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From the 9/17/2021 release of VAERS data:

Found 711,579 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 6 out of 7,116

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VAERS ID: 1700196 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flu shot a few days prior
Current Illness: No
Preexisting Conditions: None
Allergies: Allergic to keflex
Diagnostic Lab Data:
CDC Split Type:

Write-up: After about 7 hours I payed down to get some rest. I had whole body aches, headache and whole body chillz shivering. I also felt warm to touch and had a fever. Injection arm was very sore and I felt very fatigued


VAERS ID: 1700201 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Flushing, Interchange of vaccine products, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Medication errors (broad)

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

Write-up: Patient registered and presented for Pfizer vaccine. Stated she had not received any other COVID-19 vaccine. Denies any allergies. She was vaccinated and observed for 15 minutes. Approximately 30 minutes later she reported nausea. She appeared flushed. Vital signs normal. She was observed for an additional 15 minutes. Nausea did not improve. Patient then stated she had lied about receiving COVID-19 vaccine. She stated she received 1 dose of Moderna COVID-19 vaccine a few months ago but that she waited too long to get the second dose so she lied in order to get the Pfizer vaccine. She was advised to go to the hospital if symptoms worsens.


VAERS ID: 1700202 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Insomnia, Tinnitus
SMQs:, Hearing impairment (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: low dose aspirin
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type: n/a

Write-up: Tinnitus coupled with mental anxiety, insomnia. Symptoms started approximately 24 hours after vaccine.


VAERS ID: 1700212 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

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

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

Write-up: Pt received COVID Vaccine, Pfizer 30mcg, IM left deltoid at 1250. Pt waited for 15 minutes prior to leaving facility. Patient reports that he noticed itchiness as he drove back, he returned at 1355, and reported symptoms. Pt ambulated to triage area accompanied by RN. Pt sit on gurney, assessment completed, itching/redness on trunk, no difficulty swallowing or breathing. Vital signs at 1401: 125/89, HR 89, 100% SPO2, resp 16. Pt with allergy to PCN, unknown reaction, no previous adverse reaction to vaccines. Pt currently prescribed Adderall, and tramandol. 1418: pt continues to report itching, redness observed on trunk. As the vaccination location does not have medical treatment capabilities, will contact EMS for further evaluation. 911 contacted at 1418. Vital signs at 1420: 125/85, HR 84, 99.7% SPO2, resp 17. pt denies difficulty swallowing/breathing. 1425 - EMS arrives, SBAR given to EMT. 1427 - pt ambulate to ambulance.


VAERS ID: 1700224 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Hypoaesthesia, Hypotension, Rash, Swelling, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Sexual dysfunction (broad)

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

Write-up: Lowered B/P, Itchy Throat, Rash, Swelling, Hand numbness


VAERS ID: 1700242 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe headache, nausea, fever.


VAERS ID: 1700247 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect dose administered, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo-Provera EpiPen injection,auto-injector ProAir HFA actuation aerosol inhaler
Current Illness: none
Preexisting Conditions: Dermatitis, atopic / eczema
Allergies: Peanut, tree nut, shellfish derived
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient was given the entire vial contents of non- reconstituted Covid 19 Pfizer vaccine. Error was discovered the next morning. Pfizer called. Patient called. Appropriate physicians notified of event. Patient stated the symptoms that she was displaying was pain/tenderness to injection site and mild dizziness. Patient in clinic for office visit. Per provider, patient vitals WNL, area at injection site noted to have some redness and mild swelling consistent with a local vaccine reaction. Per provider, no further follow-up at this time. May receive 2nd Pfizer dose on schedule. Patient to call with questions and/or concerns. Advised to use a cold pack, ibuprofen or APAP as needed for pain/ swelling..


VAERS ID: 1700251 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Headache, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu 2016 Bell?s palsy
Other Medications: None
Current Illness: None
Preexisting Conditions: Blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vomiting, diarrhea , headache and achy everywhere.


VAERS ID: 1700263 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: few minutes after vaccine was administered , the person fainted, passed out (syncope), presumably fear of the vaccine. . made the person to lay flat on the floor, checked her pulse and breathing, no swelling of lips or tongue. called 911, and was checked by the EMT outside the pharmacy and was released, didn''t need to be taken to the hospital


VAERS ID: 1700266 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Diarrhoea, Dizziness, Headache, Injection site swelling, Myalgia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shot #2 some dizzy
Other Medications:
Current Illness: Heart failure
Preexisting Conditions: Heart disease
Allergies: Shell fish , dairy
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Stomach cramps, severe diarrhea, head ache, dizzy, chills, shakes, shot arm shoulder swollen to the size of a soft ball, all over muscle pain. All still ongoing. Taking Tylenol and hot vegetable broth, hot shower, stay in bed.


VAERS ID: 1700279 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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: blood pressure meds
Current Illness:
Preexisting Conditions:
Allergies: seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: low grade fever (200 degrees), sever back pain


VAERS ID: 1700288 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Facial paralysis, Fatigue, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hearing impairment (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No acute illness
Preexisting Conditions: Underlying autoimmune condition, being followed by rheumatologist
Allergies: latex and PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: left sided facial paralysis/Bells palsy within hours of receiving 2nd dosage of COVID -19 vaccine. Had symptoms of feeling unwell, fatigued, myalgia etc with 1st dosage lasting for 3-4 days


VAERS ID: 1700294 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 3 UN / IM

Administered by: Military       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: Norgestimate 0.25mg + Ethinyl Estradiol
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received third dose of Pfizer vaccine following previous completion of Pfizer vaccine series at off campus vaccination clinic location. The error was noted during documentation into patient''s electronic medical record following return to medical campus. Patient was contacted and reported that she had lost her vaccination card for her First dose. Upon receiving her second dose at civilian immunization clinic, the clinic provided her a new proof card. She presented her proof card to military medical clinic to update immunization status and was instructed by staff that her proof card requires two vaccinations to be documented prior to updating Imms status. Patient arrive to vaccination clinic and made her own decision to endorse receiving only a single Pfizer vaccination for purposes of receiving an additional dose in order to have a second dose recorded on her vaccination proof card. This resulted in a third dose of COVID vaccine for patient. Guidance will be posted and required to be read prior to administration of vaccine regarding proper procedure for updating or validating vaccination proof cards to prevent further inappropriate third doses. No identified harm was done to patient following administration.


