National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 60 out of 8,753

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159   next


VAERS ID: 1840806 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-03
Onset:2021-10-30
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / SYR

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

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

Write-up: woke with red spots on my ankle, elbows. knee and wrist. I took Allergra 10mg The spots were Itchy


VAERS ID: 1840818 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Fever, body aches


VAERS ID: 1840826 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna 1x body aches ,Headache 2x headache ,stomach cramps body aches
Other Medications: omeprazole, magnesuim, Vitamin
Current Illness:
Preexisting Conditions: GERD, Rosacea
Allergies: tetracycline, maybe feathers, statins
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Saturday Rash started welts,red,itching on neck continued getting worse until Monday then rash ran down my spine and along sweat lines waist, underarms, neck. Dr suggested benadryl started on Tuesday . it is now Wednesday evening and rash is slowly going away, Today swollen glands and more body aches still able to go about items of daily living with out any problems.


VAERS ID: 1840953 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site pruritus, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Moderna 3rd shot
Current Illness: none
Preexisting Conditions: none
Allergies: morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling at left upper arm injection site approx. 5cm Itch and slightly sore for three days. Now swelling is going down.


VAERS ID: 1840968 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Feeling jittery, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: PMH and Medications unknown to this writer.
Current Illness:
Preexisting Conditions: PMH and Medications unknown to this writer.
Allergies: Pt w/ known hx of allergy to latex (localized swelling and itchiness).
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt w/ known hx of allergy to latex (localized swelling and itchiness). PMH and Medications unknown to this writer. 12mins post vaccination pt had a syncopal episode associated w/ dizziness and chin jittery x 7mins Vitals: @15:58 BP 117/77, HR 99, RR 16, SPO2 100% (supine) -- $g @16:06 115/68, 96, 14, 100% -- $g @16:11 126/79, 93, 14, 100% -- $g @16:16 112/77, HR 94, 14, 100% -- $g @16:19 123/79, 98, 14 (sitting) -- $g @16:21 118/82, 105, 14, 100% (standing) Pt given water. Pt stable and released from the vaccination site."


VAERS ID: 1841181 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest pain, Computerised tomogram thorax, Dyspnoea, Electrocardiogram, Headache
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Proair, Symbicort, Duoneb, Metformin, Trulicity, Mevacor, Neurontin
Current Illness:
Preexisting Conditions: COPD, depression, restless legs, anxiety
Allergies: Vicodin
Diagnostic Lab Data: 11/1/21- EKG, chest CT, multiple blood tests
CDC Split Type:

Write-up: Developed headache shortly after vaccine- then chest pain and shortness of breath.


VAERS ID: 1841186 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Pain
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: Moderna after second injection
Other Medications: Paxil, Omerprazole., Losartin, Avorstatin, Exbriet, calcium, silver centrum, caltrate, fish oil, aspirin.
Current Illness: High blood pressure, high cholesterol, diabetes, idiopathic pulmonary fibrosis.
Preexisting Conditions: Sameasabove
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fatigue, chills, and ached all over.


VAERS ID: 1841197 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Therapeutic response unexpected
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spirulina, CoQ10, Flaxseed, multivitamin, calcium, vitamin D, probiotics, Fluoxetine 20mg
Current Illness: Covid positive. Became sick September 27. Tested positive October 7th. Sick 3 weeks. Had VERY tight and sore muscles in neck and shoulders. Right hip ached.
Preexisting Conditions: Degeneration of disks in neck.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Prior to my vaccine I have had VERY tight muscles in shoulder and back as well as right hip pain. Right hip pain came after being sick with Covid for 3 weeks. Shortly after vaccine, I noticed my muscles completely relaxed , back pain is gone and hip pain was gone. It was not a bad reaction. I just found it strange that after the vaccine it felt like my body loosened up. Even the right hip joint pain.


VAERS ID: 1841205 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

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

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

Write-up: Fever, chills, swollen right lymph node- axilla


VAERS ID: 1841394 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Antibody test normal, Bell's palsy, Borrelia test negative, Chest X-ray normal, Chills, Computerised tomogram head normal, Ear pain, Electrocardiogram normal, External ear pain, Extra dose administered, Facial paralysis, Fatigue, Full blood count normal, Headache, Metabolic function test normal, Nausea, Pain, Tension headache, Toothache
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid Vit C, D3, B12 Flexeril Zetia Cozaar
Current Illness: NONE
Preexisting Conditions: GERD controlled HTN
Allergies: Augmentin
Diagnostic Lab Data: CT of the head without contrast, EKG, CXR, CMP, CBC and Lymes Antibody were all negtive
CDC Split Type:

Write-up: Received Modera booster 10/29. 10/30- Headache woke me up around 8:00 AM. Radiated from the back of the head to both temperoal regions with intensity of pain behind right and in the right ear. Chills T-99.7, nausea, and extreme fatigue. Right lower teeth even ached. 10/31 -Same symptoms, except for chills were less T-98.9. and did have a little more energy. 11/1- Still having a headache, lower right teeth pain, and ear pain. At work, when drinking from a cup, liquid was dribbling out of mouth right-sided facial drooping was noted. BP was 160/102. Went to ER. Upon arrival BP-179/90. Dx with Bell''s Palsy Upon discharge BP-10/62 with any ut medication treatment for it. Started on Prednisone 60mg. Was given a Rx for Valtrex 1 Gm tid


VAERS ID: 1841399 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / JET

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium, glucosamine hci/chondroiton, one a day vitamin, maca gold, bupropion xl 150mg, buspirone 5mg
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Several hours of fatigue and leg muscle aches in the afternoon the day after receiving booster shot


