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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 63 out of 8,010

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VAERS ID: 1760269 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-24
Onset:2021-09-30
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chest discomfort, Diarrhoea, Ear discomfort, Eye pruritus, Headache, Nasal congestion, Oropharyngeal pain, Pain, Productive cough, Sinus congestion, Sneezing, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (narrow), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cefuroxime; Vitamin D; Omeprazole; Oscella; Lialda; Biotin; Flonase
Current Illness: none
Preexisting Conditions: crohn''s disease; dyslipdemia; irriatable bowel
Allergies: humira; remicade
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, sore throat, productive cough at times, body aches, loss of taste, loss of smell, diarrhea not abnormal, sinus congestion, nasal congestion, post nasal drainage, chest tightness, sneezing, ear fullness, itchy eyes. starting 9/30/21


VAERS ID: 1760442 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-11
Onset:2021-09-30
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Nasal congestion, Rhinorrhoea
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: fluticasone nasal BID hydrochlorothiazide-triamterene 25 daily olmesartan 5mg daily omeprazole 40mg daily polyethylene glycol 3350 daily valacyclovir 2gm q12hrs
Current Illness: None documented
Preexisting Conditions: hypertension, impaired fasting glucose, gastroesophageal reflux disease, constipation
Allergies: Codeine - nausea and shaking losartan - cough
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated runny nose and congestion


VAERS ID: 1760456 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-01
Onset:2021-09-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / SYR

Administered by: Pharmacy       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe rash on feet, 2 inches long on left foot and spotty on the right


VAERS ID: 1760466 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Dyspnoea, Fatigue, Heart rate increased, Hypoaesthesia, Mobility decreased, Nausea, Pain, Pyrexia, Weight increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro; Xeloda; Atorvastatin; Aspirin; Calcium/Vitamin D3; Trazadone; Xanax
Current Illness: None
Preexisting Conditions: Metastatic breast cancer
Allergies: None
Diagnostic Lab Data: None as of yet.
CDC Split Type:

Write-up: Within 6 hours of the booster shot, I started having numbness in my fingers, pain in my neck and down to my elbow. I started running a fever of 100.5. The next morning I couldn''t get out of bed; couldn''t lift my head off the pillow. Fever still at 100.5 throughout the second day. Third day fever was gone but the extreme fatigue continued to get worse. Fourth day again extreme fatigue and nausea. Also started bloating. On the 5th day again extreme fatigue. Continued pain in my neck and back and down my arm, as well as general aches and pains throughout my body. My heartrate has risen to 112 beats per minute, and my blood pressure as been around 100/73. I have been having a hard time getting a deep breath. It feels like I am always short on oxygen. My oxygen level has been 93 most of the day. I also have gained 7 pounds since the booster shot. 133 pounds to 140 pounds. Nausea has continued to get worse as well.


VAERS ID: 1760639 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-24
Onset:2021-09-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Rash pruritic, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase, famidotine, Breo Ellipta, Singulair, azelastine HCL nasal spray, zertec, magnesium, Calcium citrate, D3, elderberry, zinc, C, FLO gummie vitamin, and women''s multi.
Current Illness:
Preexisting Conditions: Asthma. Allergies.
Allergies: Allergies to mold, ragweed, animals, grasses, various trees.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling. Pain, itchy rash a week after injection.


VAERS ID: 1760660 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-27
Onset:2021-09-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Fatigue
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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor 10mg
Current Illness: none
Preexisting Conditions: High cholesterol controlled with Lipitor.
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath, pressure/weight on chest, fatigue. Lasted intermittently for two days.


VAERS ID: 1760662 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial pain, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Sexual dysfunction (broad)

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

Write-up: Patient reported numbness and pain on left side of face on same side vaccine was given. Symptoms have continued as of 10/4/21. Patient saw their primary care md, who advised them to continue to monitor symptoms, and hopefully they will pass on their own.


VAERS ID: 1760666 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache
SMQs:

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: Headache, fatigue


VAERS ID: 1761032 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Hyperhidrosis, Pain in extremity, Photophobia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: **Started Metronadizole 500mg BID on 9/28/21 scheduled for 7 days Wellbutrin 150mg BID Zyrtec Probiotics Multivitamins
Current Illness: None
Preexisting Conditions:
Allergies: NKDA or food allergies
Diagnostic Lab Data: None, Did not seek treatment
CDC Split Type:

Write-up: Sore arm developed on day of injection in afternoon 9/29/21 9/30/21 developed fatigue, chills, sweats, felt feverish but no fever, photophobia


VAERS ID: 1761230 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 3 RA / IM

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

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

Write-up: Patient marked on consent form that he had received 2 Pfizer doses at least 6 months ago. It was later discovered his first 2 doses were Moderna and his 2nd Moderna dose was in April.


VAERS ID: 1761241 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Impaired work ability, Nausea, SARS-CoV-2 test negative, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 2nd COVID Shot, headache, arm was really sore
Other Medications: Aimovig
Current Illness: Hearing aid stuck, was removed by doctor I was on antibiotics
Preexisting Conditions:
Allergies: Cipro; Horse
Diagnostic Lab Data: COVID test
CDC Split Type: vsafe

Write-up: I was leaving work and all of a sudden got very nauseous. I went home and pushed fluids and tried getting sleep. I kept vomiting due to the nausea. I was unable to work the next day. I also as still nauseous and I felt like I was going to pass out. I went to the urgent care and was tested for COVID which I was negative for. I was told to keep drinking fluids and rest. I spent 4 days and 3 nights in bed which is very unusual for me. I went into work on Sunday and have been feeling fine ever since.


VAERS ID: 1761274 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pfizer covid second dose 3/30/2021 lot EP6955
Other Medications: Bystolic, Tekturna, Synthroid
Current Illness: none
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, weakens, and high fever for 36 hours. Temp ran from 101 to over 103 for 36 hours.T emp perked at over 103 for 5 hours. Took tylenol for this.


VAERS ID: 1761287 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis, Troponin T increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Elevated Troponin T (417 ng/L)
CDC Split Type:

Write-up: Myocarditis


VAERS ID: 1761297 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-12
Onset:2021-09-30
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / IM

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

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1761330 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Fever, chills, body aches so bad my clothes hurt touching my skin, nausea


VAERS ID: 1761361 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Diarrhoea, Nausea, Pain, Tinnitus, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pneumonia vaccine
Other Medications: Zinc Vitamin D3 and multivitamins Plavix Repatha Metopropel
Current Illness: None
Preexisting Conditions: Diabetes/ Heart disease
Allergies: Morphine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vomiting Diarrhea chills severe stomach cramps nauseous and aches and pains lasting 24 to 48 hours a week later ringing I''m the ear


VAERS ID: 1761382 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Carpal tunnel syndrome, Axillary lymphadenopathy


VAERS ID: 1761413 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 2 RA / IM

Administered by: Public       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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client came to Covid vaccine clinic and attested on consent form that he has never received a Covid Vaccine before. Client provided a dose of Janssen on 9/30/21, and later it was determined that client had already received a dose of Janssen on 5/6/2021.


