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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 57 out of 4,799

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VAERS ID: 1437222 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: Site: Bruising at Injection Site-Medium, Site: Redness at Injection Site-Medium


VAERS ID: 1437294 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Military       Purchased by: ?
Symptoms: C-reactive protein increased, Chest discomfort, Electrocardiogram abnormal, General symptom, Pericarditis, Pleuritic pain
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Development of pleuritic, positional chest discomfort, friction rub on auscultation, ECG with diffuse ST elevations, elevated CRP consistent with a diagnosis of acute pericarditis


VAERS ID: 1437349 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 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: progesterone HRT; Folic acid
Current Illness: denied
Preexisting Conditions: denied
Allergies: Amoxicillin
Diagnostic Lab Data: PE
CDC Split Type:

Write-up: Right cervical Shingles; treated with antiviral meds


VAERS ID: 1437476 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-23
Onset:2021-06-26
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ischaemic stroke
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow)

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

Write-up: I63.9 - Acute ischemic stroke (CMS/HCC)


VAERS ID: 1437628 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-13
Onset:2021-06-26
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OC7C21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood lactate dehydrogenase, Differential white blood cell count, Full blood count, HIV test, Hepatitis viral test, Immune thrombocytopenia, Petechiae, Platelet count decreased, Platelet transfusion, Rash, Red blood cell analysis
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide (25 MG tablet), Amlodopine (5 MG tablet), Citalopram (10 MG tablet) . One A Day Daily Vitamins, Vitamin C, Vitamin D, B-12,
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Several tests ran on 6/26/2021 and 6/27/2021. CBC and Differential, Megaloblastic Anemia Panel, LDH, Hepatitis Panel, HIV 1/O/2, Extra PST - Light Green Lihep Breaker, Slide Manual Review, B Negative Blood type.
CDC Split Type:

Write-up: I was diagnosed with Accute IPT - platelet count dropped to 10,000 and was hospitalized for 2 days. Also, noted petechial rash in bilateral lower extremities. I received Platelet infusions. I quite smoking in 2003 - over 18 years ago.


VAERS ID: 1437631 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

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

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

Write-up: Error: Improper storage (temperature).


VAERS ID: 1437635 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 2 AR / IM

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

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

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


VAERS ID: 1437641 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

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

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

Write-up: Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Weakness-Medium, Additional Details: pain in right leg shooting down entire leg and numbness in right foot


VAERS ID: 1437655 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-01
Onset:2021-06-26
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 AR / IM
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Deep vein thrombosis, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: asa metoprolol achiphex zocor
Current Illness: no
Preexisting Conditions: htn pvd dl
Allergies: nkda
Diagnostic Lab Data: CT with PE 6/29/21
CDC Split Type:

Write-up: DVT/PE 3 months after 2nd vaccine


VAERS ID: 1437666 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Epistaxis, Laboratory test
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: albuterol HFA 90 mcg/actuation inhaler, 4 puffs inhaled four times a day AND every 4 hours as needed for wheezing, cough. fluticasone furoate (ARNUITY ELLIPTA) 100 mcg/actuation dsdv, Inhale 1 Puff into lungs once a day. DM/pseudoephed/acet
Current Illness: asthma
Preexisting Conditions: asthma
Allergies: Omnipaque 300; Bactrim; Sulfa
Diagnostic Lab Data: Easy WOB on exam, abdomen soft and non-tender. Well-appearing. Labs are reassuring- no evidence of microcytic anemia (iron deficiency), normal coags and transaminases. Reassured patient. Minimal bruising- typical of active 19 yo F.
CDC Split Type:

Write-up: Pt. came to hospital with scatter bruising to legs noticed after COVID vaccine on Saturday. Nose bleeds since COVID vaccine. Had one in the hospital, but no more were reported.


VAERS ID: 1437739 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: rash to arm


VAERS ID: 1437857 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia
SMQs:, Taste and smell disorders (narrow), 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: Loestrin FE
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Experiencing loss of smell and taste, which started 24 hours or so after the vaccine and progressively getting worse (at day 5 now)


VAERS ID: 1437868 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / IM

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

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

Write-up: PATIENT IS 17 YEARS OLD. HE WAS INADVERTENTLY GIVEN THE JANSSEN COVID-19 VACCINE BY THE CERTIFIED MEDICAL ASSISTANT. ERROR WAS NOTED IMMEDIATELY AFTER ADMINISTRATION. PATIENT AND MOTHER WERE BOTH NOTIFIED. PATIENT WAS OBSERVED AND DID NOT HAVE ANY ADVERSE EFFECTS. WAS INFORMED OF WHEN TO SEEK MEDICAL ASSISTANCE IF NEEDED.


VAERS ID: 1437879 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown - Nothing listed on form
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: No Adverse Events


VAERS ID: 1437899 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-24
Onset:2021-06-26
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 UN / IM

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

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

Write-up: Patient was seen on 6/25/21 by PCP and diagnosed with Shingles (Herpes Zoster).


VAERS ID: 1437943 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-26
Onset:2021-06-26
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Atrial fibrillation, Blood test normal, Electrocardiogram abnormal
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Actos, Toujeo, Trulicity, Xigduo, Crestor, Zetia, Lovaza, Metoprolol, Benicar, Norvasc, HCTZ, Zyloprim, Protonix, Pepcid, Testosterone, Xalatan, aspirin, Zyrtec, primrose oil, Centrum Silver, Os-Cal+D
Current Illness: None
Preexisting Conditions: Diabetes, High Cholesterol, High Triglycerides, Heart blockages, Carotid blockages, High blood pressure, Gout, acid reflux, low testosterone, glaucoma, seasonal allergies, gastroparesis
Allergies: None
Diagnostic Lab Data: EKG - several on 6/26 - All showed that I was in AFib. Blood work on 6/26 - Not having a heart attack.
CDC Split Type:

Write-up: Atrial fibrillation with RVR I woke up on 6/26/2021 in AFib. Went to the ER and they confirmed that I was in AFib. I was given Metoprolol through IV to lower my heart rate and they also doubled the Metoprolol prescription that I was taking. They added Eliquis to keep me from having blood clots and a stroke. I was admitted to the hospital overnight. The AFib began about 1:00 am on 6/26 and it went back to normal sinus rhythm about 10:00 pm on 6/26. I was released from the hospital the following day. I have an appointment with my cardiologist (listed above) on 7/9/21. I do not know if the AFib will return or how long I will need to remain on the new prescriptions.


VAERS ID: 1438061 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: enalapril 20 mg, Hydrocodone 10/325 mg, metformin 500 mg, Prozac 20 mg
Current Illness: none
Preexisting Conditions: diabetes, HTN, Depression
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Rash on right upper arm. Swelling of right upper arm.


VAERS ID: 1438226 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT STATED FEELING EXHAUSTED TWO DAYS AFTER THE SECOND SHOT OF MODERNA. ADDITIONALLY, SHE REPORTED OF HAVING LOW GRADE FEVER (98-99 F). TOOK TYLENOL AND REPORTED OF FEELING A LITTLE BIT BETTER. DENIES SHORTNESS OF BREATH, CHEST PAIN, NAUSEA NOR VOMITTING.


VAERS ID: 1438459 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abortion spontaneous, Arthralgia, Blood test, Chills, Exposure during pregnancy, Headache, Muscle spasms, Myalgia, Pyrexia, Ultrasound scan, Vaginal haemorrhage
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Eosinophilic pneumonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins, D3 vitamin, B12 vitamin
Current Illness:
Preexisting Conditions: hEDS, Atrial septal defect (repaired three years ago), raynaud''s syndrome
Allergies: Zithromax, kiwi, monistat, triple antibiotic
Diagnostic Lab Data: Ultrasound, exam and blood work 6/26/21 Blood work 6/31/21
CDC Split Type:

Write-up: I was pregnant at the time of my first and second dose of the vaccine. My estimated due date was February 15th 2022. A half hour after my second dose I had a little bit of spotting and moderate to severe cramping. This was dismissed as gas pains. Later that night I went to the bathroom to find a substantial amount of blood in my underwear at which point I called a nurse line and was directed to go to the ER. They gave an ultrasound and ran blood work. Miscarriage was strongly suspected but not totally confirmed. I was also running a low fever and experiencing severe chills, muscle and joint pain and a severe headache. I was sent home and told to follow up with my doctor for more blood work to confirm the miscarriage. I continued to get severe cramping, bleeding and loss of uterine tissue vaginally. On Monday I saw my doctor had blood work and confirmed the miscarriage. I am still bleeding today.


