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

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



Case Details (Reverse Sorted by Onset Date)

This is page 63 out of 4,799

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VAERS ID: 1459953 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-23
Onset:2021-06-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Duragesic-12 Patch 72 Hour 12 MCG/HR (fentaNYL) Insulin Lispro Solution ASA 81mg 1 x say ferrous and vit D supplements Tamsulosin HCl Capsule 0.4 MG amLODIPine Besylate Tablet 5 MG Lorsartan
Current Illness: Osteomyelitis,
Preexisting Conditions: HTN, muscle wasting, DMII, PVD, seizures, hyperlipidemia
Allergies: Bactrim, MS contin
Diagnostic Lab Data: na
CDC Split Type:

Write-up: fever on 6/25/2021 of 100.1


VAERS ID: 1459960 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-05
Onset:2021-06-25
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Brain natriuretic peptide increased, Cardiac failure congestive, Cardiomegaly, Cardiomyopathy, Chest X-ray abnormal, Echocardiogram abnormal, Ejection fraction decreased, Left ventricular dysfunction, Left ventricular enlargement, Mitral valve incompetence, Pericardial effusion, Pleural thickening, Pulmonary arterial pressure abnormal, Pulmonary vasculitis, Right ventricular dysfunction, Right ventricular enlargement, Ultrasound Doppler abnormal, Vasodilatation
SMQs:, Cardiac failure (narrow), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Pulmonary hypertension (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (narrow), Vasculitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ECHO Summary: 1. Severely increased left ventricular cavity size. 2. The visually estimated left ventricular ejection fraction is <20%, which is severely decreased. 3. Grade III diastolic dysfunction. 4. Moderately enlarged right ventricle with severely reduced global right ventricular systolic function. 5. Moderate mitral regurgitation by color Doppler observation. 6. Moderately elevated pulmonary artery systolic pressure (49 mmHg). 7. Trivial pericardial effusion, as described above. 8. No prior studies are available for comparison. 6/28/2021 at 12:46:52 PM Chest X-ray: Moderate to more pronounced cardiomegaly. Dilated azygos vein suspected. Pulmonary vascularity. Thickening of fissures. Above findings are suspicious for presence of CHF. BNP 1598
CDC Split Type:

Write-up: Congestive heart failure, cardiomyopathy


VAERS ID: 1460046 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Keppra 250 mg, Topamax 100 mg, Metoprolol 25 mg, Ambien 5 mg, Cialis 5 mg, Flonase nasal spray
Current Illness:
Preexisting Conditions: Insomnia, GERD, Hypertension, ED, Epilepsy
Allergies: Iodine, shellfish, garlic, lactose (patient has many allergies. this is what our office has documented)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient broke out in a red, diffused rash within one hour after receiving vaccine.


VAERS ID: 1460307 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-15
Onset:2021-06-25
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait disturbance, Hypoaesthesia, Muscle spasms, Pain in extremity, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Coumadin, Lipitor,Metoprolol
Current Illness: Aortic Stenosis, Peripheral Artery Disease
Preexisting Conditions: Aortic Stenosis, Peripheral Artery Disease
Allergies: None
Diagnostic Lab Data: Ultrasound 7/6/2021
CDC Split Type:

Write-up: I have Peripheral Artery disease and have had bypasses done on both legs. It has been managed fairly well with a several minor "tune ups" by angio. I was able to walk pretty well with minimal pain. About a week after my second dose I started noticing increased pain in both of my calves which has become considerably worse since then. I cannot walk 1/10 of a mile without taking a break. Also, around July 1st, my fingers went numb in my right hand, then I started getting pain in my right forearm and cramping in my hand. That pain has made it so the way up my arm. I saw my vascular surgeon and an ultrasound revealed a clot in the bend of my elbow. I was asked how I think I could have gotten the clot, the only thing I''ve done differently was get that vaccine. It''s extremely obvious to me that the vaccine has caused a severe reaction in me. I have a surgery scheduled on Wed. July 14 to have the clot removed.


VAERS ID: 1461717 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Blood test, Haemoglobin decreased, Heavy menstrual bleeding, Menstrual disorder, Pallor, Syncope, Thrombosis, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: Blood work (Hemoglobin) taken on June 28 (10.3), June 29 (9?), July 3 (7.3), July 7 (8).
CDC Split Type:

Write-up: Abnormal menstrual cycle started on June 25, the day after dose 2; she already had a period June 10-16. This involved increasingly heavy bleeding, with large blood clots. My daughter became very pale, weak on the morning of Mon, June 28, she fainted, then vomited. Made dr appt and got bloodwork. Started her on iron supplements. Dr said the hemoglobin was at 10.6, but had us get blood checked 3 more times, lowest hemoglobin was at 7.3.


VAERS ID: 1461943 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-25
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Menstruation delayed, Menstruation irregular, Paranasal sinus discomfort, Secretion discharge, Sneezing, Vaccine positive rechallenge, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Fertility disorders (broad), Hypersensitivity (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, ibprofren, caffeine, Tylenol, florastor; Pfizer COVID vaccine: 1st vac: 6/3/21 2nd vac: 6/25/21
Current Illness: None
Preexisting Conditions: Seasonal allergies (typically fall - winter); diverticulitis; low gallbladder function; GERD; PCOS
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After 1st, shot, within days I developed painful sinus pressure in cheek above left jaw that persisted for a week, followed by constant pressure and mucus drainage; coughing; wheezing; sneezing. After 2nd shot, same as above has persisted. HOWEVER, I have not menstruated ! I had typical period pains, felt like I was going to start on schedule, but I have not to date. All typical menstral pains are now gone. Date of last cycle began normal on 6/5/21, lasted 4 days.


VAERS ID: 1462098 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-23
Onset:2021-06-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling/needle/itchy feeling in hands, feet, scalp, inner thighs


VAERS ID: 1462117 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-21
Onset:2021-06-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dermatitis allergic, 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: ZOLOFT, HYDROXYZINE, TRAZODONE
Current Illness: NO
Preexisting Conditions: N/A
Allergies: TETRACYCLINE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT EXPERIENCED A DELAYED CUTANEOUS REACTION OCCURING ABOUT A WEEK AFTER RECEIVING VACCINE RESULTING IN A RASH THAT IS STILL PRESENT


VAERS ID: 1463258 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-23
Onset:2021-06-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FW0181 / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Electrocardiogram, Mitral valve disease, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IBUPROFEN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: Test Date: 20210625; Test Name: EKG; Result Unstructured Data: Test Result:premature contractions in the mitral
CDC Split Type: USPFIZER INC2021784928

Write-up: Heart palpitations; Premature contractions in the mitral valve; This is a spontaneous report from a contactable consumer (patient herself). A 32-year-old non pregnant female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection and Lot Number: FW0181) via an unspecified route of administration, administered in Arm Right on 23Jun2021 09:45 (at the age of 32 years old) as single dose for COVID-19 immunization. Medical history included known Known allergies: Penicillin. Concomitant medications included ibuprofen taken for occasionally for headaches. It was reported that the patient had the vaccine on Wednesday and this morning on Friday on 25Jun2021 07:00, (two days later) started having heart palpitations which she never had before. They''ve been on and off. She went to the doctor this morning and had an EKG, she said she had premature contractions in the mitral valve. No treatment was received for the adverse events. The adverse event resulted in Doctor or other healthcare professional office/ or clinic visit. The patient was not diagnosed with COVID-19 prior to the vaccination and has not been tested for COVID-19 since the vaccination. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient underwent lab tests and procedures which included electrocardiogram: premature contractions in the mitral on 25Jun2021. The outcome of the events was unknown. Follow-up attempts have been completed and no further information is expected.


