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From the 7/23/2021 release of VAERS data:

Found 506,830 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 67 out of 5,069

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VAERS ID: 1446423 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Blood culture, Computerised tomogram, Culture urine, Pain, Pyrexia, X-ray
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Pantoprazole, Effexor-XR
Current Illness: Twisted Intestine, Anemia,Peptic Ulcer
Preexisting Conditions:
Allergies: Penicillins
Diagnostic Lab Data: CT Scan X-Rays Blood and Urine Cultures
CDC Split Type:

Write-up: High Fever 102.5 Severe Abdominal Pain Severe Lower Back Pain Body Aches


VAERS ID: 1446427 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 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: The vaccine storage did not meet standards, vaccine stored in freezer beyond allowable time. Recommend revaccination.


VAERS ID: 1446432 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-07-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: The evening after my second dose Pfizer, I had fever and chills all night long. I felt like I was outside in a freezer. I was running a fever and it lasted at least 12 hours. I took Tylenol to reduce my fever and my aches and pains. I got plenty of rest. I am better now.


VAERS ID: 1446473 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Brain natriuretic peptide normal, C-reactive protein normal, Chest X-ray normal, Chest discomfort, Chest pain, Costochondritis, Dyspnoea, Electrocardiogram, Fatigue, Fibrin D dimer increased, Full blood count, Haemoglobin decreased, Influenza A virus test negative, Influenza virus test negative, Lipase, Liver function test normal, Musculoskeletal chest pain, Myalgia, Nausea, Pain, Painful respiration, Pyrexia, Red blood cell sedimentation rate normal, Respiratory syncytial virus test negative, SARS-CoV-2 test negative, Sinus tachycardia, Tenderness, Troponin T normal, Troponin normal, Ultrasound scan, Urine analysis, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Bowel resection a few years ago (occurred during appendectomy) - no further details, not performed at second hospital
Allergies: None
Diagnostic Lab Data: D-Dimer 1.21 mcg/mL Troponin T: < 0.01 ng/mL BNP 56 pg/mL SARS-CoV-2 POCT - negative Influenza A/B POCT - negative RSV POCT - negative Procedure Point of Care Limited Transthoracic Echocardiogram Performed by: Two Drs. Indication: chest pain s/p covid vaccine Technique: Two cardiac view obtained Findings (Effusion): The pericardial space was visualized and was negative for significant effusion Findings (Function): The LV was noted to have normal global function Impression: The focused cardiac ultrasound exam was normal
CDC Split Type:

Write-up: Patient is a 13-year-old who was transferred from another hospital for chest pain in the setting of Covid vaccination. She received her second dose of Pfizer vaccine on Tuesday, June 29. On Wednesday she developed fatigue chest pain shortness of breath weakness, nausea and mild abdominal pain. She also had a fever to 102.5 Fahrenheit. mom is a nurse and took her pulse and felt that it was 30 and fast. She then took 1 with her home equipment it was in the 120s. She called her neighbor who took her pulse and it was in the 130s. She then transferred her to another Hospital for further care at hospital her vital sinus evaluation was a temperature of 37.4 pulse 119 respiratory rate is 15 blood pressure 106/62 satting 98% on room air. On exam she was well appearing with tenderness to palpation of sternum heart rate normal rate and rhythm lungs clear bilaterally and abdominal exam benign. they obtain CBC with white count of 4.8 hemoglobin 12.9 Camm that was unremarkable LFTs are within normal limits troponin that was negative BNP 223 with a normal upper limit of 125 ESR 2 D-dimer 0.697 with upper limit of normal 0.5 and a CRP of 9 with upper limit of normal of 8.1. UA bland. She was given Toradol for chest pain EKG with sinus tachycardia . She was given 1/2 L normal saline bolus ondansetron Toradol and started on maintenance IV fluids of D5 NS. She was then transferred to another hospital for further care . Upon arrival here she notes improvement in her energy level and all of her pain except for her chest pain. She describes it as a pressure on top of her chest that is right in the center and is worse with movement and deep breaths. Of note she had a appendectomy a few years ago that was complicated by surgeons making the bowel and then required her to have a bowel resection. She has no dietary restrictions and eats by mouth, no GI complications in the long-term. PMH: as above PSH: No significant past surgical history FH: Reviewed and noncontributory to current presentation SH: Lives with caregivers Meds: None Allergies: No known drug allergies Immunizations: UTD Review of Systems Constitutional: fever, no chills, no sweats, fatigue Skin: no rash, no lesions, Eye: no redness ENMT: no ear pain, no sore throat, no congestion, no hoarseness Respiratory: + shortness of breath, no cough, no wheezing Cardiovascular: + chest pain, no palpitations, Gastrointestinal: + nausea, no vomiting, no diarrhea, no GI bleeding Genitourinary: no dysuria, no hematuria, Musculoskeletal: + muscle pain, Neurologic: no headache, no dizziness, no numbness, no weakness Psychiatric: no sleeping problems, Allergy/Immunologic: no recurrent infections, Additional ROS info: All other systems of a 10 system review are negative. Briefly, patient is presenting with chest pain, myalgias, and fever in setting of recent covid vaccine (2nd dose Pfizer 2 days ago). Seen at an outside hospital where labs were notable for mildly elevated BNP and D-dimer, negative troponin, normal LFTs and chemistries. Chest x-ray reportedly negative. EKG with T wave inversions in V1 through V4 (read as nonspecific ST changes by their physician), but otherwise normal. Given the possibility of post Covid vaccine myocarditis or PE, transferred for further management. Patient states that after Toradol that she received the outside hospital all of her other symptoms have resolved but she continues to have chest pain. My exam showed: Gen: tired but nontoxic appearing, no acute distress, alert and active; HEENT: PERRL, EOMI, normal conjunctiva, neck supple without LAN; Chest: significant reproducible chest pain; Card: RRR, no murmur, good perfusion, brisk radial pulses bilaterally; Lungs: CTAB, good air entry, no increased WOB; Abd: soft, non-tender, non-distended, no masses; Ext: warm and well perfused, moving all extremities; Skin: no rashes Chest pain. Overall well appearing with normal exam with reproducible tenderness. Given recent Covid vaccine, must consider myocarditis, although only mildly elevated BNP and negative troponin at the outside hospital are reassuring, especially given reproducible pain and reassuring EKG. Symptoms then may represent musculoskeletal etiology such as costochondritis or myositis related to vaccination. Less likely pneumonia or pneumothorax, but possible. Low suspicion for PE given lack of persistent tachycardia (tachycardia improved while in ED, currently HR 80s) or hypoxia. EKG obtained which showed T wave inversions in V1-V4 (normal for age). Bedside ultrasound with normal global function and lack of pericardial effusion. Labs obtained in BCH ED notable for negative BNP and troponin, along with reassuring lipase given abdominal pain. Thus, unlikely to be true myocarditis, more likely musculoskeletal etiology such as costochondritis or chest wall pain. Cardiology will discuss with mom for reassurance. Final Diagnosis 1. Chest pain R07.9 2. Fever R50.9 3. Fatigue R53.83 4. Shortness of breath R06.00 PLEASE NOTE: Since the patient is not from here, we do not have access to her vaccination records and cannot supply lot number, etc.