VAERS ID: 1841402 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-17
Onset:2021-10-30
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Hypoxia, Inflammatory marker test, Malaise, X-ray normal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ARIPiprazole (ABILIFY) 10 MG tablet atorvastatin (LIPITOR) 10 MG tablet benzonatate (TESSALON) 100 MG capsule glipiZIDE (GLUCOTROL) 10 MG tablet lisinopril (PRINIVIL,ZESTRIL) 5 MG tablet metFORMIN (GLUCOPHAGE) 1000 MG tablet potassium chlor
Current Illness: NA
Preexisting Conditions: COVID-19 Type 2 diabetes mellitus with diabetic neuropathy Essential hypertension History of pulmonary embolism Hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.30.21); COVID-19 (10.30.21); fully vaccinated Discharge Provider: MD Primary Care Provider at Discharge: MD Admission Date: 10/30/2021 Discharge Date: 11/1/2021 PRESENTING PROBLEM: Hypoxia [R09.02] COVID-19 virus infection [U07.1] COVID-19 [U07.1] HOSPITAL COURSE: Patient presented to the emergency department on 10/30/2021 with complaints of worsening shortness of breath and cough. He was fully vaccinated for COVID-19. During emergency department course, it was noted that his oxygen levels were 88% and he was placed on 2 L via nasal cannula and was given IV Decadron. X-ray was without infiltrate. He was admitted for hypoxia with COVID-19. During hospitalization, Decadron was continued, remdesivir given the and supplemental oxygen continued. Inflammatory markers were followed and improved. Home Xarelto for history of DVT and PE was continued. Early this morning, he was easily weaned to room air. States that he feels much better and is requesting discharge home. With able to ambulate without significant hypoxia. We discussed continued quarantine, and need for self-monitoring and return to the emergency department immediately if he becomes short of breath or begins to feel increasingly ill. Is being discharged with personal pulse oximetry monitor. Is to return to the emergency department if pulse oximetry readings are 89% or lower for 5 minutes or longer. Patient is stable for discharge home to self-care at this time. He is agreeable with the plan care. All questions and concerns were addressed. Please see discharge instructions for further information


VAERS ID: 1841538 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ILLEGIBLE / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Discomfort, Fatigue, Feeling cold, Interchange of vaccine products, Musculoskeletal stiffness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: J&J covid 19, April 2021
Other Medications: Nortrypteline (50mg) zolpidem 10 mg
Current Illness:
Preexisting Conditions: ulcerative colitis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: This was my booster shot after an April, 2021J&J vaccine. I did have an annual flu vaccine in my right arm. I have never had an adverse reaction to my annual flu vaccine whatsoever. I had an almost exactly the same reaction to the J&J dose in April but I did not report that reaction. The following applies to both the reaction I had this week, as well as the April J&J. I had a positive covid test in February, 2021. My symptoms were VERY mild. I went to sleep comfortably at around 11pm after the 1:30pm vaccination. I felt fine. Approximately 12 hours after the injection I woke up with a fever (101.5), chills and severe pain all over my body. Other than these 2 vaccinations, the only thing I can compare this to was a 2018 (breakthrough) influenza. My entire body hurt. Movement of any type made it worse. I was sensitive to even the slightest touch. The weight of my body against my bed was painful. Fatigue In both cases this year, the pain began early Saturday morning after the friday afternoon shot. In both cases the pain became less severe by Monday morning. and was almost completely gone by Tuesday night. It is now Wednesday night and there is only mild discomfort/stiffness on my head/scalp, neck, shoulders and middle back. (none of which have ever been sensitive until now). I am still feeling low energy. In the first instance, It took over a week to get my full energy back. I got mild pain relief from tylenol.


VAERS ID: 1841545 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-28
Onset:2021-10-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Fatigue, Injection site pain, Neck pain, Pain in jaw, Sleep disorder
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Osteonecrosis (broad), Arthritis (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: This was my first booster shot (Pfizer) following my first John&Johnson shot 6 months ago. The day of shot: just soreness on the injected area Day 2: none Day 3: from the evening, I felt tiredness with pain in the lower neck and upper chest area. This pain persisted for about 2 hours and I started to have pain around my jaw. The jaw pain was very uncomfortable and it prevented me from sleep throughout the night. I took 1 ibuprofen pill. The next morning when I woke up, the pain was gone.


VAERS ID: 1842364 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-19
Onset:2021-10-30
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM

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

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

Write-up: pt admitted to hospital and tested positive for COVID 10/30/21 s/p receiving 2 doses of Moderna on 1/22/21 & 2/19/21


VAERS ID: 1842658 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Lethargy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Redness at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fever-Medium


VAERS ID: 1842776 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Bruising at Injection Site-Severe, Site: Itching at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe


VAERS ID: 1842816 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthritis, Condition aggravated, Drainage, Erythema, Infection, Lymph node pain, Lymphadenopathy, Pain, Skin warm
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Hypersensitivity (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis; vitamin D; Calcium; melatonin;
Current Illness: possible start of a urinary tract infection
Preexisting Conditions: arthritis; blood clots
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: swollen lymph node is groin when woke up Saturday morning; increased in size and pain over the weekend--red and warm; other body aches where I have arthritis were worse as well; went to doctor on Tues. Was infected; started antibiotic (clindamycin) Tuesday evening; started draining Wednesday. feel better and seems to be healing and reducing in size. Will go back to doctor next week for follow-up.


VAERS ID: 1842828 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Post-acute COVID-19 syndrome
SMQs:, Medication errors (narrow), COVID-19 (narrow)

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

Write-up: Covid Arm


VAERS ID: 1842831 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood culture negative, Chest X-ray normal, Culture urine negative, Pyrexia, Respiratory viral panel
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, Vitamin C, Aspirin, Calcium, Digoxin, Gabapentin, Metformin, Multivitamin, Potassium Chloride, Crestor, Torsemide
Current Illness: none
Preexisting Conditions: A fib, Diabetes, CVA, DVT, bilateral hip prostheses, watchmen procedure, prostate cancer s/p brachytherapy
Allergies: Oxycodone, Penicillin
Diagnostic Lab Data: Negative blood cultures, urine cultures. Normal Chest X ray. Negative respiratory viral panel.
CDC Split Type:

Write-up: Developed fevers and generalizes weakness day 1 post administration. Admitted to our hospital on Nov 1 due to fevers. Has had daily fevers with no other source. Started on antibiotics with no significant change.