VAERS ID: 1463273 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Blood test, Chest discomfort, Circumstance or information capable of leading to medication error, Dysgeusia, Dyspnoea, Fatigue, Hypoaesthesia, Insomnia, Loss of consciousness, Pain in extremity, Paraesthesia, Peripheral swelling, Productive cough, Seizure, Ultrasound scan
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Hypoglycaemia (broad), Infective pneumonia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer; COVID-19 (doctors believe I had Covid-19 in 2019)
Allergies:
Diagnostic Lab Data: Test Date: 20210625; Test Name: blood work; Result Unstructured Data: Test Result:unknown; Test Date: 20210625; Test Name: ultrasound; Result Unstructured Data: Test Result:unknown
CDC Split Type: USPFIZER INC2021787568

Write-up: seizure; unconscious; passed out; stopped breathing; received Pfizer vaccine, first dose 3 days ago, technically I got pneumonia vaccine, PPsV23; lost my sense of taste; I can''t smell; I am feeling like a tingling sensation in my hands, like numbness; I am feeling like a tingling sensation in my hands, like numbness; metallic taste; fatigue; coughing up phlegm; hard time getting to sleep; Left arm hurt a lot and hand is swollen; Left arm hurt a lot and hand is swollen; Tightness of Chest; I can breath but it''s like I can''t get any oxygen; it''s like very hard for me to get air; This is a spontaneous report from a contactable consumer (patient). A 34-years-old male patient received first dose BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, batch/lot number: EW0177) via an unspecified route of administration in Arm Left on 25Jun2021 15:30 as DOSE 1, SINGLE for covid-19 immunisation. Medical history included covid-19 from 2019 to an unknown date doctors believe I had Covid-19 in 2019, neoplasm malignant from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The first dose of the Pfizer vaccine was on 25Jun2021, I have got this kind, out of order. So, he said from what he remembers that he was fine following the vaccination, and everything was good but he took a few steps and collapsed. He started having a seizure and he said, my mom said, you stopped breathing, I was unconscious, tightness of chest I can breathe but it''s like I cannot get any oxygen it''s like very hard for me to get air. He says, the doctors there, the doctors, he says don''t get me started on the (sentence incomplete) and he went to the hospital and was there for like 5 hours and they gave him 5 mg of Valium treatment and he said that was it. They could not find his vein, they did an ultrasound, I guess to find his vein and apparently, he had a couple of seizures. He says, I don''t recall, all I remember is waking up in a hospital and I received the Pfizer vaccine first dose and then he said, 3 days ago, technically, I got Pneumonia vaccine which he said he received the PPSV23 vaccine prior the same day of his Pfizer vaccine. Also, he says, I hate needles, so I got tortured. I had the pneumonia vaccine (PPSV23 vaccine) first, he was with his mom, they went out for a while and then went back to where he got the Pfizer vaccine following that (PPSV23 Vaccine). He said, he was there after the Pfizer vaccine for about 30 minutes, got up and had a seizure and he says, that also his mom said that he cannot remember anything because he was unconscious, and they took him to the hospital. Also, he said, he lost his sense of taste, I cannot smell, he said, he was feeling like tingling sensation in his hands like numbness and left arm hurt a lot and hand was swollen. In 2019, he says, he got sick with respiratory issues. He was not sure if he had Covid because they did not know about Covid at that time when he was in the hospital then (consumer had respiratory issues before getting the vaccine, hence not captured as event). He said, it was freaking him out and he was scared to take the second shot. He said, he does not know if this was the combination of getting two vaccination and he says, he used to have cancer (not clarified further, hence not captured as event) and then he says, that they did blood work, it was been followed by the place and they did not tell me anything about the blood work. He says, should I be considered or concerned about getting the second dose of the vaccine because I am experiencing various symptoms and what can I do about my side effects because he is still experiencing metallic taste, loss of smell, fatigue, coughing of Phlegm, having a hard time getting to sleep. Then he says, I forgot to mention, I could feel my heartbeat and I have a cough, I have had a cough from very long time when doctors believe I had Covid-19 in 2019 (further clarification unknown). He wanted to know how safe the vaccine was. Therapeutic measures were taken as a result of seizure, unconscious, passed out. The outcome of the events was unknown. Information on Lot/Batch number was available. Additional information has been requested.


VAERS ID: 1463291 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW017A / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Gait disturbance, Illness, Movement disorder, Myalgia, Urine analysis, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Splenectomy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210626; Test Name: urine sample; Result Unstructured Data: Test Result:Negative; Test Date: 20210626; Test Name: Xray; Result Unstructured Data: Test Result:Negative
CDC Split Type: USPFIZER INC2021795481

Write-up: he is having trouble moving and getting up and walking; he is having trouble moving and getting up; he has never had the back pain before with the pain in the muscle; Sick; My husband experienced lower back pain, well today the back pain is really severe; This is a spontaneous report from a contactable consumer. This consumer (patient''s Wife) reported for a 64-year-old Male patient (Reporter''s husband) that he received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: EW017A and expiry date was not reported, at the age of 64-year-old), via an unspecified route of administration, administered in Arm Left on 25Jun2021 08:00 as dose 1, single for covid-19 immunisation. Medical history included ongoing splenectomy. The concomitant medications were not reported. Patients wife reported that her husband experienced lower back pain well today the back pain is really severe, he is having trouble moving and getting up and walking on 25Jun2021. She states she took him to the ER, and they gave him a muscle relaxer and a pain pill, which didn''t help at all. She states they were there for about 4 hours and sent home with some more pain pills and still is not helping; when he left the hospital, he was still in pain. He has never had the back pain before with the pain in the muscle. She states he had no soreness in his left arm. She states she told the ER nurse this as well, but he doesn''t have a spleen and she doesn''t know if the shot affected him worse because of the immune system to fight it. She remarks her husband is having regrets taking the vaccine because he is so sick. She states the second shot is scheduled for 16Jul2021. Additional Vaccines Administered on Same Date of the Pfizer Suspect were none. Other vaccinations within four weeks prior to the first administration date of the suspect vaccine(s) was none. The patient underwent lab tests and procedures which included urine analysis and x-ray both negative on 26Jun2021. The outcome of event low back pain was recovering and for all the events was unknown.


VAERS ID: 1463309 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-17
Onset:2021-06-25
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Blood bilirubin, Blood magnesium, Blood magnesium decreased, Blood phosphorus, Blood potassium, Discomfort, Glomerular filtration rate, Glomerular filtration rate decreased, Inappropriate schedule of product administration, Mineral deficiency, Monocyte count, Renal disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SIMVASTATIN; ALOPURINOL; INDAPAMIDE; LEVOTHYROXINE; DIGOXIN; METFORMIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210413; Test Name: Bilirubin; Result Unstructured Data: Test Result:1.8; Comments: Unspecified 1.8; Test Date: 20210413; Test Name: Magnesium; Result Unstructured Data: Test Result:1.7; Comments: Unspecified 1.7; Test Date: 20210413; Test Name: Phosphorus; Result Unstructured Data: Test Result:2.1; Comments: Unspecified 2.1; Test Date: 20210413; Test Name: Potassium level; Result Unstructured Data: Test Result:3.1; Comments: Unspecified 3.1; Test Date: 20210623; Test Name: Potassium level; Result Unstructured Data: Test Result:3.3; Comments: Unspecified 3.3; Test Date: 20210413; Test Name: GFR; Result Unstructured Data: Test Result:59; Comments: Unspecified 59; Test Date: 20210623; Test Name: GFR; Result Unstructured Data: Test Result:59; Test Date: 20210413; Test Name: Monocyte absolute; Result Unstructured Data: Test Result:0.9; Comments: Unspecified 0.9; Test Date: 20210623; Test Name: Monocyte absolute; Result Unstructured Data: Test Result:1.0; Comments: Unspecified 1.0
CDC Split Type: USPFIZER INC2021800479

