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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 61 out of 8,753

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VAERS ID: 1846224 (history)  
Form: Version 2.0  
Age: 28.0  
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: 1846249 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Missouri  
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 939905 / 4 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient failed to report full vaccination history and was administered a 4th dose of Covid-19 vaccine, patient had a the following vaccines: Moderna Lot 025J20-2A 12/24/2020, Moderna Lot 030L20A 1/22/2021, Pfizier Lot FE3592 9/2/2021, and Moderna Lot 939905 10/20/2021. Patient reported no side effects from 4th vaccine, as of 11/5/2021.


VAERS ID: 1846253 (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: 1846271 (history)  
Form: Version 2.0  
Age: 63.0  
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: Extra dose administered, Product storage error
SMQs:, Medication errors (narrow)

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

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


VAERS ID: 1846302 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Missouri  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Chills, Immunodeficiency, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin - 500mg 2x/day Claritin - 2x/day Vitamin D Fish Oil Prenatal vitamin
Current Illness: Elevated liver enzymes
Preexisting Conditions: PCOS
Allergies: Sulfa Drugs - hives
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Swollen and painful lymph node in left armpit starting approximately 24 hours after vaccination and lasting approximately 4-5 days. Low grade fever with chills approximately 48 hours after vaccination (99 degrees F). Fever was gone the following morning and responded appropriately to medication. Technically pregnant at time of vaccination according to hCG level; however, miscarriage had already been confirmed prior to vaccination via ultrasound and lowering hCG levels. Due date was June 12; however, pregnancy was determined to be a miscarriage prior to vaccination.


VAERS ID: 1846373 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Puerto Rico  
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 058F21A / 4 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Axillary mass, Breast mass, Inflammation, Mass, Neck mass, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Post vaccination adverse event. Fever Sunday and Monday feel lumps in armpit, breast, neck, shoulder. Inflammation.


VAERS ID: 1846385 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-25
Onset:2021-10-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027CZ1 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Maternal exposure during breast feeding, Suppressed lactation
SMQs:, Functional lactation disorders (narrow), Neonatal exposures via breast milk (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: Prenatal
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin- Rash
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Decrease in breastmilk supply. Was pumping 40oz of milk daily for the past several months, lost supply overnight. Baby was unsatisfied at the breast and pumping less than 20 oz of milk in a day. This lasted for approximately 3 days. After days of emptying breast 10+ times per day, supply started to resume to normal.


VAERS ID: 1846409 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Georgia  
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 076C21A-B / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported or noted on DPH Covid-19 Vaccine Information and Consent form
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported or noted on DPH Covid-19 Vaccine Information and Consent form
Diagnostic Lab Data: None - Agency followed up with patient via phone and no adverse symptoms reported
CDC Split Type:

Write-up: The vaccination card disclosed dosage 1 and 2 and was not updated to reflect vaccination status in GRITS (dosage 1, 2 and Booster 8/2021) when guest (patient) was administered the Moderna Booster dosage of 0.25 ML on 10/30/2021. GRITS may have been down the morning when this event occurred in Pre-Vaccination Area after consent form was completed by the guest (patient) and vaccination card by Pre-Vaccination team. Guest was routed to the Clinical Area and the nurse reviewed the consent form, and noted vaccinations 1 and 2 on the vaccination card. Nurse proceeded to administer the Moderna Booster dosage 0.25 ML as it was next dosage in the series. Patient was escorted to Post Vaccination for adverse reaction monitoring for 15 minutes. During which time no symptoms or discomfort was observed by the monitoring nurse. Corrective Action is in place to confirm dosages administered in a series for guests (patients) in GRITS before the guest is routed to the Clinical area.


VAERS ID: 1846486 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-10-30
   Days after vaccination:260
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Computerised tomogram head normal, Dizziness, Fall, Hypoxia, Pyrexia, SARS-CoV-2 test positive, Walking aid user
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet aspirin (ASPIRIN ADULT LOW DOSE) 81 MG EC tablet Calcium Carb-Cholecalciferol (CALCIUM 600 + D PO) ferrous sulfate 325 (65 Fe) MG tablet furosemide (LASIX) 40 MG tablet hydrALAZINE (APRESOLINE) 25 MG ta
Current Illness: NA
Preexisting Conditions: Hypothyroidism Essential hypertension Back pain Congestive heart failure Insomnia Anemia Medication management Caregiver burden Macular degeneration At risk of decubitus ulcer Mitral valve regurgitation Atrial myxoma At risk for falls
Allergies: Ceftin [Aspartame] CefuroximeOther, Dizziness Vicodin [Hydrocodone-acetaminophen]
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.30.21 - still hospitalized / admitted); COVID-19 positive (10.30.21); fully vaccinated CHIEF COMPLAINT: Fall History of Present Illness Patient is a 87 y.o. female , vaccinated with moderna feb 2021 Past medical history as noted below Resides at (PRIVACY) over the past 1-2 years Lives with her husband Uses a walker at baseline Comes in after having sustained a fall Claims to have been in her normal state of health prior States that she was doing her hair in the bathroom when she felt lightheaded She grabbed on to the towel bar but still fell Denies any head trauma Contact staff contacted EMS On arrival was found to be febrile, hypoxic CT head obtained and negative. Chest x-ray showing COVID COVID test positive Patient''s code status was do not resuscitate prior but during our conversation, opted for a full code States that she needs to be alive for her husband Acute hypoxia COVID-19 Continue remdesivir for now, symptoms only on day of admission Continue supplemental oxygen, wean as tolerated Continue Tylenol Continue melatonin Vaccinated with Moderna in February


VAERS ID: 1846556 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-28
Onset:2021-10-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lotrel, Zyrtec, Balasalazide, Calcium and D3
Current Illness: None
Preexisting Conditions: Hypertension, Ulcerative Colitis, Migraines, Vitamin D Deficiency
Allergies: Vicodin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Friday had a Temp of 101.4, broke about 3 AM and felt fine. Saturday Night Started getting Hives under her watch on wrist. Took 2 Benadryl/hydrocortisone cream. Woke up at 1:30AM and was covered on arms with Hives. Took cold shower for itching. Went away for 2 days and now they are coming and going since the shot on her arms. She continues to take benadryl without much relief.


VAERS ID: 1846578 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Virginia  
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 0090214 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Fatigue, Headache, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: Levothyroxin in the morning on an empty stomach 100mcgs, Lexopro Secitlaotrim in the morning once a day 20mgs tab, Antihistamine Seterincin hydrochloride 10mg once a day. Turmeric and ginger root supplement 600mgs of Turmeric and Ginger r
Current Illness: I was feeling fine.
Preexisting Conditions: Hyperthyroid and Cholesterol. I''m a type 2 diabetic. I''m a vegan and this helps me control my sugar levels and cholesterol.
Allergies: about 20 years ago I had a reaction the prevised for Gerd, but I only had it once.
Diagnostic Lab Data: None yet, I''m seeing the doctor on 11/05/2021
CDC Split Type: vsafe

Write-up: I was experiencing headaches and body aches, I felt extra tired. I took it easy for a couple days. My blood pressure is higher than normal and I''m seeing a doctor on 11/05/2021. My blood pressure was around 149 and normally I''m in the 100-120 to 60-70. I''m not sure if its stress related.


VAERS ID: 1846582 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Breast induration, Breast swelling, Chest discomfort, Heart rate increased, Injection site pain, Injection site swelling, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Dehydration (broad)

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

Write-up: First dose of vaccine (10/29/21 to 11/05/2021): 10/29/21 3:07PM: Got the jab Night: Swollen and pain on injection site 10/30/21 PM: Started tingling all over the body 10/31/21 Noon: Started tingling and pinching on feet and ankles when walking Night: Felt Left breast harden and swollen 11/01/21 8AM: Sudden fast heart beat while keeping still & a little bit tight feeling on the chest 11/02/21 Injection site felt back to normal 11/04/21 No longer felt Left breast harden and swollen 11/05/21 Still have tingling, fast heart beat * So far, did not go to hospital due to no dizziness or serious short of breath, and did not know how much it would cost if go to the hospital to check out.


VAERS ID: 1846676 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-13
Onset:2021-10-30
   Days after vaccination:290
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Nasopharyngitis
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: Vitamin D And Fish oil. Zinc.
Current Illness: None
Preexisting Conditions: None
Allergies: Nome
Diagnostic Lab Data: Negative
CDC Split Type:

Write-up: I have been experiencing cold like symptoms for one week. The symptoms are net improving after a week. I am healthy and have a excellent health history and started taking vitamin D supplements approximately 4 years ago. I was exposed to covid several times before being vaccinated and never had any symptoms. Since the vaccine isn?t reducing transmission was it necessary for me to have. My fear is that it has negatively impacted my immune system. I have never had a cold like this that lasted this long. Thanks for your consideration.


