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

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



Case Details (Reverse Sorted by Onset Date)

This is page 66 out of 4,799

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VAERS ID: 1430646 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0579 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Chills, Fatigue, Feeling abnormal, Lymph node pain, Lymphadenopathy, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Perindopril erbumine 4mg Magnesium oxide 400mg D3K2 vitamin supplement B12
Current Illness: None
Preexisting Conditions: Just blood pressure but under control
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain in muscles and joints Fatigue Foggy thinking Fever Chills Upset stomache Swollen lymph nodes under left arm and very painful


VAERS ID: 1430923 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-08
Onset:2021-06-24
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6021 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN3247 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adverse event, Blood lactate dehydrogenase increased, C-reactive protein increased, COVID-19, Confusional state, Cough, Dyspnoea, Endotracheal intubation, Fibrin D dimer, Hypoxia, Lethargy, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Bronchitis
Preexisting Conditions: CHF (diastolic), DM type 2, HTN, HLD, Atrial fibrillation
Allergies: Iodine, morphine
Diagnostic Lab Data: SARS-CoV-2 antigen test: Positive (unknown time/date) SARS-CoV-2 PCR (Roche): Positive - 6/26/21 C-reactive protein (6/25/21) 26.36 mg/dL LDH (6/25/21) 246 u/L D-dimer (6/24/21) 1.12 feu/mL
CDC Split Type:

Write-up: Developed symptoms of SARS-CoV-2 infection including shortness of breath, cough and was tested due to persistence of symptoms despite antibiotic treatment. Antigen testing was positive. Approximately 1 week after symptom onset patient was noted to be lethargic and confused by family who contacted EMS. Patient was hypoxic in ER and required 8 L of O2. Was admitted with COVID-19. Subsequently did decompensate on the floor and required intubation. Currently intubated receiving remdesivir, dexamethasone, and antibiotics.


VAERS ID: 1430928 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary mass, Chills, Headache, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabepentin 300mg at night Vartalon Compositum 1500-1200 mg morning
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Headache, arm and shoulder pain- 06/24/21 4pm Fever, chills, body aches- 06/24/21 11pm Lumps under right underarm- 06/26/21 8am Lumps under left underarm - 06/28/21 8am


VAERS ID: 1430976 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Rash, Rash erythematous, Rash pruritic, Scab, Skin warm
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient presented with red rash and some swelling around elbow area of left arm (which is the same arm as vaccination). Patient reports the rash started approx. 2 pm on 6/24. He reports it is very itchy and warm to the touch. Upper and lower arm not affected rash and swelling was localized to the elbow area. Pt had a few scabs on the area which he reported were due to him scratching the affected area. Patient reports no other symptoms occurred and is already scheduled to see PCP on Thursday to be evaluated. Advised patient on OTC measures he could take at this time (benadyl and topical hydrocortisone) and if condition worsens to seek medical attention sooner.


VAERS ID: 1430994 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-13
Onset:2021-06-24
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Dyspnoea, Electrocardiogram, Hyperhidrosis, Ultrasound scan, X-ray
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: xrays, ultrasound, ekg, cat scan,
CDC Split Type:

Write-up: hard time breathing, profuse sweating.


VAERS ID: 1431007 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. T000892 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NO PRESCRIPTIONS OR OTC MEDICINES. PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.
Current Illness: NO PRESCRIPTIONS OR OTC MEDICINES. PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NO LAB TESTS DONE
CDC Split Type:

Write-up: NO PRESCRIPTIONS OR OTC MEDICINES. PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.


VAERS ID: 1431134 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Electrocardiogram, Magnetic resonance imaging abnormal, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Troponins trended, EKG''s trended, Cardiac MRI, Echo
CDC Split Type:

Write-up: Chest pain, elevated Troponin


VAERS ID: 1431197 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. T000892 / 1 LA / SC

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NO PRESCRIPTIONS OR OTC MEDICINES. PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.
Current Illness: NO ILLNESS
Preexisting Conditions: NO CHRONIC OR LONG STANDING CONDITIONS.
Allergies: NO ALLERGIES
Diagnostic Lab Data: NO MEDICAL OR LAB TESTS DONE
CDC Split Type:

Write-up: PT GOT BOTH MMR VACCINE AND MODERNA VACCINE AT THE SAME TIME. INITIALLY, PT WAS REQUESTING FOR MMR AND NOT MODERNA.PT ALREADY HAD GOT JOHNSON AND JOHNSON VACCINE IN APRIL 2021.COVID VACCINE GOT DUPLICATED.