VAERS ID: 1446488 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-07-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sodium levothyroxine 100mg. 75% 6 days a week Acxion 30mg. 1 daily Metformin 850mg. 1/2 every night Cabergoline 0.5mg. 1/2 tablet 2 times a month
Current Illness:
Preexisting Conditions: Hypothyroidism
Allergies: Gluten shrimp
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe pain in the left armpit.


VAERS ID: 1446504 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site reaction, Injection site swelling, Skin tightness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: Patient has complained of redness at injection site which has enlarged over the past 2 days from inital injection. Also swelling has occured and she also expressed a tightness in the injection site area. She was advised to take benadryl for the redness and we will follow up with her tomorrow to see if redness has resolved or improved.


VAERS ID: 1446536 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes simplex, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion xl 300mg, Naltrexone 50mg, vitamin c 1000mg, zyrtec 10mg, Culturelle probiotic,
Current Illness: None
Preexisting Conditions: None
Allergies: Latex, bacitracin, percocet
Diagnostic Lab Data: Went to er to receive medications to treat outbreak since it was a holiday.
CDC Split Type:

Write-up: Outbreak of Herpes Simplex 1 on face. Approximately 30 hours post injection. Increased swelling in affected area. Went to ER to receive anti viral medications.


VAERS ID: 1446574 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Alopecia, Influenza like illness, Therapeutic response unexpected
SMQs:

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

Write-up: Feeling flu symptoms the next day. Then noticed Saturday, all the hair on my upper right arm fell out. Gradually thinnig to normal mid forearm. My psoriasis on my elbow improved but not disappeared.


VAERS ID: 1446576 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-07-01
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Portal vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow)

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

Write-up: portal vein thrombosis


VAERS ID: 1446595 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Hypotension, Malaise, Nausea, Oropharyngeal discomfort, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: Pfizer
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Cephalexin and penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient b/c diaphoretic, pale w/ facial flushing w/in 3 min of injection. He then c/o feeling dizzy and nauseous. Vitals were stable other than his BP being slightly low at 97/58. After ~10 min he c/o feeling his throat getting a little tight, at which time he was injected w/ 0.3 mg of Epinephrine w/ an auto-injector. His throat started to feel better shortly after, but still felt sick. He was given Cetirizine 10mg along w/ Pepcid 10 mg , but avoided benadryl d/t h/o severe sedation and wanted to keep him alert during the observation period. After 2 hrs of observation, he was feeling much better and all vitals were normal. However, he still c/o some discomfort w/ his throat, so another 0.3mg of Epinephrine was injected using an auto injector. He continued to recover and after another 2 hrs of observation, he was allowed to go home w/ his wife for close monitoring. He was called 1 hr later and confirmed that he continue to do well. He was advised to take 25 mg of Benadryl before going to bed. He was seen the following day and was back to normal.


VAERS ID: 1446605 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Back pain, Fatigue, Myalgia, Nausea, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D Zyzal Calcium, Magnesium & Zinc Iodine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received Moderna 1st dose on Tue 6/29 @0933am. Very mild soreness in left arm Tue and Wed. Otherwise, felt fine until Thu 7/1 around 530pm with the onset of mild lower back pain, hip joint pain, and nausea. Friday and Saturday morning, the pain was severe and eased throughout the days to a dull ache. Hurt to inhale. Saturday afternoon, mild muscle pain in neck and shoulders. General feeling of weakness and fatigue.


VAERS ID: 1446632 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-07-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Electrocardiogram, Feeling cold, Headache, Heart rate increased, Malaise
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: XYZAL AND TYLENOL
Current Illness: NA
Preexisting Conditions: ASTHMA
Allergies: NA
Diagnostic Lab Data: SHE WAS LATER TAKE TO STAND -ALONE ER FACILITY. THEY PERFORMED EKG, BLOOD WORK
CDC Split Type:

Write-up: APPROX AROUND 6:30P MY DAUGHTER COMPLAINED OF NOT FEELING WELL. SHE COMPLAINED OF ELEVATED HEART RATE (138 AND 143), HEADACHE AND FEELING COLD


VAERS ID: 1446646 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. T036820 / N/A LA / IM

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

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

Write-up: Abscess/infection on arm. Fever. Fever presented same day as vaccines administered.


VAERS ID: 1446657 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO169 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Echocardiogram normal, Electrocardiogram T wave inversion, Immunoglobulin therapy, Magnetic resonance imaging heart, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (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? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponin 3.2-- $g5.36-- $g 3.67 Echo with good function EKG shows inverted T-waves Cardiac MRI performed and awaiting read
CDC Split Type:

Write-up: Myocarditis with elevated troponins. Treated with IVIG.


VAERS ID: 1446677 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient developed urticarial rash, fatigue, pruritis approx 12 hours after recieving vaccination.