VAERS ID: 1700332 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chest discomfort, Discomfort, Injection site pain, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Right inflammatory blepharitis 1 month ago( resolved with Diphenhydramine 50mg every night)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received dose at 2pm, started with general discomfort, local pain in the left arm, feverish feeling at 7pm, proceeds to take oral ENANTYUM. At midnight with chest tightness without dyspnea and proceeds to use Salbutamol inhaler with another intake of oral ENANTYUM. Associated with #2 vomiting, consultation the next day (09/15) at 9 am with BP: 124/076 mmHg T: 38 c So2: 98% room air. Eupneic, cardiopulmonary without added noise, no foot edema. Sg Levine (neg) Tietze (neg) .


VAERS ID: 1700363 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FS2588 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Fatigue, Headache, Swelling face, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: right side of face swollen, heachache, tiredness, blurred vision, confusion


VAERS ID: 1700369 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, 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), 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: unknown
Current Illness: none according to screening questionnaire
Preexisting Conditions: none according to screening questionnaire
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: - few minutes after administering vaccine Patient passed out (syncope) - lay her flat on the floor and she came around - called 911 and was checked by Emt and released


VAERS ID: 1700383 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-05
Onset:2021-09-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Vaccination site erythema, Vaccination site induration, Vaccination site pain, Vaccination site swelling, Vaccination site warmth
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Smallpox vaccine, age 9, infection of vaccination site
Other Medications: Amiloride-hydrochlorothiazide 5-50 mg tablet daily, Xanax 1mg PRN
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: Penicillin: rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9 days following vaccination pt developed 5cm x 5cm localized redness, swelling, warmth, induration, tenderness and pruritis of vaccination site


VAERS ID: 1700386 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.


VAERS ID: 1700397 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK AR / IM

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

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

Write-up: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.


VAERS ID: 1700402 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-14
Onset:2021-09-14
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Taste disorder
SMQs:, Taste and smell disorders (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: Orencia - 1xweekly Sulfasalazine- 1xdaily Nabumetone 1xdaily Atorvastatin 1xdaily Gabapentin 1xdaily Low Dose Aspirin 1xdaily Multi Vitamin 1xdaily Calcium with Vitamin D 1xdaily Probiotics 1xdaily
Current Illness: none
Preexisting Conditions: Rheumatoid Arthritis
Allergies: Moxifloxacin
Diagnostic Lab Data: none
CDC Split Type: vsafe

Write-up: I had a strong metallic taste in my mouth. The doctor said it could be thrush or an adverse reaction to the vaccine. I was prescribed an antifungal mouth rinse and after the 2nd day of user the taste was gone. I do believe I had thrush.


VAERS ID: 1700412 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.


VAERS ID: 1700417 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-09-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Computerised tomogram, Headache, Magnetic resonance imaging, Nausea, Visual impairment
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient had headaches with vision disturbances and also had nausea


VAERS ID: 1700425 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-01
Onset:2021-09-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Migraine, Pain, Paraesthesia, Pyrexia, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Left arm/hand numb and tingling for at least 12 hours. 103 degree fever Migraine Aches all over - unable to sleep


VAERS ID: 1700426 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (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: Denies any
Current Illness: Denies any
Preexisting Conditions: Denies any.
Allergies: Denies any
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient arrives at vaccine clinic and reports no issues with first dose. He questions the consent form question regarding pericarditis and says that he had pericarditis about 15 years ago. Nurse checking patient in for vaccine contacted supervising RN and asked her for the procedure regarding patients who have a history of pericarditis. RN supervisor contacted director who consulted with Dr. who stated patient was fine to receive vaccine if fully recovered from pericarditis. Patient states no issues / symptoms and wants to receive vaccine today. RN administered vaccine and patient sat in chair in observation area. After a couple of minutes patient stated "I feel like I am going to pass out" as he leaned forward out of his chair. Another patient helped him to the ground and he did lose consciousness briefly. Rapid response was called and patient assessed. Once patient conscious he denies any pain, trouble breathing, dizziness or vision changes. Vital signs stable at time. Rapid Response team arrived and took responsibility assessing patient/situation. EMT''s arrived on site. Patient refused ED visit / transport and walked out of clinic on his own.


VAERS ID: 1700427 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

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

Write-up: he presented at our clinic - during screening process he marked no and stated he had never received a COVID19 vaccine in the past. requested J&J - vaccine given upon data entry saw he had a pfizer on 9-8-21 at Pharmacy. Called to the pharmacy to confirm that he had received that dose. they confirmed. we checked with IDPH - was advised he is considered fully vaccinated 2 weeks from J&J dose. Called patient to let him know he did not need any other COVID shots at this time.