Write-up: inappropriate schedule of vaccine administered; kidney problem; it is causing me some real concern; Magnesium becomes low; GFR is low; minerals are going low; strange sensation; This is a spontaneous report from a contactable consumer. A 75-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot Number: EL8982), dose 1 via an unspecified route of administration, administered in Arm Left on 17Jan2021 as (At the age of 75-years) DOSE 1, SINGLE, dose 2 via an unspecified route of administration, administered in Arm Left on 02Jun2021 (Batch/Lot Number: EL8982) as DOSE 2, SINGLE for covid-19 immunisation. The patient medical history was not reported. Concomitant medication included simvastatin 20 milligrams; alopurinol; indapamide 2.5 milligrams; levothyroxine100 micrograms; digoxin; metformin, and Potassium Pill, Potassium COER 20 mEq. It was reported that he was not diabetic at metabolic syndrome at the extended release 500 that effect last A1C was 4.8. No Prior vaccination within 4 weeks. It was reported that patient had no Family medical history related to adverse event. The patient experienced kidney problem, it is causing me some real concern, magnesium becomes low, gfr is low, minerals are going low (mineral deficiency), and strange sensation on 25Jun2021. It was reported that patient got the situation rising, it was causing some real concern. It was reported that he was vaccinated the corona virus in early February and then in the early mid-April he had some blood lab with again some worrying results and today he has follow up with that then he got information on and results are more concerning like those concerns involve kidney problem. It was reported that When probed whether consumer took first dose of the vaccine or both doses, Consumer stated, he got the second shot in February. Later patient reported that It will be good, and he should mention also that one of just when he got that final vaccination, he had some strange sensation afterwards and he reported those, and they sent some paper works but he did not see on anything going on at that time. So, he didn''t follow up with it. It was reported that patient was not exactly sure when the onset was. He was seeing it that was between the date of the vaccination and date of the first blood test on 13Apr2021. So, that would say March, somewhere in March, this year. That would be 75. first Starting date of Adverse Event, he noticed there was a problem that''s when he had the first blood test done and that was on 13Apr2021. It was reported that There are probably 20 or 30 different tests on each one of these sheets, he got the first one here, Monocyte absolute 0.9, the next one, Potassium level is 3.1, and here most concerning one GFR 59. It was reported that Magnesium becomes low 1.5 that is only the first test Monocyte was now 1.0, potassium is 3.3, GFR is still 59, bilirubin is now 1.8, there was one more magnesium was 1.7, Phosphorous is 2.1. It was reported that GFR is low, and the minerals are going low one by one and the bilirubin that''s the most recent now, it was high which was this is going, it''s bad and now better looking again. The patient underwent lab tests and procedures which included blood bilirubin: 1.8 on 13Apr2021, blood magnesium: 1.7 on 13Apr2021, blood phosphorus: 2.1 on 13Apr2021, blood potassium: 3.1 on 13Apr2021, blood potassium: 3.3 on 23Jun2021, glomerular filtration rate: 59 on 13Apr2021, glomerular filtration rate: 59 on 23Jun2021, monocyte count: 0.9 on 13Apr2021, monocyte count: 1.0 on 23Jun2021. Treatment: Consumer stated, "There is no treatment that I still continue because there is more here. Magnesium becomes low 1.5, Okay that is only the first test. So, here GFR went down and minerals are the one went down, Now, the second one, so, this is for the date of 6/23/21. Monocyte is now 1.0, potassium is 3.3, GFR is still 59, bilirubin is now 1.8, there is one more magnesium is 1.7, Phosphorous is 2.1. So, hang on more page, that should cover. So, what you see happening here is the GFR is low and the minerals are going low one by one and the bilirubin that''s the most recent now, it was high which was this is going, it''s bad and now better looking again. The outcome of events was unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1463318 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-25
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210625; Test Name: tested positive COVID; Result Unstructured Data: Test Result:Positive
CDC Split Type: USPFIZER INC2021805308

Write-up: Four of my colleagues (including myself) have contracting COVID within a week despite all having been vaccinated; Four of my colleagues (including myself) have contracting COVID within a week despite all having been vaccinated; This is a spontaneous report from a Pfizer sponsored program. This consumer reported adverse events with similar suspect for 4 patients. This report is One of four patients. This consumer (patient) reported that: A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Patient reported that four of my colleagues (including myself) have contracting COVID within a week despite all having been vaccinated. Exposure could not have occurred before Monday 21Jun2021 and symptom onset (all positive tested individuals were symptomatic) was by 25Jun2021. We are all researchers and recognize the impossibility of this not being a variant. I am totally willing to participate in any studies that might help understand variants and the efficacy of the vaccine on them. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 25Jun2021. The outcome of the event Four of my colleagues (including myself) have contracting COVID within a week despite all having been vaccinated was unknown. Information on the lot/batch number has been requested.


VAERS ID: 1463319 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-25
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210625; Test Name: Covid-19; Test Result: Positive
CDC Split Type: USPFIZER INC2021805357

Write-up: Four of my colleagues (including myself) have contracting COVID within a week despite all having been vaccinated; Four of my colleagues (including myself) have contracting COVID within a week despite all having been vaccinated; This is a spontaneous report from a contactable consumer via Pfizer sponsored program via contactable consumer reported for an unknown patient (colleague #1 of 3). A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot number: Unknown), via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On 25Jun2021, four of my colleagues (including myself) have contracting COVID within a week despite all having been vaccinated. Exposure could not have occurred before Monday 21Jun2021 and symptom onset (all positive tested individuals were symptomatic) was by 25Jun2021. We were all researchers and recognized the impossibility of this not being a variant. Reporter was totally willing to participate in any studies that might help understand variants and the efficacy of the vaccine on them. The patient underwent lab tests and procedures which included SARS-CoV-2 test: positive on 25Jun2021.The clinical outcome of the events was reported as unknown. Information about batch/Lot number has been requested.


VAERS ID: 1463320 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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: Test Date: 20210625; Test Name: Covid; Test Result: Positive
CDC Split Type: USPFIZER INC2021805359

Write-up: Four of my colleagues (including myself) have contracting COVID within a week despite all having been vaccinated; This is a spontaneous report from a contactable consumer from Pfizer sponsored program. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, lot number: unknown; Expiration date: unknown) via an unspecified route of administration on Jun2021 as unknown single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. It was reported that four of my colleagues (including myself) reporter''s colleagues (including reporter) have contracting COVID within a week despite all having been vaccinated. Exposure could not have occurred before Monday 21Jun2021 and symptom onset (all positive tested individuals were symptomatic) was by 25Jun2021. They all were researchers and recognize the impossibility of this not being a variant. Consumer was totally willing to participate in any studies that might help understand variants and the efficacy of the vaccine on them. The patient underwent lab tests and procedures which included SARS-COV-2 test which was positive on 25Jun2021. The outcome of event was unknown. Information on the lot/batch number has been requested. .


VAERS ID: 1463667 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-01
Onset:2021-06-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Hyperaesthesia, Muscle twitching, Pain in extremity, Pyrexia, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Pcn, sulfur
Diagnostic Lab Data: None I didn?t go I waited it out. My joints still have pain. I?m improving.
CDC Split Type:

Write-up: I had the sore arm after 12 hours. Started running fever 102.8 then 103 for three days joint pain all over my body that was so severe you couldn?t touch me, for several days, headache, facial twitching, blurred vision, I


VAERS ID: 1463779 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-18
Onset:2021-06-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Malaise, Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow)

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

Write-up: FELT SICK ON JUNE 25TH AND REPORTED TO EMERGENCY ROOM. ADMITTED FOR BLOOD CLOT IN LUNG


VAERS ID: 1463898 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-18
Onset:2021-06-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Mouth swelling, Ocular hyperaemia, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Additional Details: patient reported redness in her eyes, and went to urgent care and noted inflammation and prescribed steriod eye drop for redness which helped with redness.


VAERS ID: 1464049 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-23
Onset:2021-06-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast enlargement, Feeling hot, Galactorrhoea, Pregnancy test negative
SMQs:, Lipodystrophy (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 shot 8 years ago, I broke out in hives and made my eyes yellow
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to x-ray cat scan dye, seasonal environmental allergies.
Diagnostic Lab Data: 6 pregnancy test that all came back negative, so I am not pregnant.
CDC Split Type:

Write-up: The only side effect I had was my head was a little hot but really did not have any fever, and two days after the shot my breasts began to lactate and grew a cup size. I am not pregnant and my child is 8 years old.