VAERS ID: 1761536 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-09-30
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207, EW0158 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cough, Decreased appetite, Dyspnoea, Fluid intake reduced, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: unable to eat or drink much or take medications, too weak to do anything, vomiting, fevers, myalgias, cough and SOB.


VAERS ID: 1761543 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Feeling hot, Palpitations, Paraesthesia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Basaglar (glargine) insulin 37 U daily, enalapril 20 mg daily, farxiga 10 mg daily, metformin 500 mg twice daily, niacin ER 500 mg twice daily, pantoprazole 20 mg daily, pravastatin 40 mg daily, spironolactone 25 mg daily, Vascepa 2000 MG t
Current Illness: None
Preexisting Conditions: T2 diabetes, hypertension, gastroparesis with delayed stomach emptying
Allergies: Penicillin, adhesive on silk tape or bandaids.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I received the covid booster on Thursday Sept 30th at approx 11 AM. About 10:30 PM that evening, I felt a cascade of heat starting in my scalp and slowly down the body. Red patches appeared all over my body, pinpricks all over, my heart was tachy and pounding. I took 50 mg benadryl PO and the event completely passed in about 30-40 minutes. The next day, Oct 1, there was a similar event at about 11 AM, and again at 10 PM the evening of Oct 1. Treated as before. Total of 3 events in the 48 hours following the vaccine.


VAERS ID: 1761578 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: Tested + for COVID on 9/4/21 after 9/1/21 exposure.
Preexisting Conditions: none known
Allergies: no vaccine allergies, other allergies unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Recipient developed very painful, swollen lymph node in axilla. 600mg ibuprofen administered at home by recipient and symptoms decreased. After the incident, the recipient recalled that she had received monoclonal antibody treatment after her COVID diagnosis in early September and forgot to mention that prior to receiving the booster vaccination. Symptoms lasted approximately 4 days.


VAERS ID: 1761611 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

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

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

Write-up: Swelling of lymph nodes along left clavicle starting approx 18 hours after injection. No treatment, swelling reduced over the next few days


VAERS ID: 1761664 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-09-30
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1761684 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-06
Onset:2021-09-30
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Respiratory tract congestion, Rhinorrhoea
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: acetaminophen 1000mg BID prn for pain aspirin 81mg daily atorvastatin 20mg daily cholecalciferol 1000IU daily duloxetine ferrous sulfate 325mg daily gabapentin 600mg TID multivitamin daily naproxen 500mg BID Fish Oil 1000mg BID pantoprazo
Current Illness: None documented
Preexisting Conditions: Gastro-esophageal reflux disease, impaired glucose tolerance, dyssomnia, daytime somnolence, peripheral neuropathy, onychomycosis
Allergies: Brewer''s yeast - throat swelling mold - throat swelling
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated Runny nose/Congestion


VAERS ID: 1761720 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-30
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Constipation, Diarrhoea, Fatigue, Injection site pain, Migraine, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Head cold
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intestinal upset - diarrhea/constipation alternately. Migraine headache, nausea, fatigue and injection site pain.


VAERS ID: 1761735 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-09-30
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1761759 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Cold sweat, Dizziness, Electrocardiogram normal, Fall, Feeling cold, Full blood count normal, Metabolic function test, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (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? 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: NKDA
Diagnostic Lab Data: EKG, CBC, CMP, TSH wnl 9/30/21
CDC Split Type:

Write-up: Patient presents for new evaluation of syncope. Patient received this second dose of the COVID-19 vaccine manufactured by Pfizer at 1700 on 9/29/2021. Patient received the patient was taking notes in algebra during second period when she started to feel lightheaded earlier today on 9/30/2021. She requested to go to see the school nurse and was able to walk down the stairs and to the hallway to get to the school nurse. She states that during this time she was "seeing different colors, blacking out," and was very lightheaded. She did not experience syncope during this time. When she got to the school nurse, she called her Grandmother to request for a ride home, then went to lay on bench in clinic - fell onto bench, then became lightheaded, but she was never unconscious. She was clammy and cold. VS at the time were 94/44, HR 50, RR 16. She was responsive and followed commands. She was placed into trendelenberg, placed cold compress on forehead and then she slowly recovered. This lasted for about 7 minutes. VS upon discharge from the office 108/64, HR 86, and RR 20 at 0950. Afebrile during this period of time. Afterwards, she was picked up by her father and was ambulatory home. She endorses that this is not her first experience with lightheadedness. She has felt this way before, but never had syncope, during volleyball games.


VAERS ID: 1761774 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chest X-ray normal, Chest discomfort, Chest pain, Chills, Electrocardiogram normal, Fatigue, Headache, Hyperhidrosis, Influenza like illness, Insomnia, Laboratory test normal, Myalgia, Nausea, Poor quality sleep, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/4/2021 8:00am visited RN. Performed lab tests, EKG, chest xray, all normal. Finally got some much needed rest that afternoon and night.
CDC Split Type:

Write-up: 9/30/2021 2:00pm received covid 19 booster vaccine 5:30pm felt fine and did exercise workout 9:00pm - 6:00am insomnia, did not sleep much at all 6:00 am headache and muscle soreness 7:00am clocked in to work 10:00am headache, muscle soreness, joint pain and fatigue 12:00pm headache, extreme fatigue and joint and muscle pain 3:30pm same as above with chills 4:00pm same as above but severe chills and temp 98.8, slight chest pain 7:30pm same as above with nausea, temp 101.0, bp 154/95, pulse 128 10:00pm fever broke, sweating, pressure in chest, unable to sleep 6:00am most of the flu like symptoms are gone except headache and fatigue, still experiencing chest pain and pressure especially in a reclined position. Subsides when I sit up or walk around. This persisted throughout the day. bp and hr returned to normal. Still very fatigued and still not sleeping well. 6:00am feeling better, not as fatigued. Chest pain and pressure better. Still very tired due to lack of sleep. 8:00am visited RN. Performed lab tests, EKG, chest xray, all normal. Finally got some much needed rest that afternoon and night. 7:00am clocked in to work, feeling better with slight fatigue and headache but much better than previous days.


VAERS ID: 1761779 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-09-30
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1761786 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-09-30
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid positive contact unknown


VAERS ID: 1761899 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 3 RA / IM

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

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

Write-up: Red, itch rash on torso, arms, and legs. Treated with Benedryl and Hydrocortisone cream. Improved overnight and continued improving.