VAERS ID: 1700457 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Palpitations, Pulse abnormal, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: rosuvastin 10mg daily, fluoxetine20mg daily hctz 12.5mg daily d3 2000u daily bcomplex daily losartan 100mg daily
Current Illness: none
Preexisting Conditions: hypertension, hypercholesteremia, anxiety
Allergies: adverse event lisinopril cough
Diagnostic Lab Data: I continue to monitor heart rate today 09/15/2021 and I am in communication with my primary care physician this morning who advised if I have persistent tachycardia to go to the ER. My heart rate this morning is in the 70s although I have some concern if any damage may have been caused to my heart as I have a strong family history of cardiac problems including cardiomyopathy, valve replacement, stent placement, multiple cardiac arrests, heart failure, CKD, and heparin-induced thrombocytopenia, (my own mother''s history) as well as her sister and brother have life-limiting cardiac conditions as well
CDC Split Type:

Write-up: 3 to 4 hours post-vaccination tachycardia measured at 109, feeling of my chest pounding, and also when feeling my pulse it seemed as though I had 3 strong beats and a soft beat very rapidly occurring which lasted for hours into the night. Upon repeat heart rate checks I found the heart rate to come down over the hours to into the 90s


VAERS ID: 1700458 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Eye irritation, Influenza like illness
SMQs:, Guillain-Barre syndrome (broad), Corneal 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports flu-like symptoms, burning eyes, and weakness starting about 2 hours after the vaccine. They have continued up to the time of submission of this form (9/15/2021 1:30PM)


VAERS ID: 1700471 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Tonic convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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: Patient denies any medications
Current Illness: Patient denies any other illnesses
Preexisting Conditions: young adult, denies any chronic conditions
Allergies: Patient denies any allergies to Medications or food.
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: 2-5 minutes after the administration of Moderna COVID vaccine, patient had 3 episodes of general tonic seizures. 2 L of Oxygen was administered. 911 was called and patient was transferred to ED.


VAERS ID: 1700473 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Pyrexia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: Duloxetine 10mg PO
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting Loss of consciousness Fever of 102 unrelieved by Tylenol


VAERS ID: 1700474 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-26
Onset:2021-09-14
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 325 mg oral tablet, 650 mg= 2 TAB, PO, Q8H (Every 8 hours), PRN Allergy Relief (Fexofenadine HCl) 180 mg oral tablet, 180 mg= 1 TAB, PO, Daily ALPRAZolam 0.25 mg oral tablet, 0.125 mg= 0.5 TAB, PO, QHS (At bedtime) BENGAY U
Current Illness: history of IBS, hiatal hernia, GERD, hypercholesterolemia, venous insufficiency, incarcerated hernia
Preexisting Conditions: history of MDRO, ESBL, MRSA. No cardiac history reported
Allergies: sulfa drugs
Diagnostic Lab Data: 09/14/2021 positive for COVID rapid antigen test
CDC Split Type:

Write-up: Received COVID vaccine x2 doses, Pfizer. Last dose was on 02/26/21. On 09/04/2021 admitted to hospital, not COVID related. Does report abdominal pain, no other symptoms. Positive for COVID on 09/14/2021, still hospitalized


VAERS ID: 1700475 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-22
Onset:2021-09-14
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Eye irritation, Headache, Nasal discomfort, Oropharyngeal discomfort, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Tested positive for Covid on 9/14/21 was asymptomatic at the time, testing was routine. Last evening she became febrile temp of 102.4, has a headache, throat has mucus, eyes and nose are burning.


VAERS ID: 1700510 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: N/a
Current Illness: n/a
Preexisting Conditions: Psychosis, anxiety, depression, and migraine
Allergies: pediazole
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt dizzy and fainted. She ended up having to vomit and felt fine afterwards.


VAERS ID: 1700514 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-09
Onset:2021-09-14
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

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

Write-up: Patient got 2 doses of Moderna Covid-19 vaccine and tested positive


VAERS ID: 1700542 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-02
Onset:2021-09-14
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

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

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

Write-up: Patient presented as a walk-in to Covid Vaccine Clinic for direction regarding receiving second Moderna vaccine. Per patient, received first Moderna vaccine 9/2/2021 at pharmacy in her left arm. Reports during first week after injection that ?site where needle went in was a little sore.? Reports last week upper right arm ?was really swollen and much sorer? than in the previous week. Reports edema in area decreasing, Yesterday she noticed large (5 x5 or larger) area of redness in right upper arm that feels ?hot with a burning sensation.? She denies having the following at any time since Covid vaccine administration: fever, SOB (has COPD ? no changes), rash / hives any other problems. Patient encouraged to call her PCP today for evaluation of arm and to discuss with MD if should receive second Moderna vaccine. Patient states she will call physician as soon as she returns to her car. Consult with RN regarding above and she concurs with plan. If MD approves second dose, encouraged client to obtain that in writing to take with her to clinic where will receive second vaccine dose. At this time, client states she doesn?t believe she will take the second dose.


VAERS ID: 1700584 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Post injection 2 hours full body uticartia/hives, itching and heat


VAERS ID: 1700600 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-28
Onset:2021-09-14
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Condition aggravated, Malaise, Pain, Productive cough, Pyrexia, SARS-CoV-2 test positive, Systemic inflammatory response syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Fever, chills, coughing , shortness of breath, weakness
Allergies: contrast dye, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/14/21: Patient arrived at the ER due to complaints of productive cough x 1week, body aches and chills. Patient stated that her daughter is a flight attendant and also was not feeling well and her test results for COVID came back positive 9/13. Patient tested positive for COVID on 9/14/21. Patient currently diagnosed with acute COVID-19 infection, with fever and systemic inflammatory response. Patient received first dose Moderna vaccine on 1/31/2021 Lot # 012M20A and the second dose on 2/28/2021 Lot # 012M20A


VAERS ID: 1700620 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site erythema, Injection site induration, Injection site nodule, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cozaar, Hydrochlorothiazide, atorvastatin, multivitamin, vitamin d, Zoloft
Current Illness: None
Preexisting Conditions: high blood pressure, high cholesterol, anxiety
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 12 hours after injection patient experienced severe headache and extreme tenderness at injection site. The injection site progressively became swollen, red, very tender, hot to the touch, and itchy. It is going on 3 days from the injection and the site remains very tender, red, hot to touch, and itchy, however it feels like there is a knot (hardened) under the skin. The severe headache lasted 24 hours without responding to multiple doses of NSAIDs.


