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

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



Case Details (Reverse Sorted by Onset Date)

This is page 57 out of 8,010

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VAERS ID: 1779230 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-13
Onset:2021-10-01
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, COVID-19, Confusional state, Dysarthria, Exposure to SARS-CoV-2, Fatigue, Hemiparesis, SARS-CoV-2 test positive, Slow response to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: At baseline he has some dysarthria/slurring of words and mild right sided hemiparesis. Son (who is a Firefighter) was called by his sister who arrived at pt''s house, where he found his father with delayed responsiveness, increased slurring/dysarthria, appearance of increased fatigue and confusion. He was then placed in ambulance - per son he cannot recall/remember if patient rhythm was Afibb when placed in ambulance. Son reports the patient did test positive for COVID 10/1/21 - the reason he was tested was because his daughter and son in law were both tested and symptomatic, and given the patient''s contact with them he too was tested. He has not exhibited any symptoms of shortness of breath or cough. Per son, reported that for the 2 days prior to his admission here his blood sugars were significantly elevated running in the "400s" consistently. Limited history obtained from patient, he responds with one word replies for majority of questioning, when asked if he has chest pain, shortness of breath, nausea, vomiting, abdominal pain he replies "no" to all.


VAERS ID: 1779332 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-17
Onset:2021-10-01
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / UNK - / -

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

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

Write-up: Covid positive contact with neighbor


VAERS ID: 1779341 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-25
Onset:2021-10-01
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1779362 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Bell's palsy, Eye irritation, Eyelid function disorder, Hypoaesthesia, Impaired work ability
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Corneal disorders (broad), Hearing impairment (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), 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: metformin, glipizide, amlodipine, omeprazole
Current Illness:
Preexisting Conditions: diabetes, hypertension
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: Vaccine recipient was vaccinated on 9/28/2021. Around bedtime on 10/1/2021, he noticed symptoms of numbness on the right side of his face. On 10/2/2021., he woke up and was unable brush his teeth. he noticed that his right face was numb and he could not close his right eye. He then went to urgent care and they diagnosed him with Bell''s Palsy. He is currently going to physical therapy. He currently cannot close is right eye completely at all. He has to sleep with an eye patch at night, sometimes he eye burns from keeping it open all the time. He was out of work for 1 week and returned to work on 10/12/2021.


VAERS ID: 1779380 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-04
Onset:2021-10-01
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Mental status changes
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Afib, Alzheimers dementia, chronic aphasia, hypercholesterolemia, BPH
Allergies: ragweed
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalizaton w/AMS


VAERS ID: 1779408 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-07
Onset:2021-10-01
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Confusional state
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient has a history of seizures, dementia, hypertension, and A. fib. (Patient''s second dose of Pfizer-BioNTech COVID-19 vaccination was on 4/28/2021, Lot # ER8735).
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presents for evaluation of worsening confusion. Patient comes from nursing home facility with confusion and worsened from from yesterday, along with worsening weakness.


VAERS ID: 1779443 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-14
Onset:2021-10-01
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / UNK - / -

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

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

Write-up: Covid positive household contact


VAERS ID: 1779452 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-12
Onset:2021-10-01
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol Tamsulosin Clopidogrel Ferrous Sulfate Amlodipine Clonidine Lisinopril Rosuvastatin Aspirin Fludrocortisone Glipizide
Current Illness:
Preexisting Conditions: DM, BPH, bilateral carotid artery stenosis, COPD, chronic disease anemia, CKD3b, HTN, HLD
Allergies: None
Diagnostic Lab Data: Positive COVID-19 test
CDC Split Type:

Write-up: Hospitalized for COVID-19 after COVID-19 vaccination


VAERS ID: 1779484 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-03
Onset:2021-10-01
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1779500 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-23
Onset:2021-10-01
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1779651 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-24
Onset:2021-10-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH RR2589 / 1 - / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: The following week exactly 7 days later, I broke out in full body hives. Blister looking bumps from my chest all the way down to my feet. I went to urgent care and told the provider I haven''t made any new changes, I hadn''t been anywhere new, ate anything new, used any new soaps or fragrance or been around anyone who had. I have no documented allergies. I asked if it could be vaccine related and told him that I got my first dose less than 7 days ago, and he said he has seen " a lot" of cases of hives within 1 week of the 1st covid shot.


VAERS ID: 1779658 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-12
Onset:2021-10-01
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Rash, Vaccine positive rechallenge
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nexium; Oxycodone; Zyrtec- allergy medication; Allegra - allergy medication; Coalase; Vitamin D; Vitamin B12
Current Illness: None
Preexisting Conditions: None
Allergies: Bacterium; Iv Contrast Dye; Flu vaccine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rashes occurred after the 1st dose and continued after 6 months after the second shot. Rash stomach on back. It would rotate from different spots of my back and stomach. Rashes topped in September.


VAERS ID: 1779681 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blindness, Cold sweat, Hyperhidrosis, Pupillary light reflex tests abnormal, Pupillary reflex impaired, Pupils unequal, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (narrow), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

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

Write-up: Within a minute of receiving the vaccine, the patient stated she was having blurred vision and feeling clammy. Patient was diaphoretic and stating her field of vision was black and she was unable to see anything. Blood pressure was 66/40. EMS was called. Left pupil was four times larger than the right with neither responsive to light. She was able to answer questions completely. She had no chest pain or shortness of breath. She was assisted into a wheelchair and transported to a room where she could lay flat. Five minutes later, blood pressure had increased to 106/58. Patient stated she was starting to regain some of her vision. She was assessed by EMS upon their arrival. This was her second dose, and she denied any issues with the first dose.


VAERS ID: 1782235 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-17
Onset:2021-10-01
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GL3802 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Hypertension Cardiovascular Disease Renal Disease Chronic Depression
Allergies: Unknown
Diagnostic Lab Data: Antigen Test administered on 10/01/2021 at Nursing Home.
CDC Split Type:

Write-up: Patient Contracted COVID-19


VAERS ID: 1782251 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-02
Onset:2021-10-01
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GL0140 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GL0140 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes, Hypertension, Cardiovascular Disease, Chronic Renal Disease.
Allergies: Unknown
Diagnostic Lab Data: Antigen Test administered on 10/02/2021 at Nursing Home.
CDC Split Type:

Write-up: Patient Contracted COVID-19.


VAERS ID: 1782319 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Private       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine, adderall, levothyroxine, nefedipine, , losartan, Linzess,ducosate sodium sennocide, vitamin D 3
Current Illness: None
Preexisting Conditions: Bipolar depression, high blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash turned to hives on back, chest, stomach, inner thighs. triage nurse said to take antihistamine which I did. It took two days to go away. Skin continued to itch 1 more day.


VAERS ID: 1782335 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-02-12
Onset:2021-10-01
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Exposure to SARS-CoV-2, Hypoxia, Oxygen saturation decreased, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MANA on 09/26/2021
CDC Split Type:

Write-up: 72-year-old female presents to the emergency room tonight complaining of cough congestion shortness of breath. Her symptoms started 5 days ago. She reports that 4 days ago she went to her primary care physician and was tested for COVID and was negative. She has not improved with her symptoms in fact she has gotten more short of breath so she returned today and today she tested positive. Due to her hypoxia she was referred to the emergency room. The patient did receive the vaccination for COVID in March. She has not had any treatment as an outpatient as today was the 1st day she has had a positive test. She is a nonsmoker. She does report having fever for the past 5 days intermittently. She reports that her granddaughter who she has been around tested positive 5 days ago. Review of Systems Constitutional: [Patient denies fever, chills, sweats, and weight changes.] Eyes: [Patient denies any visual symptoms] ENT: [No difficulties with hearing. No symptoms of rhinitis or sore throat.] Cardiovascular: [Patient denies any chest pain, palpitations, orthopnea, or PND.] Pulmonary: As in HPI Gastrointestinal: [No nausea, vomiting, diarrhea, constipation, abdominal pain, hematochezia, or melena.] GU: [No urinary hesitancy or dribbling. No nocturia or urinary frequency. No abnormal urethral discharge.] Musculoskeletal: [No myalgias or arthralgias. No hot, swollen joints.] Neurologic: [No headaches, no seizures. Patient denies numbness, tingling, or weakness on either side of the body. There are no visual symptoms.] Psychiatric: [Patient denies problems with mood disturbance or anxiety.] Endocrine: [No excessive urination or excessive thirst noted. No heat or cold intolerance. No weight gain or changes in skin or hair.] Dermatologic: [Patient denies any rashes or skin changes.] Physical Exam Vitals & Measurements HR: 94(Peripheral) HR: 94(Monitored) RR: 24 BP: 126/91 SpO2: 92% WT: 91 kg VITAL SIGN LAST CHARTED MINIMUM MAXIMUM Blood Pressure 126/91 (10/01 22:30) 86/59 (10/01 22:15) 198/94 (10/01 17:45) Heart Rate 94 (10/01 22:30) 79 (10/01 18:30) 108 (10/01 22:15) Respirations 24 (10/01 22:30) 18 (10/01 16:41) 32 (10/01 18:30) Temperature 100.1 (10/01 16:41) 100.1 (10/01 16:41) 100.1 (10/01 16:41) SpO2 92 (10/01 22:30) 81 (10/01 17:45) 99 (10/01 18:00) O2 Flow Rate 4 (10/01 18:00) 4 (10/01 18:00) 4 (10/01 18:00) Weight 91 (10/01 16:41) 91 (10/01 16:41) 91 (10/01 16:41) HOSPITAL COURSE: A 72-year-old female, primary care patient of Dr. presented to the emergency room with 5 days of symptoms of shortness of breath and cough. She was mildly hypoxemic in the emergency room. She was admitted, given dexamethasone and remdesivir. By hospital day #2, she was feeling markedly better, and was wishing to go home. She seemed very stable from an oxygen standpoint, did qualify for home oxygen with 2 L since she desaturated to 86% with ambulation. This was set up and she was felt to be stable for discharge home to complete a course of oral dexamethasone. She also had a followup scheduled the following day. DISCHARGE DISPOSITION: CONDITION: Stable and improved.