VAERS ID: 1464075 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-15
Onset:2021-06-25
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Blindness, Cerebrovascular accident, Computerised tomogram, Echocardiogram, Ultrasound Doppler
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Biotin supplement.
Current Illness: No illnesses at the time of vaccination.
Preexisting Conditions: No chronic or long standing health conditions.
Allergies: No known allergies.
Diagnostic Lab Data: I had a CT scan, CT angiogram, echocardiogram, an ultrasound of my arm and a MRA of my pelvis.
CDC Split Type: vsafe

Write-up: I had a left occipital stroke and I lost part of my vision.


VAERS ID: 1464131 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-04
Onset:2021-06-25
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / -

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

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

Write-up: MI on 6/25/21


VAERS ID: 1464184 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-21
Onset:2021-06-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, Sensory loss
SMQs:, Peripheral neuropathy (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: Influenza Vaccine
Other Medications: No
Current Illness: No
Preexisting Conditions: Endometriosis, Heat-induced urticaria, Iron deficiency anemia, Lichen planus, Migraine, Mitral regurgitation , Myalgias.
Allergies: Shellfish Influenza Vaccine Adhesive Bandage
Diagnostic Lab Data: None
CDC Split Type:

Write-up: diminished sensation, numbness nd tingling in bilateral hand and feet


VAERS ID: 1464236 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-21
Onset:2021-06-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood potassium decreased, Cellulitis, Electrocardiogram, Feeling abnormal, Near death experience, Palpitations, Supraventricular tachycardia
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Cardiomyopathy (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: Hepatitis B vaccine 04/21/2016
Other Medications: Fish Oil Fluoxetine HC 20 mg qd Aspirin 81 mg qd Vitamin D3 OTC once daily Otelza 30 mg 1 po daily lorazepam 0.5 mg 1 po bid as need for anxiety Metoprolol Succinate ER one tab po daily for BP and heart rate Lisinopril 20 mg one po bid
Current Illness: pain in right arm post vaccination SVT vertigo daytime somnolence depression
Preexisting Conditions: essential hypertension tinnitus deviated nasal septum suicidal thoughts anxiety and depression steatosis of liver chronic maxillary sinusitis palpitations
Allergies: Hepatitis B vaccination-chest pain, sweating, and swelling of entire arm Sulfa
Diagnostic Lab Data: as above + cardiology consult on 06/29/21, diagnosed with SVT, discontinued potassium and hydrochlorothiazide(patient did not report HCTZ use when obtaining medications for VAERS) with treatment plan to include echo scheduled 07/27/2021 to evaluate heart muscle and valves(to call with results post procedure) and follow up with doctor in 6 months. Electrophysiology referral scheduled on 08/11/2021
CDC Split Type:

Write-up: cellulitis rt arm post vaccination; treated and resolved When called to follow up on above cellulitis diagnosis, patient reported she had an event on 06/25/21 as she was driving out of town. experienced "weird, really strange" feeling, "heart running away, pulled over, called ambulance," states had EKG done and medication administered, heard parmedic states "did not want to shock you, but i am going to have to". states "hurt like hell" and woke up in hospital. said "i died because i saw my daddy" who had passed away 5 months prior. states admitted to hospital 06/25/21, discharged 06/26/21, also stated potassium was "critically low, 2.4". states received medications to get heart rate down, was discharged home on potassium 10 mg once per day. follow up with PCP and also referred to cardiologist


VAERS ID: 1464475 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-09
Onset:2021-06-25
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 UN / SYR

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

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

Write-up: Hospitalization


VAERS ID: 1466501 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-06-23
Onset:2021-06-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Ear pruritus, Headache, Pain in extremity, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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: Thyroid meds, Vitamin D
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 2 days after I got the vaccine, my arm was sore and I had a pretty bad headache. About 6 days later, my ears and throat would get itchy and it felt like my ear and throat would close. I''ve taken allergy meds for the reaction, but I have not seen a doctor yet.


VAERS ID: 1466623 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Paraesthesia, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pt reports GI symptoms (nausea, vomitting), tingling in fingers, fever. Pt believes she has developed Guillian Barre.


VAERS ID: 1466642 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-21
Onset:2021-06-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea, Dyspnoea at rest, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unsure
Current Illness: Unsure
Preexisting Conditions: asthma, seasonal allergies, hyperplasia of tonsils and adenoids, obstructive sleep apnea, xerosis of skin, unspecified Vitamin D deficiency, adverse food reaction
Allergies: Shrimp, chocolate
Diagnostic Lab Data: 6/25/2021 - chest x-ray, 7/13/2021 - SARS Coronavirus 2 PCR
CDC Split Type:

Write-up: Per MD Note: She developed the shortness of breath on 06/25, which was four days after she received her first dose of the mRNA Pfizer vaccine. The child describes experiencing shortness of breath, but denies any cough, tightness of the chest, or fever. Since onset, her shortness of breath has been occurring random episodes, but more so at rest than with activity. She mentions that these episodes do not make her conscious of her breathing.


VAERS ID: 1466717 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Electrocardiogram, Fatigue, Headache, Injection site pain, Neck pain, Pain
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

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

Write-up: Back pain, left arm pain from shoulder down to elbow that is continuously, had pain, neck pain, tired and fatigue, headaches


VAERS ID: 1466777 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-16
Onset:2021-06-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Eczema, New daily persistent headache, Vaccination site pain
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: benadryl, Vit E, Omega 6 and 9 , tylenol, allopurinol, carvedilol. colchicine-probenecid, cyclobenzaprine, valium, hydroxyzine, losartan, valacyclovir
Current Illness: shingles
Preexisting Conditions: Eczema, hypertension
Allergies: Penicillin and Sulfa Drugs
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pain on the vaccine site. After that everyday headache until now. Eczema flare up all over his body after the second dose of Moderna.


VAERS ID: 1466820 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-20
Onset:2021-06-25
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A210 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Guillain-Barre syndrome, Hypoaesthesia, Visual impairment
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (narrow), Glaucoma (broad), Optic nerve disorders (broad), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Active Outpatient Medications Status ========================================================================= 1) ALBUTEROL 90MCG (CFC-F) 200D ORAL INHL INHALE ONE TO TWO PUFFS BY INHALATION EVERY SIX HO
Current Illness:
Preexisting Conditions:
Allergies: Magnesium
Diagnostic Lab Data:
CDC Split Type:

Write-up: Began with visual changes, numbness on June 25th; admitted to hospital July 9-12th, 2021 w/ presumtive Guillain Barre syndrome; has had CT scan showing no lesions


VAERS ID: 1467067 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-23
Onset:2021-06-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWNWILLCALL / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest X-ray, Cough, Diarrhoea, Dyspnoea, Influenza like illness, Nausea, Pain, Pneumonia, Pyrexia, Rash, Rash erythematous, Rash pruritic, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

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

Write-up: After the 2nd dose vaccine, I had nausea, vomiting and diarrhea. A few days later, I developed a rash on both my arms. The rash looked like little raised bumps and was itchy. I applied some Benadryl cream on it and it hasn''t improved. About a week after my vaccination, I had flu like symptoms- shortness of breath, cough, low grade fever, body aches and joint pain. I went to the ER (Hospital) and was given oxygen, breathing treatments and was diagnosed with pneumonia. I was given a prescription of Z-pak azithromycin and discharged to follow up with my PCP.