VAERS ID: 1846812 (history)  
Form: Version 2.0  
Age: 61.0  
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 011F21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Feeling of body temperature change, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I woke up with stabbing pains in my feet, repeated very frequently from 30 seconds to 2 minute intervals. This got better slowly over the day. I also felt feverish, hot and cold


VAERS ID: 1846857 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-12
Onset:2021-10-30
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Dysphonia, Dyspnoea, Oropharyngeal pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKA
Diagnostic Lab Data: COVID 19 rapid antigen testing positive on 10/30/2021
CDC Split Type:

Write-up: Patient tested positive for COVID 19 on 10/30/2021 symptoms reported: Fever 102.5, chills, sore throat, congestion, hoarseness, shortness of breath, cough


VAERS ID: 1847373 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: California  
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 048C21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Arthritis
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow), 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
Current Illness: none
Preexisting Conditions: atrial fibrillation
Allergies: none
Diagnostic Lab Data: visit to primary care provider
CDC Split Type:

Write-up: Left shoulder joint inflammation and pain


VAERS ID: 1848407 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-03-11
Onset:2021-10-30
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site mass, Vaccination site pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: has a bump; redness all around like a bull''s eye; pain in my arm/moderate pain; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE MASS (has a bump), VACCINATION SITE ERYTHEMA (redness all around like a bull''s eye) and VACCINATION SITE PAIN (pain in my arm/moderate pain) in a 68-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 032F21A, 031B21A. and 044A21A) for COVID-19 vaccination. No Medical History information was reported. On 11-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 28-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Oct-2021, the patient experienced VACCINATION SITE MASS (has a bump), VACCINATION SITE ERYTHEMA (redness all around like a bull''s eye) and VACCINATION SITE PAIN (pain in my arm/moderate pain). At the time of the report, VACCINATION SITE MASS (has a bump), VACCINATION SITE ERYTHEMA (redness all around like a bull''s eye) and VACCINATION SITE PAIN (pain in my arm/moderate pain) outcome was unknown. no concomitant and treatment medications are provided by the reporter. Vaccination facility address for dose 1 and 2 is given as Airport, for 3rd dose is Pharmacy/Drug Store.


VAERS ID: 1848722 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F12593 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary mass, Axillary pain, Contusion, Headache, Pyrexia, Skin discolouration
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (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: Only Fever, 75, on 2/21/2021, Pfizer, EN6201
Other Medications: Daily: 1 Asperin (81mg), 2 Calcium (1,200mg), 1 CoQ10 (200mg), 1 Omeprozole (20mg), 1 Ultra Woman Vitamin +50, 1 Omega -3, 1 Metformin ER (500mg), 1 Vitamin C (1,000mg), 1 Potchloride ER (10mg), 1 Simvastatin (40mg), 1 Zinc (50mg)
Current Illness: Skin Cancer on Right Temple of Face Minor Siatica
Preexisting Conditions: None
Allergies: Sulphur Methylchloroisothiazolinone, Neomycin, Bacitracin, Balsam of Peru
Diagnostic Lab Data: None. My shot was administered at the above hospital on Friday, October 29. I sent pictures to my doctor and waited for the conditions to pass. I have two pictures Monday(Nov1), two pictures Tuesday(Nov2), two pictures Thurs(Nov4), and one picture Friday(Nov5).
CDC Split Type:

Write-up: Day After I experienced fever, as I did with #2 shot. I treated with low dose Tylenol. I experienced a slight head ache off and on but not bad. On the next day the under pit of that arm began to hurt and I noticed lumps in the under pit. On that same day I had bruises scattered on top and underneath my arm. On the next day the under pit began hurting really bad and those lumps started turning yellow. By the fourth day the bruises began to disappear and the yellowed lumps did too. My fifth day was yesterday and everything was normal.


VAERS ID: 1848788 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-10-01
Onset:2021-10-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Ischaemic stroke, Magnetic resonance imaging head abnormal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mitral valve regurgitation, type 2 diabetes, high blood pressure
Allergies: Iodine
Diagnostic Lab Data: CAT, MRI, at hospital on 10/30-11/1/2021
CDC Split Type:

Write-up: Ischemic stroke


VAERS ID: 1849059 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Discomfort, Dyspnoea, Heart rate decreased, Oxygen saturation decreased, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: fibromyalgia, seasonal allergies
Preexisting Conditions: fibromyalgia, acute asthma
Allergies: sulfa, flonase, some laxatives, percocet, lactose, scallops, flucstisone proponate cream
Diagnostic Lab Data: still waiting to hear back from the on call doctor to see if I should be seen in a hospital, my symptoms are getting worse each day that goes by, each occurrence is getting longer, and more intense
CDC Split Type:

Write-up: feels like my heart is racing, and i was short of breath, but when I check my heart rate was actually low, it was 59, and my oxygen level was 90, after some time it went back up, then it dropped again, then it went back up, both, it feels very uncomfortable, I have never had this feeling in my chest, and my heart rate has never been that low in my life


VAERS ID: 1849071 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-23
Onset:2021-10-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Cardiac disorder, Cardiac failure, Cardiogenic shock, Deep vein thrombosis, Echocardiogram abnormal, Interchange of vaccine products, Laboratory test normal, Pulmonary embolism
SMQs:, Cardiac failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Medication errors (broad)

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

Write-up: Patient is an active, healthy 63-year-old man, not on medication and has never smoked. Received J&J 4/7/2021. Received Moderna booster 10/23/2021. The patient developed L femoral DVT and massive saddle pulmonary embolus on 10/30/2021. He was in cardiogenic shock and R heart failure initially, with ECHO showing severe R heart strain. Patient received TPA and then clinically improved. Able to be discharged to home on oral anti coagulation. Autoimmune work-up negative.


VAERS ID: 1849160 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-28
Onset:2021-10-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Heavy menstral bleeding


VAERS ID: 1849375 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-28
Onset:2021-10-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Herpes zoster, Spinal disorder
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Alendronate Certrazine Diclifenac Proton is Propafenone Tramadol
Current Illness: Diverticular bleed(resolved) Physical de conditioning(in rehab)
Preexisting Conditions: Gerd Atrial Fib Hypertension
Allergies: Erythromycin Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles rash. Thoracic dermatomal distribution.


VAERS ID: 1849426 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-15
Onset:2021-10-30
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Feeling abnormal, Muscle spasms, Palpitations, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Hypertension (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad)

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

Write-up: Brain fog, dizziness, heart palpitations, increased blood pressure, Muscle spasms, ear ringing. The symptoms have not left, and continues to bother me everyday.


VAERS ID: 1849488 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Constipation, Decreased appetite, Full blood count, Gastrooesophageal reflux disease, Hyperhidrosis, Injection site erythema, Injection site pain, Injection site swelling, Metabolic function test, Myalgia, Nausea, Pyrexia, Temperature regulation disorder, Thyroid function test, Tinnitus, Urine analysis, Weight decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Temazepam (30 mg daily), Aurovela FE 1/20 birth control (one tablet daily), omzeprazole (40 mg as needed)
Current Illness: None
Preexisting Conditions: Mild asthma, anemia, eczema, bipolar II, cPTSD, panic disorder
Allergies: Sulfa drugs, codeine, lamotrigine, lurasidone, latex, ginger root, most adhesives
Diagnostic Lab Data: CBC, CMP, UA, and thyroid panel on 11/06/21. Awaiting interpretation of results
CDC Split Type:

Write-up: Low grade fever; joint pain; muscle pain/soreness; injection site pain, swelling, and redness; loss of appetite resulting in weight loss of 5 pounds in one week; nausea; abdominal cramping; severe constipation; acid reflux; tinnitus; inability to regulate body temperature/profuse sweating


VAERS ID: 1849523 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003FZ1A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Standard Elderberry Gummies with Vitamin C and Zinc
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: I WAS DIAGNOSED BY DR (LUNG DOCTOR) HAVING COVID-19 VACCINE SIDE EFFECTS
CDC Split Type:

Write-up: FOR THE PAST TEN DAY, I HAVE BEEN STRUGGLING WITH SHORTNESS OF BREATH.