VAERS ID: 1446777 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-15
Onset:2021-07-01
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: diclofenac,norvasc,fluticosone,cortisone,monovisc,levothyroxine,montelukast, lidocaine
Current Illness: back pain
Preexisting Conditions: thyroid, allergies
Allergies: nkda
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: RASH ON LOWER BACK, SLIGHTLY ITCHY


VAERS ID: 1446827 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cough, Hypertension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Glimepiride, Glipizide, pioglitazone
Current Illness:
Preexisting Conditions: HTN, DM
Allergies: Insulin, Penicillin, Metformin, Sea food, iodine
Diagnostic Lab Data: V/S
CDC Split Type:

Write-up: Cough, HTN 180/90


VAERS ID: 1446841 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Chest X-ray, Dizziness, Flushing, Palpitations, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood pressure monitoring, chest x-ray, blood panel to rule out heart attack
CDC Split Type:

Write-up: Skin flushing on neck, chest and back. Heart pounding, lightheadedness, 60 pt spike in systolic BP lasting over 1 hour. Tingling sensation on upper body including both arms.


VAERS ID: 1446877 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Dyspnoea, Inflammatory marker increased, Intensive care, Myocarditis, Pyrexia, Troponin, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No OTC med was taken at time of vaccine.
Current Illness: No illnesses was none.
Preexisting Conditions: None
Allergies: No allergies
Diagnostic Lab Data: Troponin was 6, and the next day Sunday is 5.
CDC Split Type:

Write-up: Patient started by having fever, chills and vomiting. The next day, he started having chest pain and shortness of breath. Mother took him to Urgent care and then was asked to go to the ER. He was admitted to the ICU for positive cardiac inflammatory markers and diagnosed with Myocarditis.


VAERS ID: 1446893 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-03
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Expired vaccine was injected into the patient. A vial was punctured on 7/2/21 at 1:35pm Central time and kept in proper refrigeration temperatures. Instead of the vial being thrown out after the six hour viability window per the manufacturer, it was used on 7/3/21 and a single dose was injected into the patient. Janssen was contacted after the error was discovered and they could give no guidance as to a course of action to take. There was no recommendation on if the patient should be revaccinated or not. The patient will be contacted regarding the information gathered. No adverse event has been reported from the patient as of yet.


VAERS ID: 1446904 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Patient reported to pharmacy on July 5th to report swelling and pain in right side of face and neck. She was on her way to emergency room or clinic seeking steroids to calm the reaction


VAERS ID: 1446981 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the patient received the second vaccine, he stood up and appeared to become dizzy. He was advised to sit down and began to shake uncontrollably, similar to heat stroke shaking. The pharmacist at the time felt it was necessary to administer an EpiPen. He called family and after about 40 minutes family arrived to take him home. Patient declined emergency care.


VAERS ID: 1446982 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078E24 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alopecia, Blood pressure increased
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? Yes
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: Flu shot 2009 age 38chronic flu like symptoms for 6 weeks
Other Medications: None
Current Illness: None
Preexisting Conditions: Chronic pain
Allergies: Mushrooms
Diagnostic Lab Data: Afraid to seek medical attention
CDC Split Type:

Write-up: Hair loss started 10 hours after injection. With in 90 minutes of dose 2 my blood pressure skyrocketed. We?re talking stroke/heart attack level blood pressure 164/145 146/119 162/100 165/105 144/106 159/102 158/116 156/122 169/152. It?s been 4 days since the second dose and my blood pressure is still high


VAERS ID: 1447022 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-05
Onset:2021-07-01
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dizziness, Fatigue, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Positive COVID test on July 1st Congestion began on July 2nd along with a cough, low-grade fever, dizziness/fatigue


VAERS ID: 1447039 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK LA / IM

Administered by: Unknown       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: Patient was administered vaccine that was kept in freezer 2-3 days longer that prescribed 14 days that manufacturer recommends before moving to fridge for 30 days. Manufacturer was contacted and they stated vaccine was still within limits for safety and efficacy and that no further action was needed.


VAERS ID: 1447072 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-05
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Unknown vaccine or date but patient stated history of syncope about 10-15 years ago.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Following the administration of the second dose patient sat down to wait for 15 minutes. A couple minutes after sitting down patient began to feel "odd" and had a syncope event. Patient hit his head when falling and had some minor bleeding. We immediately attended the patient and called 911 so that he could be checked on. After some time patient felt ok, paramedics attended his wound and checked vitals. Patient''s family came to the pharmacy to pick him up, aside from the wound patient felt ok.


VAERS ID: 1447073 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-10
Onset:2021-07-01
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Fatigue, Myalgia, Nasal congestion, Oropharyngeal pain, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: Rapid test positive done on 7/4/2021
CDC Split Type:

Write-up: Client was vaccinated with Pfizer vaccine for Covid on April 10 and May 1, 2021. She developed Covid symptoms on July 1, 2021 (nasal congestion, chest congestion, fatigue, mild myalgia, sore throat, mild loss of taste and smell). She tested positive with rapid test on July 4, 2021. This case being reported as client was fully vaccinated against Covid illness and became symptomatic and tested positive over 2 weeks s/p vaccination.


VAERS ID: 1447100 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site nodule, Injection site pruritus, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: On 1st the injection site was itchy, red, slight rash and knot developed. Day 5 still itchy and round knot at injection site


VAERS ID: 1447116 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Penicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient felt light headed and passed out which led to falling down on the ground 2-3 minutes after receiving the first dose of the Moderna vaccine. Patient with supported to the ground until EMT showed up and assessed the reaction. The patient felt okay minutes later and refused to go to the hospital with the EMTs.


VAERS ID: 1447156 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-17
Onset:2021-07-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pericarditis, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient states she ended up in the hospital 2 weeks after her 2nd covid shot. She states she had fluid in her lungs and inflammation surrounding her heart. She now has to see a cardiologist for follow up but the Dr. at the hospital said it could have been caused by the vaccine.


VAERS ID: 1449421 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 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? 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: USJNJFOC20210702811

Write-up: VACCINE GIVEN 6 HOURS AFTER THE FIRST PUNCTURE OF THE VIAL; INCORRECT PRODUCT STORAGE; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, expiry: UNKNOWN) dose was not reported, administered on 01-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUL-2021, the subject experienced vaccine given 6 hours after the first puncture of the vial. On 01-JUL-2021, the subject experienced incorrect product storage. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the incorrect product storage and vaccine given 6 hours after the first puncture of the vial was not reported. This report was non-serious.