VAERS ID: 1782351 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-11
Onset:2021-10-01
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Condition aggravated, Cough, Cystic fibrosis, Dyspnoea, Oxygen saturation decreased, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Hospital Cystic Fibrosis Pneumonia Due To COVID-19 Respiratory Failure With Hypoxia Anemia Hyponatremia CO Hospital Cystic Fibrosis Pneumonia Due To COVID-19 Respiratory Failure With Hypoxia Anemia Hyponatremia COVID-19 Infection
Allergies: NKA
Diagnostic Lab Data: COVID + at outside facility, no record of this result on file as of yet.
CDC Split Type:

Write-up: CHIEF COMPLAINT/REASON FOR VISIT Fever (Pt covid positive 10/1. Pt reports temp of 105 at home today with SOB. Pt 88% on room air with EMS. temporal temp 40.4) HISTORY OF PRESENT ILLNESS He presents to the emergency by ambulance for a fever and shortness of breath. He states tonight the fever spiked and he was having a hard time taking a deep breath as it was triggering a cough. He called EMS and they treated him with IV acetaminophen and a DuoNeb during transport he is feeling a little better now. He 1st had symptoms of body aches and shortness of breath going back to September 24th after getting his influenza immunization on September 23rd. After having the symptoms persist for a week he got tested for CO CHIEF COMPLAINT/REASON FOR VISIT Fever (Pt covid positive 10/1. Pt reports temp of 105 at home today with SOB. Pt 88% on room air with EMS. temporal temp 40.4) HISTORY OF PRESENT ILLNESS He presents to the emergency by ambulance for a fever and shortness of breath. He states tonight the fever spiked and he was having a hard time taking a deep breath as it was triggering a cough. He called EMS and they treated him with IV acetaminophen and a DuoNeb during transport he is feeling a little better now. He 1st had symptoms of body aches and shortness of breath going back to September 24th after getting his influenza immunization on September 23rd. After having the symptoms persist for a week he got tested for COVID on October 1st and was positive. He has had intermittent fevers, body aches, weakness, cough, and shortness of breath. He states his pulse oximetry has gotten as low as 86%, but most the time has been in the 90s at home. He has cystic fibrosis and follows with the adult cystic fibrosis clinic at University Hospital. He has been in contact with them and they had him on what I believe was prednisone and is he has not fully improved they switched him to dexamethasone 6 mg, which he last took yesterday morning. Infectious diseases-focused impressions: 1. COVID-19 pneumonia with mild hypoxemic respiratory failure 2. Chronic cystic fibrosis 3. On empiric oral trimethoprim/sulfamethoxazole started by the patient''s local cystic fibrosis group 4. COVID 19 directed therapies: Currently dexamethasone plus remdesivir


VAERS ID: 1782381 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-10
Onset:2021-10-01
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Dyspnoea, Escherichia infection, Glycosylated haemoglobin decreased, Hepatic enzyme increased, Hyperglycaemia, Hypertension, Hypokalaemia, Hypoxia, Leukopenia, Obesity, Oedema, Oedema peripheral, Pyrexia, Rales, SARS-CoV-2 test positive, Type 2 diabetes mellitus, Urinary tract infection
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive for COVID-19 on 10/01/2021
CDC Split Type:

Write-up: 75-year-old female presents to the emergency room with complaint of cough fever shortness of breath. It is difficult to tell exactly how long symptoms have been present. She states 2 weeks off and on but at other times states that most of her symptoms have really only been worse for the past for 5 days. No diarrhea. Patient lives alone. She has tested positive for COVID tonight. She has had the vaccination. She knows of no exposure. Review of Systems Constitutional: [Patient denies fever, chills, sweats, and weight changes.] Eyes: [Patient denies any visual symptoms] ENT: [No difficulties with hearing. No symptoms of rhinitis or sore throat.] Cardiovascular: [Patient denies any chest pain, palpitations, orthopnea, or PND.] Pulmonary: As in HPI Gastrointestinal: [No nausea, vomiting, diarrhea, constipation, abdominal pain, hematochezia, or melena.] GU: [No urinary hesitancy or dribbling. No nocturia or urinary frequency. No abnormal urethral discharge.] Musculoskeletal: [No myalgias or arthralgias. No hot, swollen joints.] Neurologic: [No headaches, no seizures. Patient denies numbness, tingling, or weakness on either side of the body. There are no visual symptoms.] Psychiatric: [Patient denies problems with mood disturbance or anxiety.] Endocrine: [No excessive urination or excessive thirst noted. No heat or cold intolerance. No weight gain or changes in skin or hair.] Dermatologic: [Patient denies any rashes or skin changes.] Physical Exam Vitals & Measurements HR: 89(Peripheral) HR: 90(Monitored) RR: 17 BP: 155/80 SpO2: 95% WT: 114.9 kg VITAL SIGN LAST CHARTED MINIMUM MAXIMUM Blood Pressure 155/80 (10/01 21:15) 120/62 (10/01 20:15) 156/80 (10/01 19:15) Heart Rate 89 (10/01 21:15) 86 (10/01 20:45) 101 (10/01 18:20) Respirations 17 (10/01 21:15) 16 (10/01 20:30) 21 (10/01 19:10) Temperature 99.0 (10/01 18:20) 99.0 (10/01 18:20) 99.0 (10/01 18:20) SpO2 95 (10/01 21:15) 86 (10/01 19:10) 97 (10/01 20:30) O2 Flow Rate 2 (10/01 19:56) 2 (10/01 19:56) 2 (10/01 19:56) Weight 114.9 (10/01 18:20) 114.9 (10/01 18:20) 114.9 (10/01 18:20) General: Alert and oriented, No acute distress. Eye: Extraocular movements are intact. HENT: Normocephalic, Atraumatic. Neck: No jugular venous distention. Respiratory: Crackles bilaterally Cardiovascular: Normal rate, Regular rhythm. Gastrointestinal: Soft, Non-tender, Non-distended, Normal bowel sounds. Obesity Musculoskeletal: 4+ pitting pedal edema bilaterallyAdmitted with Principal Diagnosis of COVID-19 pneumonia, Hypoxemia, Acute on Chronic hypoxemic respiratory failure. Plan: Vaccinated: Yes Symptom onset: 9/17/21 Diagnosis: 10/1/21 Dexa day: 4 - wil complete 10 days at dc Symptom duration likely too long to benefit from remdesivir. She is on home oxygen 2 liters/minute while sleeping only, but she does not have tanks at home, will arrange home oxygen continuously at least for a few weeks... Diagnosis: COPD. Plan: No active wheezing. On Advair. Quit smoking in 1991 Diagnosis: Obesity. Diagnosis: E. coli UTI. Plan: Empiric ceftriaxone appropriate based on culture sensitivities, complete 3rd day here before dc. Diagnosis: Hypokalemia. Course: Improving. Diagnosis: Leukopenia. Plan: Likely from virus, monitor. Diagnosis: Hypertension. Course: Well controlled. Diagnosis: Elevated liver enzymes. Plan: Likely from virus Diagnosis: Type 2 diabetes mellitus with hyperglycemia. Plan: She says she has been diabetic for 15 years but has never required medicine, always controlled with lifestyle. Current flare likely from corticosteroid effect. Checked A1c. 6.2, will be off Dex in a week so will not rx further insulin at dc.


VAERS ID: 1782559 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Injection site pain, Interchange of vaccine products
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

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

Write-up: The patient received a 0.5 dose of Moderna on 10/01/2021 at 11:30am, the patient agreed to receive a Moderna Covid-19 vaccine. The patient''s state record chart showed he had received a Pfizer dose on 02/25/2021 . The patient agreed to receive the vaccine per provider recommendation. The patient reported having a tender and sore arm at the site after one hour had passed. No other side effects . Our Vaccine Coordinator was called and advised we report the incident.