VAERS ID: 1431214 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia, Muscle spasms, Nausea, Paraesthesia, Vertigo, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Moderna lot# 037k20A given 12/23/2020, age 42, reaction SOB (went to ER)
Other Medications: HCTZ MVI Omega-3
Current Illness: N/A
Preexisting Conditions: HTN
Allergies: NKDA
Diagnostic Lab Data: CBC, CMP, D-Dimer, UA and pregnancy test All seem to be WNL with some values low
CDC Split Type:

Write-up: This is my 3rd time filing this form because their is an error. Hopefully it takes this time Severe SOB, numbness and tingling of hands, legs, and feet. Cramping of thumbs where they are claw like and cannot move. This lasted for 4hours Severe dizziness/vertigo with intractable nausea and vomiting Took 2 meclizine and zofran at home ER gave 1L NS, zofran, toradol, and valium


VAERS ID: 1431246 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Asthenia, Diarrhoea, Muscle spasms, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Guillain-Barre syndrome (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: Wellbutrin, Pepcid AC Ibuprofen 800mg
Current Illness: none,
Preexisting Conditions: Sciatica, Torn hip labrum, depression,
Allergies: Mobic, Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe epigastric pain, nausea, diarrhea, abdominal pain, body aches, muscle spasms, weakness,


VAERS ID: 1431266 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-26
Onset:2021-06-24
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / N/A - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fibrin D dimer, Pulmonary embolism, Pulmonary imaging procedure abnormal
SMQs:, Embolic and thrombotic events, venous (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metoprolol, losartan, atorvastatin, albuterol, insulin, allopurinol, pramipexole, duloxetine, mometasone, amlodipine, pantoprazole, fluticasone, mirtazipine
Current Illness:
Preexisting Conditions: diabetes, chronic obstructive asthma, arthritis, OSA, hypertension, GERD, gout, aortic atherosclerosis
Allergies: enalapril, lisinopril, levofloxacin, losartan, lovastatin, simvastatin, trazodone
Diagnostic Lab Data: chest imaging, D-dimer
CDC Split Type:

Write-up: pulmonary embolus


VAERS ID: 1431314 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-26
Onset:2021-06-24
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

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

Write-up: a month after the 2nd shot I developed shingles


VAERS ID: 1431319 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Impaired work ability, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: About 15 minutes after receiving the vaccine patient stated that she was dizzy and that her head hurt. Patient was advised to sit for 15 minutes and was monitored by pharmacist. After about 10 minutes patient complained of nausea and was advised to sit for 15 more minutes and was monitored by the pharmacist. After about 45 minutes following initial complaint patient stated that nausea subsided but she was dizzy and her head still hurt. Patient was given a note to call out of work upon request and took a cab home. Pharmacist contacted patient evening of 6/24/21 and patient stated that symptoms were gone after resting for the day.


VAERS ID: 1431342 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Restlessness
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: Patient reports tingling in knees and restlessness that started on day of vaccination and has continued since. Patient has been asked to continue following up/reporting with status of the adverse event to healthcare provider.


VAERS ID: 1431354 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Neck pain, Pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Shortly after vaccination client felt intense pain in the right side of her neck radiating down her arm. Client was at the vaccination site in the observation lot at this time, and the Nurse called the ambulance to come assess the client. The client was transported to the ER with the consent of the mother.


VAERS ID: 1431370 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac telemetry normal, Chest pain, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram abnormal, Fatigue, Headache, Magnetic resonance imaging heart, Myocarditis, Pain, Sinus tachycardia, Troponin I increased
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: Presenting ECG on 6/27/21 showed sinus tachycardia at 112 BPM and was otherwise normal (no evidence by ECG for pericarditis) Troponin-I was 4.20 on 6/27/21 at 8:38 am. The troponin-I peaked at 6.30 on 6/27/21 at 2:00pm before trending down. Echocardiogram on 6/28/21 was normal including normal estimated left ventricular ejection fraction of 55%. Cardiac MRI was ordered and pending at this time.
CDC Split Type:

Write-up: Chest pain developed later on the same day as his 2nd Moderna COVID-19 vaccine dose. He presented to the emergency department on 6/27/21. Other symptoms, including body aches, headaches, and fatigue resolved prior to presentation. The chest pain resolved completely by 6/28/21, the day after presentation. He was given ibuprofen for pain management. He was monitored on telemetry without significant events as of the time of this report. He was being treated for a presumed diagnosis of myocarditis secondary to the Moderna COVID-19 vaccine.


VAERS ID: 1431404 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-01
Onset:2021-06-24
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 - / -

Administered by: Private       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine 2.5 mg aspirin 81 mg atorvastatin 10 mg Cozaar 50 mg Eliquis 5 mg ezetimibe 10 mg Lasix 20 mg Lidocaine Pain Relief 4 % topical patch metoprolol succinate ER 25 mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: carvedilol Ceclor cefaclor Crestor hydralazine iodine losartan melatonin rosuvastatin simvastatin St. John''s wort
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: new onset localized eruption both upper arms.