VAERS ID: 1761905 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-01
Onset:2021-09-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Extra dose administered, Injection site pain, Neuralgia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Medication errors (narrow), 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: Metroprol 25 bid, Lisinipril 10 qd, Atorvastatin 40 qd, Vitamens, D3, C, multivite ( over50), Calcium 600 with D,
Current Illness: None
Preexisting Conditions: None
Allergies: Brazil nuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 1 hour after, injection I experienced tachycardia - rate 120''s ( HR usually 60-68) and upper chest and throat pressure, not pain, but a definite felling of air hunger and pressure-felt as though I could not get enough air- the following day had extreme neuralgia (back, shoulder, and legs) plus the L upper deltoid was a 10/10 with movement - still experiencing discomfort today ( 5 days later). I had absolutely no reactions to the other 2 vaccines


VAERS ID: 1761910 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Dizziness, Malaise, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)

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

Write-up: thought he was going to die. Weak, general malaise, feeling like he was going to pass out. developed lump under L arm- painful.


VAERS ID: 1761925 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-09-30
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/4 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1762008 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-23
Onset:2021-09-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762019 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-30
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762026 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Contraception, Menstruation irregular
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo Provera, Onnit Total Human multi vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Lamictal
Diagnostic Lab Data:
CDC Split Type:

Write-up: Period began within hours of receiving vaccine, despite never having period due to Depo Provera shot.


VAERS ID: 1762028 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-09-27
Onset:2021-09-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Cold sweat, Headache
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitiza Aspirin Plavix Centroid Lipitor Dilantin
Current Illness: None
Preexisting Conditions: Coronary Artery Disease Pace Maker Chronic Kidney Disease Epilepsy
Allergies: None
Diagnostic Lab Data: Various Test Ran
CDC Split Type:

Write-up: Elevated blood pressure, head aches, clammy feeling.


VAERS ID: 1762033 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3SE27 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Computerised tomogram, Ultrasound scan
SMQs:, Anaphylactic reaction (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: High cholesterol
Preexisting Conditions: High Cholesterol
Allergies: NKDA
Diagnostic Lab Data: Ultrasound with CT scan
CDC Split Type:

Write-up: Chest tightness


VAERS ID: 1762037 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-09-30
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1762064 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-16
Onset:2021-09-30
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Fatigue, Full blood count, Pain in extremity, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Some fatigue, lightheadedness Ankylosing spondylitis- on Humira
Preexisting Conditions: Ankylosing spondylitis
Allergies:
Diagnostic Lab Data: CBC
CDC Split Type:

Write-up: Lightheadedness, worsened fatigue, shaky-intermittent, lower extremity achiness-bilateral


VAERS ID: 1762111 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cough, Ear congestion, Fatigue, Headache, Inflammation, Muscle spasms, Oropharyngeal pain, Respiratory tract congestion, SARS-CoV-2 test negative, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: Tysabri 1/6 weeks Diazepam 5mg Bupropion 450xl Turmeric 2xday Cayenne 1/day Q-max minerals 2xday Cranberry 1xday
Current Illness: None
Preexisting Conditions: Multiple sclerosis, primary progressive, late stage
Allergies: None
Diagnostic Lab Data: 10/5/2021 COVID negative
CDC Split Type:

Write-up: Severe head pain Sore throat Congestion of sinus, ears, and chest Persistent cough Severe fatigue Inflammation causing more frequent/stronger spasms


VAERS ID: 1762172 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-21
Onset:2021-09-30
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: PATIENT HAD PFIZER VACCINE DOSES ON 01/21/2021 and 02/11/2021, AND TESTED POSITIVE TO COVID.


VAERS ID: 1762194 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Myalgia, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Bad back and neck pain. Right deltoid muscle pain still after 6 days


VAERS ID: 1762202 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 4 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received 4 doses of COVID vaccine. dose 1-2 back in December and January. received a moderna doe in March and we administered the 3rd Pfizer (4th total) dose 9/30/21 unaware of the moderna dose.


VAERS ID: 1762206 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-05
Onset:2021-09-30
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Nephrolithiasis, Urine analysis
SMQs:

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: Zertec. Flonase.
Current Illness:
Preexisting Conditions:
Allergies: Cats. Pollen.
Diagnostic Lab Data:
CDC Split Type:

Write-up: I got kidney stones. I went to the ER that morning and they did a CT scan, as well as draw blood and urine test. They gave me pain meds and told me I have to wait until it passes. As I noted on the app, I don''t think it is related to the shot, but it is a major enough event to document in case there is a connection.


VAERS ID: 1762295 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-29
Onset:2021-09-30
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Fatigue, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid 10/3/2021
CDC Split Type:

Write-up: Client received Pfizer vaccines for Covid on 3/29 and 4/19/2021. Symptoms started 9/30: chills, fever, fatigue. Tested PCR + for Covid on 10/3. Reported as breakthrough Covid case in a fully vaccinated person


VAERS ID: 1762311 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chest X-ray normal, Chest pain, Computerised tomogram thorax abnormal, Drug screen, Dyspnoea, Electrocardiogram, Electrocardiogram normal, Fibrin D dimer, Full blood count, Human chorionic gonadotropin, Hypotension, Laboratory test, Metabolic function test, Pain, Palpitations, Pregnancy test, Pulmonary embolism, Scan with contrast, Sleep disorder, Urine analysis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Drug abuse and dependence (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad), Hypokalaemia (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: Estarylla
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT chest pulmonary embolism with contrast ECG 12 lead X-ray chest PA and Lateral BMP CBC D-dimer Drug Screen I-stat Pregnancy Urinalysis hCG
CDC Split Type:

Write-up: The morning after my daughters vaccine, she was awoken by a stabbing pain in the middle of her back. I personally had all over severe body pain after my 2nd Covid vaccine and thought she was likely going to have the same. We started her on over the counter motrin. Friday morning she said she was having all over pain and some sharp pain in her chest. She also said she felt like her heart was racing. I gave her the pain medicine every four hours on Friday, Saturday and Sunday. She continued to complain about body pain, chest pain and back pain throughout the weekend. Monday morning she said she was still have chest pains, day 5 after the shot, and that she was completely out of breath from walking down the stairs. I called her primary care doctor to take her in and they told me she needed to go to the hospital. Hospital had a 4 hour wait so we went to ER. They did an Xray, EKG, and CT scan with contrast, looking for a blood clot. They did not find one and told us to follow-up with her primary care doctor and a cardiologist. Her blood pressure was much lower in the ER than it usually is.


