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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

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VAERS ID: 1876961 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Cold sweat, Headache, Nausea, Pain, Pallor, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Employee Vaccinated at 9:05 a.m. and observed in clinic for 15 minutes. He was released, but returned to the health center in less than ten minutes with pallor, cold clammy skin, nausea. He was under care of RN in the health center where he eventually had an episode of emesis. After a period of approximately 1 hour, he sated he was feeling better and released to go home. Employee contacted the health center 11/17 to report he would be going to care with severe headache, nausea , vomiting (when attempting to eat or take medications), body aches, and fever.


VAERS ID: 1876981 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK RA / IM

Administered by: Work       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: Vaccine Administration error. The Vaccine was given beyond 30 day refrigeration quidelines.


VAERS ID: 1876994 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK LA / IM

Administered by: Work       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: Vaccine Administration error. Vaccine was given beyond the 30 day refrigeration guidelines.


VAERS ID: 1876996 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-11-16
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / -

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

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

Write-up: Pt has a history of CAD s/p CABG, type 2 IDDM, and a history of colon cancer. Pt was admitted due to sepsis and COVID-19 pneumonia.


VAERS ID: 1877007 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-vitamin
Current Illness: None
Preexisting Conditions: PCOS, prediabetes
Allergies: penicillin, wheat, milk
Diagnostic Lab Data: none
CDC Split Type:

Write-up: At injection site: red, itchy rash, hot skin, hard knot, about 3 inches in circumference


VAERS ID: 1877009 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hyperhidrosis, Mydriasis, Posture abnormal, Presyncope, Urinary incontinence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Vestibular disorders (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: none
Current Illness: Asthma
Preexisting Conditions: Asthma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a vasovagal response to injection. Patient stated they felt like they were going to pass out about 1 minute after shot was administered. Technician informed Pharmacist then fanned patient off and had someone bring her some water, then the patient''s eyes dilated and skin became clammy and sweaty. Patient urinated herself and her head fell into her chest and she groaned. Technician called emergency number and then went to get NP on site. Another technician came in and elevated patient''s feet and applied a cold rag to the back of her neck. Patient came to within a couple of seconds and NP evaluated her and then got her some juice. NP stated she was stable and didn''t need emergency care but instructed the technician to call a family member to pick patient up. EMT arrived and took her vitals and established she was stable and did not need to be taken to the ER. Patient''s father came to pick her up.


VAERS ID: 1877010 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK LA / IM

Administered by: Work       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 Administration error. Vaccine given beyond the 30 day refrigeration guideline.


VAERS ID: 1877021 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077CUB / 2 LA / IM

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

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

Write-up: Patient presented for first dose of Moderna however when I began to place into Web Roster I found he had Pfizer 10/26/2021. I notified Dr. who stated no harm was done and to update patient card to show full vaccinated.


VAERS ID: 1877022 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid19 Moderna, dose 2--low fever and fatigue for 1-2 days after, swalling and pain at injection site
Other Medications: prenatal vitamins only
Current Illness: none
Preexisting Conditions: chronic constipation
Allergies: none
Diagnostic Lab Data: nonw
CDC Split Type:

Write-up: high fever beginning overnight, 103-104 Fever continues to persist at 101-102 the next day despite treatment with Motrin


VAERS ID: 1877023 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK LA / IM

Administered by: Work       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: Vaccine Administration error. Vaccine was given beyond the 30 refrigeration storage guidelines.


VAERS ID: 1877027 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Moderna 04/23/2021 (Fever, chills lasting 48hrs)
Other Medications: Atorvastatin, Xanax
Current Illness: N/A
Preexisting Conditions: High Cholesterol
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd Booster of Moderna 11/15/2021, started experiencing symptoms 11/16/2021 of feverish, chills, and muscle aches. Self-treating with Tylenol, no noted Primary visit/communications. Symptoms have subsided. 11/15/2021 Influenza Quad Flu Vaccine given.


VAERS ID: 1877028 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Product administered to patient of inappropriate age
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow)

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

Write-up: Patient is 17 y.o. and 12 weeks pregnant, patient received the Moderna vaccine.


VAERS ID: 1877032 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cough, Ear pruritus, Swelling of eyelid, Swollen tongue, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Yellow fever vaccine, June 2019, age 54
Other Medications: Trulicity, levothyroxine,
Current Illness: None
Preexisting Conditions: Occasional asthma Type 2 diabetes Hypothyroidism
Allergies: Sulfa drugs Morphine intolerance Grape leaves
Diagnostic Lab Data: No tests were done.
CDC Split Type:

Write-up: Ears started itching 8p, the day after the vaccine injection. Woke up at 6:30a to see hive welts on underside of arm that had injection, along with hives on legs, right arm, upper chest and back. Coughing and feeling of tongue and eyelid swelling started at 7:30a


VAERS ID: 1877039 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK LA / IM

Administered by: Work       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: Vaccine Administration error. Vaccine was given beyond the 30 day refrigeration guidelines.