VAERS ID: 1431429 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

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

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

Write-up: pt had already completed course of Pfizer in February , his MD had done a blood assay to test for the antigen it came back as negative and his MD recommended he get the moderna vaccine now - no reaction yet but unsure due to different vaccine


VAERS ID: 1431511 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Cytomegalovirus test negative, Echocardiogram normal, Electrocardiogram ST segment abnormal, Epstein-Barr virus test negative, Full blood count normal, Myocarditis, Respiratory viral panel, SARS-CoV-2 test negative, Sinus arrhythmia, Troponin increased, Viral test
SMQs:, Myocardial infarction (narrow), Disorders of sinus node function (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune 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? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: ADHD
Allergies: none
Diagnostic Lab Data: Troponin: 3.1 (6/26 @ 1830) -$g 0.06 (6/26 @ 2230) -$g 5.03 (6/27 @ 0545) -$g 3.53 (6/27 @ 1030) -$g 3.14 (6/27 @ 1600) -$g 2.8 (6/27 @ 2200) -$g 1.33 (6/28 @ 0400) -$g 0.87 (6/28 @ 1100) CBC unremarkable COVID negative (6/26), Respiratory viral panel negative (6/27), EBV PCR negative (6/27), CMV PCR negative (6/27), remainder of myocarditis panel pending CXR Normal (6.26) ECG 6/26:Normal sinus rhythm with sinus arrhythmia, Nonspecific ST abnormality Echo 6/26: Normal
CDC Split Type:

Write-up: 14 yo male presented with a 3 day history of chest pain after COVID-19 vaccine, found to have elevated Troponin level. Dx most likely myocarditis in the setting of recent COVID-19 vaccine. Patient was started on Ibuprofen 600 mg q6 hr scheduled. Troponin trended q6 hours with subsequent downtrending of Troponins. (Highest troponin 5.03; most recent troponin 0.87 prior to discharge)


VAERS ID: 1431742 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: patient experience pain at site of reaction but also experience numbness at lower left jaw/upper left neck which started a little after an hour after administration. After patient got a good night''s sleep, all symptoms disappeared after about 24 hours.


VAERS ID: 1431984 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: The patient returned for her 2nd Pfizer vaccine after 2 weeks (14 days) instead of 3 weeks. This wasn''t noticed until after the shot had been administered and her vaccination record card was being filled out. Patient was monitored for 15 minutes after and no adverse event were observed


VAERS ID: 1431993 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Malaise, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspirone escital latuda mirtazapine vitamin d prenatal vitamin strattera hydroxyzine ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: Narcotics
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sleeping dizzy feeling sick not eating much


VAERS ID: 1432811 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210654015

Write-up: LEFT ARM SWELLING; This spontaneous report received from a consumer concerned a 38 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043A21A, and expiry: UNKNOWN) dose was not reported, administered on 23-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 24-JUN-2021, the subject experienced left arm swelling. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from left arm swelling. This report was non-serious.


VAERS ID: 1432812 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210654091

Write-up: TEMPERATURE EXCURSION ON PRODUCT; INCORRECT PRODUCT STORAGE; This spontaneous report received from a patient 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: 203A21A, expiry: 07-AUG-2021) dose was not reported, administered on 24-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 24-JUN-2021, the subject experienced temperature excursion on product. On 24-JUN-2021, the subject experienced incorrect product storage. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from temperature excursion on product, and incorrect product storage on 24-JUN-2021. This report was non-serious. This report was associated with product quality complaint: 90000184025


VAERS ID: 1432823 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Paraesthesia, Shoulder injury related to vaccine administration
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad)

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

Write-up: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1432837 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Dyspepsia, Flatulence
SMQs:, Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GLATOPA
Current Illness: Gas; Multiple sclerosis
Preexisting Conditions: Comments: No known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210655821

Write-up: GAS; INDIGESTION; This spontaneous report received from a patient concerned a 59 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included gas/indigestion issues, and multiple sclerosis exposure, and other pre-existing medical conditions included no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043a21a, and expiry: 05-AUG-2021) dose was not reported, administered on 24-JUN-2021 for prophylactic vaccination. Concomitant medications included glatiramer acetate for multiple sclerosis exposure. On 24-JUN-2021, the subject experienced gas. On 24-JUN-2021, the subject experienced indigestion. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from gas, and indigestion on 25-JUN-2021. This report was non-serious.


VAERS ID: 1433146 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-07
Onset:2021-06-24
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: I30.9 - Acute pericarditis, unspecified


VAERS ID: 1433205 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-17
Onset:2021-06-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Discomfort, Joint swelling, Non-pitting oedema, Oedema peripheral, Weight increased
SMQs:, Cardiac failure (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen- PRN
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin causes anaphylaxis.
Diagnostic Lab Data: none to date.
CDC Split Type:

Write-up: Started on 24Jun2021 with left knee swelling. Progressively the swelling has become more systemic. From 25-28Jun2021, I gained 12 pounds in what seems to be ''water weight''. I have pitting edema in my lower legs and non-pitting edema in my abdomen, thighs, and upper legs. I feel ''heavy''. I''ve made an appointment with my primary care doctor for 01Jul2021 and will go to an urgent care-type appointment later today.