VAERS ID: 1467068 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Chest discomfort, Chest pain, Pericarditis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (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? 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: Cardiac Disorder (diagnosed by MD)-Mild, Systemic: Chest Tightness / Heaviness / Pain-Mild, Additional Details: pericarditis


VAERS ID: 1467986 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, 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: Buspar, 30 mg per day Trileptal, 900 mg per day
Current Illness: None
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme soreness throughout body, 3 days duration Hives I''m multiple areas, unresolved with over the counter allergy medicine, 2 week duration (ongoing)


VAERS ID: 1469620 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-06-25
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (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: Hyperlipidemia (Treated by specialist.)
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210625; Test Name: Antibody test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210717374

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned a 49 year old White and Not Hispanic or Latino male. The patient''s height, and weight were not reported. The patient''s concurrent condition included hyperlipidemia and the patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805020, expiry: not reported) dose was not reported, 1 total, administered on 16-MAR-2021 to left arm for prophylactic vaccination. No concomitant medications were reported. On 25-JUN-2021, the patient had done an antibody test which resulted as negative and hence, it was confirmed as immunological vaccine failure. The patient reported that he was going to do a spike protein test to confirm his immunity. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from confirmed immunological vaccine failure. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint: 90000185426.; Sender''s Comments: V0:20210717374- covid-19 vaccine ad26.cov2.s-Confirmed immunological vaccine failure.This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug.Specifically: SPECIAL SITUATIONS


VAERS ID: 1469675 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-06-25
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bell's palsy, Dysarthria, Facial paralysis, Facial paresis, Headache, Hypoaesthesia, Skin wrinkling, Vaccination site pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Bell''s Palsy; After the second dose, his arm was sore at the site; Face felt more droopy; Face felt more weak; Wrinkles on the right side of his forehead; His speech got messed up and slurry; The right side of his face was going numb; Severe headache; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 06-Jul-2021 and was forwarded to Moderna on 06-Jul-2021. This spontaneous case was reported by an other health care professional and describes the occurrence of BELL''S PALSY (Bell''s Palsy) and FACIAL PARALYSIS (Face felt more droopy) in a 37-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 25-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 25-Jun-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced HEADACHE (Severe headache). On 29-Jun-2021, the patient experienced HYPOAESTHESIA (The right side of his face was going numb). On 01-Jul-2021, the patient experienced FACIAL PARALYSIS (Face felt more droopy) (seriousness criterion medically significant). 01-Jul-2021, the patient experienced FACIAL PARESIS (Face felt more weak), SKIN WRINKLING (Wrinkles on the right side of his forehead) and DYSARTHRIA (His speech got messed up and slurry). On an unknown date, the patient experienced BELL''S PALSY (Bell''s Palsy) (seriousness criterion medically significant) and VACCINATION SITE PAIN (After the second dose, his arm was sore at the site). The patient was treated with NORTRIPTYLINE for Headache, at a dose of 30 milligram once a day; PREDNISONE at a dose of 50 milligram once a day and VALACICLOVIR HYDROCHLORIDE (VALTREX) at a dose of 1000 milligram three times a day. At the time of the report, BELL''S PALSY (Bell''s Palsy), FACIAL PARALYSIS (Face felt more droopy), HYPOAESTHESIA (The right side of his face was going numb), SKIN WRINKLING (Wrinkles on the right side of his forehead), DYSARTHRIA (His speech got messed up and slurry) and HEADACHE (Severe headache) outcome was unknown, FACIAL PARESIS (Face felt more weak) had not resolved and VACCINATION SITE PAIN (After the second dose, his arm was sore at the site) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No relevant concomitant medications reported. Patient underwent tests such as the EKG, chest X-RAY and results were not reported and also received a neurology consultation. Patient was discharged from the hospital at 2:15AM in the morning. Limited information regarding the events has been provided at this time and is insufficient for causality assessment. This case was linked to MOD-2021-249536 (Patient Link).; Sender''s Comments: Limited information regarding the events has been provided at this time and is insufficient for causality assessment.


VAERS ID: 1470142 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

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

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

Write-up: Incorrect BUD date of 6/25/21 was entered into the vial label and it should have been 6/23/21. Patient was given the dose 2 days after BUD date. No treatment was needed. Dr. spoke to the patient on 7/12/21 and explained the events. The patient felt comfortable and did not have any further concerns. Patient is returning for the second dose on 7/16/21. No additional treatment needed


VAERS ID: 1470364 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Areflexia, Asthenia, Balance disorder, Disturbance in attention, Dizziness, Feeling abnormal, Hypersomnia, Immediate post-injection reaction, Impaired driving ability, Impaired work ability, Influenza like illness, Lethargy, Migraine, Musculoskeletal stiffness, Pain, Vertigo
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Humolog Lexapro Levothyroxine
Current Illness: Hypothyroid Diabetes 1
Preexisting Conditions: Diabetes neuropathy
Allergies: n/A
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Right after vaccine I slept for 3 days straight with Massive migraine ( big ball of fire) i need a ice to soothe the pain/ body pain. On Monday afternoon on June 28, 2021, with less severe flu like symptoms , i went to the store and i felt dizzy and loss my balance tilting to the right, neck stiff and lac of reflect. i was in no condition for driving. Wednesday June 30th ,2021, i went to the Urgent care with dizziness/ light head/ body ache. I was diagnoses with vertigo and was giving a couple days off work. ( Meclizine prescript) making me drowsy and upset stomach... feeling worst! I still felt weak, light headed and dizzy, lethargic. on Wednesday July 7, 2021 my primary doctor gave me more days to rest. Im back at work today, still feel off, hard to focus and bit dizzy behind the wheel. fyi..


VAERS ID: 1470404 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-06-25
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Azotaemia, Dyspnoea
SMQs:, Acute renal failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Chronic kidney disease (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol
Current Illness: HTN, Gastritis, obesity, hypokalemia, Hypomagnesemia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 6.25.2021 positive test
CDC Split Type:

Write-up: SOB, Acute uremia


VAERS ID: 1470496 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dry mouth, Fatigue, Feeling abnormal, Loss of personal independence in daily activities, Nausea, Retching, Taste disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (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: Probiotics, Glutathione
Current Illness: Ear ache prior to vaccine
Preexisting Conditions: n/a
Allergies: Sulfa drugs, Penicillin, most antibiotics
Diagnostic Lab Data: n/a
CDC Split Type: vsafe

Write-up: Probably immediately, I was lightheaded and woozy. As soon as she put it in my arm I could taste it and I felt like I was going to vomit. She kept me there for 45 minutes to keep an eye on me. As a disclaimer, I am a vegan and very earthy, I do not take any drugs or anything like that. When I was driving home the lightheadedness got so bad that I had to pull over and sat for 15-20 minutes. I called my brother and he told me to get something to eat. I just had some steamed vegetables. I came home, ate and drank a lot of water to try and get the wooziness to pass. I did not have an unusual amount, no more than I would usually drink. Then after the last bottle of water I had, I started getting more queasy and started to feel dizzy. I then vomited all over my self from head to toe. That lasted for two or three hours and then after that I was dry heaving. That happened on Friday, on Saturday I was too afraid to eat anything I only had toast and a smoothie. On Sunday I was just so woozy and lightheaded and exhausted. I didn''t feel chills or anything though. My brother brought me soup on Sunday and I did have some broth. I also started drinking a little bit more water. The water didn''t taste good though - it tasted like the vaccine so I did not want to have it. I did not workout at all for that week, I was just so tired. I felt like I could sleep for a month and just not get up. I normally workout five days a week. I got an IV with fluids for hydration and a glutathione push on 7/2/2021. On the following Saturday 7/3/2021, I was still lightheaded. Now, I still am extremely tired and there are days that focusing takes more energy than it typically does. My mouth feels like I have cotton balls in it, the nausea and the lightheadedness is still present, but the tiredness is the worst. I normally run everyday but I cannot even do that at all, walking is hard enough. I just had another IV today 7/14/2021. When this started happening, I did contact my DR but I am unable to get in yet, I need to schedule for a full blood panel and see the DR.