VAERS ID: 1782667 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-13
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA173696 / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ 12.5mg, OTC: Vitamin B complex, Vitamin D3
Current Illness: none
Preexisting Conditions: Chronic sinusitis, hypertension
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: No adverse effects reported as of 1 hr after the 0.30 mL Pfizer dose was administered in error.. Of note, this individual has previously completed the Moderna vaccination series, with 1st dose on 1/25/21, and 2nd dose on 2/28/2021


VAERS ID: 1782822 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-12
Onset:2021-10-01
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abnormal loss of weight, Acute kidney injury, Acute respiratory failure, Ageusia, Anion gap, Blood calcium normal, Blood chloride decreased, Blood creatinine normal, Blood culture negative, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Blood urea nitrogen/creatinine ratio increased, COVID-19, COVID-19 pneumonia, Carbon dioxide increased, Chest X-ray abnormal, Chills, Condition aggravated, Coronary artery disease, Decreased appetite, Diastolic dysfunction, Early satiety, Ejection fraction normal, Glomerular filtration rate normal, Haematocrit normal, Haemoglobin normal, Headache, Hyperglycaemia, Intensive care, Lactic acidosis, Lung infiltration, Malnutrition, Nausea, Overweight, Platelet count normal, Productive cough, Pyrexia, SARS-CoV-2 test positive, Thrombocytopenia, Transaminases increased, Type 2 diabetes mellitus, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), 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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/1/2021 COVID-19 positive.
CDC Split Type:

Write-up: co illness onset 9/24, fever, chills, nausea, loss of appetite & taste, HA, cough. dx w covid 9/26. 9/29 had monoclonal antibodies, then to ED in BV, and was discharged on O2. today PCP. last ibuprofen at 0800 History of Present Illness Symptom onset 9/24 or 25, home test dx 9/26, then to ED - dxed, 9/29 monoclonal antibodies, sent home on O2. Went to PCP Dr. or least contacted him ?virtual visit? told to come to ED as pulse ox reading 80s despite being on oxygen Fever, HA, cough, somewhat productive but swallows sputum so hasn;t seen it. Fully vaccinated w Pfizer vaccine second shot in March. States had plans to get booster right before starting having these symptoms. Assessment/Plan 1. Pneumonia due to COVID-19 virus 2. Acute respiratory failure with hypoxemia symptom onset 9/25, s/p monoclonal antibodies, fully vaccinated second shot (Pfizer) in March, not received booster will start Dex, RDSV, Baricitinib as has many risk factors for worsening and already increased O2 needs, on 15L CXR looks more like left sided infiltrate and not severe at this point at least, repeat in am 3. Lactic acidosis he appears dry, mild AKI, urine concentrated, start fluids w LR 4. CAD (coronary artery disease) cont DAPT, statin 5. Hyperglycemia due to type 2 diabetes mellitus start basal-prandial insulin as CBGs expected to go up more with Dex 6. Transaminitis mild, not to where need to hold RDSV, baricitinib or statin but need followed 7. Thrombocytopenia no old labs to compare, ?due to COVID, will cont DAPT with CAD but hold off on adding chemical vte prophylaxis - recheck CBC in am Problem List/Past Medical History CAD HTN Dyslipidemia BPH Procedure/Surgical History CABG - Coronary artery bypass graft Hernia Stent Medications Inpatient acetaminophen, 650 mg= 2 tab(s), PO, q4hr, PRN albuterl inhaler, 2 puff(s), Inh, q4hrWA aspirin, 81 mg= 1 tab(s), PO, Daily atorvastatin, 40 mg= 1 tab(s), PO, at bedtime baricitinib, 4 mg= 2 tab(s), PO, Daily clopidogrel, 75 mg= 1 tab(s), PO, Daily dexamethasone, 6 mg= 1.5 mL, IV Push, Daily Dextrose 50%, 25 Gm= 50 mL, IV Push, as needed, PRN Insulin Corrective Scale Low Dose, Corrective Dose Scale 0-8 Units, Subcut, acTID insulin glargine, 10 unit(s), Subcut, wBKF insulin lispro, 3 unit(s)= 0.03 mL, Subcut, wMeals LR 1,000 mL, 1000 mL, IV melatonin, 5 mg= 1 tab(s), PO, at bedtime ondansetron, 4 mg= 1 tab(s), PO, q8hr, PRN ondansetr Pharmacy Consult COVID ICU Fluid Restriction - PIV, 1 EA, Misc, as directed Once Remdesivir additive + Normal Saline 250mL 250 mL Remdesivir additive + Normal Saline 250mL 250 mL Remdesivir additive + Normal Saline 250mL 250 mL Saline FLUSH Peripheral, 2.5 mL, IV Flush, BID tamsulosin, 0.4 mg= 1 cap(s), PO, at bedtime Currently hospitalized on 10/12:Length of stay: 12 Total Critical Care Days: 11 Subjective Chart reviewed. Patient is alert. He denies dyspnea. He does describe a productive cough. Taking p.o.. Patient does complain of anorexia. . Continued hospitalization due to: Current condition requires inpatient care. Objective VS/Measurements Vital Signs( 10/11/21 14:05:12 to current ) VITAL SIGN LAST CHARTED MINIMUM MAXIMUM Blood Pressure 104/67 (10/12 12:00) 97/45 (10/12 06:15) 151/78 (10/11 17:00) Heart Rate 85 (10/12 12:00) 57 (10/12 03:00) 97 (10/12 08:30) Respirations 28 (10/12 12:00) 17 (10/12 02:00) 42 (10/12 01:00) Temperature 96.5 (10/12 12:00) 96.5 (10/12 12:00) 97.4 (10/11 20:00) SpO2 100 (10/12 12:00) 84 (10/12 08:30) 100 (10/12 12:00) Oxygen Flow Rate 70 (10/12 12:00) 40 (10/11 15:46) 70 (10/12 12:00) Weight 79.6 (10/12 04:00) 79.6 (10/12 04:00) 79.6 (10/12 04:00) , Weight Measurements Current Weight Last Weight Weight Difference 79.6 kg 10/12/21 04:00 80.2 kg 10/11/21 05:52 -0.600 Current Weight Admission Weight Weight Difference 79.6 kg 10/12/21 04:00 86 kg 10/01/21 13:59 -6.400 Intake and Output I & O Summary - 24 Hour 0700-0659 Input: 10.50 ml Output: 1150.00 ml Balance: -1139.50 ml Stool Count: 0 I & O Summary - Full Visit Input: 8023.42 ml Output: 18480.00 ml Balance: -10456.58 ml Stool Count: 2 , I & O Detailed Summary - 24 Hour 0700-0659 INTAKE IV Volume Infused 10.50 ml Total 10.00 ml OUTPUT Urine Voided 1150.00 ml Total 1150.00 ml BALANCE: -1139.50 ml , I & O Summary - Full Visit Input: 8023.42 ml Output: 18480.00 ml Balance: -10456.58 ml Stool Count: 2 Physical Examination General: No acute distress. Eye: Normal conjunctiva. Sclera: Not icteric. HENT: Normocephalic. Neck: Supple. Trachea: Midline. Respiratory: Respirations are non-labored, Breath sounds are equal, Symmetrical chest wall expansion. Breath sounds: No rhonchi present, No wheezes present. Breath sounds: No crackles present. Cardiovascular: Normal rate, Regular rhythm, No murmur, No gallop, No edema, No Pericardial friction rub. Gastrointestinal: Soft, Non-tender, Non-distended, Normal bowel sounds. Integumentary: Warm, Dry. Neurologic: Alert, Oriented. Psychiatric: Cooperative, Appropriate mood & affect. Review / Management General Review: Rhythm Strip. Rhythm Strip Interpretation: I personally reviewed the study, Sinus rhythm. Ventilatory Support Basic Oxygen Information 10/12/2021 12:00 SpO2 100 % Oxygen Flow Rate 70 L/min Oxygen Therapy Nasal cannula, Humidification FIO2 100 % 10/11/2021 23:15 SpO2 96 % Oxygen Flow Rate 60 L/min Oxygen Therapy Nasal cannula, Humidification FIO2 100 % Laboratory Results: Basic Chemistry Result Sodium Level 136 mmol/L (10/12/21) Potassium Level 3.7 mmol/L (10/12/21) Chloride 92 mmol/L (10/12/21) - Low CO2 32 mmol/L (10/12/21) AGAP 12 mmol/L (10/12/21) BUN 43.9 mg/dL (10/12/21) - High Creatinine 1.1 mg/dL (10/12/21) BUN/Creat Ratio 40 (10/12/21) - High eGFR 61 mL/min/1.73m? (10/12/21) Glucose Level 75 mg/dL (10/12/21) Calcium 9.1 mg/dL (10/12/21) , , Basic Hematology Result WBC 16.53 K/mcL (10/12/21) - High Hgb 15.2 Gm/dL (10/12/21) Hct 44.9 % (10/12/21) Platelet 225 K/mcL (10/12/21) . Microbiology: Blood Cultures 10/1/2021 15:54 NEG Blood Culture 10/1/2021 15:50 NEG Blood Culture . Point of care testing: Diabetic View (FS) 10/12/2021 11:13 POC Glucose 154 mg/dL HI 10/12/2021 7:47 POC Glucose 87 mg/dL 10/12/2021 4:37 Glucose Level 75 mg/dL 10/11/2021 16:20 POC Glucose 343 mg/dL HI . Radiology results X-ray: Diagnostic Radiology (FS) : Diagnostic Radiology 10/12/2021 6:25 CDT XR Chest 1 View Radiology Report , I personally reviewed the study, Bilateral infiltrates either unchanged or slightly worse. Medication Review: Current Meds Reviewed, Home Meds Reviewed. DVTProphylaxis: Patient currently receiving: Lovenox. GI Prophylaxis: Patient currently receiving: Lansoprazole. Education and Follow-up: Counseled: Patient. Early Progressive Mobility Protocol (EPMP): EPMP Level: Level 3. Nutrition PO Nutrition ADLs 10/12/2021 12:00 Diet Type dental soft 10/12/2021 8:00 Breakfast Percent 15 % Nutrition Recommendations Malnutrition Diagnosis Malnutrition Severity: severe (10/11/21) Context: acute illness/ injury (10/11/21) Related to: poor appetite, respiratory status, early satiety (10/11/21) As evidenced by: unintended wt loss (10.9% x ~17), average intakes intakes provided <50% x1 wk prior to admit, skeletal muscle depletion (mild- 1 areas, moderate- 3 areas), subcutaneous fat loss (mild- 1 area), (10/1-10/1) avg provided 22% energy and 16% est protein needs (10/11/21) Progress: worsened (10/11/21) Dietitian Recommendations Oral 1: dental soft chopped, NCS, NAS (10/11/21) Supplement 1: Smoothie @ breakfast and dinner (10/11/21) Supplement 2: old fashioned shake @ lunch (10/11/21) Enteral 1: EN indicated as of 10/6, will be at refeeding risk. (10/11/21) Enteral 2: RD available PRN for recs if indicated MNT desired. (10/11/21) Enteral 3: . (10/11/21) Parenteral 1: TPN indicated if unable to obtain EN access as of 10/6 (10/11/21) Parenteral 2: . (10/11/21) Parenteral 3: . (10/11/21) Impression and Plan Diagnosis: Pneumonia due to COVID-19 virus. Course: Baricitinib day 9 of 14. Remdesivir day 5 of 5. Dexamethasone day 10 of 10. Plan: Continue to support. . Diagnosis: Acute respiratory failure with hypoxemia. Plan: Titrate O2 as we are able. Encourage self proning. . Diagnosis: Hyperglycemia due to type 2 diabetes mellitus. Plan: Sliding scale insulin . Diagnosis: Transaminitis. Plan: Most likely viral (COVID) induced . Diagnosis: CAD (coronary artery disease). Plan: ASA, Plavix, EF 70%. Probable diastolic dysfunction . Diagnosis: COPD. Plan: Scheduled bronchodilators . Diagnosis: Severe protein calorie malnutrition. Plan: Encourage p.o. intake . Diagnosis: Over weight BMI -26. Course: Unchanged, . Orders: Addendum: I discussed resuscitation status with the patient. He wishes to discuss this with his wife. We will speak again tomorrow..