VAERS ID: 1877054 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Product administration 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 Administration error. Vaccine was given beyond the 30 day refrigeration guideline.


VAERS ID: 1877062 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-14
Onset:2021-11-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, Lymph node pain, Lymphadenopathy
SMQs:, Medication errors (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: Duloxetine 30mg Lamotrigine 150mg (100mg AM / 50 mg PM)
Current Illness: Sore throat two weeks prior
Preexisting Conditions: Bipolar
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: First vaccine Johnson & Johnson, March 2021 Booster Moderna Covid-19 vaccine Very swollen and painful lymph node in left armpit, same side as injection.


VAERS ID: 1877067 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-31
Onset:2021-11-16
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/16/21 COVID positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1877068 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK RA / IM

Administered by: Work       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: Vaccine Administration error. Vaccine was given beyond the 30 day refrigeration guidelines.


VAERS ID: 1877093 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-11-16
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 - / -

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

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

Write-up: Patient tested positive for C19. Patient has been admitted to hospital.


VAERS ID: 1877094 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Carotid artery occlusion, Computerised tomogram head, Ischaemic stroke, Vascular occlusion
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metformin 500mg Q DAY, omeprazole 40mg BID, Wellbutrin 150mg Q DAY, lisinopril 20mg Q DAY, Acetominophen-codeine #3 300-30mg 1 tab as needed, diclofenac topical, Duloxetine 30mg Q DAY, Famotidine 40mg QHS
Current Illness: recently diagnosed HTN
Preexisting Conditions: breast cancer thought to be in remission s/p lumpectomy, radiation, GERD, remote history of alcohol use, alcoholic pancreatitis with pseudocyst, tobacco use
Allergies: Vicodin, oxycodone, azithromycin
Diagnostic Lab Data: CTH 11/16, CTA H/N 11/16, CTH 11/17
CDC Split Type:

Write-up: Acute ischemic stroke, LVO occlusion L ICA terminus on 11/16


VAERS ID: 1877099 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-11
Onset:2021-11-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Nausea, Retching, SARS-CoV-2 test
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Covid, Moderna, 1/17/2021, 2/16/2021, headache and fatigue on 1st and 2nd day after shot.
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: Mitral valve prolapse
Allergies: None
Diagnostic Lab Data: COVID test, 11/16/2021, results not back yet.
CDC Split Type:

Write-up: Nausea and intense retching. Headache. Dizziness. Fatigue.


VAERS ID: 1877103 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Back pain, Chills, Nausea, Pain in extremity, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Injection site pain from Pfizer Covid and other mild symptoms
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Right arm and hand pain Underarm pain Fever with severe chills/shaking Back pain and shoulder pain Nausea


VAERS ID: 1877116 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK RA / IM

Administered by: Work       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: Vaccine Administration error. Vaccine was given beyond the 30 day refrigeration guidelines.


VAERS ID: 1877130 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-19
Onset:2021-11-16
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D / 2 - / -

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

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

Write-up: Patient tested positive for C19 and is hospitalized receiving treatment for C19


VAERS ID: 1877134 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: None reported.
Allergies: None reported.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Administration error. Patient received pediatric Pfizer formulation at age 12; she should have received the adult 12+ Pfizer formulation. No adverse reactions, signs or symptoms were noted or reported during the 15min observation period. Patient''s parents will be notified of need for adult formulation of second Pfizer vaccine on 12/7/21.


VAERS ID: 1877135 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Product administration error, 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 Administration error. Vaccine was given beyond the 30 days refrigeration guidelines.


VAERS ID: 1877147 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-22
Onset:2021-11-16
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013SBA / 1 RA / IM

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

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

Write-up: Hospitalization 11/16/21


VAERS ID: 1877151 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-10
Onset:2021-11-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Balance disorder, COVID-19, SARS-CoV-2 test positive
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient is admitted due to weakness and balance issues. Tested positive for C19


VAERS ID: 1877169 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312880 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Inappropriate schedule of product administration, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood thinner, Zyrtec at the time of the event
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: Blood pressure
CDC Split Type:

Write-up: Patient received flu (Fluad) and covid 19 (Moderna) booster at the same time. Five minutes after she was very flushed and said her heart was racing. No anaphylaxis was present. Patient was given a Zyrtec and EMS support was called.