VAERS ID: 1470530 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-17
Onset:2021-06-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21B / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eosinophil count increased, Eosinophilia, Leukocytosis, Monocyte count increased, Monocytosis, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Eosinophilia, low grade leukocytosis, monocytosis, without neutrophilic predominance patient received vaccine on 6/17. These were normal when checked 6/3 monocytes and wbc normal when check 6/16 (eso not checked 6/16) Next time these labs were check was on 6/25 - WBC and eso - elevated eosinophils & monocytes remained elevated until 7/13 WBC still elevated more substantial now - maybe be increased for other reasons now Inpatient from 6/27- to present Patient admitted for other reasons -


VAERS ID: 1470681 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-11
Onset:2021-06-25
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CVS5872 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Eye irritation, Inflammation, Lacrimation increased, Ocular hyperaemia, Photophobia, Slit-lamp examination
SMQs:, Anaphylactic reaction (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Lacrimal disorders (narrow)

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

Write-up: Two weeks after receiving the 1st dose my eyes became irritated. I assumed it was dry eye, since they were not red, and used artificial tears. That didn?t work, so I visited my optometrist. He said it was likely an inflammatory reaction to something and told me to use Zatidor drops. The drops helped tremendously. I was still using them when I received the second dose on 7/2/2021, but the irritation was under control with the drops. Within 30 minutes of receiving the second dose, my eyes were extremely irritated, light sensitive, watering, and red. I sent a text and photo to my optometrist and he told me to take a Benadryl and use the eyes drops. The next morning the redness was gone. My eyes still felt irritated and I kept using the Zatidor drops twice a day. When I stopped using them the redness returned so I started again. My left eye still feels irritated & I?m still using the drops in it, but the right eye is fine. I?m not sure that this is related to the vaccine or not. If definitely got much worse within 30 minutes of getting the second dose, but it seems to be going on too long to have been an allergic reaction to the vaccine.


VAERS ID: 1470748 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

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

Write-up: Patient informed this writer that she had had COVID approximately 1 week after her initial vaccination. I informed the patient that she could then defer 90 days to receive her 2nd Moderna dose without any worry. She indicated she would rather receive the second Moderna dose today, for fear of getting COVID again. She was vaccinated. After vaccination was given, she informed this writer that she had in fact been hospitalized with COVID. This writer asked, "Did you receive monoclonal antibody during that hosp" She replied, "Yes." This writer informed the patient that she would need to contact Agency to report the incident, as the vaccination should have been deferred. No adverse event reported in the patient.


VAERS ID: 1470798 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-23
Onset:2021-06-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Laboratory test
SMQs:, Peripheral neuropathy (broad), 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: Zoloft, buspar, gabapentin, levothyroxine, atorvastatin, strattera, vit d,
Current Illness: none
Preexisting Conditions: high cholestrol, thyroid, gaba for head injury, anxiety, depression , adhd, arthritis
Allergies: none
Diagnostic Lab Data: . Labs ok per pt
CDC Split Type:

Write-up: numbness from middle forearm to hand from 6/25 to 7/14


VAERS ID: 1471266 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Blood test, Chills, Computerised tomogram, Dizziness, Eye haemorrhage, Eye pain, Fatigue, Headache, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 100mg Omeprazole 20mg
Current Illness: No
Preexisting Conditions: Anxiety, Panic attacks.
Allergies: No
Diagnostic Lab Data: 07/08/2021 CT scan 07/08/2021 Blood Test
CDC Split Type:

Write-up: Muscle pain (up to 7 days after vaccination) Joints and body pain (up to 11 days after vaccination) Weakness and dizziness (after vaccination until now) Tiredness (after vaccination until now) Chills (after vaccination until now) Headaches (after vaccination until now) I took Tylenol Eye pain (after vaccination until now) A blood vessel burst in my left eye on 7/7/21 and I still recovering from that.


VAERS ID: 1471271 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO217 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: SARS-CoV-2 test negative, Streptococcus test negative, Unevaluable event
SMQs:, 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: Gabapentin, amitriptalin, metapropolol, ecchinecea, vitamin D, and C, multivitamin, bedesonide
Current Illness: Not sick at vaccination day- had a low grade fever and general flu like symptoms. A couple weeks letter- woke up feeling like swallowing razors. Low grade fever, body aches, sneezing, chills, headache and extreme fatigue.
Preexisting Conditions: Asthmatic
Allergies: Nnone
Diagnostic Lab Data: Strep culture and COVID test- both negative
CDC Split Type:

Write-up: None stated.


VAERS ID: 1471832 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-01
Onset:2021-06-25
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 LA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Differential white blood cell count, Fibrin D dimer, Full blood count, Hypertension, International normalised ratio, Lymphadenopathy, Metabolic function test, Troponin I
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapenten, 300 mg 2 x day Vitamin D 25 mcg 1 x day Allegra 180 mg 1 x day Calcium 500 mg 1 x day Amlodipine 10 mg 1 x day
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: Iodine, Sulfur Pecans Feathers
Diagnostic Lab Data: CBC with Differential, Comprehensive Metabolic Panel, D-Dimer, Protime INR, Troponin I
CDC Split Type:

Write-up: On 6/4/2021 was diagnosed with high blood pressure, had usually been low to regular. Was prescribed Amlodipine to correct. On 6/28/2021 experienced pressure and pain in the heart area and went to emergency room. They found signs of possible blood clots, so also performed additional tests. Found lymph nodes under the right arm enlarged (lymphadenopathy)


VAERS ID: 1471844 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-23
Onset:2021-06-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Heart rate increased, Pain, Palpitations, Vascular pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Stabing chest pains, increased heartbeat(resting heart rate is now about 85-90 while it used to be about 65-70), heart pounding, pain in neck vessels while doing any exercise (even walking or light cleaning), have to take breaks from doing things because I feel like I am going to pass out, It is still ongoing as of today 07/15/2021 Haven''t received any treatment


VAERS ID: 1474507 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-23
Onset:2021-06-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Heart palpitations, shortness of breath, breathing problems, difficulty taking deep breaths.


VAERS ID: 1474548 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-19
Onset:2021-06-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 LA / SYR
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / -

Administered by: Military       Purchased by: ?
Symptoms: Blood urine present
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Cefprozil, Sulfa
Diagnostic Lab Data: 06/25/2021 - urine test finding 200 units of blood in urine and infection. 07/02/2021 - urine test finding 5 units of blood in urine.
CDC Split Type:

Write-up: Blood in urine starting a week later. Put on antibiotic for 12day but still having same issue.


VAERS ID: 1474766 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-27
Onset:2021-06-25
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 RA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 037C21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Hyperhidrosis, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Nausea , dizziness, tired, sweaty, , and arm was extemely sore


VAERS ID: 1474971 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling abnormal, Headache
SMQs:, Dementia (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: Headache Brain Fog Chills Fatigue


VAERS ID: 1475428 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-22
Onset:2021-06-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxybutynin 10mg 1x daily June?s Fe 1 - 20 mcg tablet Multi-vitamin Bisacodyl USP 5 mg
Current Illness: None
Preexisting Conditions: Spina Bifida (myelomeningocele) VP shunted hydrocephalus Neurogenic bowel and bladder
Allergies: Sulfa allergy Amoxicillin allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bilateral hand rash. Symptom onset on day 3 (June 25, 2021) with progressive worsening. Itching and soreness. Treated with Clobetas 0.05% cream - 2x daily beginning on July 2, 2021 through July 8, 2021.


VAERS ID: 1477799 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-11
Onset:2021-06-25
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Medium, Systemic: Lymph Node Swelling-Medium, Additional Details: Patient came in to pharmacy on 7/15 to report symptoms. Per pt, left arm soreness lasted for 1 month after vaccine administration on 6/11. Per pt, noticed swollen lymph node under left armpit that developed 2 weeks after vaccine administration. Can feel pain when she stretches or extends her left arm. Pain does not interfere with daily activities. Advised patient to make an appointment to have the swollen lymph node examined by physician. Pt agreed to make an appointment with a physician.


VAERS ID: 1428019 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-19
Onset:2021-06-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA1027 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: Heavy menstrual bleeding and increasing clotting


VAERS ID: 1430264 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Cold sweat, Fatigue, Formication, Headache, Myalgia, Nausea, Pain in extremity, Pyrexia, Restless legs syndrome, Restlessness
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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), Hypoglycaemia (broad)

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

Write-up: 3 hours after vaccination the pain came on in injected arm. Overnight was gradual onset of fever (37.1 C); restless body and legs; crawling skin sensation; chills. At that time my arm started to ache very bad in the area of biceps, triceps, and lats on the left side. The following morning I got up with a terrible nausea with fatigue. Fatigue magnitude was as such that I got to the washroom, sat on the toilet and could not move for 30 minutes (no energy); all the time feeling cold sweat dripping off my skin. 24 hours after injection severe headache started and lasted for 4 hours then faded away by the bed time. My second night was alright with only moderate pain in the injected arm. 30 hours after vaccination. I am back to almost normal with moderate pain in the arm. But I have never been so sick in my life. ( Continued on page 2 )


VAERS ID: 1430473 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-22
Onset:2021-06-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site reaction, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: No
Allergies: Only environmental - dust, pollens
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: A few days after vaccination, a hard red welt appeared on upper left arm 4 inches below where the shot was injected. It is warm and tender to the touch with some itchiness.