VAERS ID: 1438586 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-12
Onset:2021-06-26
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 2 LA / -

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

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

Write-up: headache, runny nose, sore throat received COVID-19 positive PCR test


VAERS ID: 1439565 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-26
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210663254

Write-up: FEVER; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 25-JUN-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 26-JUN-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of fever was not reported. This report was non-serious.


VAERS ID: 1439566 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-26
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210663264

Write-up: FEVER; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported) dose was not reported, administered on 26-JUN-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 26-JUN-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of fever was not reported. This report was non-serious.


VAERS ID: 1440444 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-15
Onset:2021-06-26
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 8077027399 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Dysarthria, Facial paralysis, Lacrimation increased, Lip disorder
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Lacrimal 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Colchicine, Allopurinol, Tramadol, Naproxen
Current Illness: N/A
Preexisting Conditions: Back (L3-L4 disc)
Allergies: N/A
Diagnostic Lab Data: Hosptial ER done testing and gave the diagnosis on 6/30/2021
CDC Split Type:

Write-up: I was diagnosed with Bells Palsey. Droopy face (right side) Slurred speech Crooked lips Watering eye Was put on steroids and eye drops for 7 days.


VAERS ID: 1440517 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram abnormal, Angiopathy, Arteriosclerosis, Cerebral artery occlusion, Cerebral infarction, Coma scale, Confusional state, Facial paralysis, Fall, Magnetic resonance imaging head abnormal, Sensory loss, Stenosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), 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), Accidents and injuries (narrow), Cardiomyopathy (broad), Hearing impairment (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: Armour thyroid 60 mg QD, Aspirin 81 mg QD, Cyclobenzaprine 5mg, TID prn, Diazepam 1 mg Q12h prn, Losartan 25 mg QD, Toprol XL 25 mg QD, Multivitamin QD, Percocet Q6H prn, Etodolac 400 mg BID, Sertraline 50 mg QD
Current Illness:
Preexisting Conditions: Hypothyroidism, Arthritis, GAD, HLD, HTN, PVD, CAD, Sciatica, GERD, Depression, Urinary Incontinence.
Allergies: Iodinated contrast (anaphylaxis), Penicillin (anaphylaxis), Ezetimibe, Statins.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA Patient was found on the ground in home and admitted for observation on 6/24/21, reported frequent fals. Patient was provided J&J COVID Vaccine on 6/25/2021. On 6/26/2021 at 8:14 pm patient was noted to have left sided facial droop. Pt alert, confused. Can lift arms and legs for full 10 seconds. No weakness noted. Pt unable to tell when touching her left arm with her eyes closed x 3 attempts. Denies tingling/numbness in this arm. Not present in face/left cheek or left leg. 14 MRI brain showed small right MCA infarction on the background of considerable chronic microvascular changes. MRA head and neck showed diffuse intracranial and atherosclerosis without significant. stenoses or occlusion.


VAERS ID: 1440561 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dysstasia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Next day had severe muscle pain all over body (6/26/2021) This was better the following day 6/27/2021) but had slight joint pain in knees and elbows. Elbow joint pain subsided on 6/28/2021). The knee joint pain has continued and the level of pain continued to increase. Today''s date is 7/1/2021 and the pain is to a level that it becomes difficult to stand for any period of time over 30 minutes.


VAERS ID: 1440627 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-10
Onset:2021-06-26
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / UNK - / -

Administered by: Private       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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pneumonia


VAERS ID: 1440638 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-22
Onset:2021-06-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness, Fatigue, Headache, Otitis media, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast 10mg tablet (Singular), diltiaZEM 180mg capsule (Cardizem CD), hydrOXYchloroQUINE 200mg tablet (Plaquenil), Zyrtek
Current Illness: Lupus, and rash
Preexisting Conditions:
Allergies: Food: seafood and nut allergies no other known allergies
Diagnostic Lab Data: none taken. I went to urgent care on June 27th, they ran a COVID test with no detection, and indicated that I have fluid behind my ears. They gave me Flonase and instructed that I continue to take Bactrim.
CDC Split Type:

Write-up: A couple days after the vaccine, I went to my OB/GYN for cysts on my groin (but that started prior to the vaccine) I was prescribed an antibiotic (Bactrim). Four days after the vaccine, I was light headed, dizzy and fatigued. I have headaches. My blood pressure dropped to 80/59...my blood kept going up and down, therefore, I didn''t take my blood pressure medication until my blood pressure reached a normal range and stayed for a day. Since my blood pressure is hovering around 121/67. Today, I still have minor headaches but no dizziness or light headedness.


VAERS ID: 1440649 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Confusional state, Dizziness, Fatigue
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amitriptyline (ELAVIL) 75 MG tablet 90 tablet 3 6/22/2021 Sig - Route: Take 1 tablet by mouth nightly. - Oral Class: Eprescribe Notes to Pharmacy: Dose increase as of 6/22/21. Cosign for Ordering: MD on 6/22/2021 11:16 AM mirabegron ER (My
Current Illness: None
Preexisting Conditions: Fibromyalgia Interstitial cystitis
Allergies: Hydrocodone High 05/24/2012 Nausea & Vomiting, VOMITING Meperidine High 05/24/2012 Nausea & Vomiting Prochlorperazine High 05/24/2012 Other (See Comments) agitation Unknown High 07/13/2018 RASH Veragin Cream-bacterial infection Compazine Not Specified 01/24/2017 Other (See Comments) AGITATION Gluten Meal (food Or Med) Not Specified 11/05/2015 Other (See Comments) intestineal issue Lactase (food Or Med) Not Specified 11/05/2015 GI UPSET, DIARRHEA Metoclopramide Hcl Not Specified 02/12/2015 Other (See Comments) Morphine Not Specified 01/24/2017 Nausea & Vomiting Reglan Not Specified 01/24/2017 Other (See Comments) Becomes agitated Sulfa Antibiotics Not Specified 01/24/2017 RASH Vicodin [hydrocodone-acetaminophen] Not Specified 01/24/2017 Nausea & Vomiting Zofran [ondansetron] Not Specified 01/24/2017 Other (See Comments) AGITATION
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe dizziness, fatigue, confusion


VAERS ID: 1440798 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-26
Onset:2021-06-26
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Endotracheal intubation, Intensive care, Laboratory test, Life support, Seizure, Unresponsive to stimuli
SMQs:, Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Many medical tests, and well as many test sent to Clinic
CDC Split Type:

Write-up: Seizure, unresponsive, intubation, admission to Neuro ICU, medications for critical care, AND life support


VAERS ID: 1440837 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Impaired work ability
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported to pharmacy on 7/1 complaining of left scapular stabbing pain. Patient received covid vaccine dose 2 on 6/26. Patient reported feeling the same pain directly after vaccination and for 1 hour post vaccination. Patient states that the pain then stopped until 6/30 when she awoke with the same pain. Patient has a history of back pain and is on current medication therapy for it. She tried ibuprofen, heating pads, and stretching to relieve stabbing pain in scapular region. Patient says nothing relieved the pain and she had to leave work due to the pain today. I recommended patient speak with her PCP on Tuesday 7/6 during her regular appointment to be further assessed and recommended she try ice therapy to reduce pain until then.


VAERS ID: 1440900 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-01
Onset:2021-06-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax, Limb discomfort, Pain in extremity, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Phenteramine
Current Illness: None
Preexisting Conditions: Obesity
Allergies: Rash to Amoxicillan
Diagnostic Lab Data: 6/29 upper extremity doppler 6/29 Chest CT
CDC Split Type:

Write-up: L distal internal jugular venous thrombus found on 6/29 after pt had three days of squeezing sensation on upper arm followed by acute pain on day of presentation to ED. In ED upper extremity Doppler demonstrated clot. Pt transferred to our hospital where she started on anticoagulation therapy for treatment.