VAERS ID: 1877170 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Unknown  
Location: Utah  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F2114 / 3 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast discolouration, Breast inflammation, Breast pain, Breast swelling
SMQs:, Angioedema (broad), Lipodystrophy (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: Clonazepam
Current Illness: None
Preexisting Conditions: Asthma Extra esophageal reflux disease
Allergies: No
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: This was my Moderna booster shot. It?s hard to read lot number as it was hand written. I had breast implants put in 4 weeks ago. I got the booster yesterday morning. By 8 pm my breasts became swollen, inflamed, and the right breast had three solid pink circles. The circles have gone but I still have a lot of pain and inflammation I in my breasts, especially the opposite breast if the injection site. I have not been able to get to a doctor yet.


VAERS ID: 1877171 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK RA / IM

Administered by: Work       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: Vaccine Administration error. Vaccine was given beyond the 30 day refrigeration guidelines.


VAERS ID: 1877175 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-19
Onset:2021-11-16
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hospitalized fever shortness of breath Covid pneumonia.


VAERS ID: 1877179 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F62357 / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Erythema, Feeling hot, Hot flush, Lethargy, Pain, Pain in extremity, Peripheral coldness, Pruritus, Pyrexia, Rash, Rash papular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 40mg
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: November 16 at 20:30: Deeply uncomfortable pain in right arm from shoulder to elbow. Noticed rash on right side of cheek and chin. November 16 at 22:00: went upstairs (first physical exercise), had hot flashes/throbbing hot body, deep arm pain, noticed right cheek and chin rash was almost gone. Put hydrocortisone cream on cheek and chin. November 16 at 23:00: laid down due to fever feeling and lethargic, immense arm pain continued (couldn?t move without pain), body felt feverish because of cold fingers/toes and hot legs. Took temperature (97.2) November 17 at 08:30: fever was broken during the night. Arm didn?t hurt as badly, noticed an uncomfortable itch on left chin and cheek there was a rash present.November 17 at 09:30: looked at chest in mirror, red and agitated and one large skin-colored bump. Decided to put medication on after class (by 11:00). November 17 at 12:00, there was not a rash or redness on cheeks, chin, or chest at that point despite not having any medication on it. November 17 at 13:45: right shoulder felt uncomfortable under a loose fitting cotton t-shirt, bright red agitation and raised skin-colored bumps. Photos were documented. Chest was slightly itchy at that point. November 17 at 14:15: despite most of the bump disappearing without doing anything, I put Benadryl and hydrocortisone cream on both cheeks, chin, and chest.


VAERS ID: 1877183 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immunisation, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT was given booster by nurse to R arm, but vaccine spilled out from arm. PT did not recv complete vaccine less than 50%.Bandage was applied. Confirmed with CNO who confirmed with provider, Dr. and advised if the PT did not recv full dose than she would need to be re vaccinate in the other arm. Another Nurse completed the 2nd vaccination of Pfizer in the L arm.


VAERS ID: 1877189 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / UNK RA / IM

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

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

Write-up: Hypersensitivity (urticarial) rash to neck, chest and back starting 24 hours after vaccination


VAERS ID: 1877205 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / IM

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

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

Write-up: Pharmacist on duty filled syringe with adult Pfizer vaccination instead of Pediatric Pfizer vaccination. Patient was given 0.2ml of Adult Pfizer.


VAERS ID: 1877211 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-02
Onset:2021-11-16
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Infection, Liver transplant, SARS-CoV-2 test positive, Vaccine virus shedding
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hospitalized for liver transplant, positive testing probably residual shedding from infection on 10/30/2021. No symptoms.


VAERS ID: 1877212 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 2 LA / SYR

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

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

Write-up: Left supraclavicular lymph node swelling


VAERS ID: 1877225 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram abnormal, Headache, Strabismus, Vertigo, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (narrow), Ocular motility disorders (narrow), Hypoglycaemia (broad)

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

Write-up: 3-4 hours after receiving his COVID vaccine his eyes were looking to the side, started to fell dizzy with headache and blurred vision. Child was taken to the emergency room and was dx with vertigo/dizziness. Per mother of child the ER told them that his EKG looked abnormal with "lines too high."


VAERS ID: 1877234 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-11-16
   Days after vaccination:281
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Write-up: Hospitalized at the hospital since 11/16/2021


VAERS ID: 1877239 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-19
Onset:2021-11-16
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Fatigue, Hypoxia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hospitalized for positive COVID 19 with hypoxia, fever, fatigue, chills, rigors.


VAERS ID: 1877267 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / IM

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

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

Write-up: Pharmacist on duty filled syringe with adult Pfizer vaccination instead of Pediatric Pfizer vaccination. Patient was given 0.2ml of Adult Pfizer.