VAERS ID: 1700638 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chest pain, Chills, Dyspnoea, Pain, Pyrexia, Spinal pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: During my first Covid-19 shot, I had symptoms of low fever and body aches that were gone within 2 days. I was 18 at the time. It
Other Medications: None
Current Illness: Body aches, pain where 2nd covid shot was taken, fever, and chills
Preexisting Conditions: None
Allergies: Pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: I was feeling perfectly fine during the majority of the first day after the second COVID-19 shot, but during that night I had chills and a fever. The next day, I had a couple body aches and at night at 3:25 am it turned into body aches and me getting chest pain/ache and upper spine back pain/ache. The current day is Wednesday 12:01pm and my fever and chills is gone but I still have body ache/pain and chest pain/ache and it''s harder to breathe a little (especially when I''m laying down).


VAERS ID: 1700672 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

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

Write-up: Extreme fatigue Nausea Headache


VAERS ID: 1700693 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Lymph node pain, Night sweats, Pyrexia, Renal pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 102 fever, strong kidney and lymph node pain, and bed-soaking sweat that occurred 4-6am the morning after.


VAERS ID: 1700718 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-09-14
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Infection, 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: 9/15/21 SARS/COV-2 Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1700724 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO191 / 1 LA / IM

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

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

Write-up: The patient requested to receive her first dose of the Moderna Vaccine. She was accidently administered a pfizer vaccine. There were no physical issues noted during her 15 minute observation period and no physical adverse reactions reported. The issue was just recieving the wrong vaccine. We attempted to notify her after leaving by phone and text.


VAERS ID: 1700746 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Day after injection very heavy menstrual bleeding and my cycle isn''t due for 2 weeks


VAERS ID: 1700751 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-30
Onset:2021-09-14
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / 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: 9/15 SARS/COV-2, NAAT Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1700760 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Unknown. Patient was evaluated by EMS and signed an R.M.A.
CDC Split Type:

Write-up: Patient fainted 5 minutes post vaccination


VAERS ID: 1700779 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 RA / IM

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

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

Write-up: Received a dose of Pfizer Covid vaccine 02/07/2021. She received a dose of Moderna vaccine on 9/14/2021


VAERS ID: 1700781 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: vaccine administered after BUD (prepared syringe). No adverse event noted at this time.


VAERS ID: 1700783 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-18
Onset:2021-09-14
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / 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: 9/15/21 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1700786 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Vaccine positive rechallenge
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Headache after first Covid Pfizer vaccine
Other Medications: Singular 10mg once daily Zoloft 150mg once daily Wellbutrin 150mg bid Zyrtec daily Synthroid
Current Illness: None
Preexisting Conditions: Asthma, hypothyroid, anxiety
Allergies: Nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fatigue, nausea


VAERS ID: 1700787 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Private       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: vaccine administered after BUD (prepared syringe)


VAERS ID: 1700789 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

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

Write-up: Patient was supposed to receive the second dose of Moderna and Pfizer was given at 5:45pm on Sep 14. The patient did not have any sign or symptoms of adverse effects.


VAERS ID: 1700796 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Private       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: None
Current Illness: No
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine administered after BUD (prepared syringe)


VAERS ID: 1700798 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-26
Onset:2021-09-14
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Atelectasis, Chest X-ray abnormal, Lung infiltration, White blood cell count
SMQs:, Interstitial lung disease (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Obstructive sleep apnea, obesity, HTN, restless leg syndrome, dementia, GERD, neuropathy, Serotonin syndrome, psoriatic arthritis, COPD, chronic pain disorder, interstitial cystitis
Allergies: Sulfa (Sulfonamide Antibiotics) Atropine, soap, clindamycin, povidone-iodine, adhesive tape, diphenoxylate, hydromorphone, latex
Diagnostic Lab Data: 9/14 WBC count 7.4 K/mcL; Chest x ray with questionable pneumonia: subsegmental atelectasis or infiltrate in the right lung base; oxygen saturation 80%
CDC Split Type:

Write-up: Ongoing hospitalization began 9/14/2021. Oxygen via nasal cannula, zinc, vitamin D, Thiamine, Vit C, Decadron 6mg IV, remdesivir IV,


VAERS ID: 1700810 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling cold, Headache, Immediate post-injection reaction, Myalgia, Pain, Paraesthesia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta 30mg 2x a day
Current Illness: None
Preexisting Conditions: Chronic Pain, Neuropathy, Anxiety and Depression
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cold tingles in body immediately after injection, fatigued in an hour, high fever of 105.0 and chills from 12:40am 9/15 until current 2:07pm; fluctuating fever ranging from 101.0 - 105.0 F with chills, fatigue, strong headache and muscle pain. Took an Advil at 1:00pm on 9/15 and felt some relief from body aches still currently have a 102.3 fever


VAERS ID: 1700857 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-28
Onset:2021-09-14
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral normal, Drug screen negative, Full blood count normal, Hypoaesthesia, Hypoaesthesia oral, Laboratory test normal, Magnetic resonance imaging head normal, Muscular weakness, SARS-CoV-2 test negative, Scan with contrast normal, Tongue movement disturbance
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), COVID-19 (broad), Sexual dysfunction (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/14/21 CBC and chem panel - all within normal 9/14/21 SARS-CoV-2 PCR - negative 9/14/21 Drug of Abuse test (Ethanol, Barbituate, Benzodiazepine, TCA, Phenytoin, Acetaminophen, Salicylate, Cannabinoid, Cocaine, Opiate, PCP, Methamphetamine) - All negative 9/14/21 CT Angio Head with IV contrast and whole brain perfusion - No acute intracranial large vessel occlusion, no focal perfusion deficit 9/15/21 MRI of the brain without contrast - Negative MRI of brain without contrast
CDC Split Type:

Write-up: 28 year old male with no past medical history who presents to the hospital with acute onset right arm and leg weakness and numbness, and weakness and numbness of the tongue, given alteplase for concern for stroke, now returned to baseline neuro function with no deficits.