VAERS ID: 1849839 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Product temperature excursion issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: The Moderna vile that we used was taken out of the freezer and thawed out on 9/10/21 at 7am.; This spontaneous case was reported by an other health care professional and describes the occurrence of PRODUCT TEMPERATURE EXCURSION ISSUE (The Moderna vile that we used was taken out of the freezer and thawed out on 9/10/21 at 7am.) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 30-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Oct-2021, the patient experienced PRODUCT TEMPERATURE EXCURSION ISSUE (The Moderna vile that we used was taken out of the freezer and thawed out on 9/10/21 at 7am.). On 30-Oct-2021, PRODUCT TEMPERATURE EXCURSION ISSUE (The Moderna vile that we used was taken out of the freezer and thawed out on 9/10/21 at 7am.) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route), the reporter did not provide any causality assessments. No Concomitant medications were reported. No treatment medications were reported. The reporter had question regarding product re-administration. Reporter did not allow further contact


VAERS ID: 1849846 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose, Body temperature, Diarrhoea, Heart rate, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: INSULIN; VICTOZA; METFORMIN
Current Illness: AFib; Type 2 diabetes mellitus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211030; Test Name: Blood sugar; Result Unstructured Data: blood sugar lever went up to 177 units from its usual 120 units.; Test Date: 20211030; Test Name: Body temperature; Result Unstructured Data: 101.1 degree F; Test Date: 20211030; Test Name: Heart rate; Result Unstructured Data: it only ranges from 70-90BPM prior to vaccination
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Diarrhea; fever of 101.1 deg F; Vomiting; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (Diarrhea), PYREXIA (fever of 101.1 deg F) and VOMITING (Vomiting) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939904) for COVID-19 vaccination. Concurrent medical conditions included AFib and Type 2 diabetes mellitus. Concomitant products included INSULIN, LIRAGLUTIDE (VICTOZA) and METFORMIN for an unknown indication. On 30-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 30-Oct-2021, the patient experienced DIARRHOEA (Diarrhea), PYREXIA (fever of 101.1 deg F) and VOMITING (Vomiting). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) for Fever, at an unspecified dose and frequency. At the time of the report, DIARRHOEA (Diarrhea) and VOMITING (Vomiting) had resolved and PYREXIA (fever of 101.1 deg F) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 30-Oct-2021, Blood glucose: 177 (High) blood sugar lever went up to 177 units from its usual 120 units.. On 30-Oct-2021, Body temperature: 101.1 (High) 101.1 degree F. On 30-Oct-2021, Heart rate: 101-103 breaths per minute (High) it only ranges from 70-90BPM prior to vaccination.


VAERS ID: 1849890 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dehydration, Dizziness, Dysstasia, Fall, Gait inability, Laboratory test
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 325 mg,aripiprazole10 mg,aspirin 81 mg, vitamin d3 5000 units, northera, duloxetine,finasteride,fluodrocortisone,melatonin,montelukast,nadolol,pantoprazole,potassium chloride,prasugrel,pyridostigmine
Current Illness: Patient has POTS
Preexisting Conditions: Chronic POTS patient
Allergies: all statins
Diagnostic Lab Data: Date would be 10/30/21 thru 11/2/21at Hospital Lab results available at medical records
CDC Split Type:

Write-up: Patient became extremely weak...could not stand...dizzy...pt fell...ambulance took him to the ED where he was admitted for severe dehydration. He was given IV saline and then admitted to the hospital for 3 days and is now in a rehab nursing home unable to walk or stand with weakness and now confusion


VAERS ID: 1849975 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blepharospasm, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: left eye was twitching,; her right leg was itching; had a fever, that is still going down,; This spontaneous case was reported by a consumer and describes the occurrence of BLEPHAROSPASM (left eye was twitching,), PRURITUS (her right leg was itching) and PYREXIA (had a fever, that is still going down,) in a 19-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939905) for COVID-19 vaccination. No Medical History information was reported. On 30-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 30-Oct-2021, the patient experienced BLEPHAROSPASM (left eye was twitching,), PRURITUS (her right leg was itching) and PYREXIA (had a fever, that is still going down,). On 31-Oct-2021, BLEPHAROSPASM (left eye was twitching,) and PRURITUS (her right leg was itching) outcome was unknown. At the time of the report, PYREXIA (had a fever, that is still going down,) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant and treatment medications were provided Patient reported that she had miss a day of work. This case was linked to MOD-2021-368985 (Patient Link).


VAERS ID: 1849985 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-28
Onset:2021-10-30
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy (codeine); Allergy (Anaphylaxis to Iodine.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: They administrated the Moderna booster shot to 2 patients, Vial was moved from Freezer to fridge on 10Sep2021 and were used yesterday 30Oct2021, More than 30 days in the fridge; Vial was moved from Freezer to fridge on 10Sep2021 and were used yesterday; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (They administrated the Moderna booster shot to 2 patients, Vial was moved from Freezer to fridge on 10Sep2021 and were used yesterday 30Oct2021, More than 30 days in the fridge) and PRODUCT STORAGE ERROR (Vial was moved from Freezer to fridge on 10Sep2021 and were used yesterday) in a 66-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017C21A) for COVID-19 vaccination. Concurrent medical conditions included Allergy (codeine) and Allergy (Anaphylaxis to Iodine). On 28-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (They administrated the Moderna booster shot to 2 patients, Vial was moved from Freezer to fridge on 10Sep2021 and were used yesterday 30Oct2021, More than 30 days in the fridge) and PRODUCT STORAGE ERROR (Vial was moved from Freezer to fridge on 10Sep2021 and were used yesterday). On 30-Oct-2021, EXPIRED PRODUCT ADMINISTERED (They administrated the Moderna booster shot to 2 patients, Vial was moved from Freezer to fridge on 10Sep2021 and were used yesterday 30Oct2021, More than 30 days in the fridge) and PRODUCT STORAGE ERROR (Vial was moved from Freezer to fridge on 10Sep2021 and were used yesterday) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. No treatment information was provided. Most recent FOLLOW-UP information incorporated above includes: On 02-Nov-2021: follow up added Allergies On 02-Nov-2021: Follow up contain no new information


VAERS ID: 1849989 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 3 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administration error, more than 30 days in the fridge; Administration error, more than 30 days in the fridge; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration error, more than 30 days in the fridge) and PRODUCT STORAGE ERROR (Administration error, more than 30 days in the fridge) in a 62-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017C21A) for COVID-19 vaccination. Previously administered products included for Product used for unknown indication: JJ vacine (JJ vacine) on 16-Mar-2021. Past adverse reactions to the above products included No adverse event with JJ vacine. On 30-Oct-2021 at 1:25 AM, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 30-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration error, more than 30 days in the fridge) and PRODUCT STORAGE ERROR (Administration error, more than 30 days in the fridge). On 30-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Administration error, more than 30 days in the fridge) and PRODUCT STORAGE ERROR (Administration error, more than 30 days in the fridge) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not provided. Treatment information was not provided. Patient did not experience any adverse reactions during there 15 minute observation Date the vial was initially stored in the refrigerator on 10-Sep-2021. Most recent FOLLOW-UP information incorporated above includes: On 02-Nov-2021: follow up added reporter information, added ethnic group and vaccination given time. On 02-Nov-2021: Follow Up received contain


VAERS ID: 1850009 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-02
Onset:2021-10-30
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling cold, Hyperhidrosis, Hypersomnia, Insomnia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: slept even more; broke out into a deep deep sweat; he felt like he had a fever of 100.6; body aches all over; got really cold; couldn''t sleep; This spontaneous case was reported by a consumer and describes the occurrence of FEELING COLD (got really cold), INSOMNIA (couldn''t sleep), HYPERSOMNIA (slept even more), HYPERHIDROSIS (broke out into a deep deep sweat) and PYREXIA (he felt like he had a fever of 100.6) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 051F21A, 003B21A and 001C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 02-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Apr-2021, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 30-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Oct-2021, the patient experienced FEELING COLD (got really cold), INSOMNIA (couldn''t sleep), PYREXIA (he felt like he had a fever of 100.6) and MYALGIA (body aches all over). On 31-Oct-2021, the patient experienced HYPERSOMNIA (slept even more) and HYPERHIDROSIS (broke out into a deep deep sweat). The patient was treated with IBUPROFEN for Adverse event, at an unspecified dose and frequency. At the time of the report, FEELING COLD (got really cold), INSOMNIA (couldn''t sleep), HYPERSOMNIA (slept even more), HYPERHIDROSIS (broke out into a deep deep sweat), PYREXIA (he felt like he had a fever of 100.6) and MYALGIA (body aches all over) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications reported by reporter All three doses were given in his deltoid muscle. Company Comment - This case concerns a 41-year-old male patient, with no relevant medical history, who experienced the non-serious unexpected AESI of HYPERSOMNIA. The event occurred on the day after receiving a third dose of Moderna COVID-19 vaccine. The rechallenge is not applicable since the outcome of the event is unknown and no further dose is expected at this time. The benefit-risk relation of Moderna COVID-19 vaccine is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 02-Nov-2021: Follow up added events, reporter details and updated vaccination information.; Sender''s Comments: This case concerns a 41-year-old male patient, with no relevant medical history, who experienced the non-serious unexpected AESI of HYPERSOMNIA. The event occurred on the day after receiving a third dose of Moderna COVID-19 vaccine. The rechallenge is not applicable since the outcome of the event is unknown and no further dose is expected at this time. The benefit-risk relation of Moderna COVID-19 vaccine is not affected by this report.