VAERS ID: 1877306 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 - / SYR
DF: DENGUE TETRAVALENT (DENGVAXIA) / SANOFI PASTEUR FF8841 / 3 - / JET

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Limb discomfort, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone/Hydrochlorothiazide, Travoprost, Aspirin, Folic Acid, Loradine, Timolol, Lansaprazole, Levothyroxine, Metoprolol ER100, Simvastatin, Estradiol/Testosterone Pellet
Current Illness: None
Preexisting Conditions: Coronary Heart Disease; Skin Cancer (Melanoma, Squamous Cell, and Basil Cell. Was being treated on both hands with Fluorouracil 5% Topical Cream for precancerous KAs and Squamous Cell.
Allergies: Penicillen; Sulfa; ProAir HFA, Cipro, Myrbetriq, Neosporin ointment
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Began with sore left arm which moved into the right arm around 3:00 pm. Arms felt very heavy to lift and were sore. Began chilling at about 4:00 pm. Became very tired and went to bed at 8:00 pm. Woke up around 1:00 am next morning and chills were gone, Arms were still sore but did not feel as heavy. By 10:00 am I was feeling perfectly normal.


VAERS ID: 1877317 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2bd dose of modern a but only chills and tiredness lasting one afternoon after shot given
Other Medications: Levothyroxine Sodium 137 MC
Current Illness: None
Preexisting Conditions: Nobe
Allergies: Betadine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, nausea, headache, sleepy Started 11:00 am Slept fine thru night and fine the next day


VAERS ID: 1877320 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Decreased appetite, Headache, Hypokinesia, Lethargy, Pain, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HTCZ, AMLODOPINE, BUSPAR, Buproprion, Viibryd, Pravastatin, Omeprazole, valacyclovir, welchol, hyoscyamine
Current Illness: None
Preexisting Conditions: Arthritis, hypertension
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On the morning following the vaccination, fever 102.1. Extreme generalized body aches, difficult to move in bed, lethargic, weak, severe headache. No appetite, slept off and on and stayed in bed ti? 6 p.m. that day. Only up for a couple hours at most. Still slow today.


VAERS ID: 1877356 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 - / IM

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

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

Write-up: Child given Adult Pfizer and adult dose of 0.3ml


VAERS ID: 1877367 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-11-16
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 11/16/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1877377 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Lip swelling, Pyrexia, Rash, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Swelling on face and lips; rash -- red dots -- all over face; dizziness; fever $g103.


VAERS ID: 1877409 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Anxiety, Back pain, Dyspnoea, Pain, Restlessness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: Wellbutrin
Current Illness:
Preexisting Conditions: Non alcoholic Fatty Liver
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme body ache, particularly abdomen and back, to the extent I could not fully inhale without severe acute pain in lower back. Extreme restlessness and anxiety. Breathing difficulty.


VAERS ID: 1877411 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065FUA / 3 RA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Condition aggravated, Diarrhoea, Headache, Hypoaesthesia, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Possibly ate moldy tomato sauce one day prior, mild nausea and weakness but no vomiting or diarrhea
Preexisting Conditions:
Allergies: Ceclor
Diagnostic Lab Data:
CDC Split Type:

Write-up: Experienced moderate headache, pain at injection site, chills (chattering teeth), numbness in hands from 6:00pm to 10:30pm day of vaccination. Experienced diarrhea, weakness, and nausea the following day.


VAERS ID: 1877449 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: flexeril, buspar, trazodone
Current Illness:
Preexisting Conditions: anxiety
Allergies: NKDA
Diagnostic Lab Data: EKG 11/17/21 normal
CDC Split Type:

Write-up: night after getting covid pfizer vaccine booster from pharmacy 11/15/2021, patient got up to use restroom, had syncopal episode when walking to bed


VAERS ID: 1877453 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022D / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd moderna vaccine, also had a fever, but it was two days instead of one day
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever the day after (14 hrs after vaccine) of 100.7 when I took two tylenol, which I continued for the next 15 hrs. 2 tylenol reduced the fever.


VAERS ID: 1877492 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-14
Onset:2021-11-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID-19(pfizer), at age 31 in January 2021
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever up to 102.4, headache, chills, fatigue, weakness, and muscle aches lasting 24 hours. Took ibuprofen to reduce fever.


VAERS ID: 1877502 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood lactic acid decreased, Heart rate increased, Pyrexia, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: lactic acid of 2.7, tachycardia up to 170
CDC Split Type:

Write-up: tachycardia, fever, weakness, syncopal episode prompting ED visit.


VAERS ID: 1877520 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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? 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: Fever, headache, body aches, lightheaded, nausea


VAERS ID: 1877559 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-04
Onset:2021-11-16
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram, Electrocardiogram ST segment abnormal, Gram stain negative, Hyperhidrosis, Painful respiration, Respiratory viral panel, Troponin increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clonidine, risperidone, buproprion, methylphenidate
Current Illness:
Preexisting Conditions: ADHD, bipolar disorder
Allergies: None
Diagnostic Lab Data: EKG - nonspecific ST changes (11/16/21, 11/17/21) Troponin - elevated 2.603 $g 1.605 $g 0.703 $g 5.25 (11/16/21-11/17/21) Echo - normal (11/16/21) Cocci screen - negative (11/16/21) Respiratory viral panel - negative (11/16/21)
CDC Split Type:

Write-up: Chest pain with sensation as though chest on fire, localized to substernal area with no radiation. Associated with sweating and difficulty breathing. Worse while fully supine and with deep inspiration, but improves while sitting up.