VAERS ID: 1700878 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 AR / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood pressure immeasurable, Fall, Head injury, Hyporesponsive to stimuli, Immediate post-injection reaction, Injury, Radial pulse increased, Respiratory rate increased, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: 16 year old female, fainted 30 to 60 seconds after receiving a first dose Pfizer vaccine. Patient fell from standing and hit the rear of her head/upper body. Family advised she had not eaten today. Patient was only responsive to painful stimuli. Positioned patient while maintaining spinal immobilization. Unable to obtain blood pressure with manual sphygmomanometer. Bilateral radial pulses present and rapid. Ensured patient was breathing adequately although at a faster rate. EMS called at 15:57, arrived at 16:15, and departed for the hospital at 16:28.


VAERS ID: 1700888 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Electrocardiogram, Erythema, Flushing, Headache, Hypersensitivity, Muscle tightness, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 30 minutes after injection face became very swollen, red, and flushed and developed major headache then about 15 - 30 minutes after that I started to get chest and neck tightness and developed trouble breathing. I called the pharmacist who gave me the injection and was then advised to go to the closest clinic as I was having an allergic reaction. I got to the clinic and was given epinephrine and solumedrol and was driven by ambulance to the hospital where an ECG was performed which was clear so I was sent home to rest and monitor my symptoms.


VAERS ID: 1700891 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Amlodipine, Terazosin, Metformin and a cholesterol medication that he is unable to recall the name.
Current Illness: DM, HTN, High cholesterol
Preexisting Conditions: DM, HTN, High cholesterol
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Health worker came in to report a dull pain to center area of chest. states it happened the day after 2nd dose Pfizer and lasted for about half hour. Pain was 3/10 and happened while at rest (sitting). No medication taken to alleviate pain. States that it went away on its own. He also rubbed his chest and states that it seemed to help. HCW states that not too long ago (sometime within the year) he was seen by his PCP and they had ruled out angina. HCW came in at approx. 1230 pm 9/15/21 and states he is not experiencing the pain and that it has subsided.


VAERS ID: 1700925 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (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: Olmesartan Medoxomil, Naproxen Sodium, Potassium Cl, Furosemide, Aspirin, Metoprolol Tartrate, Clonidine, Atorvastatin, Montelucast, Hydralazine, multivitamin
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: Cortisone, Seafood, X-ray dye
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pain at injection site and in joints starting the evening of the injection. The next day these symptoms continued and I also experienced headache, fatigue, chills and fever of 100.6 degrees. The following day (today) headache, fatigue and pain at injection site continue, but the other symptoms have subsided.


VAERS ID: 1700941 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dapakote Zyprexa Hydroxyzine Prazosin
Current Illness:
Preexisting Conditions: Asthma Depression Anxiety Ptsd
Allergies: Sulfa Penicillin Zyvox Vancomycin Mushrooms
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea Severe Fatigue Joint pain Muscle pain


VAERS ID: 1700942 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dyspnoea, Feeling hot, Hot flush, Rash
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine may have given patient trouble in past due to egg allergy
Other Medications: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: Grass, Bleach, Dogs/Cats, Eggs, Latex, Perfumes
Diagnostic Lab Data: None were done
CDC Split Type:

Write-up: Patient reported feeling very warm, like she was experiencing hot flashes. Soon after, developed rashes on arm and over other areas, such as groin, legs, neck and chest. Patient also reported feeling very anxious, experiencing "air hunger", and feeling like it was difficult to breathe. Patient reported taking Benadryl to help with reaction. Called today at 6:15pm to report this to us, stating that she felt better. Instructed patient to reach out to her doctor and seek medical treatment for rash since it was still bothering her.


VAERS ID: 1700948 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

Administered by: Work       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: Received a dose of Moderna when already had received a dose of JNJ months ago.


VAERS ID: 1701118 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-01
Onset:2021-09-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Turmeric and ginger supplements, no prescriptions
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intense and severe menstrual bleeding, cramping, a profound amount of bleed through throughout night and during day


VAERS ID: 1701120 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Headache, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: defibrillator/pacemaker high blood pressure thyroid blood thinness
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data: unknown, followup with primary care dr.
CDC Split Type:

Write-up: Patient''s wife arrived at pharmacy 9/15/21 the day after vaccine #3 was given 9/14/21. She stated that he had several side effects including headache and palpitations. He had a pacemaker/defibrillator installed 9 months ago and has had no issues with it. She said the defibrillator did not activate but the pacemaker did something to help the palpitations. I asked her to contact his primary doctor and then called the doctors office (listed earlier) to inform them about side effects from covid moderna vaccine and to followup with patient. She said he had no side effects out of the ordinary from vaccine part 1 and 2. (given 1/13/21 and 2/10/21)


VAERS ID: 1701124 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chills, Headache, Hyperacusis, Hyperaesthesia, Photophobia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Knee pain
Preexisting Conditions: Factor 5 Leiden, may Thurner syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I felt sick that evening a few hours later. Fever, headache, stimuli sensitivity to touch, noise, light. I got chills that night and when I woke up in the morning felt that my chest felt heavy, tight, and almost burning sensation. I?m not sure if I would say it hurt but definitely felt inflamed and like my heart was beating too fast and working too hard even when at rest. This peaked for about 24 hours and I felt better but the chest sensation has persisted today. It has subsided some but is still present.