VAERS ID: 1782865 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril atorvostatin colpidigrel amlodipine levothyroxin
Current Illness: none
Preexisting Conditions: copd
Allergies: none
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Shingles


VAERS ID: 1782876 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-25
Onset:2021-10-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Gait disturbance, Hypoaesthesia, Muscle spasms
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Patient reports chest pain last week, that has now resolved. Was seen by PCP as well. Currently reporting bilateral calf cramping that radiates to ankles, and difficulty ambulating as a result. Tenderness to ankle decreased with acetaminophen. Patient also reported R hand cramping and numbness. Patient encouraged to go to emergency room.


VAERS ID: 1783121 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-13
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 UN / IM

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

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

Write-up: ***VACCINE ERROR *** Patient came in with his daughter for a booster dose of Pfizer. All registration had been completed by the patient prior to arrival and the patient was requesting a Pfizer booster dose. Patients daughter and father verbally confirmed that the previous two doses were Pfizer vaccine to the receptionist and pharmacist. Pt did not provide CDC card. Pt and pt?s daughter dishonestly provided inaccurate information pertaining to the patients vaccine history on multiple occasions to numerous staff members. Upon receiving the Pfizer vaccine pt?s daughter admitted to deceiving staff so that her father would get the Pfizer. Pt did not have any adverse reactions, he waited 15 minutes and left. Staff immediately reached out to the CDC to get a response in regards to follow up or adverse effects. CDC advised there was no need for any follow ups and that there are no potential adverse effects of mixing vaccines.


VAERS ID: 1783186 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-12
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211AZ1A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Eye pain, Injected limb mobility decreased, Injection site pain, Joint swelling, Pain in extremity, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (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: Losartan, Zoloft, birth control pill (camrese Lo), Nature Made brand Super C
Current Illness: None
Preexisting Conditions: High cholesterol, back and hip pain, high blood pressure, endometriosis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: With 15 minutes of receiving the JandJ covid vaccine my left arm ached from my shoulder to my hand. I also had extremely blurry vision that lasted about 30 minutes. About 4 hours later I had pain behind my left eye. The next morning upon waking, my left arm, shoulder, and back of left leg ached. Could not use my left hand or arm to lift or hold. Left wrist and elbow swollen. Ached behind both eyes comes and goes.


VAERS ID: 1783196 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Disorientation, Erythema, Fatigue, Feeling abnormal, Hypersomnia, Hypoaesthesia, Pain, Piloerection, Pyrexia, Tremor, Vision blurred, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: Claritin, zinc, vitamin c & d, echinacea
Current Illness: None
Preexisting Conditions: Asthma
Allergies: sulfa, cephalosporin, Augmentin, neo/polymyxin, hydrocodone, narcotics, ibuprofen, codeine, Naprosyn, Flomax, contrast iodine, eggs, gluten, shellfish
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA 2:00am - severe vomiting that lasted for 6 hours and a fever 5:00am - fever 101.2 and severe body aches 6:00 fever 102 that wouldn''t break for 24 hours My body ached so badly, it felt like someone was cutting me open with razor blades, my fever went from 101-102 for 24 hours and would not break, vomiting for 6 hours - I couldn''t keep any food or liquids down, my pelvis to toes were completely numb - I couldn''t feel my legs at all for 24 hours, my vision was very blurry w/ extreme disorientation for 48 hours, extreme fatigue - I slept for 72 hours (awake maybe 5 of those hours), extreme chills, and body shakes for 48 hours. Big goosebumps all over my body and very red cheeks/forehead for 24 hours. Some of these symptoms lasted about a week after the vaccine (fatigue, soreness and brain fog)


VAERS ID: 1783613 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abscess jaw, Chills, Decreased appetite, Fatigue, Headache, Inflammation, Insomnia, Nausea, Pain, Pain in extremity, Pain in jaw, Pyrexia, Swelling face, Toothache, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
CDC Split Type:

Write-up: On Friday the 1st of October 2021 I woke up with a head ache and a sore arm so I took 2 Tylenol extra strength 500 mg for the pain. The head ache persisted but the soreness in the arm eventually subsided through out the day. By the evening my head ache got worse and I took 2 more Tylenol 500mg. On Saturday October 2 2021 I woke up with a worse headache with what felt like a tooth ache, I took 2 Advil since the Tylenol was not working and went about my day. By Saturday night the head ache became unbearable, blurred vision and throbbing in right jaw. I took 3 Aleve as the Tylenol and Advil wasn''t working. I was not able to sleep the night and woke up Sunday morning with a swollen face and sever pain. I spent the next day icing my face and taking pain killers. I went to my dentist and to the emergency room both who could not determine the cause. I was referred to a oral surgeon who found an abscess developing above my right jaw. I was immediately placed on antibiotics (amoxicillin) and 800 mg ibuprofen to reduce my fever, pain and inflammation. And went under for surgery A week later I''m still experiencing chills, head aches and neausea, loss of appetite and fatigue. I am due for the second shot soon


VAERS ID: 1783618 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-10-01
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Pain and soreness occurred at injection site 7 months after second dose given