VAERS ID: 1440936 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 - / IM

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

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

Write-up: patient and parent misrepresented age 2 times. Once upon registration then again when asked verbally if they were appropriate age


VAERS ID: 1440970 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-06-26
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Chest pain, Magnetic resonance imaging thoracic normal, Pyelonephritis, Troponin increased, Urinary tract infection
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: hypertension, anxiety disorder, bipolar disorder, bilateral hydronephrosis
Allergies: nkda
Diagnostic Lab Data: Elevated troponin, STEMI ruled out. Imaging negative for PE.
CDC Split Type:

Write-up: Patient was hospitalized for complicated UTI/pyelonephritis, developed epigastric and chest pain while in hospital.


VAERS ID: 1441009 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1441018 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1441023 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1441028 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1441034 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-25
Onset:2021-06-26
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Angiogram cerebral normal, Anion gap, Antinuclear antibody negative, Arteriogram carotid normal, Aspartate aminotransferase normal, Barbiturates negative, Basophil count decreased, Basophil percentage decreased, Benzodiazepine drug level, Beta-2 glycoprotein antibody, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride increased, Blood cholesterol normal, Blood creatinine normal, Blood glucose decreased, Blood glucose normal, Blood iron normal, Blood lactic acid decreased, Blood potassium normal, Blood sodium normal, Blood thyroid stimulating hormone, Blood triglycerides normal, Blood urea normal, C-reactive protein decreased, Carbon dioxide normal, Cardiolipin antibody, Cerebral infarction, Cerebrovascular accident, Creatinine renal clearance increased, Double stranded DNA antibody, Drug screen negative, Echocardiogram, Ejection fraction, Eosinophil count decreased, Eosinophil percentage, Gene mutation identification test negative, Glomerular filtration rate, Glomerular filtration rate normal, Glycosylated haemoglobin, Glycosylated haemoglobin normal, Haematocrit normal, Haemoglobin A present, Haemoglobin A2, Haemoglobin normal, Headache, High density lipoprotein normal, International normalised ratio normal, Iron binding capacity total normal, Iron binding capacity unsaturated, Low density lipoprotein normal, Lymphocyte count, Lymphocyte count normal, Lymphocyte percentage, Magnetic resonance imaging head abnormal, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Methylenetetrahydrofolate reductase gene mutation, Monocyte count decreased, Monocyte percentage increased, Neutrophil count, Neutrophil count normal, Neutrophil percentage decreased, Opiates negative, Platelet count normal, Pregnancy test urine negative, Protein C decreased, Protein total decreased, Prothrombin time normal, Pulmonary valve incompetence, Red blood cell count normal, Red blood cell sedimentation rate normal, Red cell distribution width normal, Right ventricular dilatation, Russell's viper venom time, SARS-CoV-2 test negative, Scan with contrast normal, Serum ferritin normal, Thyroxine free normal, Total cholesterol/HDL ratio normal, Transferrin saturation, Treponema test negative, Ultrasound Doppler, Ultrasound Doppler normal, Urine amphetamine negative, Urine cannabinoids decreased, Visual impairment, Wall motion score index normal, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Pulmonary hypertension (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cePHALexin monohydrate 250 mg oral capsule 250 mg = 1 Capsule, Orally, Daily EpiPen 2-Pak 0.3 mg injectable solution 0.3 mg, PRN, IM, ONCE FLUoxetine 10 mg oral capsule 10 mg = 1 Capsule, Orally, Daily
Current Illness: n/a
Preexisting Conditions: Migraine headaches
Allergies: Tree nuts
Diagnostic Lab Data: MRI Brain, 06/28/2021 - Acute right posterior cerebral artery stroke. CTA Head/Neck, 06/28/2021 - reportedly unremarkable for critical stenosis/occlusion. Transthoracic Echocardiogram, 06/28/2021 Technically fair study. Resting Left Ventricular Ejection Fraction SIM measured to be 69 %. No regional wall motion abnormalities in areas seen. Left ventricular cavity size normal. Normal left ventricular ejection fraction. No righttoleft shunt with contrast. Normal indices of LV diastolic function Normal left atrial size. Normal right ventricular systolic function. RV outflow tract appears borderline dilated Normal right atrial size.Estimated RA pressure normal Aortic valve structurally and functionally normal. Mitral valve structurally/functionally normal. Tricuspid valve structurally and functionally normal. Pulmonic valve structurally and functionally normal. Minimal pulmonic valve regurgitation (normal variant).PA diastolic pressure in the normal range No pericardial effusion. Right ventricular systolic pressure cannot be accurately estimated due to inadequate TR jet. Carotid Artery Duplex, 06/29/2021 Right: The right ICA appears within normal limits by duplex imaging. Normal right ECA. The right vertebral artery flow is antegrade. Left: The left ICA appears within normal limits by duplex imaging. Normal left ECA. The left vertebral artery flow is antegrade. Transesophageal Echocardiogram, 07/01/2021 Normal TEE findings No LA appendage thrombus No valvular vegetations No ASD/PFO Labs: WBC 7.6 k/cumm 06/29/2021 02:49 EDT RBC 4.11 million/cumm 06/29/2021 02:49 EDT Hgb 12.5 GM/dL 06/29/2021 02:49 EDT Hct 37.0 % 06/29/2021 02:49 EDT MCV 90 fL 06/29/2021 02:49 EDT MCH 30.4 pg 06/29/2021 02:49 EDT MCHC 33.8 GM/dL 06/29/2021 02:49 EDT RDW 13.3 % 06/29/2021 02:49 EDT Platelet 202 k/cumm 06/29/2021 02:49 EDT MPV 8.7 fL 06/29/2021 02:49 EDT Neutrophils % 52 % 06/29/2021 02:49 EDT Lymphocytes % 36 % 06/29/2021 02:49 EDT Monocytes % 10 % 06/29/2021 02:49 EDT Eosinophils % 3 % 06/29/2021 02:49 EDT Basophils % 0 % 06/29/2021 02:49 EDT Absolute Neutrophil 3.9 k/cumm 06/29/2021 02:49 EDT Absolute Lymphocyte 2.7 k/cumm 06/29/2021 02:49 EDT Absolute Monocyte 0.8 k/cumm 06/29/2021 02:49 EDT Absolute Eosinophil 0.2 k/cumm 06/29/2021 02:49 EDT Absolute Basophil 0.0 k/cumm 06/29/2021 02:49 EDT Sed Rate 4 mm/hr 06/29/2021 02:49 EDT Hemoglobin A % 97.3 % 07/01/2021 05:33 EDT Hemoglobin A2 % 2.7 % 07/01/2021 05:33 EDT PT 11.6 seconds 07/01/2021 05:33 EDT INR 1.03 07/01/2021 05:33 EDT AT Functional 98 % 06/28/2021 21:24 EDT DRVVT 31.5 seconds 06/28/2021 20:55 EDT Protein C Activity 57 % 06/28/2021 21:24 EDT (Low) Sodium SerPl QN 140 mmol/L 06/29/2021 02:49 EDT Potassium SerPl QN 4.0 mmol/L 06/29/2021 02:49 EDT Chloride SerPl QN 107 mmol/L 06/29/2021 02:49 EDT Carbon Dioxide SerPl QN 25 mmol/L 06/29/2021 02:49 EDT Anion Gap 8 mmol/L 06/29/2021 02:49 EDT BUN SerPl QN 10 mg/dL 06/29/2021 02:49 EDT Creatinine SerPl QN 0.78 mg/dL 06/29/2021 02:49 EDT Estimated GFR (CKD-EPI) $g90 mL/min/1.73m2 06/29/2021 02:49 EDT Estimated CRCL (CG) 118 mL/min 06/29/2021 02:49 EDT Glucose SerPl QN 68 mg/dL 06/29/2021 02:49 EDT (Low) Calcium Total SerPl QN 8.9 mg/dL 06/29/2021 02:49 EDT Alkaline Phos SerPl QN 70 Units/L 06/29/2021 02:49 EDT ALT SerPl QN 6 Units/L 06/29/2021 02:49 EDT (Low) AST SerPl QN 13 Units/L 06/29/2021 02:49 EDT Bilirubin Total SerPl QN 0.3 mg/dL 06/29/2021 02:49 EDT Total Protein SerPl QN 5.9 GM/dL 06/29/2021 02:49 EDT (Low) Albumin SerPl QN 3.6 GM/dL 06/29/2021 02:49 EDT Cholesterol SerPl QN 131 mg/dL 06/29/2021 02:49 EDT Triglyceride SerPl QN 67 mg/dL 06/29/2021 02:49 EDT HDL SerPl QN 56 mg/dL 06/29/2021 02:49 EDT LDL Calculated QN 62 mg/dL 06/29/2021 02:49 EDT Total Chol/HDL Ratio 2 06/29/2021 02:49 EDT Iron SerPl QN 80 mCg/dL 06/29/2021 02:49 EDT UIBC Meas SerPl QN 226 mCg/dL 06/29/2021 02:49 EDT TIBC Ser QN 306 mCg/dL 06/29/2021 02:49 EDT % Saturation 26 % 06/29/2021 02:49 EDT Hemoglobin A1C HPLC Bld QN 5.4 % 06/29/2021 02:49 EDT Est Average Glucose mg/dL 108 mg/dL 06/29/2021 02:49 EDT Est Average Glucose mmol/L 6.00 mmol/L 06/29/2021 02:49 EDT Lactate Bld Venous QN 1.5 mmol/L 07/01/2021 05:33 EDT Gluc-Strip, POC 71 mg/dL 06/29/2021 06:29 EDT TSH 3rd Gen SerPl QN 1.403 mcU/mL 07/01/2021 05:33 EDT T4 Free Direct SerPl QN 0.9 ng/dL 06/29/2021 02:49 EDT Ferritin SerPl QN 24.1 ng/mL 06/29/2021 02:49 EDT C-Reactive Prot SerPl QN <0.5 mg/dL 06/29/2021 02:49 EDT Amph/Meth Scn Ur QL Negative 06/28/2021 20:55 EDT Barbiturates Scn Ur QL Negative 06/28/2021 20:55 EDT Benzodiazepines Scn Ur QL Negative 06/28/2021 20:55 EDT Cannabinoids Scn Ur QL Negative 06/28/2021 20:55 EDT Cocaine Scn Ur QL Negative 06/28/2021 20:55 EDT Opiates Scn Ur QL Negative 06/28/2021 20:55 EDT PCP Scn Ur QL Negative 06/28/2021 20:55 EDT Methadone Scn Ur QL Negative 06/28/2021 20:55 EDT Oxycodone Scrn Ur QL Negative 06/28/2021 20:55 EDT Buprenorphine Scn Ur QL Negative 06/28/2021 20:55 EDT Pregnancy Test Urine Negative 06/28/2021 20:55 EDT ANA Ab Titer <1:80 Nova 06/28/2021 20:55 EDT Anti-dsDNA QN <1.0 IU/mL 06/28/2021 20:55 EDT Cardiolipin IgA Ab 0.8 APL Units 06/28/2021 20:55 EDT Cardiolipin IgG Ser QN 3.9 GPL units 06/28/2021 20:55 EDT Cardiolipin IgM Ser QN 4.0 MPL Units 06/28/2021 20:55 EDT ENA SS-A Ab EIA <0.2 Test Value 06/28/2021 20:55 EDT ENA SS-A Ab EIA Interp Negat 06/28/2021 20:55 EDT ENA SS-B Ab EIA <0.2 Test Value 06/28/2021 20:55 EDT ENA SS-B Ab EIA Interp Negat 06/28/2021 20:55 EDT Beta 2 Glycoprotein IgG QN 1.5 Units/mL 06/28/2021 20:55 EDT Beta 2 Glycoprotein IgM QN 3.5 Units/mL 06/28/2021 20:55 EDT Syphilis Treponemal Total 0.5 AI 07/01/2021 05:33 EDT SyphilisTrepTotal Interp Non-Reactive 07/01/2021 05:33 EDT Anti-dsDNA QN Interp Negat 06/28/2021 20:55 EDT F-V DNA Leiden Mutation Negative 06/28/2021 20:55 EDT PT Gene Mutation Negative 06/28/2021 20:55 EDT MTHFR C677T Mutation Negative 06/28/2021 20:55 EDT MTHFR A1298C Mutation Heterozygous 06/28/2021 20:55 EDT (Abnormal) COVID 19 Specimen Source Nasopharyngeal 06/29/2021 02:49 EDT Coronavirus SARS-CoV2 PCR GeneXpert NEGATIVE 06/29/2021 02:49 EDT
CDC Split Type:

Write-up: Acute right posterior cerebral artery stroke, symptoms (headache, vision change) started 06/26/2021, patient sought medical attention and diagnosed 06/28/2021


VAERS ID: 1441116 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-26
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Laboratory test, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen, Gabapentin, lasix, metroprohol, potassium
Current Illness:
Preexisting Conditions: back problems and high blood pressure
Allergies: pine nuts
Diagnostic Lab Data: Having lab work done this week., Dr suspects Myocarditis
CDC Split Type:

Write-up: chest pain


VAERS ID: 1441137 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Transient ischaemic attack
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), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No known
Current Illness: Per the wife she thought he had early onset of dementia.
Preexisting Conditions: Unknown
Allergies: No known
Diagnostic Lab Data:
CDC Split Type:

Write-up: The wife called us and stated after the vaccine at some unknown point the patient passed out and has been hospitalized. The patient waited for 15 minutes in the store and was talking like normal. He walked out of the store on his own. The wife states she found out today he may have had multiple mini strokes.


VAERS ID: 1441912 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-09
Onset:2021-06-26
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO182 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO202 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Seasonal allergies
Allergies:
Diagnostic Lab Data: Blood work on June 28th 2021.
CDC Split Type:

Write-up: Rash on legs and tops of feet that ended up in broken blood vessels (on tops of feet) . Thought it might be related to sun exposure, but went to specialty doctor who recommended blood work done. When that came back as normal, doctor said it may be due to reaction from vaccine. Took antihistamine for several days and the rash and itching has gotten better. The doctor thought it could possibly be a reaction to the second dose of vaccine and urged us to report it.


VAERS ID: 1442785 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-06-26
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling hot
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcoholic; Smoker (Patient not willing to answer)
Preexisting Conditions: Medical History/Concurrent Conditions: Chest discomfort (Patient was hospitalized on 21/Jun/2021); Difficulty breathing (Patient was hospitalized on 21/Jun/2021); Comments: The patient did not have any known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210667565

Write-up: ENTIRE BODY FEELING HOT AND FELT LIKE ON FIRE; This spontaneous report received from a patient concerned a 61 year old female. The patient''s weight was not reported and height was 64 centimeters. The patient''s past medical history included difficulty breathing, and hurting around heart, and concurrent conditions included alcoholic (40s per day beer), and smoker, and other pre-existing medical conditions included the patient did not have any known allergies.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A expiry: UNKNOWN) dose was not reported, administered on 24-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 26-JUN-2021, the subject experienced entire body feeling hot and felt like on fire. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of entire body feeling hot and felt like on fire was not reported. This report was non-serious.


VAERS ID: 1442842 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patiuent was unresponsive for couple of seconds after 1st shot


VAERS ID: 1443026 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-18
Onset:2021-06-26
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Herpes zoster, Lymphadenopathy, Pain in extremity, Pyrexia, Rash, Streptococcus test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sertraline, buspar,
Current Illness: none
Preexisting Conditions: asthma, seasonal allergies, sensory disorder, anxiety, adhd
Allergies: none
Diagnostic Lab Data: none other than reported above
CDC Split Type:

Write-up: June 26th- started getting a painful vesicular rash on her left arm- finger- spread up arm to axilla and then to L scapular area. + axillary lymphadenopathy. + fever and headache started 6/30/2021. Had a Dr. visit 6/30/2021. Diagnosed with shingles and started on acyclovir. No other areas of rash. No other symptoms. Fever and headache resolved mid day 7/1/2021. Rash on L arm continues- painful. Also had + rapid strep test that office visit on 6/30/2021- no throat pain- but still placed on antibiotics for strep- penicillin.


VAERS ID: 1443058 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-06
Onset:2021-06-26
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: Novel Coronavirus PCR - SARS-COV-2 detected (6/26/2021 and 6/27/2021)
CDC Split Type:

Write-up: Pt is a 25 yo male who underwent voluntary COVID-19 testing on 6/26 in preparation for upcoming travel out of the country. Test resulted positive. Patient is s/p complete Pfizer vaccination- first dose 4/15; second dose 5/6. Pt had sinus congestion about 2 weeks ago that he attributed to sinus allergy. Was symptom free 5 days up to COVID-19 testing. Pt underwent second COVID-19 test on 6/27 with another positive result. Advised to quarantine for 10 days, per CDC recommendations.