VAERS ID: 1762698 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-24
Onset:2021-09-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrioventricular block complete, Cardiac pacemaker insertion, Catheterisation cardiac, Electrocardiogram
SMQs:, Conduction defects (narrow), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cholesterol medicine Diabetes medicine Hypertension medicine Glaucoma eye drops
Current Illness: N/a
Preexisting Conditions: Hypertension Type 2 DM Osteoarthritis Glaucoma
Allergies: Penicillin
Diagnostic Lab Data: Ekg 9/30/21 Catheterization 9/30/21 Surgical placement or pacemaker 10/1/21
CDC Split Type:

Write-up: Complete heart block. Required placement of a pacemaker


VAERS ID: 1762858 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-21
Onset:2021-09-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Bowel movement irregularity, COVID-19, Dizziness, Dysstasia, Hyperhidrosis, Loss of consciousness, Malaise, Pallor, Palpitations, SARS-CoV-2 test positive
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sucralfate Tablet 1 GM Give 1 tablet by mouth four times a day related to GASTRO-ESOPHAGEAL REFLUX DISEASE WITH ESOPHAGITIS, WITHOUT BLEEDING (K21.00) Midodrine HCl Tablet 5 MG Give 1 tablet by mouth three times a day for Hypotension ho
Current Illness: OTHER PULMONARY EMBOLISM WITHOUT ACUTE COR PULMONALE (I26.99) 7/30/21 Primary/Principal/Admission (67) Primary/Principal/Admission PAROXYSMAL ATRIAL FIBRILLATION (I48.0) 7/30/21 Secondary #1 Admitting Dx (69) ENCOUNTER FOR SURGICAL AFTERCARE FOLLOWING SURGERY ON THE DIGESTIVE SYSTEM (Z48.815) 7/30/21 Secondary #2 Admitting Dx (69) HYPOKALEMIA (E87.6) 7/30/21 Secondary #3 Admitting Dx (69) OTHER ESOPHAGITIS WITHOUT BLEEDING (K20.80) 7/30/21 Secondary #4 Admitting Dx (69) ADVERSE EFFECT OF UNSPECIFIED DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES, SUBSEQUENT ENCOUNTER (T50.905D) 7/30/21 Secondary #5 Admitting Dx (69) HYPO-OSMOLALITY AND HYPONATREMIA (E87.1) 7/30/21 Secondary #6 Admitting Dx (69) SECONDARY POLYCYTHEMIA (D75.1) 7/30/21 Secondary #8 Admitting Dx (69) COVID-19 (U07.1) 9/24/21 Secondary 9 Or More During Stay PRESSURE ULCER OF LEFT BUTTOCK, STAGE 3 (L89.323) 8/18/21 Secondary 9 Or More During Stay NEED FOR ASSISTANCE WITH PERSONAL CARE (Z74.1) 8/17/21 Secondary 9 Or More Readmission ACUTE POSTHEMORRHAGIC ANEMIA (D62) 8/16/21 Secondary 9 Or More Readmission HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE (I12.9) 8/10/21 Secondary 9 Or More Admitting Dx (69) ACUTE KIDNEY FAILURE, UNSPECIFIED (N17.9) 7/30/21 Secondary 9 Or More Admitting Dx (69) ACUTE KIDNEY FAILURE, UNSPECIFIED (N17.9) 7/30/21 8/16/21 Secondary 9 Or More Admitting Dx (69) BANDEMIA (D72.825) 7/30/21 Secondary 9 Or More Admitting Dx (69) BODY MASS INDEX [BMI]40.0-44.9, ADULT (Z68.41) 7/30/21 Secondary 9 Or More Admitting Dx (69) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) 7/30/21 Secondary 9 Or More Admitting Dx (69) CONSTIPATION, UNSPECIFIED (K59.00) 7/30/21 Secondary 9 Or More Admitting Dx (69) ELEVATED WHITE BLOOD CELL COUNT, UNSPECIFIED (D72.829) 7/30/21 Secondary 9 Or More Admitting Dx (69) ESSENTIAL (HEMORRHAGIC) THROMBOCYTHEMIA (D47.3) 7/30/21 Secondary 9 Or More Admitting Dx (69) GASTRO-ESOPHAGEAL REFLUX DISEASE WITH ESOPHAGITIS, WITHOUT BLEEDING (K21.00) 7/30/21 Secondary 9 Or More Admitting Dx (69) HYPERLIPIDEMIA, UNSPECIFIED (E78.5) 7/30/21 Secondary 9 Or More Admitting Dx (69) HYPOCALCEMIA (E83.51) 7/30/21 Secondary 9 Or More Admitting Dx (69) ILEUS, UNSPECIFIED (K56.7) 7/30/21 Secondary 9 Or More Admitting Dx (69) MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES (E66.01) 7/30/21 Secondary 9 Or More Admitting Dx (69) MUSCLE WEAKNESS (GENERALIZED) (M62.81) 7/30/21 Secondary 9 Or More Admitting Dx (69) OTHER SPECIFIED DISORDERS OF BLADDER (N32.89) 7/30/21 Secondary 9 Or More Admitting Dx (69) OTHER SYMBOLIC DYSFUNCTIONS (R48.8) 7/30/21 Secondary 9 Or More Admitting Dx (69) UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE (M19.90) 7/30/21 Secondary 9 Or More Admitting Dx (69) UNSTEADINESS ON FEET (R26.81) 7/30/21 Secondary 9 Or More Admitting Dx (69) VITAMIN B12 DEFICIENCY ANEMIA, UNSPECIFIED (D51.9) 7/30/21 Secondary 9 Or More Admitting Dx (69) VITAMIN D DEFICIENCY, UNSPECIFIED (E55.9) 7/30/21 Secondary 9 Or More Admitting Dx (69)
Preexisting Conditions: OTHER PULMONARY EMBOLISM WITHOUT ACUTE COR PULMONALE (I26.99) 7/30/21 Primary/Principal/Admission (67) Primary/Principal/Admission PAROXYSMAL ATRIAL FIBRILLATION (I48.0) 7/30/21 Secondary #1 Admitting Dx (69) ENCOUNTER FOR SURGICAL AFTERCARE FOLLOWING SURGERY ON THE DIGESTIVE SYSTEM (Z48.815) 7/30/21 Secondary #2 Admitting Dx (69) HYPOKALEMIA (E87.6) 7/30/21 Secondary #3 Admitting Dx (69) OTHER ESOPHAGITIS WITHOUT BLEEDING (K20.80) 7/30/21 Secondary #4 Admitting Dx (69) ADVERSE EFFECT OF UNSPECIFIED DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES, SUBSEQUENT ENCOUNTER (T50.905D) 7/30/21 Secondary #5 Admitting Dx (69) HYPO-OSMOLALITY AND HYPONATREMIA (E87.1) 7/30/21 Secondary #6 Admitting Dx (69) SECONDARY POLYCYTHEMIA (D75.1) 7/30/21 Secondary #8 Admitting Dx (69) COVID-19 (U07.1) 9/24/21 Secondary 9 Or More During Stay PRESSURE ULCER OF LEFT BUTTOCK, STAGE 3 (L89.323) 8/18/21 Secondary 9 Or More During Stay NEED FOR ASSISTANCE WITH PERSONAL CARE (Z74.1) 8/17/21 Secondary 9 Or More Readmission ACUTE POSTHEMORRHAGIC ANEMIA (D62) 8/16/21 Secondary 9 Or More Readmission HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE (I12.9) 8/10/21 Secondary 9 Or More Admitting Dx (69) ACUTE KIDNEY FAILURE, UNSPECIFIED (N17.9) 7/30/21 Secondary 9 Or More Admitting Dx (69) ACUTE KIDNEY FAILURE, UNSPECIFIED (N17.9) 7/30/21 8/16/21 Secondary 9 Or More Admitting Dx (69) BANDEMIA (D72.825) 7/30/21 Secondary 9 Or More Admitting Dx (69) BODY MASS INDEX [BMI]40.0-44.9, ADULT (Z68.41) 7/30/21 Secondary 9 Or More Admitting Dx (69) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) 7/30/21 Secondary 9 Or More Admitting Dx (69) CONSTIPATION, UNSPECIFIED (K59.00) 7/30/21 Secondary 9 Or More Admitting Dx (69) ELEVATED WHITE BLOOD CELL COUNT, UNSPECIFIED (D72.829) 7/30/21 Secondary 9 Or More Admitting Dx (69) ESSENTIAL (HEMORRHAGIC) THROMBOCYTHEMIA (D47.3) 7/30/21 Secondary 9 Or More Admitting Dx (69) GASTRO-ESOPHAGEAL REFLUX DISEASE WITH ESOPHAGITIS, WITHOUT BLEEDING (K21.00) 7/30/21 Secondary 9 Or More Admitting Dx (69) HYPERLIPIDEMIA, UNSPECIFIED (E78.5) 7/30/21 Secondary 9 Or More Admitting Dx (69) HYPOCALCEMIA (E83.51) 7/30/21 Secondary 9 Or More Admitting Dx (69) ILEUS, UNSPECIFIED (K56.7) 7/30/21 Secondary 9 Or More Admitting Dx (69) MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES (E66.01) 7/30/21 Secondary 9 Or More Admitting Dx (69) MUSCLE WEAKNESS (GENERALIZED) (M62.81) 7/30/21 Secondary 9 Or More Admitting Dx (69) OTHER SPECIFIED DISORDERS OF BLADDER (N32.89) 7/30/21 Secondary 9 Or More Admitting Dx (69) OTHER SYMBOLIC DYSFUNCTIONS (R48.8) 7/30/21 Secondary 9 Or More Admitting Dx (69) UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE (M19.90) 7/30/21 Secondary 9 Or More Admitting Dx (69) UNSTEADINESS ON FEET (R26.81) 7/30/21 Secondary 9 Or More Admitting Dx (69) VITAMIN B12 DEFICIENCY ANEMIA, UNSPECIFIED (D51.9) 7/30/21 Secondary 9 Or More Admitting Dx (69) VITAMIN D DEFICIENCY, UNSPECIFIED (E55.9) 7/30/21 Secondary 9 Or More Admitting Dx (69)
Allergies: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: COVID positive 9-23-2021. 9-30-2021 20:29-aide went to get off toilet. resident stated she didn''t feel good and went to go forward. aide lowered to the ground. resident pale, diaphoretic, resident had on non skid socks. resident had extra large bowel movement at time of episode. resident stated she got light headed and passed out.VS, full assessment, put into bed, notified MD, called family, notified DON, supervisor, UM, intervention: all transfers sit to stand with two assist and PT to evaluate 10-01-2021 08:16am- Resident noted with c/o dizziness unable to stand and c/o heart thumping. VS 120/71, 97.9 115-159, 18 97%ra diaphoretic. Called placed to 911 resident sent out to hospital, called report to ED charge nurse POA is aware and will meet resident at hospital. Resident was A&O at time of transport.