VAERS ID: 1850086 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: fever; chills; fatigue; nausea; aches; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (fever), CHILLS (chills), FATIGUE (fatigue), NAUSEA (nausea) and MYALGIA (aches) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 058E21A) for COVID-19 vaccination. Previously administered products included for COVID-19 vaccination: Pfizer vaccine (She received the Pfizer vaccine for her primary series (2 doses) with most recent dose just over 6 months ago.). Past adverse reactions to the above products included No adverse event with Pfizer vaccine. On 30-Oct-2021 at 12:00 PM, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Oct-2021, the patient experienced PYREXIA (fever), CHILLS (chills), FATIGUE (fatigue), NAUSEA (nausea) and MYALGIA (aches). At the time of the report, PYREXIA (fever), CHILLS (chills), FATIGUE (fatigue), NAUSEA (nausea) and MYALGIA (aches) outcome was unknown. No Concomitant medications were reported. No Treatment information was reported.


VAERS ID: 1850118 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Gait disturbance, Nausea, Physical examination, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Arm sore and fatigue
Other Medications: Latanoprost eye drops
Current Illness: none
Preexisting Conditions: glaucoma
Allergies: none
Diagnostic Lab Data: Went to Urgent care on 11/1/2021. Dr. performed tests and determined my symptoms to be Vertigo. Prescribed Meclizine 25 mg. Had issue with Pharmacy as one of my insurances wouldn''t cover it. Got Meclizine over the counter - said to take once per day. By 11/2/2021, still did not feel well. Nurse told me to take 4 times per day. Felt a bit better - nausea subsided. Finally prescription OK''d and ready on 11/3/2021. Still experiencing spinning periodically when making sudden eye movements, head movements or body movements. Went back to see Dr. at urgent care on 11/7. Now on steroids to reduce inflammation. Took 1st day dose. Still experiencing spinning at times.
CDC Split Type:

Write-up: Received Moderna Booster on 10/29/2021 at 5:10 pm. By 1 am on 10/30, experienced Vertigo symptoms - room spinning and nausea (vomiting). No appetite. Vomited twice. Had to hold the wall in order to walk.


VAERS ID: 1850790 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Pain, redness, itching and swelling an injection site 12 hrs post vaccination. Fevers $g102 on Day 1 with nausea, fatigue, headaches, chills, diaphoresis, right arm pain radiating under arms down left side. Fever symptoms improved on Day 2 but nausea, fatigue, diaphoresis, arm pain persistent. Redness and swelling at injection site increased in size. Day 3 symptoms improved with persistent mild nausea, chills, diaphoresis and site and underarm pain. Site remains red, tender, and swelling. Employee health called, incident report completed.


VAERS ID: 1850859 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-17
Onset:2021-10-30
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Malaise, Nasal congestion, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), 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: LOSARTAN, METFRMIN, BREO ELLIPTA, SINGULAIR
Current Illness:
Preexisting Conditions:
Allergies: BACTTRIM
Diagnostic Lab Data: POSITIVE COVID TEST 11/1/2021
CDC Split Type:

Write-up: NASAL CONGESTION, RUNNY NOSE, SORE THROAT, DRY COUGH, GENERAL MALAISE


VAERS ID: 1850923 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Chest discomfort, Chest pain, Chills, Dyspnoea, Electrocardiogram abnormal, Headache, Myocarditis, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Body Aches Generalized-Severe, Systemic: Cardiac Disorder (diagnosed by MD)-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Chills-Severe, Systemic: Fever-Severe, Systemic: Headache-Severe, Additional Details: pt experienced severe headache, fever, body aches, chest tightness, shortness of breath, generalized pain. went to dr for evaluation and EKG showed pt had myocarditis that she did not previously have history of. pt and dr both believe this was a result of booster vaccine.


VAERS ID: 1851010 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012FZIA / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Ear pain, Headache, Hypoaesthesia oral, Lip swelling, Pyrexia, Swollen tongue, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: Diabetes type 2
Allergies: Metformin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headaches, pain back of head and ears, numbness / swollen of lips and tongue, fever ,faints, dizziness. Still have headaches


VAERS ID: 1851078 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-30
Onset:2021-10-30
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HT265 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Diarrhoea, Headache, Oropharyngeal pain, Respiratory tract congestion, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu-like symptoms next day after second dose of Pfizer COVID vaccine
Other Medications: Venlafaxine Oxybutynin Levothyroxine Trazadone Dorzolamide Zyrtec Low-dose aspirin, Vitamin D, Calcium
Current Illness: None
Preexisting Conditions: Hypothyroidism, high cholesterol, depression, obesity, glaucoma
Allergies: Cats, dust and mold
Diagnostic Lab Data: COVID test
CDC Split Type:

Write-up: Headache, congestion, cough, sore throat, diarrhea


VAERS ID: 1851098 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Chest X-ray abnormal, Injection site pain, Pain, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu Vaccine, Covid 19 Vaccine Dose #1
Other Medications: TYLENOL FLONAZE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: ANTOBIOTICS
Diagnostic Lab Data: COVID 19 Test Chest Xray Prescribed Doxycycline- due to abnormal chest xray
CDC Split Type: vsafe

Write-up: Pain at injection site fever 101.2 Body Aches in joints


VAERS ID: 1851172 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood electrolytes normal, Chest pain, Electrocardiogram normal, Feeling abnormal, Laboratory test normal, Palpitations, Troponin normal, Ventricular extrasystoles
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: Nothing of note
Preexisting Conditions: Anxiety
Allergies: NKA
Diagnostic Lab Data: EKG normal on 11/3, the palpitations did appear on telemetry though. Labs normal on 11/3, no elevated troponin or electrolyte abnormalities
CDC Split Type:

Write-up: Left sided chest pain with heart palpitations/potential PVCs that were not present before. Still ongoing at this time, waxes and wanes. Was seen in the ED on 11/3 to be on the safe side when palpitations did not go away. Seem to happen 1-2 times and hour, possibly more frequent at times.


VAERS ID: 1851196 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Ear infection, Headache, Injection site nodule
SMQs:, Extravasation events (injections, infusions and implants) (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: Multi Vitamin, Mirena, and Duloxetine
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Knot in injection site and massive headache. Was treated with Toradol and antibiotics due to ear infection


VAERS ID: 1851271 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-22
Onset:2021-10-30
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion XL 300mg daily, Vitamin D3 5000units, Paragard IUD
Current Illness: None
Preexisting Conditions: Anxiety, benign thyroid nodule, migraine headaches, exercise induced asthma.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Broke out with stinging rash to my left neck on 10/30/21 - confirmed by Dr as shingles (I had chickenpox as a child but this is my first episode of Shingles), treated last week with Acyclovir.


VAERS ID: 1851343 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 LA / IM

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

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

Write-up: Developed hives on face the day after immunization. Has since resolved.


VAERS ID: 1851400 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-22
Onset:2021-10-30
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01S211A / 3 LA / IM

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

Write-up: rash, hives


VAERS ID: 1851809 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-10-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Diarrhoea, Genital herpes, Injected limb mobility decreased, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Opportunistic infections (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: Triamterene 37.5 mg (started taking 10 days prior to vaccine), cetirizine hydrochloride 10 mg antihistamine, daily multivitamin
Current Illness: NA
Preexisting Conditions: Endometriosis, genital herpes
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild diarrhea within 1 hour of 1st vaccine Pfizer shot. Mild intermittent nausea, no vomiting. Severe injection site upper arm pain, difficulty lifting the arm for 2 days. Genital herpes outbreak within 4 hours of 1st shot, pre-existing condition.


VAERS ID: 1853294 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation, Tinnitus
SMQs:, Hearing impairment (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: USPFIZER INC202101483470

Write-up: Tinnitus-ringing in ears; The patient received the third/booster dose of BNT162b2; This is a spontaneous report from a contactable consumer, the patient. A 65-year-old male patient received third booster dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0176) via an unspecified route of administration on 30Oct2021 (at the age of 65-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported. The patient had no known allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient did not receive any other medication within two weeks of vaccination. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EL9265) via an unspecified route of administration in the right arm on 26Feb2021 at 14:00 (at the age of 65-years-old) and second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EL9267) via an unspecified route of administration in the left arm on an unknown date in 2021 at 14:00 (at the age of 65-years-old) as a single dose for COVID-19 immunisation. On 31Oct2021, the next morning of vaccination at 04:00, the patient experienced tinnitus-ringing in ears. The event did not result in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the event. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event tinnitus-ringing in ears was not resolved at the time of this report.