VAERS ID: 1842864 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-21
Onset:2021-10-30
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Fatigue, Respiratory tract congestion, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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: Rapid at home antigen test collected on 11/1/21 and resulted positive on 11/1/21
CDC Split Type:

Write-up: Fatigue, sneezing, chest congestion


VAERS ID: 1842916 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-28
Onset:2021-10-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Echocardiogram, Myocarditis, Pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Zyrtec, PNV, Flonase, magnesium, vitamin D, Colace, miralax, low dose metformin
Current Illness: None.
Preexisting Conditions: Allergic rhinitis, PCOS, constipation, BMI 27
Allergies: None
Diagnostic Lab Data: Elevated cardiac CRP, echocardiogram
CDC Split Type:

Write-up: Suspect myocarditis - dull constant chest pain, increased cardiac CRP level


VAERS ID: 1842954 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-27
Onset:2021-10-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site swelling, Lymphadenopathy, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling in the armpit noticed after 36 hours. It was very flabby, not stiff. It increased over the next 24-48 hours. By Monday it had dispersed over the left side of my rib cage down to my belt and across my peck and abs to my sternum and navel. It has not increased in the last 3 days but it has not gone away either. I still have flabby swelling from my armpit my waist, even some between my belt buckle and privates but only on the left side. Besides this, I had some stiff swelling where I received the injection and some fatigue in the 36-60 hours following the injection. These have subsided


VAERS ID: 1843004 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Decreased appetite, Headache, Lethargy, Nausea, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Icosapent Celexa Lipitor Singulair Xyzal Estradiol Norvasc
Current Illness: None
Preexisting Conditions: Asthma, high blood pressure, high cholesterol
Allergies: Bee stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, aching, lethargy, headache, nausea, loss of appetite, severe unrelenting, unproductive cough. Change of allergy medication, two inhalers, oral steroid prescription. Cough improving, other symptoms have abated.


VAERS ID: 1843043 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-29
Onset:2021-10-30
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chest pain, Chills, Cough, Dyspnoea, Muscle fatigue, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: small pox vaccine - my gland swelled and went went to ER
Other Medications: Metformin, levothyroxine, glipizide
Current Illness: no
Preexisting Conditions: arthritis, anemia and diabetic
Allergies: acrylic - certain fabric . I break out if I wear it
Diagnostic Lab Data: covid test
CDC Split Type: vsafe

Write-up: I had small reaction after the vaccine - low grade fever and body ache. 30Oct2021 with covid - I had a cough, muscle fatigue, chills, ran out of breath walking, my chest hurts. Urgent Treatment Clinic to get covid test because I failed the health screening because of my cough on 1 nov2021.


VAERS ID: 1843106 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

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

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

Write-up: NONE


VAERS ID: 1843130 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

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

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

Write-up: NONE


VAERS ID: 1843233 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Discomfort, Dizziness, Dyspnoea, Flushing, Hypersensitivity, Immediate post-injection reaction, Paraesthesia oral, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin Sulfa Bacitracin, neomycin, polymyxin B, and pramoxine Influenza vaccine Yellow dye wheat latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a severe allergic reaction after receiving first dose of Moderna vaccine on 10/30/21. Patient reports that she became immediately flushed and dizzy after getting the vaccine. She went home and developed chest pain, shortness of breath, wheezing, lip tingling and felt squeezing pressure that went up her neck and to the right side of her face. She went to urgent care and received solumedrol intramuscular injection and symptoms subsided within 15 minutes.


VAERS ID: 1843253 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-29
Onset:2021-10-30
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Blood glucose abnormal, Bordetella test negative, Breath sounds abnormal, COVID-19, Chest X-ray abnormal, Chlamydia test negative, Chronic respiratory failure, Condition aggravated, Confusional state, Coronavirus test negative, Dyspnoea, Enterovirus test negative, Essential hypertension, Human metapneumovirus test, Human rhinovirus test, Hypoglycaemia, Hypoxia, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Lung opacity, Mental status changes, Metabolic encephalopathy, Mycoplasma test negative, Procalcitonin normal, Productive cough, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Viral test negative, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Hypoglycaemia (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol 2.5 mg /3 mL (0.083 %) nebulizer solution albuterol HFA (VENTOLIN HFA) 90 mcg/actuation inhaler apixaban (ELIQUIS) 5 mg tablet ARIPiprazole (ABILIFY) 10 mg tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 40 mg tablet bloo
Current Illness:
Preexisting Conditions: Nervous Hearing loss, bilateral Peripheral neuropathy Acute metabolic encephalopathy Heat stroke, initial encounter Respiratory Asthma, mild persistent COPD with acute exacerbation (CMS/HCC) Moderate COPD (chronic obstructive pulmonary disease) (CMS/HCC) Chronic respiratory failure with hypoxia, on home oxygen therapy (CMS/HCC) Atelectasis COPD (chronic obstructive pulmonary disease) (CMS/HCC) HCAP (healthcare-associated pneumonia) Shortness of breath Circulatory Chronic atrial fibrillation Arteriosclerotic cardiovascular disease Benign essential hypertension (HFpEF) heart failure with preserved ejection fraction (CMS/HCC) ICD (implantable cardioverter-defibrillator) in place Presence of cardiac pacemaker Pulmonary hypertension (CMS/HCC) Peripheral vascular disease (CMS/HCC) Presence of stent in right coronary artery External hemorrhoid Aortic stenosis, mild Ischemic dilated cardiomyopathy (CMS/HCC) Demand ischemia (CMS/HCC) Paroxysmal atrial fibrillation (CMS/HCC) Digestive Obesity Liver lesion Vitamin B12 deficiency Genitourinary CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min (CMS/HCC) Microalbuminuria due to type 2 diabetes mellitus (CMS/HCC) Acute cystitis without hematuria Musculoskeletal Degenerative lumbar disc Osteoarthritis, multiple sites Osteoporosis Endocrine/Metabolic Diabetes mellitus (CMS/HCC) Hyperlipidemia Insulin dependent type 2 diabetes mellitus (CMS/HCC) Hypoxemia Hematologic Iron deficiency anemia Infectious/Inflammatory Parainfluenza COVID-19 virus infection Other Anxiety Depression Long term current use of anticoagulant therapy Cognitive deficits Mild cognitive impairment Status post insertion of iliac artery stent Elevated troponin Hypersomnia Advanced directives, counseling/discussion
Allergies: Bee Venom Protein (Honey Bee)Anaphylaxis PenicillinsHallucinations
Diagnostic Lab Data: 10/30/2021 0815 Respiratory virus detection panel Collected: 10/30/21 0815 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected X-ray chest 1 view, Portable Result Date: 10/31/2021 XR CHEST 1 VW PORT IMPRESSION: No significant interval change from prior. END OF IMPRESSION: INDICATION: Shortness of breath. TECHNIQUE: Portable AP view of the chest is acquired. COMPARISON: 10/23/2021. FINDINGS: The cardiomediastinal silhouette is stable. The cardiac device in the left chest wall is stable. No distinct consolidation is apparent. There is mild patchy atelectasis in the bases. Elevated left hemidiaphragm and mild gaseous distention of the stomach is again noted. No pneumothorax is identified. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view - Portable Result Date: 10/23/2021 XR CHEST 1 VW PORT IMPRESSION: Opacity at the right lung base, atelectasis versus pneumonia. END OF IMPRESSION: INDICATION: SOB. TECHNIQUE: AP portable chest. COMPARISON: 9/21/2021 FINDINGS: Elevation of the left hemidiaphragm is again identified with gastric bubble and air-filled colon identified in the left upper quadrant. Patchy opacity at the right lung base, atelectasis versus pneumonia. Heart size is stable. Unchanged pacemaker/defibrillator. Pulmonary vasculature is unremarkable. No pneumothorax. No acute bony abnormalities.
CDC Split Type:

Write-up: Office Visit 10/28/2021 Dyspnea, unspecified type +3 more Dx Follow-up Reason for Visit Dyspnea, unspecified type - X-ray chest 2 views; Future Hospital discharge follow-up Chronic respiratory failure with hypoxia, on home oxygen therapy Benign essential hypertension Patient Instructions Patient''s hospitalization reviewed. I did see her October 21, on October 23 she was admitted to Hospital with shortness of breath. Original x-ray did show a small patchy opacity consider infiltrate versus atelectasis. On further evaluation, patient''s white blood cell count was normal, pro calcitonin was normal. Overall, not felt to be pneumonia, a COPD exacerbation, or a congestive heart failure exacerbation. She was sent home on prednisone. Patient tells me that she still is feeling a bit short of breath. Her oxygen saturation here in the office today is 99%. She is not tachycardia, low likelihood of pulmonary embolism as the patient is on Eliquis and saturating normally. On examination, she does have very slight decreased breath sounds at the left lower lung base. Patient is due for fasting blood work, I have ordered a chest x-ray as well for the patient have done. I would just like to ensure there is no new or potential worsening infiltrate that would be indicative of pneumonia. I did advise the patient to order to start checking her oxygen saturations on a daily basis with her vitals. Certainly, if she has persistently low 90s on oxygen saturation with her baseline oxygen, she is to let us know right away. ED to Hosp-Admission Discharged 10/30/2021 - 11/2/2021 (3 days) Admission Shortness of breath Hospital Course This is a 82-year-old lady with history of diastolic congestive heart failure, COPD on home oxygen 2 L, CKD stage III, coronary artery disease, atrial fibrillation on anticoagulation with Eliquis and diabetes mellitus who was brought in Hospital emergency department due to cough and shortness of breath. She was admitted for work-up and she was found to be positive for COVID-19 infection. Chest x-ray did not show any evidence of pneumonia. She was treated for COVID-19 infection with dexamethasone. She remained stable on 2 L oxygen. She on admission she was also bit confused so she had acute metabolic encephalopathy likely due to hypoglycemia. Her mental status did improve as her blood sugar got better. On day of discharge her breathing is better. She is still having some occasional cough with clear color sputum. Remains afebrile. No other new symptoms or acute event as per nursing staff


VAERS ID: 1843267 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chromaturia, Myalgia, Screaming, Walking aid user
SMQs:, Rhabdomyolysis/myopathy (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, vit c, astelin, cardizem, tikosyn, cymbalta, eliquis, flonase, xyzal, metoprolol succinate, pantoprazole,trazodone
Current Illness: dysuria treated empirically c keflex 1 wk prior with subsequent sterile urine cx
Preexisting Conditions: vit d def, cardiogenci syncope, obesity, depression, breast cancer, OA knees, parox Afib s/p ablation, OSA, Fibromyalgia
Allergies: morphine, Percocet, IV contrast, bee venom, citrus, strawberries, multaq, latex, gabapentin, isoniazid, letrozole,
Diagnostic Lab Data: ordered 11/4/21 - at time of reporting (CBC, CMP, CK)
CDC Split Type:

Write-up: severe myalgias starting at 18-20yrs after injection that resulted in her screaming in bed and taking old pain pills. myalgias have continued taking pt from no assistive devices to walker x 5 days. Maybe a bit better day 5. darkening of urine.


VAERS ID: 1843275 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-28
Onset:2021-10-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Erythema
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Underarm soreness next day 24 hours after vaccine. Redness on left breast on 10/31/2021 that lasted at least two days. Resolved with antiinflammatory use.


VAERS ID: 1843372 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-13
Onset:2021-10-30
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Adenovirus test, Bradycardia, Choking, Hypoxia, Loss of consciousness, Mental status changes, Mycoplasma test negative, Posture abnormal, Respiratory viral panel, Retching, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (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), Dementia (broad), Dystonia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (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? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/30/2021. 2002 Respiratory virus detection panel. Collected: 10/30/21 2002. Final result: Specimen: Swab from nasopharynx. Adenovirus not detected. Mycoplasma pneumoniae not detected.
CDC Split Type:

Write-up: ED to hospital. Admission: Current 10/30/2021 - present (5 days) in hospital. Acute respiratory failure with hypoxia. Hospitalist attestation: This is 89-year-old female, with past medical history of atrial fibrillation on Eliquis, diabetes mellitus, hypothyroidism, dementia and hypertension presented to ER with altered mental status and hypoxia. Patient was with her daughter last evening, while at the dinner table she slumped over the side of the chair and became unconscious. During that unresponsiveness she also had choking and gagging episode. Patient taken to the nearest fire station. Over there, her oxygen saturation was in 50s. She was bradycardic as well. EMS gave 1mg of atropine.