VAERS ID: 1449433 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210704074

Write-up: TREMOR IN BOTH LEGS FOR THE PAST HALF AN HOUR; This spontaneous report received from a patient concerned a 35 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, expiry: 05-AUG-2021) dose was not reported, administered on 01-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUL-2021, the subject experienced tremor in both legs for the past half an hour. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from tremor in both legs for the past half an hour. This report was non-serious.


VAERS ID: 1449434 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Nevada  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USJNJFOC20210704218

Write-up: SORE ARM; LITTLE FEVER; This spontaneous report received from a patient via a company representative concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN) dose was not reported, administered on 30-JUN-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 01-JUL-2021, the subject experienced sore arm. On 01-JUL-2021, the subject experienced little fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the sore arm and little fever was not reported. This report was non-serious.


VAERS ID: 1449713 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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? 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: USJNJFOC20210703146

Write-up: POTENTIALLY EXPIRED VACCINE ADMINISTERED; INCORRECT PRODUCT STORAGE; This case, from the same reporter is linked to 20210704358. This spontaneous report received from a pharmacist concerned a 64 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: 1816022 expiry: 15-AUG-2021) dose was not reported, administered on 01-JUL-2021 11:50:00 for prophylactic vaccination. No concomitant medications were reported. On 01-JUL-2021, the subject experienced potentially expired vaccine administered. On 01-JUL-2021, the subject experienced incorrect product storage. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the potentially expired vaccine administered and incorrect product storage was not reported. This report was non-serious. This case, from the same reporter is linked to 20210704358.


VAERS ID: 1449985 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-07-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea
SMQs:, Fertility disorders (broad)

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

Write-up: Missed period the following month. Currently 3 weeks later than usual.


VAERS ID: 1449994 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOLOFT
Current Illness: NO
Preexisting Conditions: ECZEMA AND ANEMIA
Allergies: CODEINE AND HYDROCODONE AND BENADRL AND LATEX
Diagnostic Lab Data:
CDC Split Type:

Write-up: RED RASH OVER THE ENTIRE BODY AREA AND THEN PROGRESSED TO ITCHING AND WARM TO THE TOUCH


VAERS ID: 1449996 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: QUINAPRIL 5MG ST JOHNS WORT OTC POTASSIUM OTC MAGNESSIUM OTC IRON OTC COQ OTC MUTLIVITAMIN OTC VITAMIN B COMPLEX OTC
Current Illness: NONE; PATIENT STATED ON THE DAVY SHE RECEIVED THE VACCINE THAT HER PLATELETS ARE LOW
Preexisting Conditions: HYPERTENSION LONG STANDING
Allergies: PERCOCET
Diagnostic Lab Data:
CDC Split Type:

Write-up: arm began to swell with rash 2 days post injection and has been prolonged for 4 days post injection and is now starting to resolve. The patient did self treat with OTC topical hydrocortisone to resolve


VAERS ID: 1450038 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

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

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

Write-up: itching behind ears and head on 07/01/2021, hives appeared on 07/02/2021 , swelling of lips 07/02/2021. went to hospital was given IV Benadryl and histamines, pepcid, and epi pen for emergency, discharged on 07/03/2021 with medrol dose pack and pepcid and OTC Benadryl, on 07/03/2021 evening rash intensified all over body, itching increased, woke up sunday 07/04/2021 both eyes swollen. went back to the hospital was given more IV Benadryl and increased mg of prednisone at 60mg daily. woke up monday with rash still present. seen pcp on 07/06 and was referred to a allergist due to body being covered and prednisone not working.


VAERS ID: 1450058 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / SYR

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

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

Write-up: On July 1, 2021, I felt chest pain around 6pm. 10 times, each lasting 1 second. My heart rate was 95, higher than my normal 75. On July 2, 2021, I felt chest pain 3 times around midnight, 2 times around 2am, 2 times around 7am, 1 time around 9:30am. The above chest pain each lasting 1 second. But at 6:10pm I felt chest pain once, lasting 2 seconds and more dull than previous ones. I have never had any chest pain before the Pfizer covid vaccine. I called my pediatrician''s office in the evening of July 1 and was told to rest and observe. I saw my pediatrician at 10:30am on July 2. My blood pressure is normal and heart rate is above 90. My doctor told me it was obvious the side effects of covid vaccine.


VAERS ID: 1450159 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-02-03
Onset:2021-07-01
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoxia, Pneumonia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (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? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 7/1/2021 - still inpatient. Pneumonia and hypoxemia


VAERS ID: 1450183 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-03
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 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: N/A
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Vaccine given to minor, 17 year old although guidelines state 18 years and older for Janssen vaccine. Patient and mother notified of error. No adverse reactions at this time.


VAERS ID: 1450188 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, Chills, Decreased appetite, Fatigue, Pain
SMQs:, Neuroleptic malignant 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chills was initial symptom, followed by moderate temperature (99 - 103), general fatigue & body ache, loss of appetite. Symptoms sustained for 48 hours.


VAERS ID: 1450239 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Axillary pain, Body temperature increased, Chills, Cough, Fatigue, Headache, Influenza like illness, Nasal congestion, Nasal discharge discolouration, Nasopharyngitis, Oedema peripheral, Pain in extremity, Pyrexia, Rhinorrhoea
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (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: None
Current Illness: Sore throat.
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Day after: Sore arm Following day: fever, chills Following day: headache, cold/flu-like symptoms Following day: Underarm pain and swelling, cold/flu-like symptoms (stuffy nose, fatigue, mucus from nose-green/yellow) Today is Tuesday, almost a week since vaccine: cough, a lot of mucus from nose, temp is 99.1, underarm pain is diminishing.