VAERS ID: 1853299 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-27
Onset:2021-10-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Menstrual disorder, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre 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: USPFIZER INC202101488928

Write-up: Vaginal bleeding off normal menstrual cycle; Vaginal bleeding off normal menstrual cycle; Body chills; Weakness; This is a spontaneous report from a contactable consumer or other non healthcare professional (patient). A 49-years-old female patient received bnt162b2 (COMIRNATY, Solution for injection, Batch/Lot number was not reported), dose 3 via an unspecified route of administration on 27Oct2021 (age at vaccination 49-year-old) as dose 3 (booster), single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient received historical vaccine of dose 1 and dose 2 bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on unknown date as dose 1, single and as dose 2, single for covid-19 immunisation. After 3 days, the patient began vaginal bleeding off normal menstrual cycle on 30Oct2021, Bleeding was also darker than normal cycle. The bleeding followed day of body chills and weakness on unspecified date of 2021. The outcome of the events was unknown. No follow-up attempts possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1853300 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Back pain, Chills, Diarrhoea, Headache, Immunisation, Pain, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetic (Control diabetic); Heart disorder (Previous heart issues); Uncontrolled hypertension (High blood pressure not controlled)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101495307

Write-up: Bad headache; Weak / weak but not as much as yesterday / not as weak today; Chills; Ache and pains all over; Today back pain so bad "I" couldn''t stand or sit still weak but not as much as yesterday / Today again have back pain and trouble standing and sitting upright; Also have diarrhea/No diarrhea yet; The patient received the third/booster dose of BNT162b2; Arm was sore; This is a spontaneous report from a contactable consumer, the patient. A 60-year-old non-pregnant female patient received the third (booster) dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FH8028) via an unspecified route of administration in the left arm on 30Oct2021 at 17:00 (at the age of 60-years-old) as a single dose for COVID-19 immunisation. Medical history included control diabetic, previous heart issues and high blood pressure not controlled. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient did not receive any concomitant medications. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: El9269) via an unspecified route of administration in the left arm on 18Feb2021 (at the age of 60-years-old) and also received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EM9810) via an unspecified route of administration in the left arm on 10Mar2021 (at the age of 60-years-old) as a single dose for COVID-19 immunisation. It was reported that she had got the booster shot on 30Oct2021 (Saturday) and it was so different than the first two shot, from them she had no bad side effects but this booster was kicking her butt. On 30Oct2021, the day of the shot, the patient''s arm was sore. On 01Nov2021, the patient experienced bad headache, weak, chills, ache and pains all over. On 02Nov2021, the day of this report, the patient also had back pain which was so bad that she could not stand or sit still, the patient was weak but not as much as the day before (01Nov2021) but then also had diarrhea. On the same day, the patient had back pain again and trouble standing and sitting upright, she was not as weak that day and had no diarrhea yet. The events did not result in a visit to the doctors or other healthcare professional office/clinic, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events arm was sore, bad headache, weak / weak but not as much as yesterday / not as weak today, chills, ache and pains all over, today back pain so bad "I" couldn''t stand or sit still / today again have back pain and trouble standing and sitting upright was not resolved and while the outcome of the also had diarrhea/ No diarrhea yet was unknown at the time of this report.


VAERS ID: 1853568 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-06
Onset:2021-10-30
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USMODERNATX, INC.MOD20213

Write-up: Patient received vaccine after expiry date; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient received vaccine after expiry date) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 049E21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 30-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient received vaccine after expiry date). On 30-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Patient received vaccine after expiry date) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment medication was reported.


VAERS ID: 1853571 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Lymphadenopathy, Menstrual disorder, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: similar-less severe reaction after second dose
Other Medications: Ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: Feldene
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, dizziness, severe fatigue, nausea, severely swollen lymph node above left clavicle--painful, onset of menstration after menopause for over a year. Similar swollen lymph node that took over 6 weeks after second dose to go away


VAERS ID: 1853584 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neuralgia, Pain, Rash vesicular, Skin lesion, Varicella virus test positive, Varicella zoster virus infection
SMQs:, Peripheral neuropathy (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Yaz birth control
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Pegasparaginase - pancreatitis; gemfibrozil - rash; penicillins - rash; clindamycin - rash
Diagnostic Lab Data: Nov 4 - VZV PCR on facial lesion (positive) Nov 4 - VZV PCR on gluteal lesion (positive) Nov 4 - VZV IgM blood test (positive)
CDC Split Type:

Write-up: Note - patient was vaccinated for chickenpox in childhood with attenuated live vaccine and never infected with chickenpox previously. On Oct 29, 2021, patient received Moderna COVID booster vaccine. On Oct 30, 2021, patient began experiencing neuropathic pain in R gluteus. On Oct 31, 2021, blistering rash appeared on patient''s R gluteal dermatome, and several lesions appears on patient''s torso, scalp, and face, accompanied by pain. Lesions continued to appear on patient''s torso and extremities (arms, legs) over the next several days ($g20 lesions on various, non-gluteal sites). Patient began taking oral valacyclovir treatment on Nov 2, 2021 and was instructed to quarantine beginning on those dates. On Nov 4, 2021, VZV PCR testing on facial and gluteal lesion was positive for VZV, confirming disseminated zoster. As of reporting date (Nov 9, 2021), patient has not recovered


VAERS ID: 1853629 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-28
Onset:2021-10-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM2, GERD, HTN, HLD, RA
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced 1 week of dizziness and poor balance.


VAERS ID: 1853635 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site induration, Injection site warmth, Lymphadenopathy, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Allegra 12-hour, Sudafed 12-hour, celexa
Current Illness: None
Preexisting Conditions: Eczema
Allergies: Allergies to Penicillin
Diagnostic Lab Data: COVID-19 Test 11/1 - Negative
CDC Split Type:

Write-up: High fever (103.1 was the highest) beginning Saturday, 10/30, continuing between 101-102.7 throught the night. Hard, hot shoulder at injection site, with red rash spreading over Saturday-Monday morning when I was seen. Swelling in lymph node in armpit of arm where shot was administered. Rotated Tylenol and Ibuprofen, but it was not helping. Tried icing the arm.


VAERS ID: 1853754 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / UNK - / IM

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

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

Write-up: There was no adverse events


VAERS ID: 1853806 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / UNK - / IM

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

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

Write-up: There was no adverse events.


VAERS ID: 1853835 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / UNK - / IM

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

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

Write-up: There was no adverse events.


VAERS ID: 1853901 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-10-30
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Myalgia, Oropharyngeal pain, Paranasal sinus discomfort, Productive cough, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: o Anemia o Anxiety o Arthritis o Bronchitis o Depression o Diabetes mellitus (CMS Past Medical History: Diagnosis Date o Allergy history unknown o Anemia o Anxiety o Arthritis o Bronchitis o Depression o Diabetes mellitus (CMS/HCC) o Hiatal hernia o Hypercholesterolemia o Hypertension o Kidney stone o Sleep apnea o Syncope and collapse
Allergies: Cats claw, Shellfish products, cephalexin, cat hair extract
Diagnostic Lab Data: 10/30/21 SARS-CoV-2 PCR - IPOC Detected Abnormal 10/30/21- Regeneron infusion
CDC Split Type:

Write-up: 10/30/21-The current episode started 2 days ago. The problem has been gradually worsening. The cough is productive of sputum. The maximum temperature recorded prior to her arrival was 100 to 100.9 F (TODAY AT ICC). The fever has been present for less than 1 day. Associated symptoms include rhinorrhea, sore throat and myalgias. Pertinent negatives include no chest pain, no chills, no sweats, no weight loss, no ear congestion, no ear pain, no headaches, no shortness of breath, no wheezing and no eye redness Review of Symptoms: Review of Systems Constitutional: Negative for activity change, chills and weight loss. HENT: Positive for rhinorrhea, sinus pressure and sore throat. Negative for ear pain. Eyes: Negative for redness. Respiratory: Positive for cough. Negative for shortness of breath and wheezing. Cardiovascular: Negative for chest pain. Musculoskeletal: Positive for myalgias. Neurological: Negative for speech difficulty, numbness and headaches.


VAERS ID: 1854047 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Chills, Erythema, Feeling hot, Incorrect route of product administration, Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth, Lymphadenopathy, Nausea, Skin warm
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None (Advil/aleeve the day before 10/28)
Current Illness: None
Preexisting Conditions: Osteoarthritis
Allergies: Ceclor Seldane
Diagnostic Lab Data: None
CDC Split Type:

Write-up: This was for moderna booster. It was Injected high in left arm (higher than norma) and was about 1-1.5" down from top of shoulder bone. Very large swollen glands on left side in armpit and above/below collarbone - ongoing. Red and warm to touch. - 3 days and then has slowly gotten better (it''s been 1.5 weeks) but they are still swollen. But they are not red or warm anymore Aching under arm (different than typical vaccine injection) - went away when swelling went down. Swollen, warm, red injection site - lasted 3 days Itching at injection site and on deltoid muscle - lasted 3 days chills and felt warm but no fever. 36 hours Nausea lasted 2 days Took Tylenol and/or aleeve starting at at10pm on day of vaccine. Used for 3-4 days


VAERS ID: 1854276 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood bilirubin increased, C-reactive protein increased, Chest discomfort, Chest pain, Dyspnoea, Electrocardiogram ST segment elevation, Fatigue, Myocarditis, Pain, Platelet count normal, Troponin increased, White blood cell count normal
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Azithromycin
Diagnostic Lab Data: 11/1: EKG shows ST elevation in the inferior lateral leads. 11/1 10:13 a.m.: WBC 5.4, Plt 198, AST 45, ALT 57, Bili 1.6, Troponin 3.28 11/1 15:11: CRP 34 11/1 17:51: Troponin 5.23
CDC Split Type:

Write-up: Patient received his second dose of COVID vaccine on 10/29. On 10/30 he developed substernal chest pain that was sharp and intermittent. He also developed shortness of breath, fatigue and body aches. Patient was admitted to the hospital for observation and started on ibuprofen and colchicine. The cardiologist diagnosed him with myocarditis secondary to the vaccine. Patient was seen in a follow up appointment on 11/9 where he reported significant improvement in his chest discomfort and shortness of breath.


