigue; This spontaneous case was reported by a consumer and describes the occurrence of MONOPLEGIA (arm was paralyzed for 24 hours), HYPERHIDROSIS (sweats), BODY TEMPERATURE INCREASED (temperature), DIARRHEA (diarrhea) and CHEST DISCOMFORT (pressure on chest) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Previously administered products included for Product used for unknown indication: J&J covid 19 vaccine (1st dose of J&J covid 19 vaccine) in April 2021. Past adverse reactions to the above products included No adverse event with J&J covid 19 vaccine. On 17-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Nov-2021, the patient experienced MONOPLEGIA (arm was paralyzed for 24 hours), HYPERHIDROSIS (sweats), BODY TEMPERATURE INCREASED (temperature), DIARRHEA (diarrhea), CHEST DISCOMFORT (pressure on chest), CHILLS (chills), VACCINATION SITE SWELLING (instant swelling on left arm), VACCINATION SITE LYMPHADENOPATHY (inflammation on lymph node (side of throat)) and FATIGUE (fatigue). At the time of the report, MONOPLEGIA (arm was paralyzed for 24 hours), HYPERHIDROSIS (sweats), BODY TEMPERATURE INCREASED (temperature), DIARRHEA (diarrhea), CHEST DISCOMFORT (pressure on chest), CHILLS (chills), VACCINATION SITE SWELLING (instant swelling on left arm), VACCINATION SITE LYMPHADENOPATHY (inflammation on lymph node (side of throat)) and FATIGUE (fatigue) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 17-Nov-2021, Body temperature: high (High) high. Concomitant medications was not reported. Treatment medications was not reported. Company comment: This case concerns a female with unknown age with no reported medical history , initially vaccinated with Johnson and Johnson Covid 19 vaccine , who experienced , non-serious , unexpected events of monoplegia , hyperhidrosis , body temperature increased, diarrhea, chest discomfort and non-serious , expected events of chills , vaccination site swelling, vaccination site lymphadenopathy and fatigue which occurred on the same day after vaccination with the booster dose of mRNA-1273 vaccine ( Moderna Covid 19 Vaccine ) . The re-challenge for this case is not applicable since the events occurred after the booster dose and no additional doses will be given and also the events outcome was reported as unknown. The benefit -risk relationship of mRNA -1273 ( Moderna Covid 19 Vaccine) is not affected by this report.; Sender''s Comments: This case concerns a female with unknown age with no reported medical history , initially vaccinated with Johnson and Johnson Covid 19 vaccine , who experienced , non-serious , unexpected events of monoplegia , hyperhidrosis , body temperature increased, diarrhea, chest discomfort and non-serious , expected events of chills , vaccination site swelling, vaccination site lymphadenopathy and fatigue which occurred on the same day after vaccination with the booster dose of mRNA-1273 vaccine ( Moderna Covid 19 Vaccine ) . The re-challenge for this case is not applicable since the events occurred after the booster dose and no additional doses will be given and also the events outcome was reported as unknown. The benefit -risk relationship of mRNA -1273 ( Moderna Covid 19 Vaccine) is not affected by this report.


VAERS ID: 1923240 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-11-17
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Chest discomfort, Dyspnoea, Palpitations, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3 1000 iu
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Covid-19 test negative
CDC Split Type:

Write-up: Heart palpitations, flutter, chest pressure, shortness of breath


VAERS ID: 1923342 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-04
Onset:2021-11-17
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW062 / 2 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 3 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Fatigue, Headache, Nausea, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative, Sneezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), 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: Extended Release Keppra 3 tablets at 750 mg in evening; 1 tablet in morning, 3000 total. Regular Keppra 1 tablet 250 mg in morning. Ferrous Sulfate (Iron), once daily [Nature Made is 65 mg / 325 Ferrous Sulfate] Lo Loestrin, once daily Vita
Current Illness: Rash / acne
Preexisting Conditions: Epilepsy, lack of sense of smell after Encephalitis many years ago.
Allergies: Phenytoin/ Dilantin (rash) generic Augmentin / amoxicillin clavulanate. (rash or hives) (Amoxicillin itself OK)
Diagnostic Lab Data: Covid test Nov. 26 negative.
CDC Split Type:

Write-up: Runny nose, sneezing, congestion, exhaustion, lack of appetite, headache for about a week, then serious diarrhea Nov. 24. Headache and diarrhea eased, but nausea, lack of appetite, exhaustion continued. Covid text on Nov. 26 negative.


VAERS ID: 1923622 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-12
Onset:2021-11-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Chest pain, Chills, Dyspnoea exertional, Electrocardiogram change, Fatigue, Fibrin D dimer normal, Heart rate increased, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cytomel, synthroid, vitamin D
Current Illness: None
Preexisting Conditions: Hashimoto?s thyroiditis
Allergies: Topical silver, tegaderm, ppd
Diagnostic Lab Data: EKG w some changes. Ddimer negative, echo and stress test ordered and not performed yet.
CDC Split Type:

Write-up: Initial fatigue and chills 18 hours after the dose. They subsided within 48 hours. Subsequently five days post vaccine palpitations, DOE, chest pain w any activity where heart rate went over 80. Symptom reached peak on days 9-10 post vaccine, and began dissipating slowly. Fatigue persisting now into week 4 post vaccine. Also BP elevated starting 5 days post vaccine until 3 days ago.