VAERS ID: 1450253 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-20
Onset:2021-07-01
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM

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

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

Write-up: TEST POSITIVE FOR COVID 07/01/2021


VAERS ID: 1450269 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Erythema, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: I had a cold (tested negative for covid) 2 weeks prior
Preexisting Conditions: asthma
Allergies: cats, pollen, amoxicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Arms, neck, and back of head turned red and itchy, shortly followed by mild shortness of breath


VAERS ID: 1450273 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia
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: Remicade, Hydroxychloroquine, Restasis
Current Illness:
Preexisting Conditions: Chrohn''s Disease, Ulcerative Colitis, Remicade induced Lupus
Allergies: dicloxacillin
Diagnostic Lab Data: The emergency room was so full I was unable to be treated for any of my symptoms.
CDC Split Type:

Write-up: I received the vaccine in my left arm around 11:00 am on June 30, 2021. Tingling/Numbness started in my right arm at approximately 2:00 am July 1, 2021. The tingling/numbness remained in the right arm and traveled into my right leg at approximatey 3:00 pm. Around 12:00 am the tingling and numbness were still in my right arm and leg, and now traveling up my left leg. By 8:00 am the tingling and numbness had subsided.


VAERS ID: 1450283 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / N/A LA / IM

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

Write-up: Patient reported to PCP that she received Moderna Covid19 vaccine (lot 006C21A) at another facility on 5/20/21 and then received one dose of Pfizer vaccine as documented here on 7/1/21. Patient denied adverse reaction to either, simply concerned whether further doses would be required. No further doses administered of either product.


VAERS ID: 1450316 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A - / IM

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

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

Write-up: Individual presented for vaccination for Covid-19. Right after the vaccinator administered the Janssen vaccine without issue the data collector realized he had completed a series of vaccination with the Moderna product on 3/27/2021. He was observed for about 30 minutes post-vaccination without issue. He was informed that he had received a dose of Janssen but was already vaccinated with the Moderna series and should not seek further vaccination.


VAERS ID: 1450338 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-22
Onset:2021-07-01
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Erythema, Limb discomfort, Peripheral swelling, Rash erythematous, Rash pruritic, Rash pustular
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pussy sores and a rash on my arms and legs. Covid toes except it is my entire sole of my foot. My feet are red, swollen and feel tight and on fire. I felt better with massage and a hot shower but it is lingering. Half of my body is rash like and the other is sores that have a small amount of puss in the center. Very itchy and on fire. After benedryl lotion the rash is just red raised and present.


VAERS ID: 1450415 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-02
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA156051 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, ipratroprium, fluoxetine, losartan, budesonide suspension for inhalation
Current Illness: None
Preexisting Conditions: COPD, hypertension, obesity, anxiety, bipolar 2 disorder
Allergies: gatifloxacin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was 2 days out of date when administered. No adverse event seen


VAERS ID: 1450423 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-28
Onset:2021-07-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Moderna Dose 1, face rash
Other Medications: None
Current Illness: None
Preexisting Conditions: Seborrhic Dertmatitis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Face hives broke out on Thursday, June 24th Eyes swole up on Friday, June 25th


VAERS ID: 1450442 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown (pt does not fill rx''s at our pharmacy)
Current Illness: None
Preexisting Conditions: Has had prior adverse reactions to needle sticks (i.e. drawing blood, other vaccinations) - would get lightheaded/faint
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s hands felt tingly, was very lightheaded, broke out in cold sweat. After about an hour of lying down, patient felt fine and was able to walk on his own.


VAERS ID: 1450518 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-15
Onset:2021-07-01
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/2/2021- SARS Coronavirus-2, PCR detected
CDC Split Type:

Write-up: Developed s/s of COVID 7/1, tested positive for COVID 7/2


VAERS ID: 1450537 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anion gap decreased, Basophil percentage decreased, Blood creatinine increased, C-reactive protein increased, Chest pain, Chills, Condition aggravated, Cytomegalovirus test, Cytomegalovirus test negative, DNA antibody negative, Enterovirus test negative, Eosinophil percentage decreased, Epstein-Barr virus antibody negative, HIV antigen negative, Haematocrit increased, Human herpes virus 6 serology negative, Immature granulocyte count, Lymphocyte percentage decreased, Monocyte percentage increased, Myocarditis, Neutrophil count increased, Neutrophil percentage increased, Painful respiration, Parvovirus B19 test negative, Protein total increased, Pyrexia, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Serum ferritin increased, Streptococcus test, Troponin increased, Vomiting, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allergy serum 1 dose Q28 days
Current Illness:
Preexisting Conditions: Allergic rhinitis
Allergies: no known allergies
Diagnostic Lab Data: Chem profile 7/1/2021 07:57 Sodium Level: 138 Potassium Level: 4.4 Chloride: 104 Bicarbonate Level: 26 Anion Gap: 8 (L) BUN: 11 Creatinine: 0.95 (H) Modified Schwartz eGFR: $g=60 Glucose: 129 (H) Calcium: 9.4 Alkaline Phosphatase: 168 Albumin: 3.9 Protein, Total: 8.1 (H) AST: 20 ALT: 29 Bilirubin, Total: 1.0 7/2/2021 06:35 Sodium Level: 139 Potassium Level: 4.5 Chloride: 106 Bicarbonate Level: 24 Anion Gap: 9 BUN: 10 Creatinine: 0.68 Modified Schwartz eGFR: $g=60 Glucose: 106 (H) Calcium: 9.6 cardiac profile 7/3/2021 11:49 hsTnT: 1,367 (HP) hsTnT Interpretation: Critical (P) 7/3/2021 18:26 hsTnT: 1,474 (HP) hsTnT Interpretation: Critical (P) 7/4/2021 00:05 hsTnT: 1,457 (HP) hsTnT Interpretation: Critical (P) 7/4/2021 06:03 hsTnT: 1,070 (HP) hsTnT Interpretation: Critical (P) 7/5/2021 07:57 hsTnT: 206 (HP) hsTnT Interpretation: Critical (P) Hematology 7/1/2021 07:57 WBC: 14.13 (H) RBC: 5.29 Hemoglobin: 15.2 Hematocrit: 44.8 MCV: 84.7 MCH: 28.7 MCHC: 33.9 RDW: 13.6 Platelet: 217 MPV: 10.3 Neut Auto: 80.0 Immature Granulocyte Automated: 0.5 Lymph Auto: 9.1 (L) Monocytes Automated: 10.0 Eos Auto: 0.2 Basophil Auto: 0.2 NRBC Auto: 0.0 Neutrophil Absolute Count: 11.30 (H) Immature Granulocyte Absolute Count: 0.07 (H) Lymph Absolute: 1.28 Mono Absolute: 1.42 (H) Eos Absolute: 0.03 Baso Absolute: 0.03 NRBC Absolute: 0.00 Sed Rate: 9 anemia profile 7/1/2021 14:47 Ferritin: 202 (H) Infectious Disease 7/1/2021 07:42 COVID-19 PCR: Not Detected 7/1/2021 14:14 RESPIRATORY PATHOGENS BY FILM ARRAY: Rpt COVID-19 PCR: Not Detected 7/1/2021 14:47 Anti-DNase B Titer, S: 147 CMV IgG Ab: Negative CMV IgM Ab: Negative EBV VCA IgM: Negative EBV DNA QUANT: Rpt EBV VCA IgG: Negative EBV Nuclear Ab: Negative Parvo B19 IgG: Negative COVID-19 Anti-Spike Antibody: Positive (A) COVID-19 Anti-Nucleocapsid Antibody: Positive (A) COVID-19 Antibody Interpretation: See Comment Interpretation: SEE COMMENTS ADENOVIRUS PCR QUANTITATIVE: Rpt Adenovirus DNA Quant: 0 CMV DNA QUANT BY PCR: Rpt CMV DNA, Quant: 0 Enterovirus qRT-PCR (serum): Not Detected EBV DNA Quant: 0 Parvovirus B19 qPCR (serum): Not Detected HHV6 qPCR (Serum): Not Detected Parvovirus B19 IgM Ab: Negative HIV 1/2 Ab Ag Screen: Nonreactive
CDC Split Type:

Write-up: Pt mother called and stated that pt is vomiting and has a fever of 101.9 pt mother state that pt received the second dose of COVID vaccine on 6/29/21 and now he is having these symptoms. Pt mother state that pt had these symptoms before with the first dose however they resolved on there own. Pt is now complaining of chest pain is unable to take a deep breath because it causes him pain. Patient Has not attempted treatment at home. CHIEF COMPLAINT: VOMITING (one episode of vomiting this morning) and FEVER (fever started on Wednesday) Assessment/Plan DIAGNOSIS at time of disposition: 1. Acute myocarditis, unspecified myocarditis type 2. Acute chest pain 3. COVID-19 virus not detected Patient presents with chest pain 2 days after 2nd COVID-19 vaccine. Labs were obtained and his troponin is elevated to 122 and his CRP is also elevated. I discussed case with ID, recommended admitting to Cardiology for workup for myocarditis. 14 y/o previously healthy male who presented to hospital after onset of chest pain, fever, chills, and vomiting this morning. Found to have elevated troponin and mild ST changes on EKG. Patient recently received 2nd Pfizer-BioNTech COVID vaccine on 6/29. Admitted for close monitoring and further work up of suspected myopericarditis following COVID vaccination.


VAERS ID: 1450649 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

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

Write-up: Patient received the vaccine Wednesday June 30th, and woke up Thursday July 1st with a fever. He called to let us know about his fever on Monday July 5th and said it persisted through the weekend.


VAERS ID: 1450657 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-01
Onset:2021-07-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anosmia, COVID-19, Chest X-ray normal, Cough, Diarrhoea, Influenza virus test, Malaise, Pain, Pulmonary granuloma, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, HLD and PDA closure in childhood
Allergies: NKA
Diagnostic Lab Data: Diagnostic Results (07/01/2021 22:10 CDT XR Chest Portable) FINDINGS: Normal cardiomediastinal silhouette. No focal parenchymal process. Scattered pulmonary granulomata. No pleural effusions. No pneumothorax. No acute osseous abnormalities. IMPRESSION: No acute cardiopulmonary findings which can be seen in early COVID-19 pneumonia.
CDC Split Type:

Write-up: Patient also reporting cough, body aches, malaise, and diarrhea for ~4-5 days; unable to pin down date of onset. He reports loss of smell that he endorses as 2/2 congestion. Patient vaccinated for COVID with 2nd dose in March, but brother and father were not and are currently treated for it with his father still in the hospital. At OSH, COVID + flu PCR combination swab + for COVID. No oxygen requirement.


VAERS ID: 1450662 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-07-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ischaemic stroke
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow)

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

Write-up: Stroke (ischemic)


VAERS ID: 1450664 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Chest pain, Cytomegalovirus test, Electrocardiogram ST segment elevation, Enterovirus test, Epstein-Barr virus test, Human herpes virus 6 serology, Immunoglobulin therapy, Intensive care, Parvovirus B19 test, SARS-CoV-2 antibody test positive, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 7/4/21 COVID19 spike ab positive Pending blood/serum tests: Enterovirus PCR, parvovirus PCR, HHV6 PCR, COVID19 nucleocapsid Ab, EBV panel, Adenovirus PCR, CMV PCR, EBV PCR
CDC Split Type:

Write-up: Healthy 16yr old boy with no PMHx. Received dose #1 vaccine on 6/9/21 and dose #2 6/30/21. Developed chest pain on 7/1 relieved temporarily with Tylenol but returns when Tylenol wore off. Progressive worsening over next 2 days. Mom took pt to Urgent Care 7/3 who referred pt to ER. EKG with diffuse ST elevation, no fever, Troponin elevated at 11. Afebrile. He was transferred to our hospital and admitted to PICU 7/3. Chest pain initially improved with ibuprofen but worsened on hospital day #2 with higher troponin. Started on IVIG and solumedrol, ibuprofen changed to Toradol with good response. No pressors, otherwise hemodynamically stable.