VAERS ID: 1443086 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site rash, Injection site swelling, Migraine, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (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), 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: Birth Control; Metrazole
Current Illness:
Preexisting Conditions: Acid Reflux
Allergies: Penicillin; Celery
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I started with site injection swelling and welts. I have fever chills, migraine and body aches. I also had fatigue and nausea, I actually vomited. I could not keep anything down. I went to the doctor. I still have the migraine. The doctor gave me IV fluids and anti nausea medicine. Those seemed to help. I still get fatigue, body aches and a headache. I manage it with Ibuprofen.


VAERS ID: 1443333 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-11
Onset:2021-06-26
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pristiq 50 mg daily Yasmin birth control pill 3-0.03 mg daily Flonase 50 mcg/actuation nasal spray
Current Illness: None reported
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Diffuse urticaric rash over torso, starting on abdomen and spreading to back, breasts, neck, and thighs. Rash is mildly itchy that worsens with heat. Unimproved with OTC Benadryl or Zyrtec. No other known cause of rash, including changes in detergents/soaps, foods, or other exposures.


VAERS ID: 1443397 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-02
Onset:2021-06-26
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 UN / SYR

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

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

Write-up: Hospitalization


VAERS ID: 1443466 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-30
Onset:2021-06-26
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Oral pain, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Probiotic and Flomax.
Current Illness: No.
Preexisting Conditions: No.
Allergies: No.
Diagnostic Lab Data: No tests was needed
CDC Split Type: vsafe

Write-up: I believe it was allergy related; therefore, the temperature in the area was in the 70s and 50s at night. I woke up with a really swore throat which persists for a couple of days and moved down into my mouth. I called the doctor via telehealth and he prescribed an antibiotic and Claritin from the local drug store and I begin to feeling better after 36 hours (took it on Monday night and started to feel better on Wednesday morning).


VAERS ID: 1443469 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Blood test normal, Chest X-ray, Chest discomfort, Electrocardiogram normal
SMQs:, Anaphylactic reaction (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: Sinus infection 2-3 weeks prior
Preexisting Conditions: None
Allergies: Gluten
Diagnostic Lab Data: Chest x-ray, normal EKG, normal Blood Work looking for signs of inflammation and/or myocarditis, normal
CDC Split Type:

Write-up: Mild to moderate chest pressure, directly center of chest, under sternum. Woke up with all other normal side effects the day after the second dose, plus had this chest pressure. Is the only side effect still lingering after 7 days now. Not causing shortness of breath when resting, but does when doing previously normal activities.


VAERS ID: 1443491 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Nausea, Pyrexia
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Motrin
Current Illness:
Preexisting Conditions: Anemia and endometriosis
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Beginning the day after receiving the second shot, I began to feel fatigue, chills, headache, fever, and nausea. These symptoms lasted throughout Saturday and through the late evening. I alternated using Motrin and Dayquil to assist with the side effects. The medicine did not help with the symptoms. I had to take one Zofran pill to stop the severe nausea. Day three I felt better with the exception of a slight headache. By day four, I was fatigued, but well enough to start normal activities.


VAERS ID: 1443630 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Chest X-ray, Diarrhoea, Dizziness, Electrocardiogram, Headache, Hypotension, Intensive care, Ischaemic hepatitis, Laboratory test, Pain, Pain in extremity, Pyrexia, Rash, Thrombocytopenia, Ultrasound Doppler, Ultrasound abdomen, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatitis, non-infectious (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), 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), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin, Fosamax, Iron, Actos, Augmentin
Current Illness: Dental infection
Preexisting Conditions: Diabetes, iron deficiency anemia, osteopenia
Allergies: *Augmentin
Diagnostic Lab Data: Numerous laboratory and imaging studies done including: venous doppler, ECG, orthopanograph, abdominal US, CXR
CDC Split Type:

Write-up: Possible anaphylactic shock, acute kidney injury, shock liver, hypotension, rash, thrombocytopenia. Full body rash, abdominal pain, vomiting, diarrhea, RLE pain, fever, dizziness, body aches, headache. Sx onset 06/26/2021 after receiving COVID vaccine #2 the same day. Pt went to medical facility on 06/30/2021 and was sent to ED. Pt admitted to ICU 06/30 - 07/02. Transferred to general medical floor on 07/02/2021.


VAERS ID: 1443665 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

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

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

Write-up: One of our stores got confused with the storage parameters around the Pfizer vaccine and exceeded the 14 day freezer window. The Vaccine was placed inside the freezer on 6/5/21 and taken out on 6/25/21 and placed into the refrigerator. The temperature range for the days the vaccine was in the freezer was -0.9 (warmest) to -5.9 (coldest) with an avg temp of -4.9


VAERS ID: 1443674 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

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

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

Write-up: One of our stores got confused with the storage parameters around the Pfizer vaccine and exceeded the 14 day freezer window. The Vaccine was placed inside the freezer on 6/5/21 and taken out on 6/25/21 and placed into the refrigerator. The store has vaccinated 50 people from 6/25/21 ? 6/29/21. The temperature range for the days the vaccine was in the freezer was -0.9 (warmest) to -5.9 (coldest) with an avg temp of -4.9


VAERS ID: 1443925 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-05-06
Onset:2021-06-26
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Yellow fever
Other Medications: Lisinipril 40mg; metropolol 200mg; HCT 25mg; atorvastatin 40mg; hydrocodone 5/325
Current Illness: None
Preexisting Conditions: Hypertension, hyperlipidemia, luppushh
Allergies: Sulfa
Diagnostic Lab Data: Rash/erythema over left breas7, on left shoulder and deltoid, at base of neck in fr ok not. Raised lumps, some itching.
CDC Split Type:

Write-up: Rash/erythema on left breast, left shoulder, left deltoid, and at front of neck at base


VAERS ID: 1445704 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-06-26
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Fatigue, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Non-smoker; Social alcohol drinker (about 3-4 glasses of wine every 4 to 6 months)
Preexisting Conditions: Comments: No known allergies and no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Date: 20210626; Test Name: Body temperature; Result Unstructured Data: 101.6 F
CDC Split Type: USJNJFOC20210700942

Write-up: HEADACHE; FATIGUE; FEVER; This spontaneous report received from a patient concerned a 57 year old female. The patient''s weight was 137 pounds, and height was 63 inches. The patient''s concurrent conditions included alcohol user, and non-smoker, and other pre-existing medical conditions included no known allergies and no drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: 07-AUG-2021) dose was not reported, administered on 25-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 26-JUN-2021, the subject experienced headache. On 26-JUN-2021, the subject experienced fatigue. On 26-JUN-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 101.6 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from headache, fatigue, and fever on 28-JUN-2021. This report was non-serious.


VAERS ID: 1446249 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Headache
SMQs:, Taste and smell disorders (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: Levothyroxine sodium 88 mcg tab
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache lasting 8 days, ongoing. Experienced a metallic taste for 6 days.


VAERS ID: 1446316 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EQW0181 / 1 LA / IM

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

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

Write-up: Pt did not experience any adverse events. Pt was given vaccine that was stored at freezer temperature for 3 days greater than advised per Pfizer''s storage requirements.


VAERS ID: 1446325 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Pt did not experience any adverse events. Pt was given vaccine that was stored at freezer temperature for 3 days greater than advised per Pfizer''s storage requirements.


VAERS ID: 1446450 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram abnormal, Electrocardiogram QT prolonged, Lymphadenopathy, Myalgia, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conduction defects (narrow), Torsade de pointes, shock-associated conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: See item 18
CDC Split Type:

Write-up: Mild chest pain starting day after shot (w fever, swollen lymph nodes, muscle pains). Went to ER, told she was ok, then phone call next day telling us her ekg had abnormalities (borderline high qtc and other non-specific findings). Told to follow up w cardiologist. Went to cardiologist on 6/30, qtc had normalized but other non-specific ekg findings remained. Echo normal except for occasional extra heart beat. Told to avoid exercise, was given 24 hr heart monitor (we are still waiting on results), and come back for new ekg on 7/7/2021.