VAERS ID: 1783793 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dehydration, Extra dose administered, Eye irritation, Fatigue, Hyperhidrosis, Impaired work ability, Lymph node pain, Malaise, Nausea, Pain, Palpitations, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Corneal disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Age 54, mild reaction to Pfizer Covid vaccine, see above
Other Medications: Clonidine Alopurinol Metformin Lasix Bystolic Flaxseed Oil
Current Illness: None
Preexisting Conditions: Type II diabetes Hypertension and arrhythmia (occasional) Gout (occasional)
Allergies: Penicillin ACE inhibitors ARBs
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I was told by the pharmacist that whatever side effects I had from my second shot would likely be the same for my booster, so that?s what I was expecting: extreme fatigue, chills and body aches. The majority of my symptoms began 24 hours after the booster. I wasn?t feeling well when I woke up the morning after but still went to work. By 10a I was feeling unwell enough that I had to leave and come home. I was very fatigued, achy, and my eyes burned like when you have the flu. By 5p I was exponentially worse. I had nausea and could barely get my evening pills down. The lymph nodes in my armpits, neck and inguinal region were very tender, nothing like I?ve ever experienced before in past illnesses. I ached from my toenails to the hair on my head. I took my temperature and it was 98.3, normal by medical standards though I usually run 96-97. By 8p I was vomiting and kept that up until I went to bed about 11p. I was so miserable I didn?t even have the energy to cry about it. At 2p I woke up with heart palpitations, I think, brought on by dehydration. I had completely soaked the sheets and pillow with sweat. I contemplated going to the ER to get rehydrated (I avoid hospitals and doctors so to even entertain this idea is a testament to my misery), but remembered it would cost me my deductible, so I laid back in bed, chilling in the sweat-soaked sheets waiting for the grim reaper. By 3a I suddenly turned the corner and felt maybe I might survive this. I didn?t ache as bad and could hold down sips of water. By 8a (Saturday) I was eating toast and by 7p collecting my sister from the airport. Back to 85% on Sunday and 100% on Tuesday. What a ride that was, but can?t say I regret getting the booster. I?m convinced now I?d die for sure if I caught Covid.


VAERS ID: 1784831 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Decreased appetite, Headache, 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: I was taking Ibuprofen, Lipitor, Cymbalta, Dosenax, Motrin and Flexerall.
Current Illness: I was not experiencing any illness.
Preexisting Conditions: I am borderline diabetic and mitral valve prolapse.
Allergies: I do not have any allergies.
Diagnostic Lab Data: I did not have any tests completed.
CDC Split Type: vsafe

Write-up: The night after receiving my vaccine, I had a fever of 101, I had chills, no appetite and a really bad headache. I called my doctor on 10/04 and scheduled an appointment. When I went in for my appointment, I did not have my fever anymore, but I still had all other symptoms. My doctor gave me off work and told me to take Emergen-C. As of today, everything is back to normal.


VAERS ID: 1784921 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-15
Onset:2021-10-01
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Thrombosis, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (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, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: copd
Allergies: full strength aspirin
Diagnostic Lab Data: blood test - bloodclot sonogram
CDC Split Type:

Write-up: bloodclot in upper right side


VAERS ID: 1784927 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adverse event, Chest discomfort, Dyspepsia, Full blood count normal, Gastrooesophageal reflux disease, Hiccups, Immediate post-injection reaction, Palpitations, Sinus bradycardia, Troponin normal
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Ragweed pollen
Diagnostic Lab Data: Troponin and CBC came back normal per PA documentation.
CDC Split Type:

Write-up: Chest discomfort and heart palpitations after getting the vaccine on October 1. Symptoms still present on October 6. Information from office visit on 10/6/21 Appointment with cardiology is scheduled for 1/11/22. Chief Complaint Patient presents with ? Gastrophageal Reflux patient states he received pfzier vaccine on Fri. states he started getting hiccups right away. felt indigested all night. states he has been feeling chest discomfort also Diagnoses and all orders for this visit: Chest pain, unspecified type - Electrocardiogram clinic - CBC and differential; Future; Expected date: 10/06/2021 - Troponin I; Future; Expected date: 10/06/2021 - Cancel: D-dimer, quantitative; Future; Expected date: 10/06/2021 - Ambulatory referral to Cardiology; Future Palpitations - CBC and differential; Future; Expected date: 10/06/2021 - Troponin I; Future; Expected date: 10/06/2021 - Ambulatory referral to Cardiology; Future Dyspepsia - omeprazole (PRILOSEC) 20 mg capsule; Take 1 capsule (20 mg total) by mouth 1 (one) time a day. May take twice daily if symptoms are severe. Adverse effect of COVID-19 vaccine - Ambulatory referral to Cardiology; Future -EKG shows sinus bradycardia (57bpm), otherwise no acute changes -vitals normal. Heart is RRR on exam -will order troponin I and CBC with diff. -will refer to cardiology to r/o myocarditis given he typically runs marathons. No running until cleared by cardiology. -Strict ER precautions discussed Follow-up prn.


VAERS ID: 1785030 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram head normal, Electroencephalogram normal, Movement disorder, Psychogenic movement disorder, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit B complex, Vit D, Welchol, Nexium, Zetia, metformin, lovaza
Current Illness: none
Preexisting Conditions: diabetes type 2, high cholesterol
Allergies: Percocet, cod fish
Diagnostic Lab Data: Basic serum tests, a Head CT, and an EEG were normal.
CDC Split Type:

Write-up: irregular tremor like movements that started the day after vaccination and worsened a few days later. They responded to benzodiazepines and he was discharged from the hospital. The clinical impression was that these movements were psychogenic.


VAERS ID: 1785149 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

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

Write-up: Began with tingling in left arm after administration. Developed in to numbness in all four extremities the day after administration.


VAERS ID: 1785237 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-02
Onset:2021-10-01
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID test
CDC Split Type:

Write-up: Breakthrough case


VAERS ID: 1785246 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-10-01
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Diarrhoea, Fatigue, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: FATIGUE, NAUSEA, DIARRHEA, NONPRODUCTIVE COUGH


VAERS ID: 1785413 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Rash, Rash erythematous
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, amlodipine, aspirin, calcium carbonate, cetirizine, b12, diphenhydramine-night before, docusate sodium, ergocalciferol high dose, fluticasone nasal spray, folic acid, losartan, MVI-AREDS2, Lutein/Zeanthin and additional MVI w/folat
Current Illness: none
Preexisting Conditions: GERD, dm 2, htn, hld, oa, glaucoma,vit b 12, vit d def, macrocytic anemia, allergic rhinitis , dry eyes, constipation, CKD 3
Allergies: lisinopril, naproxen, CHLOROXYLENOL, dexamethasone, nickel, tixocortol
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient reports rash on groin initially that progressed to her ankles and later noted on her arms/both upper and lower. Described as a numerous small patches with red bumps on the surface. Non pruritic.


VAERS ID: 1785446 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: furosemide 20mg qd, feso4 325mg qd, olanzepine 5mg bedtime, ergocalciferol cap 50,000 day, apixaban 5mg bid, lipitor 40mg day, senna 8.6 bedtime, metoprolol succinate er 100mg day, olanzipine 2.5mg day, protonix 40mg bid,
Current Illness: fracture right ribs, pneumothorax
Preexisting Conditions: kidney failure, chf, atrial fib, dysphagia, malnutrition, hyperlipidemia, schizoaffective disorder, anxiety, HTN, bipolar disorder, vascular dementia, diabetes, insomnia.
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: no adverse effects from vaccine . no symptoms


VAERS ID: 1785543 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Albumin urine, Blood creatine phosphokinase, Blood thyroid stimulating hormone, C-reactive protein increased, Creatinine urine, Fibrin D dimer, Full blood count, Hepatic enzyme, Lymphadenopathy, Metabolic function test, N-terminal prohormone brain natriuretic peptide, Oedema peripheral, Ultrasound Doppler, Ultrasound pelvis
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valacyclovir, topirimate, tizanidine, spirnolactone, cosentyx, topical salicylic acid, pramipexole, ondansetron, botox, hydroquinone topical, flucinolone topical, ferrous gluconate, ethinyl estradiol-northeindrone, escitalopram, colace, vit
Current Illness: none
Preexisting Conditions: anxiety, constipation, carpal tunnel syndrome, restless leg syndrome, low back pain, chronic neck pain, psoriatic arthritis, migraines, headaches
Allergies: Gabepentin
Diagnostic Lab Data: 10/2/21: cbc, D-Dimer, Comprehensive metabolic panel, liver enzymes, CRP high sensitivity, Creatinine Kinase, TSH 10/4/21 NT-proBNP, lower extremity venous duplex scan, 10/5/21 CBC, NT-pro BNP, Comprehensive metabolic panel, liver enzymes, urine microalbumin random, urine creatinine random, microalbumin/creatinine ratio 10/7/21 pelvic ultrasound
CDC Split Type:

Write-up: She developed significant lower extremity edema within 24 hours of COVID vaccination #3. She also had lymphadenopathy in her groin, and this was considered reactive from immunizaton and the primary cause of edema, as all other factors were excluded including DVT, heart and liver disease


VAERS ID: 1785590 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-09
Onset:2021-10-01
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: actos, glimepiride, gardience, libteroxin, omperazole, aspirin, losartan, amipine, potassium, metropzole, carbamazeime, ducalax, simtcione, loperamide, fiber, imodium
Current Illness:
Preexisting Conditions: chf, IBS, high blood pressure, anemic, hypothyroid, digenerative disc disease,
Allergies: Fish iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in knees. some swelling, and pain in lower legs. States MD ruled out blood clots