VAERS ID: 1451963 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078CZIA / 1 - / SYR

Administered by: Work       Purchased by: ?
Symptoms: Ageusia, Anosmia, Axillary pain, Lymphadenopathy, Pain in extremity, Parosmia
SMQs:, Taste and smell disorders (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: The day after my arm was sore and 2 days after. Swelled lymph nodes in arm and the lymph nodes in armpit. I have a lot of pain in armpit. Then like around the 3 rd Maybe 4 days after. I notice my smell is off and hardly can taste food. And as of today july/6 i still hardly can smell or taste anything. My armpit lymph nodes still swelled and still in pain. My hole arm is not sore no more. Just the armpit


VAERS ID: 1452195 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Injection site vesicles
SMQs:

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

Write-up: Right arm blistered at the injection site and the spot is still there


VAERS ID: 1452601 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-07-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Decreased appetite, Diarrhoea, Dyspepsia, Emotional distress, Headache, Immobile, Irritability, Loss of personal independence in daily activities, Nausea, Pain, Pain in extremity, Pyrexia, Sneezing, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Adverse reaction after 1st vaccination (similar to COVID-19)
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None, recommended by physician by virtual/ZOOM appointment.
CDC Split Type:

Write-up: Headache, chills, fever, irritability, no appetite, cough, sneezing, body aches, immobilized, heartburn, sore arm, emotional, unable to care for my children, nausea, diarrhea, vomiting,


VAERS ID: 1453082 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-22
Onset:2021-07-01
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Heavy menstrual bleeding, Postmenopausal haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Seroquel, Furosemide, Rouvastatin, Zoloft, Ropinerole
Current Illness: None
Preexisting Conditions: Depression/anxiety, high cholesterol
Allergies: None
Diagnostic Lab Data: None at the moment but have a doctor?s appointment scheduled for July 15 @ 9am
CDC Split Type:

Write-up: After 9 months of being without a period due to menopause, had menstrual flooding out of no where that is heavy for a day or two, then goes away, then comes back. At the time of this notice, it is still ongoing and has not resolved. Heaviest period I have EVER had in my life with extreme abdominal pain/cramping that I have NEVER had before.


VAERS ID: 1453597 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Headache, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXCEDRIN EXTRA STRENGTH
Current Illness: Asthma; Gastrointestinal disorder; Pain; Spinal stenosis; Uterine cancer
Preexisting Conditions: Medical History/Concurrent Conditions: Back surgery (She had a back surgery in the past due to severe neck and back issues and uses a walker.); Hysterectomy; Comments: The patient was not pregnant at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210703446

Write-up: PAIN EVERYWHERE; SHORTNESS OF BREATH; HEADACHE; MUSCLE ACHES ALL OVER BODY; This spontaneous report received from a patient concerned a 56 year old female. The patient''s weight was 120 pounds, and height was 64 inches. The patient''s past medical history included back surgery, and hysterectomy, and concurrent conditions included spinal stenosis, asthma, pain, gastrointestinal disorders, and uterine cancer, and other pre-existing medical conditions included the patient was not pregnant at the time of vaccination.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, and expiry: UNKNOWN) dose was not reported, administered on 01-JUL-2021 for prophylactic vaccination. Concomitant medications included acetylsalicylic acid/caffeine/paracetamol for pain everywhere, shortness of breath, headache, and muscle aches all over body. On 01-JUL-2021, the subject experienced pain everywhere. On 01-JUL-2021, the subject experienced shortness of breath. On 01-JUL-2021, the subject experienced headache. On 01-JUL-2021, the subject experienced muscle aches all over body. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, muscle aches all over body, shortness of breath, and pain everywhere. This report was non-serious.


VAERS ID: 1453611 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210708852

Write-up: HEADACHE; This spontaneous report received from a consumer concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 03-JUL-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On JUL-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of headache was not reported. This report was non-serious.


VAERS ID: 1454062 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01788121 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram head, Laboratory test
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 7/1/2021 ER visit with lab work and CT head.
CDC Split Type:

Write-up: Bells Palsy


VAERS ID: 1454183 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: SOB, dizziness, and chest tightness at 1920, NP wanted PT put on bed with legs elevated and to monitor BP. BP did not improve after 15 minutes and another NP notified and assessed PT. New orders for IV placement, give 1000 mL NS via IV, and send to ER for evaluation. IV was placed at 0950 in R AC and 911 Notified. EMS 2 attendants placed PT on stretcher and transported PT to local Medical Center at 1020.


VAERS ID: 1454211 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Ringing in ears constant !


VAERS ID: 1454222 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Heart rate increased, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Made visit to Urgent Care Center. EKG was found to be normal, no other action taken. Subject was advised to visit ER for cardiac related symptoms. Call was made to PCP office and were advised to visit ER for cardiac related symptoms,
CDC Split Type:

Write-up: Subject passed-out for about 20 seconds, 5 minuets after injection. Approx. 24 to 36 hours later began experiencing intermittent chest pains and rapid heart beats. This has continued for the last 8 days.


VAERS ID: 1454244 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate, leucovorin, Plavix
Current Illness:
Preexisting Conditions: RA (PMR)
Allergies:
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Same as I had when I had Covid-19 seven months previously: extreme fatigue and total loss of appetite, but this time it lasted only 13 hours instead of 10 days or more. I tested positive for Covid-19 antibodies 2 weeks prior to the shot.


VAERS ID: 1454340 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-07-01
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Breast mass, Chills, Erythema, Fatigue, Lymphadenopathy, Pain in extremity, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Pepcid, Primatene tablets, Afrin Nasal Spray, Tylenol
Current Illness: None
Preexisting Conditions: Allergies, Rhinitis, GERD
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Swelling, erythema and pain right upper extremity associated with fever, chills, weakness and fatigue. Swelling extends from shoulder to mid humerus and extend from the axilla down to the level of the breast. Large palpable mass adjacent to right breast. Seen in PCP''s office on 6/29/21. Started on Bactrim without responce. Currently on Clindamycin


VAERS ID: 1454411 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C27A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose, Blood pressure increased, Hyperhidrosis, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Baclofen; berberine
Current Illness:
Preexisting Conditions: Diabetes
Allergies: Augmentin; Vicodin
Diagnostic Lab Data: Covid test. EKG. Checked my diabetes.
CDC Split Type: vsafe

Write-up: I felt okay, until that night when I was trying to sleep I was sweating so bad I took BP it was 198/100 and the next morning it was same, I called advice nurse she said to go to ER if it goes over 105 when I checked it again it was 107 so I went to the ER.