VAERS ID: 1762865 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Depression, Emotional distress, Fatigue, Headache, Lethargy, Nightmare, Pain, Self-injurious ideation, Suicidal ideation
SMQs:, Suicide/self-injury (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid second dose, much like current effects but without the emotional component. That was in the beginning of March. 2021
Other Medications: Levotyroxine, 75 mcg, Testosterone injected bi weekly, Vitamin D, fish oil, cod liver oil.
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Extreme and morose emotionality; crushing depression, onslaught of thoughts of self mutilation and ocassionally suicide. Anxious and fearful dreams. Also, body aches, lethargy, fatigue, headaches. No fever. This is ongoing as of day six following the vaccine. Tomorrow will be one week.


VAERS ID: 1763929 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-09-30
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Heart rate, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: Test Date: 20210930; Test Name: Heart rate; Result Unstructured Data: 110
CDC Split Type: USJNJFOC20211004066

Write-up: HEART RATE OF 110; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 30-SEP-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 30-SEP-2021, the patient experienced heart rate of 110. Laboratory data included: Heart rate (NR: not provided) 110. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from heart rate of 110 on 30-SEP-2021. This report was non-serious.


VAERS ID: 1763934 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Montana  
Vaccinated:0000-00-00
Onset:2021-09-30
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211004078

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a health care professional concerned multiple patients. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 203A21A expiry: 21-SEP-2021) dose was not reported, administered on 30-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-SEP-2021, the patient experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious.


VAERS ID: 1763945 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-30
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache
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: USJNJFOC20211004105

Write-up: HEADACHE; This spontaneous report received from a patient concerned an adult female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 30-SEP-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 30-SEP-2021, the patient experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache. This report was non-serious.


VAERS ID: 1763984 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-09-30
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211006668

Write-up: ADMINISTRATION OF EXPIRED VACCINE; This spontaneous report received from a health care professional concerned 3 patients. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A and expiry: 21-SEP-2021) dose was not reported, administered on 30-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-SEP-2021, the patient experienced administration of expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20211006798 and 20211006371.


VAERS ID: 1764305 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / SYR

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

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

Write-up: headache, chills, fever, nausea, body aches, fatigue


VAERS ID: 1764539 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Arthralgia, Bone pain, Feeling cold, Headache, Pain, Pyrexia, Skin warm, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Osteonecrosis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: I have COVID 4-5 week prior to the vaccine.
Preexisting Conditions: History of migraines
Allergies: Egg allergy
Diagnostic Lab Data: I didn''t go to the hospital or have any testing done.
CDC Split Type:

Write-up: After I went to bed at about 10pm, I kept waking up with feelings of anxiety, even though I wasn''t particuilary anxious about anything. At about 5am, I woke up again with pain in my joints and a headache. During the day, the pain got worse. Almost like when you were a kid and had growing pains - how it ached down to your bones and it just kept getting worse through the day. I had a low fever all day that got worse after about 8pm until I finally fell asleep at around 11:30pm. During this time with the fever my skin was hot to the touch, but yet I was so cold I was shaking, which didn''t help the pain. The next day I woke up and while I kinda felt better, I was extremely sore all over and still had the headache which I more or less had the whole weekend.