VAERS ID: 1854335 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-20
Onset:2021-10-30
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1854415 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Dyspnoea, Extra dose administered, Fibrin D dimer increased, Headache, Pain in extremity, Thrombosis, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID19(Pfizer-BioNTech) Dose 2
Other Medications: Xolair, Symbacort, Prilosec
Current Illness:
Preexisting Conditions: Moderate Persistent Asthma
Allergies:
Diagnostic Lab Data: Blood Test resulted in elevated D-Dimer 11/08/2021, Ultrasound showed superficial blood clotting in right leg 11/09/2021
CDC Split Type:

Write-up: Stabbing head pain for 2 days after shot, shortness of breath for 2 days after shot, prolonged leg pain 1+week after shot


VAERS ID: 1854487 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-26
Onset:2021-10-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF25923 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KNOWN
Current Illness: NOT AWARE
Preexisting Conditions: NOT AWARE
Allergies: NONE
Diagnostic Lab Data: NOT KNOWN
CDC Split Type:

Write-up: PATIENT COMPLAINED OF RASH OVER HIS BODY. ALSO REPORTED AN EAR INFECTION AND WAS NOT SURE IF RELATED TO VACCINE. PATIENT HAS HAD BODY RASH BEFORE. ADVISED PATIENT TO SEE DOCTOR. PATIENT AAT PRESENT TREATING EAR INFECTION WITH AMOXICILLIN. PATIENT STATES NO ALLERGIES


VAERS ID: 1854563 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 LA / IM

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

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

Write-up: When attempting to administer vaccine into left deltoid, plunger failed to work and no vaccine administered. New syringe obtained, vaccine given with no incident or complication


VAERS ID: 1854592 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: None Known
Preexisting Conditions: None Known
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: J&J covid 19 Vaccine. Administered. J&J vaccine 6 months prior to 18th birthday. Father contacted by per phone - None


VAERS ID: 1854594 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-27
Onset:2021-10-30
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Myalgia, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive, Throat irritation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID-19 test of unknown type.
CDC Split Type:

Write-up: Complaint of cough, sore/scratchy throat, headache, runny nose/congestion and myalgia.


VAERS ID: 1854746 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Mobility decreased
SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Systemic: Numbness (specify: facial area, extremities)-Severe, Additional Details: pt states his arm is numb since the shot and he is unable to use it. he was advised to seek medical attention


VAERS ID: 1854778 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-25
Onset:2021-10-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
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: Humira, Methotrexate
Current Illness:
Preexisting Conditions: Psoriatic arthritis
Allergies:
Diagnostic Lab Data: Cycle threshold of 23.1 on 10/30/21
CDC Split Type:

Write-up: Hospitalization for COVID-19 Reported per Pfizer COVID-19 Vaccine EUA (3rd dose)


VAERS ID: 1854849 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-27
Onset:2021-10-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040D21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Electrocardiogram normal, Full blood count normal, Laboratory test, Lipase increased, Metabolic function test normal, Pain, Pancreatitis, Ultrasound biliary tract, Ultrasound scan normal
SMQs:, Acute pancreatitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, sertraline, levothyroxine
Current Illness: N/A
Preexisting Conditions: Anxiety
Allergies: Penicilin, amoxycicilin, ibuprofen
Diagnostic Lab Data: 11/6 EKG: Normal 11/6 Gallbladder Ultrasound: Normal 11/6: CBC and Metabolic panel: Normal 11/6: Lipase: 2126
CDC Split Type:

Write-up: I had stomach pain that felt a bit like gas, that persisted for 7 days. I finally went to the doctor who indicated it could be a hernia and to go to the ED if it got worse. The pain got worse that night, so I went to the ED on 11/6 who found my lipase to be 2126. No other labs were abnormal. They diagnosed me with idiopathic pancreatitis despite the fact that I do not drink alcohol and am not on any medications that would cause pancreatitis. I did not have vomiting or nausea. I was discharged home on a clear liquid diet and am currently on day 9 of the pain, though it is getting better with the clear liquid diet.


VAERS ID: 1854857 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: The first two moderna covid shots but not as bad as the booster
Other Medications: Metoprolol ER Succinate 100mg, Rosuvastatin 40 mg, Losartan/HCTZ 50/12.5 mg. Lansoprazole 30 mg, Aspirin 81mg Multivitamin and vitamin d & C
Current Illness: none
Preexisting Conditions: High Blood Pressure and High Cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My arm swelled to my elbow - red and hot. That lasted for 4 days. I had the chills for two days I was exhausted for two days. On the third day I had neck pain. No fever


VAERS ID: 1854910 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5X7J5 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Diarrhoea, Extra dose administered, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 40, Nausea, 3/23/2021 Moderna COVID 2nd dose
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, vomiting, diarrhea


VAERS ID: 1854923 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-10-30
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received both doses of Pfizer on 3/18/21 and 4/8/21. Adverse event is a breakthrough COVID-19 case


VAERS ID: 1854927 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 - / IM

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

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

Write-up: There was no adverse events.


VAERS ID: 1855297 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011021A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pradaxa, Requip, Allopurinol, Tylenol, Sinemet, Levothyroxine, Sotalol, Miralax, Percoset
Current Illness: ,
Preexisting Conditions: Chronic lymphedema, diastolic heart failure, partial spinal cord injury
Allergies: Shrimp, crab, lobster Backofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: AFIB


VAERS ID: 1855298 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-23
Onset:2021-10-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Facial pain, Headache, Nausea, Oropharyngeal pain, Pain in jaw, Respiratory tract congestion, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Osteonecrosis (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pentotrazole 40mgs one a day Levothyroxine 25mcgs once a day 500 mgs of vitamin C I was taking microbed for my uti.
Current Illness: I had a uti
Preexisting Conditions: I have mild asthma triggered by animal dander.
Allergies: Levaquin and sulfa
Diagnostic Lab Data: a negative covid test.
CDC Split Type: vsafe

Write-up: It started out with a sore throat for two days. It was out of the blue. I don''t know where it came from . Then i had a headache, but it happened at night. It was very similar to dose 2. I had pain in the front of my face and jaw,. Slightly nauseated. I had congestion. I had a cough and it went away after several days.. I didn''t have a reaction until a week later.


VAERS ID: 1855335 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-22
Onset:2021-10-30
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FM8020 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bronchitis, Hyperhidrosis, Influenza virus test negative, Lymphadenopathy, Oropharyngeal pain, Pain, Pyrexia, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Busperone Rizatriptan Nuertec
Current Illness: NA
Preexisting Conditions: Chronic or Post-treatment Lyme
Allergies: NA
Diagnostic Lab Data: Covid, Flu and Strep tests on November 2 - All negative
CDC Split Type:

Write-up: I had the standard swollen lymph nodes, low grade fever, aches and sweating about 18 hours after the shot. That cleared up after about 3 - 4 days. Then I started to get a sore throat the next Saturday. I thought it was strep, so I went in for a strep test. The Covid, Strep and Flu test came back negative, but the PA listened to my lungs and said I had bronchitis.


VAERS ID: 1856629 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Sore arm; Extreme body aches; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Sore arm) and MYALGIA (Extreme body aches) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 30-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Oct-2021, the patient experienced PAIN IN EXTREMITY (Sore arm) and MYALGIA (Extreme body aches). At the time of the report, PAIN IN EXTREMITY (Sore arm) and MYALGIA (Extreme body aches) outcome was unknown. No concomitant medication information was provided. No treatment medication were provided. This case was linked to MOD-2021-369227 (Patient Link).


VAERS ID: 1856635 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:2021-01-01
Onset:2021-10-30
   Days after vaccination:302
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: aches/body aches all over; chills; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (aches/body aches all over) and CHILLS (chills) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In February 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Oct-2021, the patient experienced MYALGIA (aches/body aches all over) and CHILLS (chills). At the time of the report, MYALGIA (aches/body aches all over) and CHILLS (chills) had resolved. Concomitant product use was not provided by the reporter. No treatment information provided. This case was linked to MOD-2021-371356, MOD-2021-371343 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 01-Nov-2021: Follow up received on 01Nov2021 contains dose 1 &2 2 details and reporter drug details were updated.


VAERS ID: 1856643 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Body aches; woke up with a fever; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (Body aches) and PYREXIA (woke up with a fever) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 29-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Oct-2021, the patient experienced MYALGIA (Body aches) and PYREXIA (woke up with a fever). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) in October 2021 for Fever, at an unspecified dose and frequency. At the time of the report, MYALGIA (Body aches) outcome was unknown and PYREXIA (woke up with a fever) was resolving. NO Concomitant drug reported. This case was linked to MOD-2021-370234 (Patient Link).