VAERS ID: 1446481 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cognitive disorder, Head discomfort, Headache, Malaise, Swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mild MVP Mild asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Head face and jaw felt swollen like when a dentist administers novalvaine the pain in head and pressure was causing me to lose my cognitive it was very scary I felt near death I talked myself through it kept moving my legs walk-in in place and ate yogurt and drank liquids to stay calm it started dissipating I 20 minutes by 3:30 symptoms subsided to slight headache


VAERS ID: 1446546 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site reaction, Injection site swelling, Injection site warmth, Pain, Rash erythematous, Rash papular
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trintellix 10mg 1QD. May have not been taking at the time.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came into to the pharmacy on 7/4/21 with a red elevated rash on the left deltoid approximately 3 in. by 3 in. The rash started on 6/26 (the day after receiving the vaccine) and has only gotten worse since then. The patient stated that the pharmacist did not wear gloves while giving the vaccine and was concerned that could have aided in causing the rash. She stated that it didn''t itch, but she had achy pain throughout the entire upper arm and the rash was hot to the touch. She denied any burning or stinging pain, and had not tried any medications to help treat the rash. I advised her to take benadryl and aleve/ibuprofen to help with the rash and swelling. Since it was Sunday when the patient came to the pharmacy, I advised her to see a doctor by Wednesday if the rash hadn''t improved while taking those medications or if it got any worse.


VAERS ID: 1446714 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Dizziness, Electrocardiogram, Neck pain, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C
Current Illness: None
Preexisting Conditions: right bundle branch block
Allergies: Shrimp
Diagnostic Lab Data: EKG July 1st
CDC Split Type:

Write-up: Chest pain, sharp pain on the neck and shoulder, light-headed, dizziness, vision changed


VAERS ID: 1446772 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-21
Onset:2021-06-26
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Telismartan and Hydrochlorothiazide 80mg Felodipine 5mg
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: gluten, coconut, eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: After years of being in menopause, I had vaginal bleeding for 7 days, it became very light after 4 days.


VAERS ID: 1446788 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-07
Onset:2021-06-26
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

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

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

Write-up: Severe, ongoing pain in left anterior cervical lymph nodes. More than one week of pain - especially sensitive when touched or head is moved to the right.


VAERS ID: 1446829 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cough, Depression, Fatigue, Nasopharyngitis
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (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: Collagen Multi vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme tiredness and depression - not wanting to do anything Cold-like symptoms Cough


VAERS ID: 1446856 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling drunk, Hyperhidrosis, Loss of consciousness, Tremor
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), Parkinson-like events (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: 2 Tylenol
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: While getting my hair cut the following day I was sitting in my chair and started to feel intoxicated for about 2 minutes and then started to sweat, I then passed out and started to shake as if I were having a seizure. This went on for about a minute I was told.


VAERS ID: 1446909 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-14
Onset:2021-06-26
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / -

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

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

Write-up: Shingles, pain then rash (never had before)


VAERS ID: 1447005 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Unknown       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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administered vaccine from vial that''s BUD was 6-26-21 at 10:15 A.M. Vial was kept in refrigerator entire time prior to administration.


VAERS ID: 1447008 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: Administered vaccine from vial on 6-26-21 at 10:15 A.M. Vial was kept in refrigerator entire time prior to administration.


VAERS ID: 1449418 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-26
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210626; Test Name: COVID-19 virus test; Result Unstructured Data: positive
CDC Split Type: USJNJFOC20210702601

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient via a company representative via social media concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, 1 total, administered on 07-APR-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 26-JUN-2021, the patient was diagnosed as COVID positive by positive COVID test (suspected clinical vaccination failure and suspected COVID-19 infection). Laboratory data included: COVID-19 virus test (NR: not provided) positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected COVID-19 infection and suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210702601-Covid-19 vaccine ad26.cov2.s- Suspected clinical vaccination failure . This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1450047 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-06-26
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram abdomen, Computerised tomogram thorax, Dehydration, Diarrhoea, Diverticulitis, Electrocardiogram, Fibrin D dimer, Full blood count, Leukocytosis, Metabolic function test, Pelvic abscess, Staphylococcus test, Urine analysis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: urinalysis, CBC, BMP, MRSA screening, CT abdomen and chest, D-Dimer, EKG
CDC Split Type:

Write-up: diarrhea, pelvic abscess, dehydration, leukocytosis, diverticulitis


VAERS ID: 1450130 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-06-26
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / UNK - / -

Administered by: Private       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:

Write-up: J18.9 - Pneumonia, unspecified organism


VAERS ID: 1450367 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type: AR2143

Write-up: COVID 19 Janssen EUA- patient was given 0.3ml dosage of vaccine. Correct dosage should have been 0.5ml. No adverse side effects or symptoms noted at time of vaccination. No further treatment recommended at this time.,


VAERS ID: 1450390 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling cold, Genital blister, Genital pain, Pain in extremity, SARS-CoV-2 test negative, Smear vaginal normal
SMQs:, Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol 500 mg 2x day.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Vaginal swab, results came back negative for everything tested
CDC Split Type: vsafe

Write-up: After receiving the second dose of the vaccine I had the occasional sore arm. Later on throughout the day I just started to feel so tired and very fatigue. I had to catch a flight later on that day and while sitting in the airport I just felt these chills rushing in on my body and I felt so cold, that lasted for about 3 days. I was told by my job to get a covid test done in order to come back to work and the results came back negative. I just never experienced anything like this in my life. Another symptom that I experienced after getting covid and my 2nd dose was that I had these painful blisters forming on my vagina. They were so painful I could not sit or walk comfortably. I made an appointment regarding what occurred and the physcian that assisted me did a vaginal swab on the area and sent them to the lab. The results came back that there was absolutely nothing wrong, no BV, no yeast, or std''s at all. I decided to google some home remedies on what to do because it was even painful to use the restroom correctly.


VAERS ID: 1450507 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: none
Preexisting Conditions: none
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type: AR2144

Write-up: COVID 19 Janssen EUA- patient was given 0.3ml dosage of vaccine. Correct dosage should have been 0.5ml. No adverse side effects or symptoms noted at time of vaccination. No further treatment recommended at this time.,


VAERS ID: 1450516 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: COVID 19 Janssen EUA- patient was given 0.3ml dosage of vaccine. Correct dosage should have been 0.5ml. No adverse side effects or symptoms noted at time of vaccination. No further treatment recommended at this time.,


VAERS ID: 1450521 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: PER PATIENT''S MOM - PATIENT WOKE UP THE NEXT DAY FEELING LIKE SOMETHING WAS GRABBING HIS CHEST. EXPERIENCED THIS ON AND OFF UP UNTIL TODAY (7/6/21) WHERE HIS CHEST LOOKS SWOLLEN AND HAD DIFFICULTY BREATHING AT WORK. ADVISED PATIENT''S MOM TO GET TESTING/IMAGING DONE


VAERS ID: 1450547 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-06-26
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Gastrooesophageal reflux disease
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: One a day multivitamin and CBD oil
Current Illness: N/A
Preexisting Conditions: PCOS, migraines, C-PTSD
Allergies: Lexapro, nickel, rabbits
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Sudden intense acid reflux, started on 6/26/2021 and continued with no relief, also experiencing trouble swallowing. Saw a doctor on 7/1/21 and was told to take Omeprazole daily for 2 months and to check back in September.


VAERS ID: 1450566 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-26
Onset:2021-06-26
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021EL21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Sensitive skin
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lamotrigine, sertraline, levetiracetam, cetirizine, lisinopril, jardiance, metformin, atorvastatin
Current Illness:
Preexisting Conditions: epilepsy diabetes
Allergies: seroquel
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm hypersenitivity to air


VAERS ID: 1450682 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Eye swelling, Mouth swelling, Pruritus, Rash, Skin exfoliation, Skin swelling, Swelling face, Swollen tongue
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Additional Details: Patient describes symptoms of itchiness in the face, redness (like sunburn), peeling skin and puffiness. Happened with both doses of covid vaccine.