VAERS ID: 1433212 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Electrocardiogram normal, Hypotension, Laboratory test, Lethargy, Pain, Palpitations, Pyrexia, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: b12/folate, probiotic, vitamin c, vitamin d, zinc, fish oil
Current Illness: none
Preexisting Conditions: none
Allergies: allergic to egg and dairy, sulfa, propofol
Diagnostic Lab Data: cardiac labs and EKG were normal
CDC Split Type:

Write-up: Had vaccine at 4 pm on 6/23/21 1 am woke to racing heart and palpitation lasted two hours and resolved 6 am woke fever chills and achey 10 am racing heart, palpitations then resolved 1pm severe chest pain, severe tachycardia and low BP Went to ER continued to be tachycardic and low BP, chest pain less, had episode of HR shooting up to 180 and then violently throwing up cardiac labs and EKG were normal left with tachycardia on standing and suggested we follow up with cardiologist asap- appt is 7/6/21 received one bag of IV fluids fever, erratic heart rate and lethargy resolved on 6/27/21


VAERS ID: 1433266 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Heavy menstrual bleeding, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Prolonged menses. Patient stated that she was on the last day of her menses, was having scanty flow. The next day her period was very heavy saturating 3 pads per day from then to now (6days later). Started with headaches, and achy, felt feverish inside and then also had chills. Took Tylenol for other symptoms, but still has heavy menses. Referred her to her GYN physician.


VAERS ID: 1433276 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 1 LA / IM

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

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

Write-up: Unknown - Unable to reach patient''s guardian or patient himself to inquire. Unable to confirm whether or not patient has experienced an adverse event at this time. Patient or his guardian have not been in contact to report an adverse event.


VAERS ID: 1433352 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-12
Onset:2021-06-24
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Anticoagulant therapy, Arthralgia, Atrial fibrillation, Blood sodium increased, Brain natriuretic peptide increased, Cardioversion, Chest pain, Electrocardiogram abnormal, Myocardial infarction, Troponin increased
SMQs:, Cardiac failure (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, arterial (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Date of 6/24/21= Troponin= 0.322, BNP= 148, Na+= 146. EKG= A-Fib with HR of 154 prior to IV Cardiovert.
CDC Split Type:

Write-up: Patient had a Non-STEMI MI on 6/24/21 with new onset A-Fib also. Pt arrived to ER from clinic with c/o chest and Left shoulder pain for 2weeks. Arrived to ER with HR in 150s that converted with IV Diltiazem. Pt showed s/s of MI with elevated Troponin. IV Heparin drip and IV Heparin bolus was given. Pt was transported by helicopter to hospital for further treatment and studies.


VAERS ID: 1433365 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Feeling cold, Malaise, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodopine, Atorvastatin, Vitamin D, Baby Aspirin
Current Illness:
Preexisting Conditions: lower back pain
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Feverish symptoms (feeling cold), body ache, and fatigue


VAERS ID: 1433427 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Skin discolouration
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (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: na
Preexisting Conditions: na
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received his second dose of the Pfizer COVID vaccine around 10 am in his left arm and noticed that later than evening his right forearm changed colors (purple/red). The next day the color had returned to normal but his right hand and middle finger were swollen and purple/red in color. He said he had applied a cream but does not remember what it was. Reports no itching or pain. Followed up with the patient a few days (6 days from administration of vaccine) later. Patient reports they are feeling better and the swelling is gone and color is back to normal. He only used ice and did not take any other medications.


VAERS ID: 1433470 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-17
Onset:2021-06-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Pain in extremity, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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: Mirolax-1x daily Psyllium Fiber 2x daily Fluocinolone - Ears Albuterol Sulfate HFA inhalation aerosol ? as needed Baby Aspirin 1x daily Furosemide 20 mg - 2 x daily Tums ? 1x wk. Melatonin ? 1x wk Azelastine 0.1% as needed (once a week at t
Current Illness: High Blood Pressure only when laying down (low normal during the day when out of bed), Irritable Bowel Syndrome, Cataracts, Periodic Asthma, Sleep Apnea, High Cholesterol , Arthritis, Osteoporosis
Preexisting Conditions: IBS, Periodic Asthma, Sleep Apnea, High Cholesterol, Arthritis, Osteoporosis
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pain for a few days in upper left leg in back and then in front, now it stopped Pain in upper left back, below shoulder, for at least 5 days. Pulsations in left side of back - almost on my side, at night and during the day.


VAERS ID: 1433539 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Second Pfizer Co Vid vaccine given too soon (given at 14 days out instead of 21 days). No harm to patient


VAERS ID: 1433639 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

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

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

Write-up: Second Pfizer Co Vid vaccine given to soon, given at day 14 instead of day 21 d/t scheduling error and not realizing date


VAERS ID: 1433654 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WE0181 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Headache, Injection site pain, Neck pain, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (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: Rosuvastatin 5mg, Thyroid 13.5mcg, Ezetimibe 10mg, Fenofibrate 145mg, Olmesartan 40mg, Metoprolol Succ ER 25mg,
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Entire left arm tingling, weak, pain in injection site area and forearm. Pain continues up left side of neck and head, headache pain on left side of head and front left forehead. General fatigue.