VAERS ID: 1877573 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fear, Feeling cold, Gait disturbance, Hyperhidrosis, Illness, Lymph node pain, Lymphadenopathy, Muscle spasms, Pain, Pyrexia, Sensitive skin, Skin warm, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: This is the list, unclear if any changes. Pt has moved away and reported the adverse reaction via messaging that still is active. alprazolam 1 mg tabs, per psych; 1 tab po no more than daily prn anxiety cyclobenzaprine 5 mg PO tid as needed
Current Illness: none
Preexisting Conditions: Allergic rhinitis J30.9 and dysphagia Androgenic alopecia L64.9 per derm Ankle pain(unspecified ankle and joints of unspecified foot) M25.579 L side - chronic Anxiety F41.9 per psych Breast pain N64.4 Cardiac arrhythmia I49.9 Cervical spondylosis M47.812 chronic Ear pain(right ear) H92.01 and tinnitus Gastroesophageal reflux disease K21.9 see dysphagia Genitourinary syndrome of menopause N95.2 Hearing loss(unspecified ear) H91.90 Hip pain(right hip) M25.551 Hypertension I10 Mixed irritable bowel syndrome K58.2 Orolabial herpes B00.1 Posttraumatic stress disorder F43.10 anxiety - per psych Tinnitus(bilateral) H93.13 see ear pain Underweight R63.6 Varicose vein(s)(bilateral lower extremities) I83.93 Axilla pain(right upper arm) M79.621 Change in bowel habits R19.4 Colonic polyp(s) K63.5 Diarrhea R19.7 Generalized abdominal pain R10.84 Hemorrhoid(s) K64.9 Leg pain(right leg) M79.604 Nocturnal leg cramps G47.62 Thyroid nodule E04.1 Wrist pain(left wrist)
Allergies: Mucinex body aches Drug-Allergy Incompatible St. John''s wort racing heart Sulfa (Sulfonamide Antibiotics) rash Talwin unsure of reaction Valtrex arthralgias terbinafine liver toxicity - pancreatitis tetracycline phototoxicity valerian racing heart
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt reporting in messaging: The inoculation itself was painless, and I scarcely thought of it again Monday evening and all day yesterday (Tuesday 16 Nov) till about 24 hours had passed. Very suddenly I began to shiver and shake - more violently than I can recall since 1998 when I was living abroad and had a serious case of the flu that was circulating. I experienced spasms in my neck and throat so strong that I used my hands to prevent my jaws from involuntarily biting my tongue or perhaps breaking a tooth. I could not control my shaking and felt colder than I have ever felt in my life. I could not walk properly I was shaking so hard. I quickly turned on an electric throw blanket and piled coats and blankets on myself. Within about thirty minutes the symptoms were reduced but far from gone. When a breath of air touched my skin it felt like ice and the shaking would accelerate, as would the spasms in my neck and jaws. I was so ill that I felt it wiser to stay home and address the symptoms than to call for assistance because I''m in an apartment complex which is a bit remote and have seen ambulances getting lost out here. I was concerned that trying to meet the ambulance driver would result in the uncontrollable spasms, which even impacted my breathing for a time. In short, I felt it more dangerous to call for an ambulance than to address the symptoms myself. I had a fever but don''t know what my temp was as my thermometer is still in storage. My son, who was not here when this started, said I was very hot. The lymph nodes in my groin swelled and were tender. I finally fell asleep and awoke in a few hours feeling better but far from normal. Throughout the day today I have either been sweating, or shivering as I am doing as I write. I hurt all over and I have only eaten a bit, and rested today. Recently I have been feeling very hale and healthy, almost recovered from the move, so this was a big surprise, especially considering that I experienced virtually no side effects to the first two doses. I have not exaggerated - if anything am unable to aptly describe the symptoms. It was a bit scary for a while. I hope this will be reported to Moderna.


VAERS ID: 1877661 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: sre injection site, large swollem lymphnodes


VAERS ID: 1877675 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Product administered to patient of inappropriate age
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: Patient is 13 years old and received a Moderna booster. Patient has no side effects to report after 24 hours except sore arm.


VAERS ID: 1877691 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Cough, Dysphonia, Nausea, Productive cough, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Dose 2 Covid Pfizer vaccine on 4/18/21?had sore throat for a week and headache for 3 days following vaccine. Flu shot on 10/17/2
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Took an at home test on day 3 after vaccine and results were negative. Was tested day before getting vaccine by PCR and test was negative.
CDC Split Type:

Write-up: Mild cough with phlegm on day 2 after vaccine. Cough worsened on day 3 and became painful to cough by end of day 3. Horse voice on day 3. Some nausea started early on day 3 and came in spurts through the day. Slight chills on day 3.