VAERS ID: 1785643 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin d hydrochlorothiazide motrin metoprolol tylenol
Current Illness: none
Preexisting Conditions: HTN heart murmur hip issues sleep apnea
Allergies: none
Diagnostic Lab Data: n/a advised to see pcp to rule out other neurologic dz
CDC Split Type:

Write-up: numbness and tingling to fingers to both hands started 2 days after vaccine administered and persists to today


VAERS ID: 1785737 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Heart attack/stroke like symptoms from Yellow Fever vaccine in 2010
Other Medications: Lisinopril Protonix Lexapro
Current Illness:
Preexisting Conditions: Sleep Apnea
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe dizziness Headaches Heart palpitations


VAERS ID: 1785758 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (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: 2nd Pfizer Covid-19 vaccine received 3-17-21, similar effects
Other Medications: Omeprazole, Citalopram, Vitamins C & D, Calcium
Current Illness: none
Preexisting Conditions: GERD, OSA
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Chills (2 hours) then headache, nausea and weakness (16 hours)


VAERS ID: 1785798 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-08
Onset:2021-10-01
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, COVID-19, Chills, Cough, Diarrhoea, Headache, Malaise, Myalgia, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Positive PCR Covid-19 test.
CDC Split Type:

Write-up: Complaint of cough, chills, elevated temperature, sore/scratchy throat, headache, runny nose/congestion, myalgia, malaise, and diarrhea.


VAERS ID: 1785799 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

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: Booster dose provided outside specifications of EUA (last updated September 22, 2021) Page 2 Booster Dose: A single Pfizer-BioNTech COVID-19 Vaccine booster dose (0.3 mL) may be administered intramuscularly at least 6 months after completing the primary series to individuals: ? 65 years of age and older ? 18 through 64 years of age at high risk of severe COVID-19 ? 18 through 64 years of age whose frequent institutional or occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of COVID-19 including severe COVID-19 First two doses 4/12/2021, 05/03/2021


VAERS ID: 1757202 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-29
Onset:2021-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Neuropathy peripheral, Palpitations, Pudendal canal syndrome
SMQs:, Peripheral neuropathy (narrow), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Immune-mediated/autoimmune 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: Estrogen Progesterone Thyroid
Current Illness:
Preexisting Conditions: Hashimotos
Allergies: Egg Dairy
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3 days post vaccine, I developed neuropathy in The soul of my right foot, my peri area and rectum/bladder. Fatigue, heart palpitations and racing heart started day 4 post vaccination,


VAERS ID: 1760882 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: BGJNJFOC20211004083

Write-up: PNEUMONIA; This spontaneous report received from a consumer concerned a 43-year-old female patient of unspecified race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration was not reported, batch number: unknown, and expiry: unknown) dose, start therapy date were not reported, 1 total, administered for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date (4-5 days after vaccination), the patient experienced difficulty in breathing, and chest pain (notable in the cardiac area). On 01-OCT-2021 (evening), the patient went to the emergency room and was diagnosed with pneumonia (unsure if covid-19 or not) and at that time, the patient''s heart was was found to be normal (reported as ''ok''). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of pneumonia was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20211004083-COVID-19 VACCINE AD26.COV2.S ?Pneumonia. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.


VAERS ID: 1764172 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Loss of consciousness, Malaise, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211004884

Write-up: PASSED OUT; FELT ILL; NAUSEOUS; This spontaneous report received from a consumer via a company representative concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, frequency 1 total, administered on 01-oct-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 01-Oct-2021, It was reported that after vaccination the patient felt nauseous and ill and passed out. The Strangers helped the patient and she was taken to the hospital. The patient was hospitalized for unspecified days. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the nauseous, felt ill and passed out was not reported. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20211004884- Covid-19 vaccine ad26.cov2.s- Passed out. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20211004884-COVID-19 VACCINE AD26.COV2.S- Nauseous, felt ill. This event(s) is labeled per regulatory authority and is therefore considered potentially related


VAERS ID: 1767125 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Back pain, Fatigue, Pain in extremity, Rhinitis, Rhinorrhoea
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Rhinitis, nasal flow, exhaustion, leg pain and joint pain, stomach discomfort, back pain. From the day of application until the moment of completing this form.


VAERS ID: 1777192 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 203S21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anosmia, Asthenia, Chills, Diarrhoea, Dizziness, Fall, Headache, Nausea, Pain in extremity, Pyrexia, Seizure, Thermal burn
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune 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: Medical History/Concurrent Conditions: COVID-19 (4 month ago, patient specified that it was very strong, but she recovered)
Allergies:
Diagnostic Lab Data:
CDC Split Type: COJNJFOC20211015099

Write-up: DIZZINESS; FELL AND GOT HIT; CHILLS; BURNED SKIN; COULDN?T SMELL ANYTHING; INTENSE HEADACHE; DIARRHEA; NAUSEA; FEELING OF WEAKNESS; FEELING OF CONVULSION; VERY HIGH FEVER FOR MANY HOURS; NORMAL ARM PAIN; This spontaneous report received from a patient concerned a 34 year old female of unspecified race and ethnicity. The patient''s height, and weight were not reported. Patient got infected with COVID-19 before 4 months ago. Patient specified that it was very strong, but she recovered. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203S21A, expiry: UNKNOWN) dose was not reported, 1 total administered on 04-OCT-2021 on left arm at approximately 14:00 for prophylactic vaccination. No concomitant medications were reported. On 04-OCT-2021, patient felt normal. At approximately 19:00 at night, patient began to feel a lot of chills, had an intense headache, and felt that she could not stand anything. She had diarrhea all the first night and she did not consume any food. The only drug administered was acetaminophen. Patient felt like burned skin and could not smell anything. On 05-OCT-2021, she could not go to work and the symptoms were until midday. Patient was so dizzy that she fell and got hit. Patient had fever which was very high for many hours (the temperature was not measured) and feeling of convulsion. On an unspecified date in OCT-2021, the patient had feeling of weakness, nausea and normal arm pain from vaccine. On 07-OCT-2021, patient still had nausea and no different signs, no bruises, no numbling. There was no doctor''s consult. She was very concerned about the symptoms, and older people or like her who had covid and if they would react as well as her. She was afraid that the mom will get vaccinated with vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from couldn''t smell anything, intense headache, very high fever for many hours, and diarrhea, had not recovered from dizziness, nausea, and feeling of weakness, and the outcome of chills, burned skin, feeling of convulsion, normal arm pain and fell and got hit was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20211015099-Covid-19 vaccine ad26.cov2.s- feeling of convulsion. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1780519 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-01
Onset:2021-10-01
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Acne, Rash, Swelling, Synovial cyst
SMQs:, Anaphylactic reaction (broad), Angioedema (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Allergies to cats and to graminians since a teenager
Diagnostic Lab Data:
CDC Split Type:

Write-up: A multitude of pimples and rashes on the back, arms and legs. He went to the emergency room and the nurse injected him with Urbason. It had no effect, as the pimples persist three days later (no more, no less). The pimples do not itch or hurt, they are just there, and they came out all of a sudden. She is a teacher and an autistic student scratched her a few days ago, causing a wound on her arm. The place where he made the wound became quite swollen and a ganglion in the neck also appeared swollen, which has already returned to its normal size. Now only the pimples persist, I don''t know if it has anything to do with it.


VAERS ID: 1782129 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Platelet count, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202110; Test Name: Platelet count; Result Unstructured Data: 3,000
CDC Split Type: BRJNJFOC20211017824

Write-up: THROMBOCYTOPENIA; This spontaneous report received from a patient via a company representative concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, 1 total, administered on OCT-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date in OCT-2021, the patient took the vaccine and was admitted to the ICU (intensive care unit) with thrombocytopenia with only 3000 platelets. The doctor had diagnosed it as vaccine reaction. Number of days of hospitalization was not reported. Laboratory data included: Platelet count (NR: not provided) 3, 000. The action taken with covid-19 vaccine ad26.cov2.s was not reported. The outcome of the thrombocytopenia was not reported. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20211017824-COVID-19 VACCINE AD26.COV2.S-Thrombocytopenia. This event is considered unassessable. The event has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.


VAERS ID: 1783239 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF822 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Blood test normal, Diarrhoea, Fatigue, Full blood count normal, Myalgia, Neck pain, Neuralgia, Pain in extremity, Pain in jaw, Sciatica, Temporomandibular joint syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Arthritis (narrow), Noninfectious diarrhoea (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: Heart and chest pain after first dose and injection site swelling
Other Medications: Paracetamol, Zinc, Vitamin C, Escitalopam 20mg, Vitamin D, Magnesium, vitamin B6
Current Illness: Digestive problems, anxiety, overweight, migraine
Preexisting Conditions:
Allergies: No
Diagnostic Lab Data: Blood count and type normal
CDC Split Type:

Write-up: Weakness, fatigue, extreme muscle, nerve and join pain, especially sciatic nerve, deltoid, jaw, his, legs pain, ankles, knees, hip joints, neck, TMJ, wrists, shoulders, diarrhoea lasting 2 weeks from vaccination.