VAERS ID: 1433759 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-12
Onset:2021-06-24
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Injection site reaction, Nausea, Peripheral swelling, Rash erythematous, Rash pruritic, Somnolence, Tenderness, Tremor
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Had large red rash, swollen left arm very swollen. Hurt to touch, nauseating, headache. Slept for hours. Tremors and itchy red rash at injection site.


VAERS ID: 1433891 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cellulitis, Erythema, Induration, Tenderness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1) diclofenac 75 mg tablet Bid 2)cetirizine 10 mg oral table once daily 3)citalopram 20 mg oral tablet once daily 4)Ayuna 0.15mg-30 mcg oral tablet once daily 5)tretinoin 0.04 topical gel 6)tacrolimus 0.03% topical ointment
Current Illness: None
Preexisting Conditions: anxiety obesity scoliosis irregular menses
Allergies: NKDA or NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her second dose of the Covid19 Pfizer vaccine at a Pharmacy on 6/24/2021. Patient was seen in the office on 6/29/2021 for Left arm cellulitis with symptoms of firm bump, red tenderness. Patient was prescribed Keflex 500 mg oral capsule to treat.


VAERS ID: 1433930 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-17
Onset:2021-06-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BUPROPION XR 150mg Doxepin 50mg April 75mg Elderberry gummies
Current Illness:
Preexisting Conditions: Raynauds
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My arm was very sore for 2-3 days after the injection and then got better. That was expected. About a week after I noticed pain in my armpit (maybe a lymph node ?) and also in my elbow. I wasn?t expecting this and This pain lasted cold several days but is gone now.


VAERS ID: 1434021 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Diarrhoea, Dizziness, Feeling abnormal, Flushing, Headache, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Noninfectious diarrhoea (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? No
Hospitalized? No
Previous Vaccinations: Flu and MMR vaccines- his arm would swell up and he would get a super local reaction to his arm.
Other Medications:
Current Illness:
Preexisting Conditions: thrombocytosis, psoriasis disease
Allergies: Gluten, psoriasis disease
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: My son experience after the vaccine around 03:40pm, he felt dizzy, started to black out and passed out. I gave him fluids and called his PCP. I made him eat since he did not eat earlier that day. He states he felt off, I gave him some Tylenol medication. He also had a headaches and started with diarrhea. The next day he stayed in bed, continued with flushed bright red cheeks, diarrhea and the headaches. The day after that he started to feel bit better, I think his symptoms lasted between 36-48 hours. His glucose level was 90.


VAERS ID: 1434071 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Limb discomfort
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Right pinky went numb and is still experiencing numbness. Right arm numbness in hand and blockage feeling in upper arm close to bone.


VAERS ID: 1434093 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: Patient arrived to COVID Pfizer vaccine clinic for second Pfizer vaccine to complete series. Patient was below the approved age of 12 years old for vaccination by one year. Patient has not reported any adverse outcomes.


VAERS ID: 1434509 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-03-11
Onset:2021-06-24
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: A doctor visit to my gynecologist is scheduled for July 8, 2021
CDC Split Type:

Write-up: I am 64 years old. I went through menopause at age 52. I began getting a period after 12 years.


VAERS ID: 1434706 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2020-12-24
Onset:2021-06-24
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 - / SYR

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Blood test normal, Dizziness, Heavy menstrual bleeding, Palpitations, Uterine leiomyoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, Nora Be, Levothyroxine
Current Illness:
Preexisting Conditions: Hypothyroidism, OCD
Allergies: none
Diagnostic Lab Data: Diagnosed with fibroids at ER visit. Blood work was in normal range even though displaying obvious signs of anemia
CDC Split Type:

Write-up: 20 days straight of menstrual bleeding. Weak and dizzy. Heart palpatations.


VAERS ID: 1437037 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-21
Onset:2021-06-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Hypotension, Malaise, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash Generalized-Medium, Systemic: Hypotension-Medium, Additional Details: Patient states that she woke up in the middle of the night a few days after receiving the vaccine feeling unwell. She reports itchy palms, hives, and malaise. She was hospitalized for 2 days and received epinephrine and steroids in the hospital. She is feeling better post-hospitalization.


VAERS ID: 1437056 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pt presented to drive up vaccination site stating he had never received a COVID vaccine. He was then given 1 dose of Pfizer. Upon documentation later that day, it was noted that pt received Janssen in 4/2021.


VAERS ID: 1437386 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-26
Onset:2021-06-24
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 2 trips to ED within 1 week.
CDC Split Type:

Write-up: asthma attack, fever


VAERS ID: 1437448 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-10
Onset:2021-06-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chest pain, Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Urgent care on 6/24/21 Followup with PCP 6/30/21 @ 3:15 Appointment with Cardiologist 7/1/21 @ 9:00
CDC Split Type:

Write-up: Symptoms started on 6/24 at 2:00am: chest pain difficulty breathing horrible cough Per doctor request to take IB profrin and plenty of rest and asthma pump for lungs. As of today, he states the chest pain is minimum and his breathing is better. However the cough is still around mainly in the mornings.