VAERS ID: 1443691 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

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

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

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


VAERS ID: 1457102 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX0575 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arrhythmia, Arthralgia, Chest pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: SKIN ALLERGY CHEST PAIN FEVER JOINT PAIN ARRHYTHMIA


VAERS ID: 1465398 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD5613 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GEDAREL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Contraception
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Comments: No-Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021797751

Write-up: Tiredness; Headache; Muscle pain; This is a solicited report from a contactable consumer. This is a report received from the Regulatory Agency. Regulatory authority report number GB-MHRA-YCVM-202106241114220220-RGEQF, Safety Report Unique Identifier GB-MHRA-ADR 25551709. An 18-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 25Jun2021 at age of 18-year-old (Lot Number: FD5613) as DOSE NUMBER UNKNOWN, SINGLE for COVID-19 immunisation. Medical history included contraception. Patient last menstrual period date was 11Jun2021. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. Patient is not pregnant. Patient is not currently breastfeeding. Concomitant medication(s) included desogestrel, ethinylestradiol (GEDAREL, Manufacturer unknown) taken for contraception. The patient experienced tiredness on 25Jun2021 with outcome of recovered on 27Jun2021, headache on 25Jun2021 with outcome of recovering, muscle pain on 25Jun2021 with outcome of recovered on 27Jun2021. The events were reported as serious for medically significant. The patient underwent lab tests and procedures which included COVID-19 virus test: negative COVID-19 test on unknown date. The reporter''s assessment of the causal relationship of the events with the suspect product was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Based on temporal association and known safety profile the reported fatigue, headache and muscle pain are assessed s related to BNT162B2. Case will be reassessed if additional information is received.


VAERS ID: 1468794 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-19
Onset:2021-06-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: HUPFIZER INC2021802073

Write-up: myocarditis; This is a spontaneous report from a contactable physician. A 17-year-old male patient received the second dose of BNT162B2 (COMIRNATY), via an unspecified route of administration on 19Jun2021 as DOSE 2, SINGLE for COVID-19 immunisation. The patient''s medical history and concomitant medications were not provided. By 25Jun2021 myocarditis developed, which may correspond to side effects. Outcome of the event was unknown. Information on the lot/batch number has been requested.; Sender''s Comments: A possible contributory role of the suspect drug to the reported event myocarditis cannot be completely excluded based on temporal association. This case will be re-assessed when additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identifies as part of this review, as well as any appropriate action in response, will be promptly notifies to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


VAERS ID: 1475141 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Maternal exposure during pregnancy, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID
Current Illness: Pregnancy
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Comments: No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021786747

Write-up: Maternal exposure during pregnancy third-trimester (29-40 weeks); Vomiting; This is a spontaneous report from a contactable consumer received from the Regulatory Agency. The regulatory authority report number is GB-MHRA-WEBCOVID-202106251249125840-J01CC, Safety Report Unique Identifier GB-MHRA-ADR 25543552. A 30-year-old female patient received of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration on 24Jun2021 (lot number and expiry date: unknown) as dose 2, single for COVID-19 immunisation. Medical history included lactation decreased and ongoing pregnancy. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. Concomitant medication included folic acid taken for folic acid supplementation, start and stop date were not reported. The patient previously received first dose of BNT162B2 for COVID-19 immunisation. The patient experienced maternal exposure during pregnancy, third-trimester (29-40 weeks) on an unspecified date, and vomiting on 25Jun2021. Additional information: Patient was exposed to the medicine on third trimester (29-40 weeks). The health authority assessed the events as serious due to other medically important condition. The patient underwent lab tests and procedures which included COVID-19 virus test: no-negative on unspecified date. Outcome of the event vomiting was not recovered. No follow-up attempts are needed, information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1422785 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

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

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

Write-up: UNKNOWN


VAERS ID: 1422846 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Headache, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular 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: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 24y/o AD female w/Dizziness,nausea,HA,Vomiting,SOB, after receiving Moderna vaccine @0800 today. Denies diarrhea or any other symptoms.


VAERS ID: 1423302 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Body temperature increased, Malaise, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, Plavix, Zofran, Benazapril, Metoprolol, Famotadine, Tylenol, Acarbose, Breo Elipta, ASA, Trajenta, Atorvastatin, Incruse Ellipta, Methylprednisone, Xanax, Sertraline, Novolog, Metformin
Current Illness:
Preexisting Conditions: COPD, HTN, CAD, CKD, DM II, PVD
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Resident developed elevated temp of 101.2 with malaise, nausea and vomitting


VAERS ID: 1423374 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-24
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Headache, Injection site pain, Lethargy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: Benazepril and Androgel and Saw Palmetto
Current Illness: Hypogonadism, Hypertension
Preexisting Conditions: Hypogonadism, Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fatigue, pain at injection site, weakness, lethargy, tiredness


VAERS ID: 1423420 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ear swelling, Swelling face
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:
Current Illness:
Preexisting Conditions: HX of Hives
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the second vaccine the patient had a large swollen area starting at the level of her left ear extending down the face to about the jaw


VAERS ID: 1423465 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Lymphadenopathy, Sluggishness
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Patient denies
Current Illness: Patient denies
Preexisting Conditions: Patient denies
Allergies: Patient denies
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient called health department on 6/24/21 @ 0900 to report that she received the 2nd Moderna Covid Vaccine on 6/22/21 and "felt sluggish for a few days, but I woke up this morning and noticed a lump on my collar bone and it moved with I pressed on it". When asked patient reports not having any shortness of breath, difficulty swallowing or dizziness or change of vision. Patient encouraged to contact her PCP but patient reports "I don''t have one, do I need to go to the ER" Nurse once again verified patient was not having any difficulty breathing or any other reportable symptoms.


VAERS ID: 1423470 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-13
Onset:2021-06-24
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 RA / IM

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

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

Write-up: TESTED COVID-19 POSITIVE ON 06/24/2021


VAERS ID: 1423472 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-14
Onset:2021-06-24
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dysmenorrhoea, Menstrual disorder
SMQs:

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

Write-up: Men?s trail period bleeding and cramping


VAERS ID: 1423485 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-11
Onset:2021-06-24
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 - / -

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

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

Write-up: Patient received second dose of Pfizer on June 11th, 2021 and a rash appeared on entire posterior side of back. Patient stated he wanted to come back to Center to get it checked out. Patient also stated that he has a past medical history of hypertension and hyperlipidemia. EMS was called and vitals were taken. EMS advised patient to go to ED and patient complied. BP: 163/108. HR: 86.


VAERS ID: 1423519 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-12
Onset:2021-06-24
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038121A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: birth control
Current Illness: no
Preexisting Conditions: no
Allergies: penicillin seasonal allergies
Diagnostic Lab Data: na
CDC Split Type:

Write-up: severe rash, pain under armpit, rash is painful and spreading , nausea


VAERS ID: 1423531 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-07
Onset:2021-06-24
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arrhythmia, Chest discomfort
SMQs:, Anaphylactic reaction (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

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

Write-up: I have been having heaviness of the chest when leaning forward. And concerning amounts of heart rhythm issues during my normal exercises that I have been doing for years. I thought my heart was going to stop I had my finger over 911 ready to call if it did.


VAERS ID: 1423634 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
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: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose of Moderna COVID 19 vaccine on 6/5/21 and second dose on 6/24/21. Second dose was given too soon; prior to 28 days and prior to the 4 day grace period.


VAERS ID: 1423638 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-12
Onset:2021-06-24
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation delayed, Menstruation irregular
SMQs:, Fertility 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data: Non existent period
CDC Split Type:

Write-up: Period is a week late. It?s never irregular. I was perfectly healthy before this. There is no reason for my period to be late.