VAERS ID: 1856651 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: sore arm; tired; This spontaneous case was reported by a patient family member or friend and describes the occurrence of PAIN IN EXTREMITY (sore arm) and FATIGUE (tired) in an 80-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 29-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Oct-2021, the patient experienced PAIN IN EXTREMITY (sore arm) and FATIGUE (tired). At the time of the report, PAIN IN EXTREMITY (sore arm) and FATIGUE (tired) outcome was unknown. Not Provided No concomitant medication were reported No treatment medication were reported Most recent FOLLOW-UP information incorporated above includes: On 05-Nov-2021: Follow up received on 05-Nov-2021 contains no new information.


VAERS ID: 1856671 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Nausea, Vaccination site erythema, Vaccination site swelling
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Splitting headache; Nausea; Redness and swelling on left arm at injection site. It looks like a red knot.; Redness and swelling on left arm at injection site. It looks like a red knot.; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE ERYTHEMA (Redness and swelling on left arm at injection site. It looks like a red knot.), HEADACHE (Splitting headache), NAUSEA (Nausea) and VACCINATION SITE SWELLING (Redness and swelling on left arm at injection site. It looks like a red knot.) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017F21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 30-Oct-2021, the patient experienced VACCINATION SITE ERYTHEMA (Redness and swelling on left arm at injection site. It looks like a red knot.) and VACCINATION SITE SWELLING (Redness and swelling on left arm at injection site. It looks like a red knot.). On 02-Nov-2021, the patient experienced HEADACHE (Splitting headache) and NAUSEA (Nausea). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) for Adverse event, at an unspecified dose and frequency. At the time of the report, VACCINATION SITE ERYTHEMA (Redness and swelling on left arm at injection site. It looks like a red knot.), HEADACHE (Splitting headache), NAUSEA (Nausea) and VACCINATION SITE SWELLING (Redness and swelling on left arm at injection site. It looks like a red knot.) outcome was unknown. Concomitant medications were not provided. Treatment information included Nausea relief.


VAERS ID: 1856693 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bone pain, Bone swelling
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (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: USMODERNATX, INC.MOD20213

Write-up: Painful swelling on collarbone; developed painful swelling on collarbone; This spontaneous case was reported by a consumer and describes the occurrence of BONE SWELLING (Painful swelling on collarbone) and BONE PAIN (developed painful swelling on collarbone) in a 56-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 025C21A) for COVID-19 vaccination. No Medical History information was reported. On 30-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Oct-2021, the patient experienced BONE SWELLING (Painful swelling on collarbone) and BONE PAIN (developed painful swelling on collarbone). At the time of the report, BONE SWELLING (Painful swelling on collarbone) and BONE PAIN (developed painful swelling on collarbone) had not resolved. No concomitant medication reported. No treatment medication reported. Patient developed painful swelling on collarbone which was still there (left side - same side as the injected arm). Patient was wondering if this could be a blood clot. It was confirmed all three doses were Moderna COVID-19 vaccine


VAERS ID: 1856718 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Feeling intense sensation like "jackhammering in every joint"; Exhausted; This spontaneous case was reported by a consumer and describes the occurrence of ARTHRALGIA (Feeling intense sensation like "jackhammering in every joint") and FATIGUE (Exhausted) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 29-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Oct-2021, the patient experienced ARTHRALGIA (Feeling intense sensation like "jackhammering in every joint") and FATIGUE (Exhausted). On 31-Oct-2021, ARTHRALGIA (Feeling intense sensation like "jackhammering in every joint") and FATIGUE (Exhausted) had resolved. No concomitant medication reported. No treatment information was provided. Patient stayed home to rest all day, and reported symptoms were cleared by 31-OC-2021.


VAERS ID: 1857014 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-24
Onset:2021-10-30
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FAMOTIDINE; CLONAZEPAM; ATENOLOL; LEVOTHYROXINE; LISINOPRIL; ASPIRIN [ACETYLSALICYLIC ACID]; FLUOXETINE; ATORVASTATIN; TAMSULOSIN; SUCRALFATE; BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]; VITAMINS NOS.
Current Illness: Kidney disorder (to help kidneys filter better); Palpitation.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: lowgrade fever 98.7 F.
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: chills; tired; low-grade fever 98.7 F; This spontaneous case was reported by a consumer and describes the occurrence of CHILLS (chills), FATIGUE (tired) and PYREXIA (low-grade fever 98.7 F) in an 86-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002A21A and 017B21A) for COVID-19 vaccination. Concurrent medical conditions included Palpitation and Kidney disorder (to help kidneys filter better). Concomitant products included LISINOPRIL for Kidney disorder, ATENOLOL for Palpitation, FAMOTIDINE, CLONAZEPAM, LEVOTHYROXINE, ASPIRIN [ACETYLSALICYLIC ACID], FLUOXETINE, ATORVASTATIN, TAMSULOSIN, SUCRALFATE, DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) and VITAMINS NOS for an unknown indication. On 24-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Oct-2021, the patient experienced CHILLS (chills), FATIGUE (tired) and PYREXIA (low-grade fever 98.7 F). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) for Adverse event, at an unspecified dose and frequency. At the time of the report, CHILLS (chills), FATIGUE (tired) and PYREXIA (low-grade fever 98.7 F) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 98.7 (High) lowgrade fever 98.7 F.The patient did not had any reactions after first two doses. The adverse events were treated with Tylenol, hot drinks.


VAERS ID: 1857375 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

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

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

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


VAERS ID: 1857405 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 RA / IM

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

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

Write-up: Swollen axillary lymph node on the right measuring about 1.5cm x 1cm. Not red, not painful, mobile.


VAERS ID: 1857419 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Angioedema, Cardiac stress test abnormal, Chest discomfort, Chest pain, Discomfort, Echocardiogram normal, Electrocardiogram, Lipids, Nausea, Oropharyngeal swelling, Paraesthesia oral, Periorbital swelling, Positron emission tomogram, Swelling face, Swollen tongue, Troponin
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol sulfate, 2 puff, Inhalation, Q6H PRN ? azelastine, 2 spray, Nasal, Daily ? calcium carbonate, 1 tablet, Oral, Daily ? cholecalciferol (vitamin D3), 10,000 Units, Oral, Every Other Day ? docusate sodium, 100 mg, Oral, BID PRN ?
Current Illness: none noted.
Preexisting Conditions: Allergic rhinitis Trauma Closed nondisplaced fracture of head of right radius, initial encounter Female stress incontinence Hyperlipidemia Osteopenia Subclinical hypothyroidism Vitamin D deficiency Rosacea Meningioma (HC Code) (HC CODE) Postconcussion syndrome Hx of allergy Chronic constipation Dry eye syndrome Senile nuclear sclerosis Diverticulosis Esophageal reflux Symptomatic menopausal or female climacteric states Conductive hearing loss, unilateral OAB (overactive bladder) Mixed stress and urge urinary incontinence Palpitations
Allergies: Amoxicillin-hives Latex-rash
Diagnostic Lab Data: 11/2/21: Lipid panel, serial troponins, echo, EKG, PET, stress test 11/1/21: Bedside echo performed. Images reviewed with Doctor. No acute findings.
CDC Split Type:

Write-up: 10/30/21 (day of vaccine) ED visit: 61yF h/o asthma, cerebral meningioma presents with concern for allergic reaction to Pfizer booster 2/2 tongue swelling and lip tingling. Received booster at 15:45 and received epi pen @17:05. No fever, rash, chest pain, shortness of breath, nausea, vomiting, urinary or bowel irregularities Review of Systems Constitutional: Negative. HENT: Positive for facial swelling. Respiratory: Negative. Cardiovascular: Negative. Gastrointestinal: Negative. Genitourinary: Negative. Musculoskeletal: Negative. Skin: Negative. Allergic/Immunologic: Negative. Neurological: Negative. Hematological: Negative. Psychiatric/Behavioral: Negative. Physical Exam ED Triage Vitals [10/30/21 1755] BP: 116/73 Pulse: 60 Pulse from O2 sat: n/a Resp: 18 Temp: 98.1 ?F (36.7 ?C) Temp src: Oral SpO2: 96 % BP (!) 99/57 | Pulse 67 | Temp 98.1 ?F (36.7 ?C) | Resp 18 | SpO2 100% Physical Exam Vitals reviewed. Constitutional: Appearance: Normal appearance. HENT: Head: Normocephalic. Right Ear: Tympanic membrane normal. Nose: Nose normal. Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: No posterior oropharyngeal erythema. Comments: Airway patent, No tongue or lip swelling Cardiovascular: Rate and Rhythm: Normal rate. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: No stridor. No wheezing, rhonchi or rales. Chest: Chest wall: No tenderness. Abdominal: General: Abdomen is flat. There is no distension. Palpations: Abdomen is soft. There is no mass. Tenderness: There is no abdominal tenderness. Hernia: No hernia is present. Musculoskeletal: General: Normal range of motion. Cervical back: Normal range of motion and neck supple. Skin: General: Skin is warm. Capillary Refill: Capillary refill takes less than 2 seconds. Coloration: Skin is not jaundiced. Findings: No bruising, lesion or rash. Neurological: General: No focal deficit present. Mental Status: She is alert. Psychiatric: Mood and Affect: Mood normal. ED COURSE Patient Reevaluation: 61yF h/o asthma, cerebral meningioma presents with concern for allergic reaction to Pfizer booster 2/2 tongue swelling and lip tingling. Patient well appearing, maintaining airway without evidence of Respiratory distress. Will give fluids, steroids, pecid benadryl, and monitor and reassess 2211 Doctor: Patient reassessed and reports improvement of symptoms. Strict return precautions have been given. Patient will be prescribed epi pens. All questions answered and concerns addressed 10/31/21 return ED visit 61 yo woman with Hx of asthma with recent ED visit for angioedema and ?anaphylaxis who presents to the ED again for facial swelling and concern for worsening symptoms. Symptoms began yesterday after receiving COVID booster, manifested as facial swelling, swelling of the tongue, no respiratory distress or loss of consciousness, unclear if BP dropped, but received 1 dose of epi in vaccine center and transferred to ED, received steroid, antihistamines, and IVF, discharged with recommendation to have epi-pen accessible, apparently with no outpatient treatment. Today, she presents with some worsening of facial swelling and peri-orbital swelling, denies shortness of breath, wheezing, chest pain, palpitation, nausea/vomiting, abdominal pain, skin rash. She has not secured epi-pen as she wanted to wait until Monday when she can take it from Hospital pharmacy. The history is provided by the patient. Allergic Reaction Presenting symptoms: swelling Presenting symptoms: no difficulty breathing, no difficulty swallowing, no itching, no rash and no wheezing Severity: Mild Prior allergic episodes: Allergies to medications Context: medications Relieved by: Antihistamines and steroids Worsened by: Nothing Patient with mild facial swelling and slightly enlarged tongue size, suggestive of delayed-phase allergic reaction (angioedema), HDS with no evidence of airway compromise. - Explained the natural Hx of allergic reaction to the patient, explained that complete resolution of symptoms will take 3-5 days - IV methyl-prednisone, benadryl, and famotidine - Encouraged to have epi-pen all the times for the next 3-5 days - loratadine 10 mg tid - Prednisone 20 mg for the next 3 days - Discharge home with return precautions 11/1/21 3rd ED visit: Patient presents today with new chest pressure radiating to jaw since this morning. Positive nausea. No diaphoresis or exertional symptoms. Patient received 5 her vaccine Saturday afternoon this is her 3rd visit in 3 days 1st 2 visits were for presumed allergic reaction for which she was given antihistamine steroids. Symptoms prompting today''s visit are different, predominantly chest pressure. No vomiting. Patient continues to feel sensation of oropharyngeal swelling was given intravenous Solu-Medrol yesterday took prednisone this morning was waiting on taking Claritin. Admitted for chest pain observation. Abnormal stress test by EKG only with no pain No coronary artery calcification Most likely a false postive Follow up with PMD in one to two weeks Return with any worsening symptoms


VAERS ID: 1857422 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Fatigue, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer
Other Medications: Lexapro, Trazadone, Multi-vitamin, Vitamin D, Vitamin B
Current Illness: None
Preexisting Conditions: Degenerative Disk Disease, Lyme''s Disease
Allergies: adhesive
Diagnostic Lab Data: None
CDC Split Type:

Write-up: COVID-19 (Booster) - both vaccines and booster were Pfizer booster on 10-29-21... symptoms were severe left arm soreness, extreme fatigue, extreme back pain - upper/middle/lower still have left arm muscle soreness, moderate fatigue, back pain (right side only, middle/lower)


VAERS ID: 1857648 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01AF21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash
SMQs:, Hypersensitivity (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: #2 covid vaccination
Other Medications: Metoprolo Succ ER 25 mg Pantoprazole SOD DR 40 mg Cinacalcet 30 mg Atrovastatin 40 mg CoQ-10 200 mg Vitamin D 5000IU
Current Illness: None
Preexisting Conditions: High blood pressure High cholesterol High Parathyroid hormone
Allergies: Naproxin Morphine Trilipix Dr. Caps Erythromycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash and itching on left upper arm 1 inch below shot entrance. About 5 inches long and 4 inches wide


VAERS ID: 1857673 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Asthenia, Mobility decreased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Felt feverish and weak. Stayed in bed 24 hours.


VAERS ID: 1857762 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hypotension, Insomnia, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not interested in disclosing
Current Illness: No
Preexisting Conditions: Osteoarthritis and spiral problems; Anemia
Allergies: Phenothiazines; Sulphur drugs
Diagnostic Lab Data: No.
CDC Split Type: vsafe

Write-up: The next day at 10AM, I didn''t have much sleep. Soreness overall and dizzy. Fever for 2 days Sore and achy and didn''t get get better saw doctor and didn''t get better, Shot of anti inflammatory with nurse practitioner. BP was low.


VAERS ID: 1857791 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: heart palpitations, heart started racing


VAERS ID: 1857794 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW6199 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Chest X-ray, Pain in extremity, Peripheral swelling, Thrombosis, Ultrasound Doppler, Ultrasound scan, X-ray
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Fenofibrate, Atorvastatin, Ezetimibe, Losartan, Nifedipine, Levemir, Carvedilol, Aspirin, Tylenol, Trazadone, Vitamins: CQ10, Vitamin C, Vitamin D3, B12, Multi Vitamin
Current Illness: None
Preexisting Conditions: Two heart by passes, Diabetes, Blood Pressure.
Allergies: None
Diagnostic Lab Data: Doppler, Ultrasound and x-rays of legs and chest, October 20th, 2021
CDC Split Type:

Write-up: The day after my 3rd COVID vaccine I had pain and swelling in my legs and feet. I went to the emergency room where the doctor admitted me overnight with blood clots in both legs. I am currently taking Eliquis, 5mg, twice daily, to try to dissolve the clots.


VAERS ID: 1857850 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Jardiance Janumet Atorvastatin Paroxitine 81 mg aspirin
Current Illness:
Preexisting Conditions:
Allergies: Sulpha
Diagnostic Lab Data: Have an appointment on Monday 11/15/2021 to discuss with doctor
CDC Split Type:

Write-up: The first 2 shots on 3/4/2021 and 3/26/2021 were given with little or no arm pain and zero shoulder pain. This was the booster shot .Severe pain in left shoulder (not the arm) started a few days after getting the shot and continues to date. Range of motion of left shoulder is limited.


VAERS ID: 1858175 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-23
Onset:2021-10-30
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest pain, Cough, Dyspnoea, Headache, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol Hfa (Proventil;Ventolin Hfa) 90 Mcg/Actuation Inhl Inhaler Ascorbic Acid (Vitamin C Oral) Bd Insulin Syringe Ultra-fine 0.5 Ml 31 Gauge X 5/16" Diazepam (Valium) 2 Mg Oral Tablet Ferrous Sulfate (
Current Illness:
Preexisting Conditions: Acute asthma exacerbation CKD (chronic kidney disease), stage 3 (moderate) Diabetes mellitus type II Essential hypertension, benign Umbilical hernia
Allergies:
Diagnostic Lab Data: Positive COVID test 11/7/21
CDC Split Type:

Write-up: cough, headache, chest pain, SOB


VAERS ID: 1858277 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-28
Onset:2021-10-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 LA / IM

Administered by: Public       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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Prilosec, Losartin, Vesacare, Vit D, Zyrtec
Current Illness: none
Preexisting Conditions: thyroid problems, GERD, bladder incontinence
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: itching began 48 hours after vaccine and continues daily.


VAERS ID: 1858518 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-30
Onset:2021-10-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / N/A - / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, Pain
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: COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Full dose of Moderna Vaccine. 0.5 ml administered to individual meeting criteria for booster dose 0.25 ml. 11/04/2021 per patient she experienced a few aches that resolved in a couple of days and "thought it was normal" "feels fine now". Primary COVID-19 vaccine was Janssen vaccine 3/05/2021.


VAERS ID: 1859032 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50mg Armour thyroid 75mg
Current Illness: N/A
Preexisting Conditions: PCOS
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Break through menstrual bleeding for $g2 weeks


VAERS ID: 1859044 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, lisinopril Hctz, NCA, zinc with quercetin, juice plus supplements, fish oil, Sam-e, melatonin
Current Illness: N/A
Preexisting Conditions: Thyroid cancer 2018
Allergies: Shellfish, penicillin, clindamyacin
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: Hives around mouth and ears on October 30. Responded well with Benadryl until November 7 when I broke out in hives over face , neck, scalp, ears, arms, sides, and upper legs. Also experienced mild chest pain on that same day.


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