VAERS ID: 1437545 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-12
Onset:2021-06-24
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Tongue biting
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Epilepsy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states that she believes she had a seizure on 6/24/201 that resulted in her biting her tongue while she slept. Patient has been in contact with her neurologist, but has not been able to speak to them regarding the possible correlation between the vaccine and her seizure.


VAERS ID: 1437578 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-24
Onset:2021-06-24
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea, Fatigue, Productive cough
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (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: Fatigue, shortness of breath, coughing up Phlegm


VAERS ID: 1437590 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-18
Onset:2021-06-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Joint range of motion decreased, Pain, Pain in extremity, Sleep disorder
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dotti patch, ibuprofen, recent platelet rich fibrin on 5/26 for dental procedure, compounded testosterone, nicotine patch
Current Illness: dental procedure involving platelet rich fibrin in preparation for implants
Preexisting Conditions: previous smoker, menopause
Allergies: None
Diagnostic Lab Data: None so far
CDC Split Type:

Write-up: severe right arm pain over bicep and tricep, limits ROM, sharp shooting pain down arm, wakes her from sleep, no localized reaction, pulses and circulation are normal, pain does not improving with tylenol or ibuprofen.


VAERS ID: 1437652 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

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

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


VAERS ID: 1437729 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-17
Onset:2021-06-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Deep vein thrombosis, Pain in extremity, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fentanyl, Bactrim, Zinc, Vitamin C, Multivitamin, Folic Acid, Fluticasone, Metoprolol, Oxycodone, Valsartan, Tylenol, Truvada, Melatonin, Dolutegravir, Thiamine, Rosuvastatin
Current Illness: HIV, HTN, CHF, DM, rhabdomylosis, GERD, malnutrition, pressure ulcers, GERD, hyperlipidemia
Preexisting Conditions: HIV, CHF, DM, HTN, pressure ulcers, hyperlipidemia
Allergies: NKA
Diagnostic Lab Data: 06/24/2021 Ultrasound bilateral lower extremities
CDC Split Type:

Write-up: patient with chronic pain to bilateral lower extremities and is followed by wound care. During visit, 6/24/21 an ultrasound of bilateral lower extremities was ordered due to the pain and wounds to both heels. The ultrasound indicated acute occlusive DVT left mid femoral vein segment.


VAERS ID: 1437839 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-06-24
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: G51.0 - Bell''s palsy


VAERS ID: 1437850 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Chills, Palpitations, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, calcium
Current Illness: None/Healthy
Preexisting Conditions: IBS, Heart Palpitations: PVC, PAC - no medications taken for heart.
Allergies: Penicillin, nickel
Diagnostic Lab Data: None - Didn''t see a doctor, figuring shot probably wouldn''t kill me.
CDC Split Type:

Write-up: First pfizer covid shot on 6/2/2021 gave me mild heart palpitations. Called my doc, he said to go head and get 2nd shot. Second shot produced severe chest pain, heart palpitations, along with fever and chills. Second shot symptoms felt as if I was having a heart attack.


VAERS ID: 1437863 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-06-24
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Pulmonary embolism, Systemic inflammatory response syndrome
SMQs:, Embolic and thrombotic events, venous (narrow), Tumour lysis syndrome (broad), Sepsis (broad), Opportunistic infections (broad)

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

Write-up: Pulmonary embolus, right SIRS (systemic inflammatory response syndrome)


VAERS ID: 1437930 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Fatigue, Injection site inflammation, Injection site pain, Nausea, Pain, Pain in extremity, Rash erythematous, Skin burning sensation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The first day fatigue, soreness, nausea. Left arm was very sore. 3 days afterward my arm was burning, red rash, sore and very inflamed at the site of injection. It was very uncomfortable and took over the entire left upper arm. Paid on the bottom side of my upper arm. Slight pain in left chest.


VAERS ID: 1437963 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Product container issue
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Klonopin 2 mg Depakote 500 mg Gabapentin 800 mg Synthroid 50 mcg Risperdal 3 mg Zoloft 100 mg
Current Illness: None
Preexisting Conditions: Hypothyroidism Depression and anxiety
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: The vaccine expires 6 hours after the vial is first punctured. The patient received 1 dose of the vaccine 72 hours after the vial had been punctured. The patient was observed for 15 minutes at the clinic after the vaccine was administered. The patient stated she felt "light headed" 5 minutes after the vaccine was administered. Patient was given water and then became asymptomatic. Patient was then discharged home. No other events have been reported by the patient at this time.