VAERS ID: 1877713 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Confusional state, Fatigue, Feeling abnormal, Headache, Heart rate increased, Hyperhidrosis, Insomnia, Pain, Pyrexia, Restlessness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA Events: 6 hours post injection: --general tiredness/exhaustion set in but with restlessness, not able to sleep --sweating begins --light headache set in 12 hours post injection: very rough night and morning --Elevated resting heart rate: 101 --Fever: 101.1 --Chills/shivers --Heavy Sweats --Restless but very fatigued --Body aches, especially back. --Mental Confusion --Severe headache 36 hours post injection: --fever reduced to almost normal --headache persists but not as strong --body aches persist but not as strong --chills come and go --some mental fog persists but improved


VAERS ID: 1877731 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Headache
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 had JNJ vaccine, booster should be given at 0.25 ml. Patient was administered with 0.5 ml. Called patient, he had mild headache 12 hours post vaccine, drank water, NSAIDS, headache gone. No other side effect by the end of 11/17/21. Called patient at 1940 on 11/17/21, his wife and patient both stated he was feeling "just fine".


VAERS ID: 1878010 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Large amount of Swelling in armpit, lymph nodes ,


VAERS ID: 1878029 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-19
Onset:2021-11-16
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Cough, Pain, Sneezing
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: nonproductive cough, body aches, chest pain, sneezing. starting 11/16/21


VAERS ID: 1878040 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-14
Onset:2021-11-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Feeling abnormal, Migraine, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

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

Write-up: 2 days after getting the booster I had a migraine headache that was extremely painful and my speech was garbled. I couldn?t think straight enough to get words out. I took Tylenol and iced my head, and later in the day I took Benadryl to get some sleep. My husband had called his brother who is a doctor. Today, day 3, my head feels foggy and I?ve slept part of the day. I have a milder headache this evening. I?ve never had a migraine before.


VAERS ID: 1878045 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       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''s mom falsified child''s age stating they were 5 yo. Patient was actually <5 yo and not eligible for COVID vaccination.


VAERS ID: 1878052 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia oral
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: moderna 1st and second dose
Other Medications:
Current Illness: unknown
Preexisting Conditions: hypertension, asthma
Allergies: polyethelyne glycol, thiazide, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt experienced dizziness immediately then approximately 6 minutes later felt lip and tongue numbness. I gave the patient 50mg of liquid diphenhydramine, after waiting approximately 40 minutes patient stated she felt fine and left.


VAERS ID: 1878067 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / N/A LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, Wellbutrin, Zantac, spironolactone, probiotics, biotin, vitamin D, vitamin C, zinc, magnesium, vitamin B
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extremely swollen and painful axillary lymph nodes on left side (same arm as shot)


VAERS ID: 1878214 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Next morning after shot developed fever, nausea, lack of energy. By end of evening on 16th fever was at 101.1, severe chills, headache, nausea, no appetite, no energy and elevated heart rate. At rest and no movement it was at 98-120 bpm. My heart rate usually around 60-65 at rest. Took some ibruprofen which helped fever go down. Heart rate is now around 80-85. Also developed large red spot, swollen sore arm at shot site.


VAERS ID: 1878216 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / N/A LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Feeling abnormal, Pain, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nature Made (brand) Multi For Her 50+ ........multi-vitamin/mineral supplement - 1 tablet daily GNC (brand) Turmeric Curcumin 500 mg - 1 capsule daily
Current Illness: none
Preexisting Conditions: Lichen Sclerosus - controlled with topical Clobetasol ointment 0.05% Overactive bladder
Allergies: Erythromycin shrimp
Diagnostic Lab Data: none
CDC Split Type:

Write-up: This Moderna vaccine was a Covid-19 booster (not a 3rd shot). Received vaccine Nov. 15th - sore arm that night. Nov. 16th at 6:00 AM - woke up feeling lousy, achy, slightly dizzy. Took my temp. - 100.2 degrees F. Took again 8:00 AM - 100 degrees . Slept till noon - felt much better, still tired but not extremely. Nov. 17th - feel normal.


VAERS ID: 1878219 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol 90mcg Sertraline 25 mg Montelukast 10 mg Ibuprofen Capsaicin
Current Illness: Depression Twisted ankle.
Preexisting Conditions: Moderate depression Moderate persistent asthma Chronic Sinusitis Eczema
Allergies: No known Allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient came with family member who was scheduled to get a COVID-19 injection. Patient was given a third Pfizer shot.