VAERS ID: 1701131 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site hypoaesthesia
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81mg, pioglitazone 15/metformin 850, lisinopril 40mg, atorvastatin 20mg, sertraline 25mg
Current Illness: None listed
Preexisting Conditions: None listed
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states that his left arm from his elbow down was numb yesterday (9/14). It is still not 100% today (9/15) but he has more feeling in it today than yesterday.


VAERS ID: 1701320 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Contacted Moderna with case# MOD21-144021. Medical affairs will determine the safety and efficacy, and whether the patient should be revaccinated.
CDC Split Type:

Write-up: Pt did not have any reaction, however expired vaccine was administered. Moderna Vial was punctured on 9/13/21 a little after 1:13 PM. Dose was given a little after 5:15 PM on 9/14/21


VAERS ID: 1701324 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood magnesium, Chest X-ray, Computerised tomogram abdomen, Computerised tomogram head, Computerised tomogram pelvis, Computerised tomogram spine, Computerised tomogram thorax, Echocardiogram, Electrocardiogram, Electroencephalogram, Fall, Full blood count, Head injury, Metabolic function test, Neurosurgery, Skull fracture, Subdural haematoma, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: children''s multivitamin, children''s vitamin D3, children''s vitamin C
Current Illness: none
Preexisting Conditions: autism spectrum disorder
Allergies: NKDA
Diagnostic Lab Data: head CT, CXR, chest/abdomen/pelvis CT, C-spine CT, CBC, CMP, magnesium, EKG, EEG, echocardiogram
CDC Split Type:

Write-up: collapse of unknown etiology ? syncopal episode, no cardiac or neurologic etiology of event identified; struck head during fall resulting in skull fracture and subdural hematoma requiring neurosurgery, had work-up to identify possible cardiac or neurologic (seizure) causes of collapse and no specific causal etiology was identified


VAERS ID: 1701327 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-12
Onset:2021-09-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein, Echocardiogram, Myocarditis, Troponin
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Myocarditis


VAERS ID: 1701335 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site discharge, Injection site scab, Peripheral swelling, Rash, Rash erythematous, Rash pruritic
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, trazadone, omeprazole, multivitamin, methylfolate
Current Illness:
Preexisting Conditions: Celiacs Disease, eosinophilic-esophagitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large red/painful/swollen/itchy, rash on arm that was injected. Also scabby puss where needle was injected.


VAERS ID: 1701337 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysphagia, Oropharyngeal pain, SARS-CoV-2 test, Streptococcus test
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Covid and strep swab
CDC Split Type:

Write-up: Throat pain and swallowing difficulty


VAERS ID: 1701338 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: We contacted Moderna on 9/15/21 and we have case# MOD21-144021. Medical affairs will determine the safety and efficacy, and whether the patient should be revaccinated.
CDC Split Type:

Write-up: Patient did not have any reaction, however an expired vaccine was administered. Moderna Vial was punctured on 9/13/21 a little after 1:13 PM. Dose was given a little after 4:15 PM on 9/14/21


VAERS ID: 1701340 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK - / -
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS X2K7D / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Cough, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: PATIENT CALLED IN PHARMACY ON 09/15/21 AND COMPLAINED THAT SHE HAS SORE THROAT,COUGH,AND CHEST PAIN AFTER GETTING COVID-19 PFIZER AND FLUARIX SHOTS ON 09/14/21. I TOLD PATIENT TO GO TO CLINIC.


VAERS ID: 1701342 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: We contacted Moderna on 9/15/21 and we have case# MOD21-144021. Medical affairs will determine the safety and efficacy, and whether the patient should be revaccinated.
CDC Split Type:

Write-up: Patient did not have any reaction, however an expired vaccine was administered. Moderna Vial was punctured on 9/13/21 a little after 1:13 PM. Dose was given a little after 6:12 PM on 9/14/21


VAERS ID: 1701348 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Feeling cold, Feeling hot, Headache, Pain, Palpitations, Pyrexia, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Vitamins A,C,D, zinc, fish oil Birth control
Current Illness: None
Preexisting Conditions: No
Allergies: Pseudophedrine
Diagnostic Lab Data: I have not taken any tests
CDC Split Type:

Write-up: Uncontrollable shaking; freezing for quite some time then it would change becoming hot?fever feeling during the middle of the night. The morning after I had a very bad headache; then the freezing and fever started again. I have had body aches the entire time. It?s like I can feel the vaccine moving within my body from my left arm, through my neck and back, move to my right arm and then to My lower extremities?.moving down my legs. My heart was pounding very hard while I was laying down?I had some pain in my right chest area. I feel WORSE with this vaccine than I did having COVID in February 2021z


VAERS ID: 1701510 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever 100.7, chills, body aches, weakness, fatigue, severe headache, and nausea 6am when I woke up until I went to bed for the day at 830pm


VAERS ID: 1701511 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / UNK LA / IM

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

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient said she took "pot" before vaccination.
Current Illness:
Preexisting Conditions: No history of seizures of diabetes.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed out and started seizing for <1 minute. I held on to her to prevent her from falling down. Once she was conscious, I went to grab her mom (and an RN passerby available). Mom got her water and we provided her a cold compress. She was very sweaty and a little bit of low heart rate (per RN). She refused an ambulance. She sat down for at least 30 minutes after using the bathroom (with mom helping). Patient says she she has a history of passing out when she got tattoed or got her dermal filler.