VAERS ID: 1843398 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-15
Onset:2021-10-30
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Aortic arteriosclerosis, Asthenia, Bordetella test negative, COVID-19, Cardiomegaly, Chest X-ray normal, Chlamydia test negative, Condition aggravated, Coronavirus test negative, Deep vein thrombosis, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Enterovirus infection, Enterovirus test positive, Haemorrhoids thrombosed, Human metapneumovirus test, Human rhinovirus test positive, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Limb discomfort, Mycoplasma test negative, Respiratory syncytial virus test negative, Respiratory viral panel, Rhinovirus infection, SARS-CoV-2 test positive, Treatment failure, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler dilTIAZem CD (CARDIZEM CD) 240 mg 24 hr capsule donepeziL (ARICEPT) 5 mg tablet esomeprazole (NexIUM) 40 mg capsule furosemide (LASIX) 20 mg tablet levothyroxine (SYNTHROID) 5
Current Illness:
Preexisting Conditions: Nervous Peripheral neuropathy Numbness in feet Spinal stenosis of lumbar region with neurogenic claudication Greater trochanteric bursitis, right Lumbar radiculitis Dementia without behavioral disturbance, unspecified dementia type (CMS/HCC) Circulatory Atrial fibrillation (CMS/HCC) [I48.91] DVT (deep venous thrombosis) (CMS/HCC) Essential hypertension First degree AV block Pulmonary embolism (CMS/HCC) Diastolic dysfunction Hypertension Digestive Barrett''s esophagus Gastroesophageal reflux disease without esophagitis Gastroesophageal reflux disease Acute diverticulitis Genitourinary UTI (urinary tract infection) Musculoskeletal Arthritis Lumbar spondylosis Osteoarthrosis, localized, primary, knee Age-related osteoporosis without current pathological fracture Primary osteoarthritis of right hip Lumbar herniated disc Endocrine/Metabolic Hyperlipidemia Hypothyroidism Hypokalemia Hematologic Coagulation defect (CMS/HCC) Immune Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present (CMS/HCC) Other Anxiety Living will in place Long-term (current) use of anticoagulants Controlled substance agreement signed Weakness
Allergies: TerazosinSyncope Sulfamethoxazole-trimethoprimHives / Urticaria TheophyllinePalpitations VerapamilSwelling AmoxicillinNausea Only Vistaril [Hydroxyzine Hcl] Amoxicillin-pot ClavulanateNausea and Vomiting CefuroximeNausea Only, Nausea Only ClarithromycinNausea Only, Nausea Only CodeineNausea Only, Other (document details in comments) Erythromycin BaseNausea Only GatifloxacinOther (document details in comments) Hydrocodone-acetaminophenOther (document details in comments) MeperidineOther (document details in comments) MinocyclineNausea and Vomiting PenicillinsRash Sulfa (Sulfonamide Antibiotics)Welts TetracyclinesNausea and Vomiting VancomycinItching ZafirlukastOther (document details in comments)
Diagnostic Lab Data: 10/30/2021 1402 Respiratory virus detection panel Collected: 10/30/21 1402 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Positive Abnormal Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected 10/30/2021 1402 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 10/30/21 1402 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result Detected Critical Narrative: XR CHEST 1 VW PORT IMPRESSION: No acute radiographic findings. NB: Imaging can be negative in the early stages of COVID 19 pneumonia. END OF IMPRESSION: INDICATION: covid. TECHNIQUE: Portable AP projection of the chest was acquired. COMPARISON: 9/29/2021. FINDINGS: EKG wires project over the thorax. A battery projects over the mid left hemithorax.. The heart size is borderline enlarged. The vascular distribution is normal. The aorta is calcified. The lungs are clear. No acute airspace opacity is identified radiographically (taking into account the overlying battery on the left). No pleural effusion is identified. There is no evidence of pneumothorax. There is a healed fracture of the right humeral head and neck. There is a stable leftward tilt of the thoracic spine. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. Ultrasound lower extremity venous bilateral [3312148160] (Abnormal) Resulted: 10/30/21 1631 Order Status: Completed Updated: 10/30/21 1632 Narrative: PROCEDURE INFORMATION: Exam: US Duplex Lower Extremity Veins, Bilateral Exam date and time: 10/30/2021 2:50 PM Age: 86 years old Clinical indication: Pain; Leg, lower; Bilateral; Additional info: R/O dvt TECHNIQUE: Imaging protocol: Real-time duplex ultrasound of the extremities with 2-D gray scale, color Doppler flow and spectral waveform analysis with image documentation. Complete exam focused on the bilateral lower extremity veins. COMPARISON: US LOWER EXTREMITY VENOUS BILATERAL 12/12/2018 11:38 AM FINDINGS: Right deep veins: Occlusive thrombus is noted within the right peroneal and posterior tibial veins. The remaining evaluated venous structures of the right lower extremity are patent. Right superficial veins: Saphenofemoral junction is patent without thrombus. Left deep veins: Unremarkable. The common femoral, femoral, proximal profunda femoral and popliteal veins are patent without thrombus. Normal Doppler waveforms. Normal compressibility and/or augmentation response. Left superficial veins: Nonocclusive superficial venous thrombosis is noted within the left small saphenous vein. Soft tissues: Unremarkable. THIS REPORT CONTAINS FINDINGS THAT MAY BE CRITICAL TO PATIENT CARE. The findings were verbally communicated via telephone conference 10/30/2021. The findings were acknowledged and understood. IMPRESSION: 1. Occlusive thrombus involving the right peroneal and posterior tibial veins. 2. No evidence of DVT in the left lower extremity. 3. Nonocclusive superficial venous thrombosis involving the left SSV.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 10/30/2021 - 11/3/2021 (4 days) Weakness Presenting Problem/History of Present Illness/Reason for Admission Weakness Diarrhea, unspecified type COVID-19 Hospital Course 86 yo female admitted with generalized weakness, shortness of breath, leg discomfort, diarrhea. Was found to have both rhinovirus/enterovirus, and COVID-19 positive on viral PCR. She was started on appropriate medications, and did show improvement in terms of viral infection. She was however found to have a lower extremity DVT in spite of being on Eliquis for stroke prevention and A. fib. Due to this we considered her to be a treatment failure, and she was transitioned to Coumadin. She was bridged with heparin, and became therapeutic today at 2.6. She received 5 mg x 3 days, I will transition her to 1 mg daily with INR check in 3 days. Attempted to obtain stool cultures to rule out infectious etiology for diarrhea however patient having minimal stool output therefore cultures could not be obtained. If she continues to have symptoms this could be addressed as an outpatient. She will discharge to skilled nursing facility for post hospital reconditioning and then return home. The remainder of her stay was otherwise unremarkable.