VAERS ID: 1878338 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Atrial flutter, Intensive care, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), 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: Denies
Preexisting Conditions: HTN, high cholesterol
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to ED with sudden onset tachycardia/atrial flutter 145-150bpm, admitted to ICU on cardizem and heparin drip. Currently still in ICU 11/17/2021


VAERS ID: 1878349 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-14
Onset:2021-11-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Right under arm pain and swelling 2 mornings after receiving booster Covid and flu vaccines. It is the arm that the Covid vaccine was given in.


VAERS ID: 1879516 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Migraine, Pain in extremity
SMQs:, 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: Birth control, Fish Oil, Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache (migraine - very intense); fatigue; sore arm.


VAERS ID: 1879210 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-11-16
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, 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: USJNJFOC20211136275

Write-up: A PUNCTURED VIAL LEFT IN REFRIGERATOR FOR MORE THAN 6 HOURS; MEDICATION ERROR; This spontaneous report received from a pharmacist concerned multiple patients. 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: 211D21A expiry: 04-NOV-2022) dose was not reported, administered on 16-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 16-NOV-2021, the patient experienced medication error. On an unspecified date, the patient experienced a punctured vial left in refrigerator for more than 6 hours. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the medication error and a punctured vial left in refrigerator for more than 6 hours was not reported. This report was non-serious.


VAERS ID: 1879533 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-14
Onset:2021-11-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Mood altered, Pain, Pain in extremity, Palpitations, Panic attack, Psychomotor hyperactivity, Therapeutic response unexpected
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (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: Runny nose 2 weeks prior without any other obvious cold symptoms -did not seem sick
Preexisting Conditions: Exercise induced asthma only
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: My daughter had expected aches, fatigue, sore arm and headache for 2days. On the 3rd day she felt back to normal but that night she told me her heart was racing twice. She went on to have a panic attack which she has never had before. The next night (4th night) she was abut hyper and happier but continues to say her heart is racing. She says she has never that before except for in an asthma attack.


VAERS ID: 1879543 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-02
Onset:2021-11-16
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Red yeast rice, CoQ-10, I-Caps, Vitamin K2+D3, Thera Tears Dry Eye Therapy, Zyrtec
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I went to the Hospital Emergency Room tonight. The doctor prescribed Prednisone, Famotidine and Benadryl. 5 day course for these meds. No tests or labs were taken.
CDC Split Type:

Write-up: I have hives on my feet, hands, arms, body. The red patches come and go. They are very itchy. This started last night around 6PM on 11-16-2021 and continue as of this writing, at 1:00AM on 11-18-2021.


VAERS ID: 1879929 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Influenza like illness, Injection site erythema, Injection site induration, Injection site mass, Injection site pruritus, Injection site swelling, Injection site warmth, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna 2nd dose on 2/17/2021 causes sever flu symptoms for 30 hours. Severe chills, fever, aches, headache.
Other Medications: Estradiol
Current Illness: N/a
Preexisting Conditions: Menopause
Allergies: N/a
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Flu-like symptoms started 31 hours after I received my booster shot of Moderna - body aches, fatige and exhaustion, headache, sever chills, low grade fever. The next morning the injection site in my right arm was a hard lump, swollen, hot, red, and slightly itchy. The discomfort is localized to about 3 inches diameter. The rest of my arm is fine. The flu symptoms have resolved 24 hours after they started, but he arm is still red and itchy and swollen at the vaccine injection site.


VAERS ID: 1880054 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1880058 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / UNK LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1880060 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 RA / SYR

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

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

Write-up: Body aches, headache


VAERS ID: 1880062 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Tylenol
Current Illness: N/A
Preexisting Conditions: Pulmonary hypertension, asthma, fibromyalgia
Allergies: All Nuts, green beans, squash Sulfur, CT scan dye,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 102, nausea, headache, fatigue, muscle aches


VAERS ID: 1880077 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Hypersensitivity (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, Systemic: Flushed / Sweating-Mild


VAERS ID: 1880079 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Loss of consciousness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Additional Details: Pt said she "felt weird" and fainted/passed out on floor for 5-10 seconds. Mom declined EMS. After laying on floor for a few seconds, pt said she felt better and stood up and was able to walk to chair to continue to lie down. Looked pale, but she said she felt fine. BP was 100/83mmHg, HR was 75 bpm. Patient said she felt completely fine and left with her mom after ~45 mins without issue. No further follow up needed.


VAERS ID: 1880082 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 3 RA / IM

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

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

Write-up: Sever bodyaches, chills, low grade fever, fatigue less than 24 hours after getting COVID booster. Patient had to rest and call into work due to body aches.


VAERS ID: 1880084 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1880272 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Muscle spasms, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Severe fatigue, muscle cramps and soreness.