VAERS ID: 1764547 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-12
Onset:2021-09-30
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/04 tested PCR positive @ Hospital
CDC Split Type:

Write-up: patient tested positive for COVID-19 $g 14 days after vaccine series


VAERS ID: 1764664 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-16
Onset:2021-09-30
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/5/21 SARS/COV-2, Naat, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1764686 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-01
Onset:2021-09-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Fatigue, Pityriasis rosea, Rash
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aurovela 1.5mg acetaminophen 650mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 10/4 examined in urgent care
CDC Split Type:

Write-up: diagnosed Pityriasis rosea widespread rash followed with extreme fatigue, chills, diarrhea,


VAERS ID: 1764723 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-09-30
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: breakthrough COVID-19 after vaccination


VAERS ID: 1764739 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-22
Onset:2021-09-30
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNK / 2 UN / UN

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

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

Write-up: Patient vaccinated and then tested positive for COVID-19


VAERS ID: 1764751 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:1958-01-11
Onset:2021-09-30
   Days after vaccination:23273
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen, acyclovir, buspirone, calcium citrate, Carafate, cyclobenzaprine, famotidine, levothyroxine, multivitamin, omega 3, pantoprazole, ProAir, sertraline, Topamax, trazodone, vitamin b12, vitamin d3, vitamin e
Current Illness: none
Preexisting Conditions: obesity, anxiety, osteoarthritis, hypothyroid, anemia, s/p bariatric surgery, insomnia, HTN
Allergies: gabapentin, Chantix, keflex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt developed severe diarrhea, nausea, decreased appetite within 24 hours of vaccine administration


VAERS ID: 1764760 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-09-30
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: breakthrough COVID-19


VAERS ID: 1764764 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO183 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Lethargy, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Dizzy, 80, Pfizer Covid 2
Other Medications: Pravastatin, Protonix, Restatis, Mirtazapine, Meloxicam, Multi-vitamin
Current Illness: None
Preexisting Conditions: Lumbar Spondylosis
Allergies: None Known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Nausea, very lethargic, whole body ache, dizzy, elevated temperature, over 24 hour period


VAERS ID: 1764771 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Migraine, Neck pain, Photophobia, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Arthritis (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: Novolog flex fen Tylenol Imitrex
Current Illness: none
Preexisting Conditions: Migraines Diabetes
Allergies: Sulfa
Diagnostic Lab Data: Sent to ER for further Evaluation
CDC Split Type:

Write-up: Patient reports having the worse headache of her life started within 24 hrs after getting covid vaccine Pfzier last week Weds. She states is getting worse. Calls it a "migraine" states her "migraines are usually behind her eyes. This is different. This is in her temples and posterior neck and head. Notes visual changes/Photosensitive. Tylenol and imitrex are not working like her usual migraine medication. Denies fever, chills, nausea, vomiting, diarrhea, cough, shortness of breath. Blood sugars are "normal". Wearing glasses. Last eye exam is up to date.


VAERS ID: 1764781 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Decreased appetite, Fatigue, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Extra-Strength Tylenol, Prednisone 5mg, Lisaprenaprol, Hydrochlorothiazide, Amistad, Aumapramazal, Astrozal
Current Illness: N/A
Preexisting Conditions: Immunocompromised, HBP, High Cholesterol, PMR Arthritis
Allergies: Cipro, Arithamicine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd dose of Booster Moderna 09/30/2021, started experiencing symptoms 09/30/2021 of chills, fever, nausea, fatigue, loss of appetite, and dry cough. Still continuing to experience symptoms, Primary communications still waiting for recommendations.


VAERS ID: 1764862 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphoedema
SMQs:, Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID-19 Moderna, Second Dose -fever, chills, aches, resolved after one day.
Other Medications: Letrozole, escitalopram, vitamin B complex, folic acid, diclofenac potassium, magnesium and calcium supplement, Centrum Silver one-a-day.
Current Illness: None
Preexisting Conditions: No spleen, hemochromatosis, breast cancer ("cured")
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lymphedema under the left arm - worst on day 2, and slowly resolving at day 6.


VAERS ID: 1764897 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-09-30
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A - VACCINE N / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A - VACCINE N / UNK - / -

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

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

Write-up: Patient was vaccinated with two doses of Moderna COVID-19 vaccines on 4/1/2021 and 4/29/2021, then subsequently diagnosed with positive COVID PCR on 9/30/2021 in the ED but was subsequently sent home. Patient then re-presented to the same hospital and this time was admitted on 10/4/2021.


VAERS ID: 1764940 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-18
Onset:2021-09-30
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram head, Facial pain, Laboratory test, Treponema test
SMQs:, Glaucoma (broad), Hearing impairment (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: Levothyroixine 225mg
Current Illness: necortizing cellulitis, neuropathy
Preexisting Conditions:
Allergies: nkda
Diagnostic Lab Data: testing for stroke, CT head, tpa, woods lamp test to check for scrathed cornea
CDC Split Type:

Write-up: i got bells palsy on my right side of face, its very painful and showed up a litle less then 2 weeks after shot and upon talking to the doc i work for, he said i should submit this


VAERS ID: 1764950 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Decreased appetite, Extra dose administered, Fatigue, Nausea, Pyrexia, Respiratory tract congestion, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt. states that after receiving the 3rd dose Booster of Moderna 09/30/2021, started experiencing symptoms 09/30/2021 of fever (103.0), Chills, nausea, vomiting, dry cough, congested, loss of appetite, and fatigue. No noted Primary visit. Still continuing to experience fatigue and loss of appetite.


VAERS ID: 1764960 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-09-30
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Fully vaccinated employee became symptomatic and tested positive for Covid-19.


VAERS ID: 1764971 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (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: blood thinner, tylenol, cholestrol
Current Illness:
Preexisting Conditions:
Allergies: shell fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: dizziness, light headedness


VAERS ID: 1765152 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

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

Write-up: Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash Generalized-Medium


VAERS ID: 1765176 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8889 / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Burning sensation, Chills, Headache, Muscle spasms, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness:
Preexisting Conditions: pulmonary sarcoidosis, fibromyalgia, diabetes II
Allergies: sulfa, garlic,
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: I am having bilateral muscle spasm down my lower leg. I am having my spasms and muscle locking at my ankles. At night I am having upper and lower leg spasms. I also have burning pain near my L5 and S1. I also have bilateral weakness. I have felt feverish but with no fever. I had chills at times, not severe. I wake up in the morning and my legs are burning with pain. I had intermittent on and off headaches which I did not have prior to the vaccine. This pain kicked up again after the booster shot. With each shot, symptoms got worse about 3 days after. I also experienced abdominal pain. I have been referred to a pain clinic by my doctor.