VAERS ID: 1783334 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: DEJNJFOC20211021092

Write-up: MYOCARDITIS; This spontaneous report received from a consumer via regulatory authority (EVHUMAN Vaccines, DE-PEI-CADR2021187786) on 12-OCT-2021 concerned a 19 year old male of an unspecified race and ethnic origin. The patient''s weight was 60 kilograms, and height was 176 centimeters. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, subcutaneous, batch number: unknown, expiry: unknown) dose was not reported, 1 total, administered on 20-AUG-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 01-OCT-2021, the patient experienced myocarditis (evidence of acute myocarditis). On an unspecified date, patient was hospitalized for unspecified days. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from myocarditis. This report was serious (Hospitalization Caused / Prolonged).


VAERS ID: 1784349 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Cardiac arrest, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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: JPPFIZER INC202101302426

Write-up: Cardiac arrest; convulsion; poor physical condition; This is a spontaneous report from a contactable pharmacist via a Pfizer sales representative. A 32-year-old male patient received bnt162b2 (COVID-19 VACCINE - MANUFACTURER UNKNOWN), via an unspecified route of administration on 28Sep2021 (Batch/Lot number was not reported) as dose 2, 0.3 mL single for COVID-19 immunisation. Medical history and concomitant medications were not reported. The patient received the first vaccination of COVID-19 VACCINE on an unspecified date for COVID-19 immunization. On 01Oct2021 (3 days after second vaccination), the patient experienced cardiac arrest and convulsion. The course of the events were as follows: On 01Oct2021 around 06:00, the patient seemed to become poor physical condition. At that time, the patient also had the symptom of convulsion. In the morning, the patient was sent to the hospital for cardiac arrest. However, the place of inoculation was unknown. There was a high possibility to community, but the specific information had not been confirmed (as reported). The patient was recovering after taking emergency measures. The pharmacist considered the events as serious, life-threatening; and the causality between the suspect drug and event was related. The outcome of the events was recovering. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.; Sender''s Comments: Based on the information available, a possible contributory role of the suspect BNT162B2 cannot be excluded for the reported events of cardiac arrest and convulsion. The case will be reassessed once new information is available. 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: 1786607 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: Allergy NOS; Penicillin allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: IEJNJFOC20211024684

Write-up: BRUISING; This spontaneous report received from a consumer via Regulatory Authority (regulatory authority, IE-HPRA-2021-085173) on 12-OCT-2021 and concerned a 33 year old female. The patient''s weight was 63 kilograms, and height was not reported. The patient''s concurrent conditions included: allergy NOS (not otherwise specified), and penicillin allergy. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 2149-91 and expiry: unknown) dose was not reported, 01 total, administered on 17-AUG-2021 for Covid-19 immunisation. No concomitant medications were reported. On 01-OCT-2021, the patient experienced bruising (excessive bruising). The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of bruising was not reported. This report was serious (Other Medically Important Condition).


VAERS ID: 1787061 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20211025782

Write-up: FATIGUE; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA] concerned a 59 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 213C21A, and batch number: 213C21A expiry: UNKNOWN) dose was not reported, administered on 29-JUL-2021 for an unspecified indication. No concomitant medications were reported. On 01-OCT-2021, the patient experienced fatigue, and was hospitalized (date unspecified). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from fatigue. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20211025782-Covid-19 vaccine ad26.cov2.s-Fatigue. This event(s) is labeled per RSI and is therefore considered potentially related.


VAERS ID: 1787267 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Depression, Fatigue, Malaise, Pain, Pyrexia, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Depression (excl suicide and self injury) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211001; Test Name: Body temperature; Result Unstructured Data: 37.3 C
CDC Split Type: ROJNJFOC20211024412

Write-up: GENERAL BODY PAIN; FEVERISH; FATIGUE; TACHYCARDIA; GENERAL MALAISE; DEPRESSION; This spontaneous report received from a consumer via Regulatory Authority (RO-NMA-2021-SPCOV12790) on 12-OCT-2021 and concerned a 70 year old male. The patient''s weight was 80 kilograms, and height was 175 centimeters. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: XE389 and expiry: unknown) 1 dosage forms, 1 total administered on 26-SEP-2021 for covid-19 immunisation. No concomitant medications were reported. On 01-OCT-2021, the patient experienced general body pain, feverish, fatigue, tachycardia, general malaise and depression. Laboratory data included: Body temperature (NR: not provided) 37.3 Celsius . The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from general body pain, feverish, fatigue, tachycardia, general malaise, and depression. This report was serious (Disability Or Permanent Damage).


VAERS ID: 1747543 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-09-30
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Injection site induration, Injection site mass, Injection site pruritus, Injection site warmth, Menstrual disorder
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Itchiness & hives over entire body starting around June 23, 2021. Has not resolved yet, but severity has decreased. Never experi
Other Medications: Fexofenadine HCI 180mg, daily for allergies
Current Illness: Seasonal allergies
Preexisting Conditions: Ulcerative colitis (dx Dec 2001)
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Woke up on Sep 30, 2021 with a large swollen lump at injection site. Lump is hard, warm to the touch, and slightly itchy. No visible bite mark to suggest bug bite, and no recollection of incident that could have caused lump (e.g., no recent trauma to the area that could explain the lump). Unsure if related to AE, but started menstrual period on Sep 29, 2021. No lump has appeared at injection site during other menstrual periods between vaccine and now.


VAERS ID: 1747550 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Allopurinol, Losartan, Tamsulosin, Meloxicam, Metolazone, Indapamide, Bumetanide, Potassium, Magnesium, Vitamin D3, Multivitamin
Current Illness: None.
Preexisting Conditions: High blood pressure, Gout, Arthritis, obesity
Allergies: None known.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Appearance of blood in loose stool on waking.


VAERS ID: 1747759 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dysgeusia, Neck pain, Oropharyngeal pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

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

Write-up: Swelling and pain in neck, metallic taste, sore throat


VAERS ID: 1749317 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NONE LISTED / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest pain, Discomfort, Dyspnoea, Fatigue, Night sweats, Pain in extremity, Palpitations, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: About 30 minutes after receiving the shot, I was walking and felt a heaviness throughout my entire body starting from the top (face) all the way down to my toes. It felt as if I was walking in slow motion or in quicksand. I became extremely tired. For the next 5-6 days, I was weak with night sweats, pin-cushion like pains on my upper extremities, slight fever, fatigue, palpitations, shortness of breath and slight chest pain on the right side of my sternum. The palpitations were recurrent throughout the day and into the night.


VAERS ID: 1749320 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-01
Onset:2021-09-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins Migraine meds Albuterol
Current Illness: Migraines
Preexisting Conditions: Chronic migraine Asthma
Allergies: Contrast dye Bees Food coloring Preservatives Blood pressure pills
Diagnostic Lab Data: None yet .... this is less than 24 hours
CDC Split Type:

Write-up: Nausea Vomiting Migraine Fever Body aches Chills


VAERS ID: 1749330 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-19
Onset:2021-09-30
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 1 UN / UN

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

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

Write-up: hospitalization (non-ICU) Only one dose documented. Lot number/site not documented.


VAERS ID: 1749343 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-24
Onset:2021-09-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache
SMQs:, 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: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Shoulder soreness, fatigue, headache , treatment SIQ and tylenol


VAERS ID: 1749357 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Losartan, Fish Oil, Zoloft, Zocor, Calcium with Vitamin D and Multivitamin
Current Illness:
Preexisting Conditions: HTN, High Cholesterol
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID-19 after being fully vaccinated


VAERS ID: 1749369 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

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

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

Write-up: Woke up at 2 am with 102.5 degree fever. Fever persisting


VAERS ID: 1749376 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155NA / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Iritis . age 51 shingles : shringrex 9/23/19 and age 52 for second dose 12/27/19. Both occasions were about one week after admin
Other Medications: Xyzal and airborne and vitamin D3
Current Illness: None
Preexisting Conditions: Seasonal allergies
Allergies: Penicillin and oxycodone
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Pain under arm of injection site (left) noticed upon waking up. Ibuprofen taken orally


VAERS ID: 1749383 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Headache, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin and probiotics
Current Illness: No
Preexisting Conditions: No
Allergies: Gluten and corn
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Running a fever, dizzy and headache, slight itchy tightness in lungs


VAERS ID: 1749390 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Injection site swelling, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: moderna dose 2
Other Medications: fluoxetine, buspirone, wellbutrin, daily multivitamin, birth control, allergy otc pill
Current Illness: none
Preexisting Conditions: depression, anxiety, mild obesity, type 2 diabetes, borderline high blood pressure
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: severe body aches, swelling at injection site, exhaustion. began about 12 hours after shot was administered.


VAERS ID: 1749408 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vaccine given after 6 hour time frame so was expired.