VAERS ID: 1880283 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-10
Onset:2021-11-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac monitoring, Chest X-ray, Dizziness, Electrocardiogram, Fibrin D dimer, Full blood count, Influenza A virus test, Influenza B virus test, Metabolic function test, Nasopharyngitis, Pain, Palpitations, Pyrexia, SARS-CoV-2 test, Troponin I, Upper respiratory tract infection, X-ray
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: BusPirone 7.5mg 1x daily, Omeprazole 40mg 1x daily, amitriptyline 25mg 1 x daily
Current Illness: n/a
Preexisting Conditions: Celiac, Acid reflex
Allergies: Pencillin, Macrobid, Bactrim, Nuts, gluten
Diagnostic Lab Data: EKG, D-Dimer, BMP, Cardiac Monitor, CBC, Troponin-I, XR CXR 2V, Sars/Influenza A and B Ag FIA Combo Negative Covid and Flu. Upper respiratory infection, Heart Palpitations were discovered
CDC Split Type:

Write-up: Day after vaccine 11/12/21, body aches (Bad), Fever 11/15/21 Faint feeling, cold like symptoms 11/16/21 Heart Palpitations, and upper respiratory infection


VAERS ID: 1880286 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Moderna Covid-19 Vaccine EUA Booster caused arm pit lymph node swelling


VAERS ID: 1880290 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-13
Onset:2021-11-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A-B / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ764AA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: 11/16/21 SWELLING AND ITCHING OF LEFT HAND 11/17/21 SWELLING AND ITCHING OF LEFT AND RIGHT HANDS TREATMENT BEGINNING ON 11/17/21 INDOMETHACIN 50MG TID X 7 DAYS HYDROXYZINE HCL 25MG BID PRN X 7 DAYS OUTCOME NOT DETERMINED YET


VAERS ID: 1880293 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site swelling, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Velivet (oral contraceptive), Restasis (dry eyes)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Injection site pain, swelling, and redness Fatigue and weakness Muscle and joint pain Fever Headache


VAERS ID: 1880299 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Feeling abnormal, Mobility decreased, Restlessness
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament 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: Fiber pills, low dose aspirin, b-12
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: lisinopril
Diagnostic Lab Data: Did not go to the Dr. office. Just let it run its course
CDC Split Type:

Write-up: started with chills and a low grade temp (no higher than 99.8). Restlessness and mental fog through most of Wednesday, November 17. Had little appetite during the day. Also experienced continued brain fog. Stayed in bed from 10pm on the 16th to around 6pm on the 17th. Today (11/18), feeling more normal, somewhat fatigued and appetite still not strong, but I''m ready to get back to a mostly normal routine but I don''t think I''ll be too physical in the things I will be doing.


VAERS ID: 1880303 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: Based on age pt received the wrong dose. Should have received the purple cap Pfizer 30 mcg. Instead received the orange cap Pfizer 10 mcg.


VAERS ID: 1880304 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Headache, Migraine, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 100mcg LEVOTHYROXINE
Current Illness: N/A
Preexisting Conditions: hypothyroid
Allergies: Shellfish, tree nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever started a few hours after injection. 102-103 temps, extreme body aches, headache, nausea, migraine, joint pain. Lasted for 36 hours. Patient had NO reactions to 1st dose and only about 30 mins of feeling flushed 12 hours after 2nd dose. Took 1000mg Tylenol 10pm on 11/17/21. Arm still very sore and mild headache now.


VAERS ID: 1880309 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-22
Onset:2021-11-16
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid+ test on 11/16/21
CDC Split Type:

Write-up: covid vaccine breakthrough case


VAERS ID: 1880315 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-08
Onset:2021-11-16
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid+ test on 11/16/2021
CDC Split Type:

Write-up: covid vaccine breakthrough event


VAERS ID: 1880316 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Hot flush, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: hot flashes, lightheaded & unsteady, unsatisfying itching on arms & face, rash on left arm & left neck. Took Benadryl at 2:45pm which helped with the rash & itching. Felt a lot better by 4:00pm. I work in a hospital so was helped by my coworkers that were nurses, so I did not have to go to the Drs office. But if I was home and not at work, I would''ve gone to urgent care.


VAERS ID: 1880319 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-01
Onset:2021-11-16
   Days after vaccination:288
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid + test on 11/16/2021
CDC Split Type:

Write-up: covid vaccine breakthrough event


VAERS ID: 1880321 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-11-13
Onset:2021-11-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine given 11/13/2021 in the left deltoid. Developed a "fullness" and tenderness of the the left axilla on 11/15/2021. No worsening, no improvement. Pt otherwise feels well. No chills, no fever, no loss of appetite, no rash. Tenderness of the left axillary lymph noted noted on exam. No erythema, drainage noted.


VAERS ID: 1880337 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: 15 year old patient was given pediatric (5-11 year old ) dose . Patients mother was notified. Patient will receive 12 year old and above dose in 21 days. Patient tolerated vaccine with no adverse effects


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