VAERS ID: 1923626 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-15
Onset:2021-11-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Tinnitus
SMQs:, Hearing impairment (narrow), Medication errors (narrow)

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

Write-up: Bilateral tinnitus began approximately 36 hours after receiving booster dose of Moderna vaccine. Has continued since November 15th , 2021.


VAERS ID: 1923797 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-05
Onset:2021-11-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin d, lexapro, levothyroxine, wellbutrin, biotin, oxybutinin
Current Illness: None
Preexisting Conditions: Hypothyroid, anxiety and depression
Allergies: Pcn
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Head to toe hives that began 11/17/21 and continue to this day. I''ve been to urgent care twice, two courses of steroids. I have an allergist and dermatologist appointments coming up.


VAERS ID: 1923836 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dysgeusia, Exercise tolerance decreased, Fatigue, Heart rate increased, Immediate post-injection reaction, Lymphadenopathy, Painful respiration
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Co-q-10 Curcumin Fish oil
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Metallic taste in mouth upon injection lasting several hours. Swollen lymph nodes in left armpit and around left shoulder for three weeks. Fatigue for one week. Higher resting heart rate (ongoing) Lower exercise capacity (ongoing) Chest discomfort with certain body positions (e.g., laying on side, taking deep breaths) (ongoing)


VAERS ID: 1924159 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-03
Onset:2021-11-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Allergy test, Headache, Hypertension, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Hypertension (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: All allergy panel None detected
CDC Split Type:

Write-up: Severe hives all over the body Severe headache High blood pressure


VAERS ID: 1924253 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-07
Onset:2021-11-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Laboratory test normal, Liver function test normal, Pruritus, Rash, Renal function test normal, Skin swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Kelnor Iron Vitamin b Multivitamin Omega Probiotic Mitochondria ATP Calcium magnesium
Current Illness: None
Preexisting Conditions: Celiac Hypothyroidism
Allergies: Gluten
Diagnostic Lab Data: Lab tests were done to check liver and kidney function. All results came back normal. I can provide pdfs of lab work if needed. Lab work was done 11/19 and 12/4.
CDC Split Type:

Write-up: My skin is very itchy. There is no rash, but when I itch my skin becomes red and swollen. Hives will appear after my skin is itched. I have seen the ER and an urgent care. They have given me prednisone which doesn?t really help. Zyrtec and Benadryl make me less itchy but the skin rash still appears if I itch. Eucerin / ice packs helps relieve itching once itched


VAERS ID: 1924684 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0172 / 3 LA / SC

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood test, Dizziness, Erythema, Fatigue, Headache, Lumbar puncture, Lymphadenopathy, Magnetic resonance imaging, Muscular weakness, Pyrexia, Scan with contrast, Tremor, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: peniciline - augementin- bactrin- amoxiciline
Diagnostic Lab Data: yes mri mri contrast lumbar punction blood test
CDC Split Type:

Write-up: nov 16/21 - vaccine -booster nov 17 - 18 red arm and glands under arm inchadas- fever nov 24-25-26 weak legs - nov 28- headache -vomit- dizzie- lef side body shake few minutes- weak legs special left side nov 28-dec 2- hospitalized dec 2 - dec 6 at home - tires weakness


VAERS ID: 1924741 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 3 LA / IM

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

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

Write-up: On November 18th, I developed hives on my stomach which started moving around to my legs, thighs, low back, hands and feet


VAERS ID: 1925044 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-15
Onset:2021-11-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Nausea, Nipple disorder, Pain in extremity, Pruritus, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: 11/17 symptoms began 48 hours after the vaccination. Patient''s arm was sore (left). Patient felt nauseous and did vomit for one week. Patient also has severe itching on her arm and upper chest specifically her nipple. Her nipples (both) are itchy and she has put lotion on her chest area but has not helped. Pt. has taken vitamin E capsules and cut them in half and placed on her nipples for relief for dryness. No trouble breathing, no chest pain. She has not yet seen a doctor yet but is going to see her PCP.


VAERS ID: 1925143 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-15
Onset:2021-11-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Blood test, Chest X-ray, Fatigue, Malaise, Neck pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (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: Adderall 10mg. Only partial dosage at time of booster, Valium 0.5mg. Only if absolutely necessary Norco. If needed Edarbi 40mg. Protonix 40mg, Prednisone 10mg. Provigil only minimal partial dosage at time of booster. Vitamin B, C, D, and He
Current Illness: Asthma, GERD, venous insufficiency in lower legs
Preexisting Conditions: Asthma, GERD, venous insufficiency in lower legs & C-diff.
Allergies: Garlic
Diagnostic Lab Data: On 12/3/2021 bloodwork; chest x-ray.
CDC Split Type:

Write-up: Very swollen, sore neck, shoulder, excessive fatigue, felt ill and very very weak.