VAERS ID: 1453600 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-06-26
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Heart rate, Heart rate increased, Injection site pain, Pain, Pain in extremity, Rash papular, Visual impairment
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), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes; Latex allergy; Non-smoker
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210626; Test Name: Heart rate; Result Unstructured Data: Increased
CDC Split Type: USJNJFOC20210708242

Write-up: SPOT ON HER LEFT LEG THAT LOOKED LIKE A VEIN HAD RAISED UP/RED SPOT ON HER LEG; FEELS LIKE ITS MOVING UP AND DOWN; WHOLE BODY HURT; DIZZINESS; FAST HEART RATE; SHORTNESS OF BREATH; ARM PAIN ON INJECTION ARM; PAIN IN ARM WHEN INJECTING; This spontaneous report received from a patient concerned a 65 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included diabetes, non-smoker, and latex allergy. The patient experienced drug allergy when treated with codeine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A expiry: UNKNOWN) dose was not reported, administered on 26-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 26-JUN-2021, the subject experienced dizziness. On 26-JUN-2021, the subject experienced fast heart rate. On 26-JUN-2021, the subject experienced shortness of breath. On 26-JUN-2021, the subject experienced pain in arm when injecting. On 26-JUN-2021, the subject experienced arm pain on injection arm. On 27-JUN-2021, the subject experienced whole body hurt. On 02-JUL-2021, the subject experienced feels like its moving up and down. On an unspecified date, the subject experienced spot on her left leg that looked like a vein had raised up/red spot on her leg. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from fast heart rate on 30-JUN-2021, and shortness of breath on 01-JUL-2021, had not recovered from whole body hurt, feels like its moving up and down, pain in arm when injecting, and arm pain on injection arm, and the outcome of dizziness and spot on her left leg that looked like a vein had raised up/red spot on her leg was not reported. This report was non-serious.


VAERS ID: 1454066 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dizziness postural, Head discomfort, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sunburn
Preexisting Conditions: Migraine/recurrent headaches, hypothyroid
Allergies: hydromorphone (seizures)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, vomiting, headache - pressure like headache. Lightheaded and dizzy when they get up. (All several hours after the vaccine)


VAERS ID: 1454451 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Injection site erythema, Injection site pruritus, Nervousness, Rash, Rash erythematous, Urticaria, Vaccination site swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra
Current Illness:
Preexisting Conditions: Non-allergic asthma, not currently exacerbated, not currently taking any medications, haven?t used albuterol in 2+ years
Allergies: dairy (sensitivity), grass, wheatgrass, animal dander, latex (sensitivity)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1st vaccination shot of Moderna: Shot was given on left upper arm, the typical swollen itchy sensitive red spot was present at the vaccination area for about 4 days. Approximately 24 hours after the vaccination I began to feel very shaky all over, that lasted for about an hour. This was also the onset of hives on both arms, shoulder to wrist. With my right arm (opposite arm of vaccination) displaying large hives over the entires forearm area, the large hives looked like a bunch of mosquito bites. I also had a patch of regular hives on my right outside ankle and a very small patch on my left ankle. I had a headache that lasted about 5 days, I typically do not get headaches. I wanted to get the best immune response so I did not take Benadryl or any Acetometaphin or pain medication. The hives were gone sometime overnight (between 2:00-5:00am) after I finally fell asleep. A red rash, not itchy or bumoy continued on the left forearm for another few days. I contacted my dr a couple days later and was instructed to not get the 2nd shot of Moderna or any mRNA vaccines.


VAERS ID: 1454640 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-26
Onset:2021-06-26
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O23C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Dizziness, Dyspnoea, Eating disorder, Electrocardiogram, Full blood count normal, International normalised ratio, Lipase, Metabolic function test, Pregnancy test, SARS-CoV-2 test negative, Troponin I, Urine analysis
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Women?s multi vitamin (olly)
Current Illness: None
Preexisting Conditions: Fatigue
Allergies: Gluten intolerant Lactose intolerant
Diagnostic Lab Data: Test for COVID -negative June 27th CBC with Differential Complete Metabolic Panel Lipase Pregnancy, Urine Qual Protime INR Troponin I Urinalysis with Microscopic ECG 12 lead XR chest PA and Lateral - all done on 6/30/2021 and all appeared ?normal?
CDC Split Type:

Write-up: chest pain, hard to breathe, dizziness. Ran tests came back looking normal. Thought it looked like acid reflex or food intolerances. A few days later, symptoms are getting worse, now with eating difficulties.


VAERS ID: 1454786 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

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

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

Write-up: On 6/25 caller got 2nd moderna vaccine. States the next day he woke up with hives, went to ER and was treated with Benadryl and steroids. States he has had several additional visits to the hospital since then and hives are persistent.


VAERS ID: 1456640 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Erectile dysfunction, Panic attack
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Erectile Dysfunction; Panicking; This spontaneous case was reported by a consumer and describes the occurrence of ERECTILE DYSFUNCTION (Erectile Dysfunction) in a 31-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 051C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 26-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Jun-2021, the patient experienced ERECTILE DYSFUNCTION (Erectile Dysfunction) (seriousness criterion medically significant) and PANIC ATTACK (Panicking). At the time of the report, ERECTILE DYSFUNCTION (Erectile Dysfunction) and PANIC ATTACK (Panicking) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication information was mentioned No treatment medication information was mentioned Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1457176 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-23
Onset:2021-06-26
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Diarrhoea, Headache, Nasal congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 03/02/2021, pfizer,Lot# EN6205 2nd dose: Pfizer 03/23/2021, Pfizer lot# EN6208 Diagnosed covid positive:06/26/21 Exposure:Home Symptoms:Headache, cough,nasal congestion, rhinorrhea, diarrhea.


VAERS ID: 1457326 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Nausea, Vital signs measurement, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient reported vomiting after a previous vaccine shot. Shot was unspecified.
Other Medications: None reported
Current Illness: None reported
Preexisting Conditions: Anxiety, history of panic atacks
Allergies: None reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: At approximately 1605, patient reported feeling nauseous in vaccination chair. Patient vomited in emesis bag. Patient reported feeling anxious before vaccination and a history of anxiety and panic attacks. Patient reported vomiting after receiving an unspecified vaccine in 2019. Patient offered anti-gravity chair. Patient refused anti-gravity chair. Patient denied difficulty breathing, difficulty swallowing, itchiness, rashes and hives. Patient advised to wait for further observation. Patient given water. At 1615, EMT assessed patient vital signs: blood pressure 136/88 mmHg and pulse 115 beats/minute. At 1621, EMT reassessed patient vital signs: blood pressure 130/80 mm Hg and pulse 78 beats/minute. At 1633, EMT reassessed patient vitals: blood pressure 112/76 mmHg and pulse 74 beats/minute. At 1635, lead nurse assessed patient. Patient denied feeling nauseous. Patient stated "I feel okay". Lead nurse educated patient on signs/symptom of when to seek emergency care, to sign up on v-safe, and to follow up with primary care provider. At approximately 1640, patient left facility with unlabored respirations and steady gait.


VAERS ID: 1457363 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-10
Onset:2021-06-26
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), 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), Embolic and thrombotic events, arterial (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Non-ST elevation (NSTEMI) myocardial infarction Acute kidney failure, unspecified Thrombocytopenia, unspecified


VAERS ID: 1457409 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-21
Onset:2021-06-26
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

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

Write-up: I21.4 - NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC)


VAERS ID: 1457440 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dysgeusia, Dyspnoea, Panic attack, Paraesthesia, Tremor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Cardiomyopathy (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: Flu: Obtained auto immune disease, Sjogren
Other Medications: Levothyroxine 88mcg
Current Illness: None
Preexisting Conditions: Sjogren Hypothyroidism
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Tasted a metal taste, panic attack, shaking all over, hard to breath, increased blood pressure, tingling in back


VAERS ID: 1457554 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-09
Onset:2021-06-26
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / PUBLI / 1 LA / IM

Administered by: Other       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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: COVID-19 positive PCR
CDC Split Type:

Write-up: After being fully vaccinate Client became positive with COVID-19. Client is also displaying symptoms.


VAERS ID: 1457604 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: None reported
Current Illness: None reported
Preexisting Conditions: Anxiety,; aversion to needles
Allergies: Shellfish allergy reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: At approximately 1916, patient reported lightheadedness, feeling "sweaty", and feeling "like my heart is racing". Lead nurse assessed patient. Patient denied difficulty swallowing, itchiness, rashes and hives. EMT assessed patient vital signs: blood pressure 98/42 mmHg, pulse 50 beats/minute, and SpO2 98%. Patient reported aversion to needles and history of needles. Lead nurse offered to call 911. Patient refused needing 911. Lead nurse utilized guided breathing techniques with patient. At approximately 1925, patient reported feeling less lightheaded, sweaty, and denied feeling her heart was racing. Lead nurse continued to use guided breathing techniques. At 1935, EMT reassessed patient vital signs: blood pressure 126/92, pulse 82 beats/minute, and SpO2 99%. Patient given water. Patient able to drink water. At 1945, EMT reassessed patient vital signs: blood pressure 136/96 mmHg, pulse 66 beats/minute, and SpO2 99%. Lead nurse assessed patient. Patient denied lightheadedness, diaphoresis, and feeling her heart was racing. Patient reported she felt "a lot better". Lead nurse educated patient on signs/symptoms of when to seek emergency care, to sign up on v-safe and to follow up with primary care provider. Patient called family member to pick her up from facility. At approximately 1955, patient left facility with steady gait and unlabored respirations, accompanied by family member.