VAERS ID: 1843481 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Extra dose administered, Incorrect dose administered, Inflammation, Malaise, Myalgia, Peripheral swelling, Pruritus, Pyrexia, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine; atorvastatin; Norvasc; omeprazole; Plaquenil; Voltaren; metoprolol; multivitamin; calcium; tramadol; folic acid; vitamin d3; valium; Imodium; Cimzia
Current Illness: None
Preexisting Conditions: Lupus; hypothyroidism
Allergies: Sulfa; IVP dye; surgical tape; pravastatin
Diagnostic Lab Data: 2 Covid tests, negative
CDC Split Type: vsafe

Write-up: Friday night in the middle of the night I woke up not feeling well. By Saturday afternoon I started spiking fevers. My upper arm, from the shoulder to the elbow was bright red and swollen and itchy. All my muscles were hurting. I kept taking Tylenol. Monday morning it was still red and swollen. I called my PCP and he sent me to urgent care. They did 2 Covid tests and both were negative. They said I did not have any bacterial infection and that it was just an inflammatory response. The nurse who administered the vaccine said a full dose is .5 ml and a booster is .25 ml. They told me they will give me the full dose due to my age and autoimmune condition. Most of the redness is going down. I still have a red circle on my arm.


VAERS ID: 1843561 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Was diagnosed with Shingles; rash on face


VAERS ID: 1843582 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-11
Onset:2021-10-30
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Cough, Diarrhoea, Dyspnoea, Influenza virus test, Lung opacity, Malaise, Nasopharyngitis, Nausea, Red blood cell sedimentation rate increased, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (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: alendronate, allopurinol, calcium carbonate, folic acid, methotrexate, omega-3, vitamin D
Current Illness:
Preexisting Conditions: hypertension, hyperlipidemia, rheumatoid arthritis, osteopenia, chronic bronchitis
Allergies: codeine
Diagnostic Lab Data: 11/4/21 Chest X-ray: bibasilar opacities COVID-19/influenza combo: positive for COVID-19 Sed rate: 45
CDC Split Type:

Write-up: Patient became ill on 10/30/21 with cold symptoms. She reports worsening cough over the past two days, as well as nausea, vomiting, and diarrhea. She is currently experiencing shortness of breath requiring 2 L O2 by nasal cannula. Current BP is 95/56. The patient will receive 6 mg dexamethasone. She will be admitted to the hospital.


VAERS ID: 1843599 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Computerised tomogram, Dizziness, Fibrin D dimer, Immunodeficiency
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 20mg 1xday night Pirmella
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin
Diagnostic Lab Data: Tests were did on 11/2/2021: chest xray- normal d dime blood test for blood clots- slightly high cat scan with contrast- negative
CDC Split Type: vsafe

Write-up: Tuesday morning on 11/2/2021 around 2:30 I started to have chest pains. At 3:30 I went to the ER. When I was there they ran tests on me. They didn''t diagnose me with anything, but told me take Advil. The chest pains have not subsided. I take Advil every 6 hours, but that doesn''t seem to be helping with the pains. I am still having the exact same pain. On 11/3/2021 I did experience some light headiness so I just worked from home that day.


VAERS ID: 1843616 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-20
Onset:2021-10-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood urine present, Burning sensation, Dysuria, Nephrolithiasis
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol, losartan, metformin, escitalopram, loratidine, vitamin D, vitamin C, magnesium, evening primrose oil, women''s multivitamin
Current Illness: none
Preexisting Conditions: hypertension, diabetes
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: pain, burning, frequency with urination, large blood clots in urine on October 30th, ended up having kidney stone


VAERS ID: 1843741 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Feeling abnormal, Hyperhidrosis, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), 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: heartburn medicine, Pastoral
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: The next after I got my shot, I was feeling fine. About 9AM, I was feeling little off. About 10am, I felt sweaty, clampy, and light-headed. I was just standing there. Then I fainted. I was clammy and had no color. They called the ambulance. They checked me out. I went home. I feel fine now.


VAERS ID: 1843769 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: semaglutide, dexilant
Current Illness: none
Preexisting Conditions: well controlled DM
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: diffuse itching, palms, hands, neck, back, legs at time of reporting $g 5 days not very responsive to antihistamines


VAERS ID: 1843802 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-27
Onset:2021-10-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Breast pain, Cardiac imaging procedure normal, Computerised tomogram thorax abnormal, Dyspnoea, Electrocardiogram normal, Intensive care, Interchange of vaccine products, Pulmonary thrombosis, Scan normal, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Lipodystrophy (broad), Medication errors (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Birth control pills (generic for Yaz)
Current Illness: N/A
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: As mentioned, within 5 days after receiving a follow up "booster" of Moderna vaccine (original vaccine was Janssen), case patient was admitted to ICU with blood clots in each lung (discovered with CT scan). Leg scan indicated no evidence the clots originated in the legs. Heart scan was good. EKG was normal. It was relayed to the patient that this was likely due to the risk of blood clots from birth control pills. While this is the diagnosis, due to the timing, it seemed prudent to report as a potential vaccine adverse reaction, especially as there may be little data on people who received the J&J and the Moderna vaccine at this time (I am a Public Health professional...).
CDC Split Type:

Write-up: My sister was vaccinated with the COVID-19 Janssen vaccine (J&J) the last week of March, 2021. She received a COVID-19 Moderna "booster" shot on October 27, 2021. Several days after receiving the vaccine, she started to feel a sharp pain under her left breast and then experienced shortness of breath. On November 1, 2021 (5-days after her second vaccine/ a mix-and-match JJ/Moderna), she was admitted to the ICU and was found to have blood clots in her lungs. She was treated with Ribaroxaban (Xarelto) and released on November 3, 2021. From her account, she did NOT have thrombocytopenia (low platelets) as is associated with TTS (Thrombosis with Thrombocytopenia Syndrome) as was feared since she originally received the J&J vaccine and is 50 years old.