VAERS ID: 1437973 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Expired product administered
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Medication errors (narrow)

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

Write-up: The vaccine expires 6 hours after the vial is first punctured. The patient received 1 dose of the vaccine 72 hours after the vial had been punctured. The patient was observed for 15 minutes at the clinic after the vaccine was administered. The patient stated he felt "light headed" 5 minutes after the vaccine was administered. Patient was given water and then became asymptomatic. Patient was then discharged home. No other events have been reported by the patient at this time.


VAERS ID: 1438014 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-21
Onset:2021-06-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (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: Yes i was taking prescriptions.
Current Illness: No other illnesses.
Preexisting Conditions: Asthma, Migraines, Diabetes
Allergies: No allergies
Diagnostic Lab Data: No medical or lab tests
CDC Split Type: vsafe

Write-up: I had twitching


VAERS ID: 1438041 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Joint range of motion decreased, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Levaquin, Metformin, Lavender Oil, Benadryl
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient awoke from pain from shoulder down to forearm at 9am the morning after her vaccine. She described it as "absolute misery" and she had less than 5% range of motion in her arm. She was transported to a hospital where she was released on 6/26/21 at 4pm. She said she also experienced minor nausea.


VAERS ID: 1438240 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Eye swelling, Gingival swelling, Lip swelling, Pharyngeal swelling, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Postural Orthostatic Tachycardia Syndrome (POTS)
Preexisting Conditions: Postural Orthostatic Tachycardia Syndrome (POTS)
Allergies: Shellfish allergy (swelling of tongue, lips, throat)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of tongue began at 3:42pm. Took Benedryl 25 mg and waited at vaccine clinic for 30 minutes. Lips, eyes, upper gums, and throat also began to swell. Advised by clinic that I could either be observed more at the clinic or go to ER. My husband and I decided to leave (around 4:15 pm) and see if I will improve at home but started getting shortness of breath 5 minutes after leaving, and headed back to the ER. It took about 30 minutes to get processed/checked-in at the ER and received oral Benedryl 25 mg, Pepcid 20 mg, and Prednisone 50 mg at approximately 5:00pm. By about 7:00pm, the swelling had reduced and the ER discharged me around 8:00pm with oral Benedryl 25 mg, Pepcid 20 mg, and Prednisone 50 mg. Today is 6 days after the vaccine and still have continuous minor swelling every day.


VAERS ID: 1438581 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cellulitis, Dysphagia, Induration, Pruritus, Rash, Rash pruritic, Sleep disorder, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Losartan 50mg levothyroxine .125mg
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: Penicillin cephalosporins Clindamycin Carry EPI PEN PREVIOUS ANAPHYLAXIS FROM CEFTIN
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Itch, hives, rash on legs and all over body. Went to walk in clinic , also had rash on left leg, Dr said looked liked cellulitis. Trouble swallowing, could not sleep due to itching and hives . Hard lumps with the itching rash


VAERS ID: 1438587 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Agitation, Amnesia, Asthenia, Blood glucose increased, Blood test, Electroencephalogram abnormal, Loss of consciousness, Magnetic resonance imaging, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol Meclizine Xarelto Vitamins: D,C,B12, Zinc Amlodipine Metoprolol Bumetanide Magnesium Duloxetine Potassium Gabapentin Trazadone
Current Illness: N/A
Preexisting Conditions: A-fib
Allergies: Penicillin Cipro and any meds related to it
Diagnostic Lab Data: MRIs(June 24, 26, EEG(June 26)(findings were abnormal), tons of bloodwork daily, blood sugar high(checked several times during the day , every day
CDC Split Type:

Write-up: Passed out, lost control of bladder, agitated, weak, memory loss, Carried to hospital by ambulance


VAERS ID: 1439533 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Diabetes; High cholesterol; Hypertension; Non-smoker
Preexisting Conditions: Comments: No known allergies
Allergies:
Diagnostic Lab Data: Test Date: 20210624; Test Name: Antibody test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210654376

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned a 63 year old female of unknown race and ethnic origin. The patient''s height, and weight were not reported. The patient''s concurrent conditions included diabetes, hypertension, high cholesterol, abstains from alcohol, and non-smoker, and other pre-existing medical conditions included no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805029, and expiry: UNKNOWN)frequency 1 total, dose was not reported, administered on 26-MAR-2021 to left arm for prophylactic vaccination. No concomitant medications were reported. On 24-JUN-2021, the patient reported that she had Antibody test which came out negative (Confirmed immunological vaccine failure). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint 90000184012. The suspected product quality complaint has been confirmed to be not voided based on the PQC evaluation/investigation performed.; Sender''s Comments: V0:20210654376-Covid-19 vaccine ad26.cov2.s-Confirmed immunological vaccination failure. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1439543 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Iowa  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A24A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Biopsy prostate, Body temperature, Chills, Eye pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210624; Test Name: Biopsy prostate; Result Unstructured Data: Not reported; Test Date: 20210627; Test Name: Body temperature; Result Unstructured Data: Decreased from 102.8 to 101.5
CDC Split Type: USJNJFOC20210660727