VAERS ID: 1423639 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chest pain, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient described increased heart rate and eventually chest pain after 20 minutes of receiving vaccine. Ambulance was called to assist - relayed heart rate and blood pressure was normal and deemed it "situational anxiety". Mom decided to have patient transported to ER.


VAERS ID: 1423704 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: AFTER GETTING VACCINE THE PATIENT STARTED FEELING DIZZY , HE GOT VERY SWEATY , FELT LIKE FAINTING


VAERS ID: 1423713 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

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

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

Write-up: Patient fainted while waiting in the seating area after the vaccine was administered. Paramedics were called and took patient to hospital for further testing and evaluation


VAERS ID: 1423718 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: b/p normal blood sugar normal lungs and pulse normal
CDC Split Type:

Write-up: pt got vaccine at 11:30, went to the waiting area to wait out 15 mins. got light headed, slid out of chair into floor. pharmacist seen her draw up like she was about to seize. pt straightened out and came to. when pt woke up she did not know how she got into the floor. 911 was called. pt was stabilized before 911 arrived. Pt states she had not ate before vaccine was given. Pt was gave a bottle of water and crackers. ems checked B/P, blood sugar, pulse, listened to lungs. all was normal. Pt was slightly light headed but remained instore for monitoring and until resolved. family was called to pick pt up.


VAERS ID: 1423729 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injury associated with device
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: patient was sent to the ER. Was not able to extract the needle with sterile tweezer
CDC Split Type:

Write-up: The needle went into the arm after the vaccine. The syringe 1ml (25Gx1") was used. The needle could not be extracted from the left deltoid.


VAERS ID: 1423750 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW00181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (narrow)

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

Write-up: Mild/Moderate Dizziness/Vertigo


VAERS ID: 1423756 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-18
Onset:2021-06-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Pain in extremity, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: yaz birth control, spironolactone 50nonmg qd
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient parents reported their daughter "froze 2 times like a seizure happened" a few days after the second Pfizer dose had been given. Patient also reported dizziness, arm soreness, and many severe headaches. patient mom said her daughter has recovered, however she continues to have some headaches.


VAERS ID: 1423764 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nothing recorded in our chart, unsure if patient is taking anything.
Current Illness: None reported.
Preexisting Conditions: None reported, per patient she does not see any primary care doctor.
Allergies: None on file.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine that was given was expired. Vaccine was diluted and drawn up at 2pm on 6/23/21 and expired on 6/23/21 at 8pm. Dose was given at 9:20am on 6/24/21.


VAERS ID: 1423770 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Face injury, Fall, Haemorrhage, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: After Moderna vaccine was given patient fainted from a standing position in our waiting area. A one inch cut was sustained to her left forehead in the fall. Patients pulse and breathing were checked while compression to forehead with gauze was used to stop bleeding. EMS responded and took over her care. Patient was transported to medical center.


VAERS ID: 1423792 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Eye pruritus, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Increased SOB." feels like I am breathing through a straw". Itchy rash chest, neck and eyes. " feels like I got hit by a truck".


VAERS ID: 1423802 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: patient indicated via translator pain in the middle of the chest. I requested that he remain in the area of the pharmacy longer time--he refused. I advised him to go to an emergency department if the pain returned or got worse ASAP


VAERS ID: 1423806 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Patient was hospitalized for 7 hours for difficulty breathing , facial numbness and pain


VAERS ID: 1423823 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient was nervous and teary eyed in the vaccination booth, prior to administrating. She is a minor so her Father accompanied her. We were in the booth for a few minutes where I was trying to get her to relax and breathe. Her father was there the entire time. I gave the Pfizer vaccine and she stated "that was it?" She seemed ok upon leaving the booth. Her and her Father sat in the observation area directly in front of the pharmacy. About 5 minutes passed when her Father tapped on the window. Went out to check on the patient and she was pale and little disoriented. She ended up throwing up as well. We gave her a bag so she wouldn''t have to stand up and could stay near her father, to prevent a fall. ?We gave her a cold compress and a water and had her stay for 30 minutes. By the time she left, she had her color back and was able to say that she was feeling much better. Her father was not surprised that she had a reaction like this and stated that she usually has form of reaction like to vaccines. She was ok by the time she left and they both stated they''d be back for the second vaccine.


VAERS ID: 1423843 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-24
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
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: HE HAD CHEST PAIN AT THE NIGHT OF VACCINATION AND IT WENT THROUGH FOR 6 HOURS. FELT BAD FOR 2 DAYS, AND STILL FEEL BAD


VAERS ID: 1424015 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Within minutes of receiving vaccine, pt verbalized feeling dizzy with a headache. Pt became pale and diaphoretic. Pt''s lower extremities were elevated, ice pack applied to back of the neck and vital signs obtained. Juice and crackers were given. Within several minutes, Pt verbalized symptoms resolved and was ready to go home. Pt will lie down to receive second dose of Pfizer vaccine.


VAERS ID: 1424038 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Feeling abnormal, Headache, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: heart , lung disease, COPD, asthma, CAD 7 stents placed
Allergies: morphine and statins cause anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt felt strange followed 5 min later by feeling short of breath and severe pain in head, mild wheezing auscultated


VAERS ID: 1424063 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure decreased, Loss of consciousness, Nausea, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (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: denies
Current Illness: denies
Preexisting Conditions: denies
Allergies: denies
Diagnostic Lab Data: observation
CDC Split Type:

Write-up: pt had nausea vomiting and passed out BP dropped


VAERS ID: 1424071 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-03
Onset:2021-06-24
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Famotidine 20 mg QD, Albuterol nebs tx QID, Fursomide 20 mg QOD, Atorvastatin QD, Miralax QD, Mucinex QD
Current Illness: Diagnosis are: Acute kidney failure, personal history of covid, dementia, g-tube, heart failure, frequent pneumonia
Preexisting Conditions: as above
Allergies: Sulfa antibotics
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: No adverse effects per Assist, at Healthcare Facility.


VAERS ID: 1424099 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: chest pain starting 2am on day following second Pfizer COVID dose, advised pt''s mother to contact physician for guidance. pt''s mother states severity has decreased since that time. Mother reported it to pharmacy at 11:30am.


VAERS ID: 1424158 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: No adverse effects occurred. Janssen was given as pt denied multiple times that he received any COVID-19 vaccines. Pt did wait 15 minutes after administration and no adverse effects.


VAERS ID: 1424163 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-20
Onset:2021-06-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yaz, clonazepam, Prozac
Current Illness: allergic rhinitis
Preexisting Conditions: Anxiety, depression, seasonal allergies
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was seen on 6/8 for same issue, but it was 10 days post covid 19 pfizer vaccine #1. Today, pt is here with similar symptoms but worse; rash covering face, neck, spreading over body; bil periorbital edema, facial edema. Pt''s second covid vaccine was 4 days ago. Today she was prescribed prednisone oral for 9 days and triamcinolone ointment.


VAERS ID: 1424169 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on left leg like dozens of bug bites, slight rash on right leg, fatigue, headache, body aches.


VAERS ID: 1424184 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Not aware of any
Preexisting Conditions: Nothing documented
Allergies: Xanax
Diagnostic Lab Data: Unknown at this time.
CDC Split Type:

Write-up: Patient was stating that he was experiencing chest pain today after his immunization. He was advised to contact his doctor office for further evaluation.


VAERS ID: 1424189 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Syncope, vomiting. Resolved after PO hydration and trendelenberg


VAERS ID: 1424196 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 3 LA / IM

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

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

Write-up: patient had a third dose of the Moderna vaccine by mistake. he received his first dose at another clinic - unknown to us - in January of 2021. Pt then received a 2nd dose at our clinic on 5/27/2021 and then another dose today 6/24/2021 - we thought this was his 2nd dose but when we went to enter his vaccine in the state vaccine registry saw that he had already had two doses.


VAERS ID: 1424200 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
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: Second shot was given 61 days after first shot


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