VAERS ID: 1843845 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-23
Onset:2021-10-30
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium 600 MG Tablet 1 tablet Orally once a day Citalopram 40 mg tablet 1 tablet Orally once daily Multi For Her 50+ - Tablet 1 tablet Orally once a day Folic Acid 1 MG Tablet 1 tablet Orally Once a day Acyclovir 800 MG Tablet
Current Illness: none
Preexisting Conditions: B Cell Lymphoma Stage IV in spleen and nodes - 7/2020; CHOP chemo completed; complications of port infection, groin skin infection, transfusions x 12 (HHH Cancer Center). Anxiety/Depression. HPV+ - 2020. Hx of EtoH Abuse - Sober since 2014. MAC Pneumonitis (Pulmonology). Perioral Dermatitis.
Allergies: SULFA DRUGS
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID + on 11/2/2021; cold like sxs, runny nose, sore throat, achy and HA.


VAERS ID: 1843883 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-23
Onset:2021-10-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Hypersensitivity, Pruritus, Rash, Swelling, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 10mg - 1qd
Current Illness: Nine
Preexisting Conditions: GAD
Allergies: None
Diagnostic Lab Data: Please email me for test results documents. I can send you all labs that were taken
CDC Split Type:

Write-up: On 10/30/21 started developing itching in my face and throat. By the next day the itching had extended down my whole body. By Monday the itching was excruciating and a full body rash developed. Went to the Er but they could not identify cause so they gave me oral prednisone, doxycycline, diphenhydramine and sent me home with prescriptions for the doxy, and 50mg prednisone to take daily. By Tuesday I began swelling in head neck face both arms trunk and legs. Went back to ER where I began experiencing extreme joint pain. They determined it was either an allergic reaction or auto immune. They gave me IV methyprednisolone and ketorolac. They referred me to an immunologist who I saw today (Thursday). He felt it was a delayed allergic reaction to the vaccine. Currently the full body swelling and rash have not subsided yet.


VAERS ID: 1844331 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient stated that she was diabetic.
Current Illness: Patient stated that she had not eaten much that morning. And verbalized not being well hydrated.
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received a booster dose of Pfizer vaccine per guidelines. Patient stated that she had not had much water to drink that morning, complained of "not feeling well." Patient stated that she was a diabetic. Patient was monitored: b/p 185/65, pulse 71, and pulse ox. was 97%. Patient was given water to hydrate and offered something to eat. Cold pack applied to back of neck and patient was monitored for 20 minutes. Patient was re-evaluated prior to being released to go with her daughter.


VAERS ID: 1844338 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-30
Onset:2021-10-30
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Electrocardiogram, Hypertension, Immunodeficiency, Nausea, SARS-CoV-2 test negative, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypertension (narrow), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (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: Sertraline Estradiol cream
Current Illness: None
Preexisting Conditions: None
Allergies: Mushrooms
Diagnostic Lab Data: Covid test negative, EKG negative
CDC Split Type:

Write-up: Nausea x 3 days blurred vision, dizziness, chest discomfort, high blood pressure - 4 hours Resolved without treatment


VAERS ID: 1844712 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / -

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Cough, Fatigue, Feeling cold, Pyrexia, Sensation of blood flow
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain, cough, fever, chills, fatigue, increase blood flow


VAERS ID: 1844720 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-26
Onset:2021-10-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Bacterial test, Blood albumin normal, Blood alkaline phosphatase increased, Blood thyroid stimulating hormone decreased, Culture urine negative, Full blood count, Haematuria, Haemoglobin decreased, Iron deficiency anaemia, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin decreased, Mean cell volume decreased, Metabolic function test, Red blood cell count increased, Red cell distribution width increased, Urinary tract infection, Urine analysis normal, White blood cell count increased
SMQs:, Liver related investigations, signs and symptoms (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Biliary system related investigations, signs and symptoms (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Tubulointerstitial diseases (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: 1) aspirin 81 mg oral delayed release tablet, 1 tab po daily 2) atorvastatin 20 mg oral tablet, 1 tab po qpm 3) butalbital/acetaminophen/caffeine 50 mg-325 mg-40 mg oral tablet, 1 tab po q6h PRN for headache 4) Eliquis 5 mg oral tablet, 1
Current Illness: none
Preexisting Conditions: 1. Headaches - chronic, possibly rebound due to chronic Fioricet 2. Systolic congestive heart failure 3. Atrial fibrillation - persistent 4. Hypertension 5. Hyperlipidemia 6. Hypothyroid 7. Colon polyp 8. Peptic ulcer due to NSAIDS 9. Depression
Allergies: none
Diagnostic Lab Data: 10/24/2021 Complete metabolic panel normal except albumin 4.8, Alkaline phosphatase 144 TSH 0.464 Hgb 10.1 MCV 77, MCH 21.9, MCHC 28.5, RDW 17.7 remainder of CBC normal UA LE 3+, protein 1+, blood 3+, WBC $g30/HPF, RBC $g30/HPF, bacteria many 11/2/2021 Urine culture - no growth
CDC Split Type:

Write-up: She had microscopic hematuria and iron deficiency anemia on labs drawn on the day of the vaccination. She is also treated with aspirin and Eliquis for an underlying heart conditions. The hematuria appeared to be consistent with a UTI. After treatment with two different antibiotics sequentially, the urine culture was negative. The gross hematuria persists.