VAERS ID: 1765211 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-07
Onset:2021-09-30
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 RA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1765216 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Hypoaesthesia oral, Injection site pain, Muscle spasms
SMQs:, Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: muscles shaking, quivering (left calf muscle and left thigh), lips go numb, and left arm in injection site still hurts


VAERS ID: 1765239 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-14
Onset:2021-09-30
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Endotracheal intubation, Hypotension, Leukocytosis, Mental status changes, Pneumonia, Respiratory distress, Respiratory failure, Urine output decreased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: 9/30/21: ED for AMS and hypoxic respiratory failure. Hx limited and mainly obtained from EMR review and ED physician. Pt was emergently intubated on arrival to the ED d/t saturating in the 60s. In the ED pt was found to have leukocytosis w/ PNA and was tx w/ Vanc and Cef. Patient has developed sustained hypotension at the time when she was in respiratory distress and getting intubated. Currently patient is on norepinephrine. Her urine output has been declining. Please note: Patient received J&J vaccine on 3/14/2021 Lot # 1805025


VAERS ID: 1765328 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Injection site erythema, Injection site pruritus, Injection site swelling, Listless
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (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: None
Current Illness: None
Preexisting Conditions: Heart trouble with a pacemaker and latest ejection fraction in the high 30s.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen injection site to this day; large(4 inch diameter) red patch which is itchy; listless for 5 days; slept 4 to 5 extra hours per day.; didn?t feel like eating. Felt certain it would go away each night, but it didn?t. Have pictures of site.


VAERS ID: 1765342 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

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


VAERS ID: 1765345 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

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


VAERS ID: 1765416 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-18
Onset:2021-09-30
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1765423 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Immediate post-injection reaction, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe, Systemic: Numbness (specify: facial area, extremities)-Severe, Systemic: Tingling (specify: facial area, extemities)-Severe, Additional Details: numbness, tingling, itching in face immediately after injection, relieved several hours after administration of benadryl


VAERS ID: 1765488 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301258A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head, Fatigue, Gait disturbance, Musculoskeletal stiffness, Postictal state, Seizure, Tremor, Vaccine positive rechallenge, X-ray normal
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Autism Spectrum Disorder Essential Tremor Intermittent Asthma Obesity NEC
Allergies: No known
Diagnostic Lab Data: Normal CT head, Normal lower extremity X-rays
CDC Split Type:

Write-up: Patient had episode concerning for seizure. Was found on floor with stiffened body, arms extended and upper and lower extremity shaking. Episode lasted 8-10 minutes. Patient then experienced likely post-ictal period for several hours in which he was more tired than usual and was dragging his Left leg when he walked. Similar event also occurred after first vaccine dose.


VAERS ID: 1765512 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic shock, Asthenia, Balance disorder, Chest pain, Feeling abnormal, Headache, Heart rate irregular, Hypoaesthesia, Myalgia, Myocardial infarction, Nausea, Pericarditis, Thunderclap headache
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: 2004-2005 Flu Vaccine (Anaphylactic Shock)
Other Medications: Lisinopril
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Opioids; latex; compazine; corn; aspirin
Diagnostic Lab Data: (Cardiologist)
CDC Split Type: vsafe

Write-up: About 40 mins after my vaccine, I started to experience anaphylactic shock. I was experiencing chest pain. I was also having bad headache and muscle pains. I went to the urgent care. They diagnosed it as I was almost having little heart attacks and they sent me to the ER and treated the anaphylaxis. They discharged me and I went back to the ER, and I was being monitored for irregular heartbeat. They discharged me and then I went back. They admitted me to the hospital for 3 days. The hospital was where I was hospitalized. They found that I had inflammation around my heart. I now have no balance, nausea, bad headache, extreme weakness. I also have no feeling in my hands and feet and my jaw is numb. I will be laying around and I feel like my whole body is disconnected. I am still having a bad headache like a clap that will not go away.


VAERS ID: 1765529 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Feeling abnormal, Headache, X-ray
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 2nd dose COVID 19
Other Medications: Hydroxyzine, Losartan
Current Illness: no
Preexisting Conditions: high blood pressure, kidney disease
Allergies: latex
Diagnostic Lab Data: Xray, a test for the proteins of the heart, lining
CDC Split Type: vsafe

Write-up: On the 30th of September after getting my vaccine, I started feeling dizzy and getting a severe headache and felt like my heart was coming out of chest. I went home and almost passed out. My BP was 212/138, my pulse was 156. On the ambulance, my BP 204/187. They gave me aspirin to chew and an IV. I got to the hospital and gave me test, pain medication for my headache and an IV. I was discharged from the ER 5-6 hours later that night. I am still getting really tired.


VAERS ID: 1765563 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-09-30
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Fully vaccinated employee became symptomatic and tested positive for Covid 19.


VAERS ID: 1765613 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 RA / IM

Administered by: School       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: anaphylactic reaction to Flu vaccine, HPV vaccine
Other Medications: Allegra, prednisone, zofran, Cymbalta
Current Illness: ? exposure to rabies
Preexisting Conditions: migraine, endometriosis,bleeding disorder, autoimmune disease
Allergies: Flu vaccine, HPV vaccine, Tetanus vaccine, Phenergan
Diagnostic Lab Data: none
CDC Split Type:

Write-up: approx 25 mins after vaccination, pt presented to the nurse with rash on neck. Benadryl 50 mg given PO at 10:40. symptoms resolved short time later and pt left for home with a ride.


VAERS ID: 1765683 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide-25 mg Pantoprazole Calcium with vitamin D3-600 mg
Current Illness: none
Preexisting Conditions: high blood pressure, GERD
Allergies: Sulfa drugs, amoxicillin, erythromycin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Slight rash and itching at and below injection site; injection site pain, redness and slight swelling; tiredness; headache; muscle and joint pain in injection arm; slight nausea; feeling unwell Symptoms began about 6-7 hours after injection, progressively became worse over the first 24-48 hours , but were mostly gone by 60 hours after the injection.


VAERS ID: 1765890 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-27
Onset:2021-09-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Condition aggravated, Rash, Rash erythematous, Rash pruritic, Rheumatoid arthritis
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: Flu Vaccine-2009
Other Medications: Levothyroxine-88mcg/Daily Predinsone --2 MG/Daily
Current Illness: None
Preexisting Conditions: Rheumatoid Arthritis--diagnosis in 2020
Allergies: Eggs, Dairy, Sulfur, Penicillin
Diagnostic Lab Data: No medical testing at this time.
CDC Split Type:

Write-up: Itchy Red Rash-consisting of small red bumps, on front of shins and forearms--started 3 days after first dose of vaccine. Rash on shins healed within 3 days, rash on forearms is still present after 7 days. Took pictures of forearms and sent to my PCP, also made appointment for an office visit. Also noticed a flare up with my RA--seemed to only last about 5 days.