VAERS ID: 1925311 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-12
Onset:2021-11-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blood test, Chest X-ray, Computerised tomogram, Nausea, Oesophageal disorder, Oral pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Just supplements: Multi Vitamin-Mineral, B Complex, Thyroid Support, Iron, Soy, Digestive Enzymes, Flax Oil, Vit. C and Bioflavonoids, Acidophilus, Vit. A
Current Illness: hypothroid systemic yeast infection Eagle Syndrome
Preexisting Conditions: see item 11
Allergies: Tylenol, Nizoral Slight allergies to potatoes, eggs, eggplant, shrimp, citrus,
Diagnostic Lab Data: as I related were done in the hospital ER on 11/17/21
CDC Split Type:

Write-up: Went to the ER with pain in abdomen, esophagus and mouth. Thought it was something I ate as I had been to a restaurant the night before. The ER did a chest xray, stomach cat scan and blood work. They could find nothing wrong and prescribed something for stomach cramps and nausea. I also went to the drugstore and purchased different kinds of indigestion products. Nothing was really working and I couldn''t eat much or sleep. I was reacting in an allergic manner to alot of things. Finally, I went back to the ER on 11/21/21 and told them I felt I was having many allergic reactions to my food in general and suspected the vaccine booster had put my immune system in overdrive. They gave me a steroid shot in the hip and an antihistamine and I felt like I was on the right track. I stepped my immune supplements and ate very carefully, but still wasn''t able to eat a regular sized meal until 4 days later. I am on the road to recovery, but now am having trouble with hyperthyroidism. The whole event really messed me up even I was having troubles to begin with, but nothing so extreme.


VAERS ID: 1925365 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-16
Onset:2021-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PF33026BD / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Condition aggravated, Dysgeusia, Heavy menstrual bleeding, Hypersensitivity, Lip swelling, Menstrual disorder, Menstruation irregular, Paraesthesia oral, Parosmia, Taste disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Fertility disorders (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: Synthroid for Hashimotos
Current Illness:
Preexisting Conditions: Hashimotos
Allergies: Allergic to Naproxen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Abnormal bleeding began the following morning after vaccination, on November 17th. It was not time for my cycle. Bleeding continued for approximately 7 days with the passing of clots. This was documented with my OBGYN. Taste became distorted on November 19th, three days after vaccination, and to date has gotten progressively worse. Taste and smell is that of a strong chemical. On and off chest pain has occurred over the course of the last 3 weeks. Lips are tingly and swollen on the left side, where prior allergic reactions have occurred.


VAERS ID: 1925368 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-28
Onset:2021-11-17
   Days after vaccination:262
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose increased, COVID-19, Chest X-ray abnormal, Chest pain, Computerised tomogram thorax normal, Cough, Dyspnoea, Electrocardiogram normal, Hypophagia, Interstitial lung disease, Laboratory test normal, SARS-CoV-1 test positive
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: loratadine (Claritin 10 mg): 10 mg 1 Tablet(s) Oral At Bedtime omeprazole (omeprazole 40 mg oral delayed release capsule): 40 mg 1 capsule(s) Oral bid losartan (losartan 100 mg): 100 mg 1 Tablet(s) Oral Daily albuterol
Current Illness: none known
Preexisting Conditions: Restrictive lung disease, CAD, cardiac stent
Allergies: Biaxin Latex PCN sulfa drugs Poison Ivy
Diagnostic Lab Data: SARS-CoV-1 by NAAT PCR, POSITIVE
CDC Split Type:

Write-up: Patient is a 70yo F who presented to the ER on 11/23 for worsening shortness of breath and chest pain after testing positive for COVID on 11/22. Symptoms onset 11/18. Chest pain workup reassuring (negative CT PE, EKG sinus rhythm with no ST or T wave elevations, CXR consistent with interstitial lung disease, labs WNL). While initially on RA, her oxygen requirements increased to 3L, so remdesivir and dexamethasone started. Oxygen was weaned as tolerated. Tessalon Perles given for cough. Patient weaned to room air. Oxygen walk test passed, no supplemental oxygen required. Overnight blood sugars elevated, no AG, negative BOB. Likely 2/2 dexamethasone and poor intake (crab salad). Recommend diabetes management with PCP. F/u with PCP within 1 week.


VAERS ID: 1925433 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33026BD / UNK UN / IM

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

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

Write-up: No adverse events noted. Pediatric formulation of COVID-19 vaccine inadvertently administered to 15 year old. In consultation with clinical director, a subsequent dose of the age appropriate formulation was administered 20 minutes later.


VAERS ID: 1925440 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33026BD / 3 RA / IM

Administered by: School       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? 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: No adverse events noted. 13 year old inadvertently administered a booster dose of Pfizer COVID-19 vaccine, which is only approved for 18+.


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