VAERS ID: 1844727 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Herpes zoster, Interchange of vaccine products, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: A visit to the patient''s primary care physician on 11/4/2021 confirmed the diagnosis of Shingles.
CDC Split Type:

Write-up: Beginning at 24 hours after the Pfizer Covid booster shot, patient began early symptoms of Shingles (pain in right torso region). Pain persisted for the next 4 days, and at 5 days post-booster, a rash on the torso appeared. Patient visited her primary care physician at 6 days post-booster (11/4/2021), who confirmed it as a case of Shingles. Additional information: Patient received the J&J Covid vaccine on 4/7/2021. This Pfizer shot administered on 10/29/2021 was a booster shot.


VAERS ID: 1845470 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-25
Onset:2021-10-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st dose Covid vaccine chest pain
Other Medications: Prenatal vitamin, emergen-c
Current Illness: Prior chest pain from first dose vaccination
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Tingling/pins & needles/numbness in hands and feet


VAERS ID: 1845502 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 51
Other Medications: Veneflaxine 75 mg, Almodapine 10mg Vitamin D 4000 UI
Current Illness: Asthma
Preexisting Conditions:
Allergies: Vicodin,I get a rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, heart palpitations it?s been 5 days and still have symptoms


VAERS ID: 1845750 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 UN / IM

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

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

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


VAERS ID: 1845766 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 UN / IM

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

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

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


VAERS ID: 1845767 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 UN / IM

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

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

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


VAERS ID: 1845768 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 UN / IM

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

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

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


VAERS ID: 1845769 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 UN / IM

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

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

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


VAERS ID: 1845772 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 UN / IM

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

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

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


VAERS ID: 1845800 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-27
Onset:2021-10-30
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FR2588 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Urinary tract infection
SMQs:

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: Vitamin C 1000mg,, Multivitamin, Vitamin D 2000U, Fish Oil Capsule 1000mg, Preservision capsules
Current Illness: none
Preexisting Conditions: none
Allergies: SUlfa, Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: UTI symptoms. COntacted Urgent Care while out of town. Have had UTIs in past and described same symptoms. Urgent care prescribed Nitrofurantoin 100mg bid x 5 days starting 10/31/21 with complete resolution of symptoms by 11/2/21 No further symptoms at this time


VAERS ID: 1845804 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1845939 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1845945 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1845949 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1845953 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 OT / IM

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

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

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


VAERS ID: 1845962 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1845969 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1845972 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1845975 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1845980 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1845984 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1845993 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fall, Pallor, Rhinalgia, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient here to receive her 1st Dose Pfizer Vaccine. Patient alert, and oriented at time of vaccine. Received vaccine in Shot Room, stood up, stated she was OK, proceeded to Pediatric waiting area and sat in chair. Seconds later ~ 12:45 PM, mother calling for some one as patient had fell out of chair onto floor face down. Mother and Nurse got her up and sat her in chair. Patient not responding, although she was breathing and had a pulse. Cool wet paper towel compress to forehead and face. Patient came to, but unaware of what had happened. Provider notified to come to area to assess patient. B/P- 97/61 P- 80, SPO2- 95%- 98%. Patient moved to an exam room, pale in color, shaking her head as her mom encouraged her to stay awake. Refusing an ambulance for care. Cool compresses to face, forehead and back of neck. ~ 12:54 patient alert and oriented, talking with mom, as color began to return. Drinking a cool Lemon Ice tea. Patient unaware of what happened. Does not recall falling to the floor. Patient did state that after the injection she felt dizzy, but did not say anything to Nurse or mother. ~ 1:00 PM- B/P- 100/74 P- 94 SPO2-96%. ~1:20 PM patient continues to complain that her nose hurts, cold ice pack applied to area, Provider aware of same. Parent encouraged to follow-up immediately with her Pediatrician to ensure that her nose is OK. Father arrived on the scene- ~ 1: 15 PM. Patient encouraged to stand and move around before leaving. ~ 1:35 PM family left the facility, again encouraged to follow up with Pediatrician.


VAERS ID: 1846043 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846047 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846052 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846055 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846063 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846064 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 LA / IM

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

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

Write-up: I had very severe lymph node swelling under my clavicle bone, armpit area and side of my breast. I also had exhaustion and fatigue for about 36-48 hours. It was the armpit pain I got concerned about. My doctor just recommended I take Tylenol which has helped. It is getting better daily.


VAERS ID: 1846065 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846068 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846070 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846073 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 OT / IM

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

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

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


VAERS ID: 1846078 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846080 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846083 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846088 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846090 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846094 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846113 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Balance disorder, Disturbance in attention
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol
Current Illness:
Preexisting Conditions: Rheumatoid Arthritis
Allergies: Bactrim, Celecoxib, Januvia, Prilosec, Refecoxib, Zantac
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe anxiety for 24 hours, stared 12 hours after injection Off balance for 24 hours Difficulty concentrating for 3 days


VAERS ID: 1846150 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Atrial fibrillation, Blood test, Chest X-ray, Chest discomfort, Electrocardiogram, Heart rate abnormal, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan
Current Illness: No
Preexisting Conditions: Afib; High Blood Pressure
Allergies: No
Diagnostic Lab Data: Bloodwork; EKG; Chest X-ray
CDC Split Type: vsafe

Write-up: Within the same the sore arm pain for 2 days. Afib - my heart went erratic and never had it this bad. 2Nov2021 - In the middle on the night, my smart watch told me that my heart beat was erratic. Slight pressure in the middle of the breast. Went to ER, everything was fine in the tests in ER.


VAERS ID: 1846154 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846157 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846162 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-27
Onset:2021-10-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Cardioversion
SMQs:, Supraventricular tachyarrhythmias (narrow)

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

Write-up: I went into Atrial fibrillation. I went yesterday to the hospital (Hospital). They did a cardio version. Then they sent me home.


VAERS ID: 1846165 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846168 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea, Vomiting
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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea and vomiting


VAERS ID: 1846173 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846182 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846185 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846193 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846196 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846199 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846204 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 UN / IM

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

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

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


VAERS ID: 1846207 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 OT / IM

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

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

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


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=60&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166