VAERS ID: 1766436 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Flushing, Lymph node pain, Lymphadenopathy
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Previous COVID-19 Pfizer vaccination (sore arm, flushed feeling and headache)
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting the day after vaccination painfully swollen lymph node under armpit on arm where shot was given. This lasted for 4 days. Felt flushed (warm skin but no fever) started day after vaccination and lasted 2 days. Fatigue the day following vaccination lasting for a day.


VAERS ID: 1766438 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Paraesthesia, Peripheral swelling, Rash, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plaqunil , symbicort, albuterol, Tylenol , microzide
Current Illness:
Preexisting Conditions: Lupus, migraines, chronic sinusitis , asthma
Allergies: Iodine, shellfish, sulfa, penicillin , aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash hives itching -4 hours after receiving second dose. Covid arm-swollen left arm up into shoulder and under arm pain and tingling down entire arm-48 hours after 2nd dose Loose stool -6 days after 2nd dose Taking 10mg steroids 2 times daily and extra strength Tylenol will follow up with PCP 10/14/21


VAERS ID: 1766856 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-09-30
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211008845

Write-up: VACCINE ADMINISTERED ONE WEEK TO 10 DAYS PAST EXPIRATION DATE; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, expiry: 21-SEP-2021) dose was not reported, administered on 30-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-SEP-2021, the patient experienced vaccine administered one week to 10 days past expiration date. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vaccine administered one week to 10 days past expiration date was not reported. This report was non-serious.


VAERS ID: 1766859 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Nevada  
Vaccinated:0000-00-00
Onset:2021-09-30
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Medication error, Off label use
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: USJNJFOC20211008994

Write-up: MEDICATION ERROR/PARTIAL DOSING; OFF LABEL USE AS A BOOSTER AFTER COMPLETING A SERIES OF PFIZER VACCINE; This spontaneous report received from a health care professional concerned a 74 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204B21A, expiry: 11-DEC-2021) 0.3 ml, administered on 30-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-SEP-2021, the patient experienced medication error/partial dosing. On 30-SEP-2021, the patient experienced off label use as a booster after completing a series of pfizer vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the medication error/partial dosing and off label use as a booster after completing a series of pfizer vaccine was not reported. This report was non-serious.


VAERS ID: 1767620 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 3 - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Body temperature, Chills, Immunisation, Nausea, Off label use, Pain in extremity, Pyrexia, Vaccination site warmth
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL; METFORMIN; ATORVASTATIN.
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high (She has high blood pressure and Diabetic); Cholesterol (Verbatim:Cholesterol); Diabetes (She has high blood pressure and Diabetic.)
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Temperature; Result Unstructured Data: Test Result:103; Test Date: 2021; Test Name: Temperature; Result Unstructured Data: Test Result:105
CDC Split Type: USPFIZER INC202101302925

Write-up: My wife just had the third booster shot; My wife just had the third booster shot; She has temperature of 103 may be a temperature of 105 under her armpit; Chills; Nausea; her growing hurt back pain; Leg pain; Injection site where they injected her it feels hot, she said the fire; This is a spontaneous report from a contactable consumer (patients husband). A 53-year-old female patient received third dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: ER8731) via an unspecified route of administration on 30Sep2021 11:00 (at the age of 53years) as dose 3 (BOOSTER), single for COVID-19 immunization. Medical history included Diabetes, High Blood pressure, she has high blood pressure and Diabetic and Cholesterol. Concomitant medications included Lisinopril taken for Blood pressure, Metformin taken for Diabetes, Atorvastatin taken for blood cholesterol. Previously patient received first dose and second dose bnt162b2 (PFIZER-BIONTECH COVID-19, Solution for injection,), dose 1, dose 2 unspecified route of administration on unspecified date as single dose for COVID-19 immunization. On unspecified date 2021 the patient experienced she has temperature of 103 may be a temperature of 105 under her armpit, chills, nausea, her growing hurt back pain, leg pain, injection site where they injected her it feels hot, she said the fire. On 30Sep2021 my wife just had the third booster shot. Reporter stated, my wife just had the third booster shot and she is experiencing chills, nausea, she has temperature of 103 may be a temperature of 105 under her armpit, her growing hurt back pain, leg pain injection site where they injected her it feels hot, she said the fire. Patient received treatment of Tylenol Dosage: 6 tablet 500 mg once a day. The patient underwent lab tests and procedures which included body temperature: 103 body temperature: 105 in 2021. The outcome of the events was unknown.


VAERS ID: 1767775 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Chills, fever, headache and fatigue. for 2 days


VAERS ID: 1768012 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypertension, Nausea, Vaccine positive rechallenge, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (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: pfizer first shot with similiar but lasted a week
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: peniciilin
Diagnostic Lab Data:
CDC Split Type:

Write-up: felt nausea, vomited, then hypertensive with diastolic 110. HR remained stable at 74.


VAERS ID: 1768063 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-27
Onset:2021-09-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: I started bleeding suddenly with sever cramps. The bleeding was very heavy. I have not bled like that in over 6 years. It was so much that I was worried if I was only bleeding from my vagina since a lot of blood would come out when I urinated. My period was due in a week plus so this was abnormal. I am disappointed that that over 30, 000 women have experienced this side effect and yet women have not been warmed or prepared for this!


VAERS ID: 1768118 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Diarrhoea, Euphoric mood, Feeling abnormal, Hyperhidrosis, Insomnia, Malaise, Migraine, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: 2nd Covid vaccine - mild side effect (lasted only 1 day)
Other Medications: None
Current Illness: None
Preexisting Conditions: Bladder cancer, had surgery in April
Allergies: Penicilliln, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe body aches, vomiting, high fever (102 degree), sweating, chills ,can''t keep food down, Migraine headache, nausea, diarrhea, couldn''t sleep, constantly feeling ill. Feeling like someone is "poisoning me." Constant reactions like being "overdosed." Symptoms have lasted at least a week. Still ongoing.


VAERS ID: 1768152 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pain, Pneumonia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Paxil,, Eloquis, Amiodorone, Crestor, Pepcid, Fish oil, Vitamin D, Iron
Current Illness: skin graft procedure 9/21/2021, MOSE procedure 9/20/2021
Preexisting Conditions: COPD, Artial fibrillation, PTSD
Allergies: Keflex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed body aches 2 days after vaccination, fever on day 3 and on day 4 was admitted to hospital with pneumonia.


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