VAERS ID: 1457895 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-14
Onset:2021-06-26
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Fatigue, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hearing impairment (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: Ranitidine, Magnesium, L-Glutamine, Vitamin D
Current Illness:
Preexisting Conditions: autoimmune disease, sinusitis
Allergies: Erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bells Palsy, crooked mouth, effective speech, one eye remains open, fatigue 11 days and counting


VAERS ID: 1459238 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Feeling hot, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021791357

Write-up: I was having trouble breathing.; I felt like I was going to faint/I was dizzy.; I was dizzy and hot; I broke out in a sweat; This is a spontaneous report from a contactable consumer (patient). A 18-years-old non pregnant female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot Number: EW0217), via an unspecified route of administration, administered in Arm Left on 26Jun2021 at 13:15 (at the age of 18-years-old) as DOSE 1, SINGLE for covid-19 immunisation. Patient had no medical history and past drug history. Patient had no known allergies. The patient''s concomitant medications were not reported. Patient had not received any other vaccines within 4 weeks prior to the COVID vaccine. Patient had not received any other medications within 2 weeks of vaccination. Prior to vaccination, patient was not diagnosed with COVID-19. Since the vaccination, the patient was not tested for COVID-19. On 26Jun2021 at 13:30, the patient experienced patient was having trouble breathing, felt like patient was going to faint, patient was dizzy and hot, patient broke out in a sweat. Facility where the most recent COVID-19 vaccine was administered was Pharmacy or Drug Store. Events resulted in Doctor or other healthcare professional office/clinic visit/physician Office Visit. No treatment was received for events. Patient had no prolonged hospitalization. On 27Jun2021, the outcome of events was resolved. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1459818 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Aspartate aminotransferase increased, Blood creatinine increased, Blood urea normal, Brain natriuretic peptide increased, Chest X-ray, Chest pain, Differential white blood cell count, Electrocardiogram, Full blood count, Immunoglobulin therapy, Respiratory viral panel, SARS-CoV-2 test negative, Troponin T increased, Viral test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Kawasaki disease at 1 years old
Allergies: NKMA
Diagnostic Lab Data: Pertinent Labs 6/28 CBCd: 3.25$g14.8/45.9<187 6/28 BUN: 11 Cr: 0.80 6/28 ALT: 19 AST: 56 6/28 BNP:355 6/29 (1159) Troponin T: 0.49, positive 6/29 (0343) Troponin T: 0.34, positiv 6/28 (2000) Troponin T: 0.37, positive 6/28 (1600) Troponin T: 0.53, positive 6/28 RVP: Not detected, including SARS-CoV-2 PCR
CDC Split Type:

Write-up: 6/29: usual state of health until Saturday 6/26/21 when he began to experience chest pain. Due to the pain persisting for 2 days, parents brought him to the ED. He describes the pain as "pounding" and lasting for up to "half an hour". He reports no recent illnesses or fevers, but does note that he received the second dose of the Pfizer vaccine 4 days ago (6/25/2021). In the ED he had a CXR, EKG and screening labs which showed elevated troponin. Secondary to this the decision was made to admit patient for continued evaluation and management of possible myocarditis. troponin up to 0.6 at 2100. SARS-CoV-2 PCR is negative. 6/30: IVIG administered overnight due to increasing troponin. troponin now 0.36. chest pain resolved. 7/1: troponin trending down to 0.06. No complaints of chest pain. discharged home.


VAERS ID: 1459864 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Full blood count, Generalised oedema, Intensive care, Pain, Pharyngitis, Polycythaemia, Swelling face
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to ED with complaint of facial swelling and pain onset today. Endorses difficulty swallowing. Patient notes that she got the Moderna COVID-19 vaccination yesterday. Patient admitted. Patient was monitored in the ICU she was empirically treated with antibiotic therapy for pharyngitis but was not felt to be bacterial this was discontinued. She maintained her airway without any increase in secretions or stridor. She was transferred to the floor and has done well on systemic steroids and scheduled Pepcid as needed Benadryl. Patient has some mild generalized edema but overall seems improved no urticaria. Airway is stable with no stridor and no dysphagia. Patient did have polycythemia on admission however this improved with IV fluids likely due to IV but would recommend outpatient follow-up and repeat CBC in 2 weeks VD.


VAERS ID: 1460010 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Decreased appetite, Diarrhoea, Dysphonia, Epstein-Barr virus infection, Fatigue, Lymphadenopathy, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro; Klonopin; Adderall; Blood pressure medication; GERD medication.
Current Illness: I had been having a lot of falls in the house.
Preexisting Conditions: High Blood Pressure; Chronic Epstein-Barre; BRCA 2 Gene; I have no memory and right leg I walk with gait and left shoulder has neuropathy in it.
Allergies: Lyrica; Gabapentin; Topamax; Morphine.
Diagnostic Lab Data: None.
CDC Split Type: vsafe

Write-up: My father was with me and drove me over there. I got the shot. Around 12PM I started vomiting and I hadn''t even ate anything, non-stop until two days ago. Diarrhea not able to keep anything down. My lymph nodes are swollen, my voice is very horse. Yesterday I was able to eat solid food very slowly. It reactivated my Epstein-Barre virus. I''m exhausted. From June 26th to July 7th those have been all my symptoms. On July 8th I was able to hold my food and water without throwing up but I still have diarrhea. I''m still fully activated with EBV and no disease doctor or primary doctor.


VAERS ID: 1460072 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-18
Onset:2021-06-26
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medication Sig Dispense Refill ? Ibuprofen (MOTRIN) 800 mg Oral Tab Take 1 tablet by mouth 3 times a day as needed for pain or inflammation 90 tablet 2 ? Zolpidem (AMBIEN) 10 mg Oral Tab Take 1 tablet by mouth daily at bedtime 30 tablet 2 ?
Current Illness: ANXIETY ? CERVICAL SPONDYLOSIS ? DM 2 ON INSULIN ? DYSPLASTIC NEVUS ? HTN (HYPERTENSION) ? INSOMNIA ? LUMBAR SPONDYLOSIS ? SKULL FX anosmia since skull fracture ? TREMOR
Preexisting Conditions: see above
Allergies: Trazodone hydrochloride
Diagnostic Lab Data: presents today with a 2 day history of a rash to both forearms. States she received her 2nd COVID vaccine 12 days ago the rash started 2 days ago she was initially concerned this could be a COVID vaccine related rash. She does not recall getting any exposure to poison ivy or being in the yd. Only real change recently is aided by comfortable so she has had a bit more sun exposure than normal. States the rash is itchy not painful on both forearms she has not tried any medication for it. She denies any other complaints problems at this time. Rash since only be located her arms. Virtual examination: Examination is assisted by the tech.Exam was performed using the Care device. Patient is well-developed well-nourished 64-year-old female appears nontoxic no acute distress. Vital signs are stable noted the chart. Examination focused chief complaint. Examination of both arms demonstrates macular papular rash on the dorsal aspect of both forearms. This does appear to be consistent with sun exposed areas. Does not appear to be linear such as poison ivy. But does appear consistent with a contact dermatitis in that its appearance is consistent as well as the associated symptoms of itching. The patient denies any difficulty breathing swallowing or shortness of breath. She has not tried any over-the-counter medications. The patient does have type 1 diabetes but is very familiar with managing her blood sugar on a sliding scale with the use of her insulin pump. She feels comfortable doing so while on steroids as the steroids will likely increase her blood sugar. poct glucose zyrtec methylprednisolone pred pack
CDC Split Type:

Write-up: Developed a rash that has progressed started 8 days after 2nd vaccination. Bilateral arm to elbow to wrist redness. states did take steroid PO/Cream. got better but didn''t go completely away. gradually getting worse by the day. rash all over body now, redness, itchy skin and bleeding from scratching.


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