VAERS ID: 1701512 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-09
Onset:2021-09-14
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Condition aggravated, Deep vein thrombosis, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: diclofenac 1 % topical gel APPLY 2 GRAMS TO THE AFFECTED AREA(S) BY TOPICAL ROUTE 4 TIMES PER DAY fiber Nature D omeprazole 20 mg capsule,delayed release TAKE 1 CAPSULE BY MOUTH EVERY DAY Tums verapamiL ER (SR) 120 mg tablet,extende
Current Illness: trophic vaginitis bladder muscle dysfunction - overactive chronic interstitial cystitis cystocele deep venous thrombosis Dx 9/2021 gastroesophageal reflux disease without esophagitis Health maintenance alteration no immunizations, mammogram, colonoscopy or dexa scan in Nextgen chart history of cardiac arrhythmia osteoarthritis pain of right wrist stress vitamin D deficiency
Preexisting Conditions: See above
Allergies: Advil PM facial swelling, moderate amoxicillin Cipro itching, mild rash, mild codeine Iodinated Contrast Media rash, moderate to severe Sulfa (Sulfonamide Antibiotics) hives, moderate to severe
Diagnostic Lab Data: blood work U/S of lower extremity
CDC Split Type:

Write-up: Pt to ED on 9/14 and dx''d with DVT Pt. discharged home on Xarelto


VAERS ID: 1701532 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose, Blood test, Electrocardiogram, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-Vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood work, EKG, a glucose meter. Given Hydration IV and Oxygen tubes. All on 9/14/21.
CDC Split Type:

Write-up: Hypotension, blood pressure 61/42. Diaphoresis.


VAERS ID: 1701732 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-07
Onset:2021-09-14
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Oropharyngeal pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Individual called with positive test result on 9/14/21. Individual still symptomatic with cough, congestion, sore throat, and fever. Advised to isolate from family in separate rooms for at least ten days (s/s onset 9/13/21) and to update mgmt. She did not participate in the study but would like to have the antibody testing done. Advised to go after isolation period is over to get test done. Also, advised to callback with any changes.


VAERS ID: 1701900 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abnormal sensation in eye, Arthralgia, Asthenia, Balance disorder, Decreased appetite, Electric shock sensation, Fatigue, Headache, Hypoaesthesia, Myalgia, Nausea, Ocular hyperaemia, Paraesthesia, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (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: no
Current Illness: none
Preexisting Conditions: none
Allergies: bupivacaine, food allergies nuts shrimp
Diagnostic Lab Data: none
CDC Split Type:

Write-up: My adverse effect started the day after my shot was given at approx 3pm, i begin to experience extreme muscle/joint pain nausea loss of appetite and blood shot eyes. I also had a mild headache Around 7PM i felt very weak and could not keep my balance at times. i also began to experience blurry vision, By 9pm i was very weak and needed to lay down AT 10pm i felt like a sharp pin go throw my left eye, sclera remained red, i then felt a electric type of shock go through my lower left leg where my leg had tingling and numbness. i continued with a more severe headache till appox 1 am. The third day i was tired but much improved. i did not seek out medical attention for the above side effects. i am only writing to you because people need to be aware of these possible side effects.


VAERS ID: 1701903 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: 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: Sore arm, herpes zoster after zosrtravax
Other Medications: Testosterone, omeprazole, synthesis, cytomel, neurontin, naproxen,calcium, Tylenol, trazodone, creator,melatonin, multivits, bee pollen, AREDS 2, move free,
Current Illness: Iron deficiency anemia
Preexisting Conditions: Low t, GERD, osteoarthritis, neuropathy, MGUS, high cholesterol, hypothyroid,
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm that lasted 24 hours or more


VAERS ID: 1701906 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-12
Onset:2021-09-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC01384 / 1 LA / IM

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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none known
Preexisting Conditions: none known
Allergies: none
Diagnostic Lab Data: physical evalution
CDC Split Type:

Write-up: Swollen lymph nodes above clavicle. Golf ball sized swollen nodes behind ear. Pt visited urgent care for evaluation and will follow up with doctor if swelling gets worse or doesn''t resolve in 72 hours.


VAERS ID: 1702854 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Myalgia, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chills, shaking, severe muscle aches, high fevers? despite around the clock ibuprofen and Tylenol


VAERS ID: 1703678 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Back pain, Breast pain, Hypoaesthesia, Pain
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Lipodystrophy (broad), Sexual dysfunction (broad)

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

Write-up: On Tuesday I woke up (the day after first shot) with pains on my right side of my back, I would move a certain way and the pain would burn, Wednesday I woke up at the pain moved slight closer to my arm pit but is still the same. Today, Thursday, I woke up and now the inside of my right HURTS and it''s on my breast as well, if i sit up, I am in pain, it''s a burning pain. My Breast is also numb


VAERS ID: 1703680 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-10
Onset:2021-09-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Musculoskeletal stiffness, Sinusitis
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3, A, C and E Garcinia Cambogia. Occasional Ibuprofin
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: only allergic to bees
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Severe headache, 9-14-21 around 7am Sinus Inflammation, 9-15 Muscle stiffness in Neck


VAERS ID: 1703724 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

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

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

Write-up: Chills, fever, headache, puking


VAERS ID: 1703732 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Feeling abnormal, Feeling hot, Headache, Muscular weakness, Nausea, Pain, Pain in extremity, Restlessness, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (narrow), Dementia (broad), Akathisia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid 15 MG Iron 18 mg Magnesium 400 mg Fish oil Adaptogenic mushrooms Calcium plus D&K Rhodiola Vitamin C
Current Illness: Covid
Preexisting Conditions: SVT
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/14-5:30 pm body aches, specifically legs joints and lower back. Tired, temp of 99.3. Took Advil and improved. Injection arm very sore 9/15-2:30 am chills, extreme body aches specifically in leg joints. Headache. Nausea. Temp 99.4. Restless. Took advil and improved but then became extremely over heated. Finally slept again approximately 5:30 am. Injection arm very sore 9/15-headache and mild body aches all day 9/15-5:00 pm body aches in leg joints returned. Headache. Nausea. Temp 99.9. Chills. Took hot shower and Advil and went to bed at approximately 9pm 9/16-6:30am weakness in extremities, arm pain, body aches, headache and mild nausea. Temp 99.2. Tired. Dizzy and lag in eyesight when I turn my head. Slight brain "fog" took Advil


VAERS ID: 1703877 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-01
Onset:2021-09-14
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: thyroid disease
Allergies: bactrim
Diagnostic Lab Data: COVID-19 positive
CDC Split Type:

Write-up: Patient admitted to Hospital with positive covid-19 breakthrough case. O2 saturation 89 % on room air on arrival. No other compliants. Patient from assisted living facility with multiple positive staff and patients. Currently on 4 L NC.