Write-up: BODY ACHES; CHILLS; FEVER/TEMPERATURE DECREASED FROM 102.8 TO 101.5; EYES HURTING; This spontaneous report received from a patient concerned a 60 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: 201A24A, expiry: UNKNOWN) dose was not reported, administered on 24-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 24-JUN-2021, the subject experienced eyes hurting. Laboratory data included: Biopsy prostate (NR: not provided) Not reported. On 25-JUN-2021, the subject experienced body aches. On 25-JUN-2021, the subject experienced chills. On 25-JUN-2021, the subject experienced fever/temperature decreased from 102.8 to 101.5. On 27-JUN-2021, Laboratory data included: Body temperature (NR: not provided) Decreased from 102.8 to 101.5. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from fever/temperature decreased from 102.8 to 101.5, and had not recovered from eyes hurting, chills, and body aches. This report was non-serious. This case, from the same reporter is linked to 20210661848.


VAERS ID: 1439544 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210660771

Write-up: VACCINE WAS ADMINISTERED FROM A PUNCTURED VIAL 18 HOURS AFTER BEING USED INITIALLY.; INCORRECT PRODUCT STORAGE; This spontaneous report received from a pharmacist 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: 201A21A, expiry: 07-AUG-2021) dose was not reported, administered on 24-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 24-JUN-2021, the subject experienced vaccine was administered from a punctured vial 18 hours after being used initially. On 24-JUN-2021, the subject experienced incorrect product storage. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccine was administered from a punctured vial 18 hours after being used initially. and incorrect product storage was not reported. This report was non-serious.


VAERS ID: 1440219 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

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

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

Write-up: Error: Booster Given Too Late-


VAERS ID: 1440247 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

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

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

Write-up: Error: Booster Given Too Late-


VAERS ID: 1440531 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-21
Onset:2021-06-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein, Chest pain, Echocardiogram, Laboratory test abnormal, Myocarditis, Red blood cell sedimentation rate, Troponin increased, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: NO
Diagnostic Lab Data: Lab work done 6/26/21, echo and repeat labs done 6/30/21, cardiac MRI will be completed on 07/02/21
CDC Split Type:

Write-up: Chest pain, vomiting after 4 days after vaccine with resultant labs consistent with myocarditis (elevated troponin, ESR, and CRP). Being followed by cardiology.


VAERS ID: 1440550 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-06-24
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Pneumonia
SMQs:, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: J18.9 - Multifocal pneumonia


VAERS ID: 1440579 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-06-24
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

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

Write-up: I63.9 - Cerebrovascular accident (CVA), unspecified mechanism


VAERS ID: 1440781 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Dizziness, Mobility decreased, Neck pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: during night , starting getting real dizzy, feels weak, cant look up or down pt is scared of laying down cannot move has to lay still hurts to move neck, her blood pressure has gone up and has double her pills to compensate for this


VAERS ID: 1440812 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Hypersensitivity, Skin discolouration
SMQs:, Angioedema (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness: No
Preexisting Conditions: No
Allergies: Yes
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: My left hand turned blue. I was diagnosed as a allergic reaction. I was experienced diarrhea, headache, fatigue.


VAERS ID: 1440838 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440845 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440855 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440860 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440868 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440874 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440890 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440894 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440904 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440913 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440916 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440918 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440923 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440929 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440934 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440940 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440943 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440946 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440950 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440954 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1440974 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / IM

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

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

Write-up: VACCINE WAS IN THE FREEZER FOR $g 14 DAYS. IT SHOULD BE MOVED OUT TO THE REFRIGERATOR AFTER 14 DAYS.


VAERS ID: 1441001 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cystoid macular oedema, Optical coherence tomography, Retinal vein occlusion, Retinogram
SMQs:, Embolic and thrombotic events, venous (narrow), Retinal 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hypertension, though she has been off medication for a year and monitoring BP at home.
Allergies: NKDA
Diagnostic Lab Data: OCT macula, fundus photos (both 7/1/21)
CDC Split Type:

Write-up: Patient suffered a central retinal vein occlusion in her left eye with symptoms beginning one day after her Covid 19 vaccination. She has associated cystoid macular edema and required treatment today with an intravitreal aflibercept (Eylea) injection in her left eye.


VAERS ID: 1441130 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0810 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Nausea, Pregnancy test negative, Urine analysis, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen, glucosamine chondroitin, rhodiola, evening primrose oil, multi-vitamin
Current Illness: None
Preexisting Conditions: Uterine fibroids
Allergies: Bug bites
Diagnostic Lab Data: Urinalysis and pregnancy test on 06/24/2021. All negative/normal range.
CDC Split Type:

Write-up: Nausea for a week since second dose, sometimes accompanied by vomiting and diarrhea. Prescribed Ondansetron for nausea.


VAERS ID: 1441321 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

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

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

Write-up: PATIENT HAS SOME REDNESS ON THE ARM, SLIGHT RAISED AREA AT THE INJECTION SITE & COMPLAINS OF ITCHINESS.


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