VAERS ID: 1749448 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Hyperhidrosis, Loss of consciousness, Nausea, Pain in extremity, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Dizziness, blacking out, fainted and was unconscious for several minutes, Profuse sweating, chills, nausea, arm pain, headache, fever.


VAERS ID: 1749457 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, 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? 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: N/A
CDC Split Type: 71925

Write-up: Patient fainted after receiving the vaccine. Staff gave water, monitored heart rate, oxygen level and took blood pressure Q15 minutes. Patient stated they forgot to tell us that they faint during some medical procedures especially after seeing blood. Patient returned to baseline approximately 30 mins after fainting. Color was good 99% oxygen pulse 67 BPM 12 blood pressure was 130/70. Offered an ambulance - patient declined, offered to take patient to the emergency department patient declined. Offered to drive patient home and patient accepted. Patient was dropped at residence with a friend meeting there. Patient was counseled on adverse affects to look for and to call 911 or go to the emergency room if condition got worse.


VAERS ID: 1749501 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine Lexapro Olmestaran
Current Illness: High blood pressure
Preexisting Conditions: Depression
Allergies: Milk. Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen armpit on left arm


VAERS ID: 1749515 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Above average soreness in shoulder around the injection site but no other side effects


VAERS ID: 1749534 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (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: Vistaril Tylenol Ibuprofen
Current Illness: Right eye pain s/p assault
Preexisting Conditions: Anxiety, sleep difficulty, reports temporal lobe seizure history
Allergies: Mayonnaise
Diagnostic Lab Data: EKG performed by emergency medical personnel.
CDC Split Type:

Write-up: A few minutes after the vaccine administration (0815) patient reported he was having blurred vision, was also feeling light-headed. BP was 79/41, HR in 40''s. Supportive care provided to patient, oral fluids given. Patient became less unresponsive, but maintained airway and respirations. Patient was also assisted to lay down. At 09:24, patient became more alert. EMS was called and patient was also evaluated by our MD. He returned to baseline and did not require transportation to the hospital.


VAERS ID: 1749541 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LOT NOT KNOWN / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Diarrhoea, Erythema, Fatigue, Headache, Injection site pain, Malaise, Myalgia, Pain in extremity, Pyrexia, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Arm pain, injection site pain, tiredness, headache, muscle pain, chills, joint pain, fever (100.6), swelling, redness, feeling unwell, decreased appetite, diarrhea TREATMENT: 2 Ibuprofin OUTCOME Feeling better, decreased fever


VAERS ID: 1749575 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 LA / IM

Administered by: Private       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? 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: booster not approved for Moderna booster in nonimmunocompromised patients


VAERS ID: 1749589 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chills, Headache, Injection site pain, Pain, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-Vitamin, Vitamin C, Garlic, Vitamin E, Vitamin D, collagen
Current Illness: none
Preexisting Conditions: asthma, eczema, allergic rhinitis, dysplastic nevi
Allergies: cats, pollen, mold, dust mites, grass, penicillin, bee stings, dairy, gluten, seafood, monosodium glutamate, citric acid, nitrates, aspartame, BHT, benzoates, autolyzed yeast extract
Diagnostic Lab Data: Not applicable, under 24 hours.
CDC Split Type:

Write-up: hives/rash, tightness in chest, headache, fever, chills, body aches, soreness at injection site


VAERS ID: 1749597 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / UNK RA / IM

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

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

Write-up: Patient was not on scheduled list today. Approached this writer and staff asking for his second vaccine. He stated he received his first dose of Pfizer in July at Pharmacy. Staff screened patient, and asked him again if he received a first dose of Pfizer. Patient stated he had received Pfizer. Second dose was given. After returning to office and entering dose in system it was discovered patient had actually received Moderna vaccine in July. Staff of jail advised.


VAERS ID: 1749600 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Hypoaesthesia, Hypoaesthesia oral, Mobility decreased, Pain in extremity, Paraesthesia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: 9/29/2021 10:23pm shot done 10:33pm pain right side of chest Tongue numb. 10:43pm arm pain and numbness 11:00pm blurred vision 11:26pm chills 9/30 8:30am woke up. Arm numb. Can?t lift to chest 10:20am entire body tingling Face numb


VAERS ID: 1749601 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3813 / 3 LA / IM

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

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

Write-up: pt given 3rd dose Pfizer after having a primary series of Moderna. No issues post vaccination


VAERS ID: 1749603 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 RA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. 1772583-07299 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Injection site swelling, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: Seasonal allergies Asthma-controlled
Allergies: NKDA NKFA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Swollen injection site-9/30 Painful injection site-9/30 nausea-9/30 dizzy-9/30


VAERS ID: 1749613 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Pain in extremity, Vaccination complication
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NKDA
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: PATIENT CAME IN MORNING OF 9/30/2021 TO REPORT ADVESE EVENT FROM PFIZER VACCINE. SHE REPORTS THAT SHE IS HAVING PAIN UP AND DOWN HER ARM. SHE IS CONCERNED ABOUT THE BRUISE ON HER ARM. SHE IS ALSO CONCERNED THAT THE SHOT WAS GIVEN TO LOW. SHE WAS ADVISED TO GO THE URGENT CARE NEXT DOOR AND HAVE THEM CHECK HER OUT. SHE DID GO TO THE URGENT CARE NEXT DOOR.


VAERS ID: 1749614 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: My left armpit is very tender and sore to touch. Right arm unremarkable.


VAERS ID: 1749636 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-06
Onset:2021-09-30
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO153 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Menstrual disorder, Oligomenorrhoea
SMQs:, Fertility disorders (broad)

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

Write-up: Three cycles after my shot (approximately 90 days), my periods began to last 11-12 days, the flow was abnormal, and they began being 30+ days apart. For 5+ years they have been 28 days apart on the dot, exactly 7 days with the same flow. Although I have PCOS, nothing in that condition has changed and have had no significant changes in my diet, exercise or stress levels - nothing that would cause my period to change after being the same for years.


VAERS ID: 1749654 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad)

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

Write-up: After receiving the vaccine the patient stood and walked to the restroom, she returned minutes later reporting feeling light headed. Sweaty and eyes fluttering. Assisted to sit in chair. BP checked 73/39. 911 called at patients request.


VAERS ID: 1749667 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

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

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

Write-up: Inmate previously received COVID vaccine, accepted second Janssen knowing this information.


VAERS ID: 1749689 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-19
Onset:2021-09-30
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Sofia Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient was vaccinated on 12/29/2020 and 1/19/2021, so was fully vaccinated when testing positive for COVID-19 on 9/30/21.


VAERS ID: 1749706 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 3 RA / IM

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

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

Write-up: Patient was given the wrong booster dose. Patient was supposed to receive a booster dose for Moderna but instead received a booster dose of Pfizer which was the incorrect completion of his series.


VAERS ID: 1749736 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Extra Strength Tylenol prn
Current Illness: None
Preexisting Conditions: Congenital Cataract Chronic Migraine Headache Depressive Disorder Anxiety Disorder
Allergies: Droperidol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Asked patient to stay 30 minutes post vaccine for observation. At 10 minutes after vaccine she notified RN that she was having chest pain. The pain increased and she was administered Epinephrine 0.3ml. FiO2 per mask given. No loss of consciousness,. Medical response team notified. Transferred to ED. O2 sat 100% and Systolic BP 146 at time of transfer.


VAERS ID: 1749738 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Wolf parkinson''s white, heart arrhythmia, weakened immune system, cerebral palsy
Allergies: Sulfameth, orange roughy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, headache, body aches


VAERS ID: 1749741 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-18
Onset:2021-09-30
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: Sep 11, 2021@13:19:16 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: Covid 19 screening


VAERS ID: 1749743 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

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

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

Write-up: Patient lost consciousness and required direct aid from RPH. EMS was activated and had to escort the patient. No Epi-Pen or CPR was needed, the patient regained consciousness within 2 minutes.


VAERS ID: 1749763 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014G21A / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 UN / IM

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

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

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: Moderna COVID-19 Vaccine EUA Patient received Pfizer COVID vaccine on 4/22/2021 from medical clinic per wallet card. Patient received the Moderna vaccine on 5/13/2021 from Pharmacy and 9/30/2021 from Pharmacy


VAERS ID: 1749767 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822794 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

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

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

Write-up: Patient was given one dose of the Pfizer vaccine today but we did not realize that he had already received a J&J vaccine in April 2021 in his home country. Patient does not currently report any side effects.


VAERS ID: 1749769 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-27
Onset:2021-09-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 RA / SYR

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

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

Write-up: Red, itchy area at the injection site with lump under the skin


VAERS ID: 1749788 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pfizer Covid-19 Vaccine
Current Illness: Unknown
Preexisting Conditions: unknown
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was checked in and registered for his first dose of the pfizer vaccine but after the administration upon recording it was discovered this was his third dose. He had gotten his second dose on 9/20/21


VAERS ID: 1749801 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Patient believed to have received 0.30mL of the 0.45mL undiluted covid-19 vaccine.


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