VAERS ID: 1703891 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-01
Onset:2021-09-14
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

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

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

Write-up: Patient admitted to hospital with positive covid-19 breakthrough case. Had a fall at nursing home. 90% room air at this time.


VAERS ID: 1703892 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Headache, Lethargy, Neck pain, Pain, Pyrexia, Tinnitus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Arthritis (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: Na
Current Illness: No
Preexisting Conditions: Na
Allergies: Na
Diagnostic Lab Data:
CDC Split Type:

Write-up: Ear ringing, headache, body aches, neck pain, 102 fever, lethargy, winded, cough. Symptoms still persist three days after shot.


VAERS ID: 1703896 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM

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

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

Write-up: Mod to severe headache fatigue chills nausea. One of the worst illness I''ve ever felt. Lasted only 1 day but same intensity. Very concerning. I did have same side effects after first but mild compared to this. Could not function. I feel good now but I do not want to go through that again.


VAERS ID: 1703930 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-01
Onset:2021-09-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Decreased appetite, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (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: ACETAMINAPHIN, STATIN FOR CHOLESTEROL
Current Illness:
Preexisting Conditions: CHRONIC ARTHRITIS, BALANCE ISSUES
Allergies: nsnaids, CORTISONE, VOLTARAN, ROMOSOZUMAB
Diagnostic Lab Data: n/a I suffered through it
CDC Split Type:

Write-up: Injection site pain, overall physical pain, especially joint pain, loss of appetite, no energy, slight fever


VAERS ID: 1703962 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-16
Onset:2021-09-14
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03621A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Dyspnoea, Flank pain, Hydronephrosis, Lung opacity, Oedema, Positive airway pressure therapy, Pyrexia, Umbilical hernia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

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

Write-up: 61-year-old female patient with past medical history of asthma, pulmonary hypertension, on home oxygen, COVID-19 infection, bilateral pedal ureteral stent placement, UTI and BSI with ESBL E coli who was being treated at home for recent UTI and BSI infection on Invanz daily. Home health care visit found fever of 101 and was advised to come to the emergency room. While in the emergency room her fevers of 100 complaining of increased shortness of breath and feels her lungs are feeling again. Continues to complain of bilateral flank pain from her recent kidney stone and stent placements. Patient did receive her COVID-19 vaccination in April 2021. Patient did receive remdesivir on previous visit. CT of the abdomen shows borderline hydronephrosis on the right, with a decompressed system on left. Bilateral ureteral stents in appropriate position. No ureteral stones. Mild nonspecific peri red will impair renal fat stranding edema. Correlate with urinalysis. Also stable known restrictive umbilical hernia containing transverse colon, small bowel and omental fat. CT of the chest shows no pulmonary emboli, shows bilateral ground-glass infiltrates. Has been on BiPAP but now has been weaned down to 4 L hemo to 5 oxygen. Discussed with nursing. States has been evaluated by Urology and plans for removal of stents tomorrow. Will continue vancomycin and meropenem, await blood and urine cultures. Monitor O2 requirements and chest x-rays repeat procalcitonin level and continue to follow. Thank you for the opportunity to assist with the care and treatment of this patient.


VAERS ID: 1703994 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest discomfort, Chills, Headache, Injection site pain, Injection site swelling, Insomnia, Nausea, Pain in extremity, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Influenza (estimated 2yrs ago), flu-like symptoms (Other reactions to all vaccines prior within childhood)
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Tylenol, Ibuprofen
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 1st dose of Phizer 09/14/2021, started experiencing symptoms that evening of Pressure in the chest, pain in right arm to neck, vomiting, nausea, fever 102.0, chills, right arm swollen at injection site, headaches, lack of sleep, still continuing experiencing symptoms, Primary recommendations not to receive the 2nd dose, Primary refuses to sign any HR forms.


VAERS ID: 1703995 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vaccine given 44 minutes after open vial discard time.


VAERS ID: 1704000 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 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: mom reported daughter was 12 years old for pfizer vaccine and wrote 12 years old on consent form but birthday in patients profile does not match patients reported age. received second pfizer vaccine on 9.14.2021


VAERS ID: 1704024 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-21
Onset:2021-09-14
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood creatinine increased, Blood potassium increased, Blood sodium decreased, Blood urine present, COVID-19, Carbon dioxide decreased, Dyspnoea, Fatigue, Haematocrit decreased, Lymphocyte count decreased, Monocyte count decreased, Neutrophil count increased, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Htn And High Cholesterol
Allergies: No Known Allergies
Diagnostic Lab Data: Hematicrate low nuetriphill Hight monocite low lymphocyte low Blood urine High Carbon diocide low Creatinine High potassium high sodium low
CDC Split Type:

Write-up: pt was Admitted 09/14/2021 expeirening S.O.B fatigue weakness and a fever. Upon admission Temp was 96.2 tested positive at an outside facility and presenting S.O.B. Pt was given monocolnal antibodies Pt was given o2, Ramdesiver Rivaroxaban, Zinc, Ascarbic acid, and dexomelozone. Pt is still currently admitted.


VAERS ID: 1704041 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: 4 days after I started having unbalance when getting up or rolling over. Two days later issue still present.


VAERS ID: 1704046 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-07
Onset:2021-09-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site rash, Lymphadenopathy
SMQs:, 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: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash at injection site started 9-15-21 and swollen lymph node by left collar bone 9-14-21


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