VAERS ID: 1454473 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-19
Onset:2021-07-01
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiovascular evaluation, Chest X-ray normal, Chest pain, Fibrin D dimer normal
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Paxil 20 mg tablet daily
Current Illness: No
Preexisting Conditions: Obstructive sleep apnea, mild asthma
Allergies: Cats
Diagnostic Lab Data:
CDC Split Type:

Write-up: She presents emergency department with chest pain that started 24 hours ago. She states that when she woke up yesterday she was experiencing central chest pain, no radiation. She states that if she applies pressure to her right anterior intercostal muscles with her hand, the pain is alleviated. The pain is worsened if the patient leans forward, alleviated by leaning back. Pericarditis Diagnosis management comments: Chest pain, story is concerning for pericarditis. Cardiac workup is negative and given it has been 24 hours since onset of chest pain, a single cardiac workup is sufficient rule out cardiac disease. D-dimer is negative. Chest x-ray, no acute cardiopulmonary abnormalities. Patient feels significantly improved after Toradol. Story remains consistent pericarditis, patient is given outpatient NSAIDs, I advised follow-up with primary care provider within the next week as may need further testing. Advised good return precautions in case of worsening chest pain, difficulty breathing, any worsening condition. Patient discharged in stable condition.


VAERS ID: 1454540 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-11
Onset:2021-07-01
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: COVID-19 PCR -positive. Individual tested positive for COVID-19 after vaccination.
CDC Split Type:

Write-up: Vaccine Breakthrough


VAERS ID: 1454584 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, doxycycline, tretinoin
Current Illness:
Preexisting Conditions: asperger syndrome
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administration error: 1st dose Moderna vaccine given to a 17 year old during annual wellness exam in clinic (not yet approved for use under 18 years). No adverse effects noted and per CDC guidance, will proceed with Moderna for dose #2.


VAERS ID: 1454617 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Diarrhoea, Dizziness, Headache, Lethargy, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu Vaccine 2009, hives, wheezing, tachycardia
Other Medications: Nexium, Magnesium, Zinc, Vitamin C, Vitamin E, Multi Vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: Latex, kiwi, avocado, banana, water chestnuts, dust mite.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Temperature of 101.7 initially, tremors, headache, nausea, dizziness, diarrhea, extreme lethargy. Lasting for 48 hours.


VAERS ID: 1454855 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dyspepsia, Heart rate irregular
SMQs:, Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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: Aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Continuous chest and heart pain. Irregular heartbeat (only a few times) and heart burn (only once).


VAERS ID: 1455092 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-10
Onset:2021-07-01
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Psoriasis on elbows
Preexisting Conditions: Asthma
Allergies: Latex
Diagnostic Lab Data: Have not been to drs. yet because the outbreaks stopped. If they don''t clear up in a weeks, I will go . They are starting to fade a little and have not spread.
CDC Split Type:

Write-up: Woke up to rash & outbreak spots on both arms & both legs (have photos). About 4 more came out during the day. No more outvreak after that


VAERS ID: 1455102 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Back pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Other ischaemic heart disease (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: Plaquenil 200mg Alpha lipoic acid Coq10 Fish oil Vit d
Current Illness: Sjogrens Endometriosis
Preexisting Conditions: Sjogrens Endometriosis
Allergies: Bella donna Pineapple Pinenuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart pain, needles in Heart type of pain. Pain in back. Went to er


VAERS ID: 1456711 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-03
Onset:2021-07-01
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6204 / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Date: 20210701; Test Name: rapid pcr; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC2021820843

Write-up: He then developed Covid and tested on 01Jul2021; He then developed Covid and tested on 01Jul2021; This is a spontaneous report from a contactable other health care professional. A 58-year-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot Number: EN 6204) via intramuscular route on 03Mar2021 (at the age of 57-years-old) as dose 2, single and first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot Number: EL 9267) via intramuscular route on 12Feb2021 (at the age of 57-years-old) as dose 1, single for covid-19 immunisation. The patient medical history was none and concomitant medications were not reported. The patient had no known allergies were not reported. Prior to vaccination patient was not diagnosed with COVID-19. Since the vaccination the patient had been tested for COVID-19. The patient received any vaccines within four weeks prior to the vaccination was unknown and no other medications in two weeks. On 01Jul2021, Nasal Swab (rapid PCR) test was positive. The patient received 2 doses of Pfizer vaccine, he then developed covid. Adverse events resulted in doctor or other healthcare professional office/clinic visit. The patient did not receive any treatment for the event. The patient underwent lab tests and procedures which included positive rapid PCR, nasal swab on 01Jul2021. The events were reported as non-serious. The outcome of the events were unknown.; Sender''s Comments: Based on the current available information and the consistency with the known safety profile of the suspect product BNT162B2, there is a reasonable possibility that events vaccination failure and covid-19 were related to suspect drug based on the temporal relation between the vaccination and onset of events. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1457092 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1067 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
CDC Split Type:

Write-up: Pt called our office 7/8/21 stating she had an adverse reaction to the Pfizer vaccine (second dose) administered on 6/29/21. Pt states she went to urgent care on 7/3/21 due to hives on body and ended up going to ER on 7/4/21 for hives and swollen feet. Tried to submit adverse reaction online herself, was not able to. Called the office 7/8/21 at 10:50am for help with submitted the reaction. Pt states that she is feeling better.


VAERS ID: 1457104 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-07-01
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebellar stroke
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (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 - Occipital infarction (CMS/HCC)


VAERS ID: 1457109 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-07-01
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 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 palsy


VAERS ID: 1457110 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-07-01
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I61.9 - Hemorrhagic stroke (CMS/HCC)


VAERS ID: 1457122 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pruritus, 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: NONE
Current Illness:
Preexisting Conditions:
Allergies: PENCILLIN AND SULFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: RASH ON BILATERAL LEGS, FEET, ARMS, AND HANDS. ITCHING SYSTEMATICALLY. THE RASH SHOWED UP THE NEXT MORNING. WOKE UP WITH THE RASH. I HAVE USED HYDROCORTISONE CREAM AND TAKING ANTIHISTAMIES


VAERS ID: 1457135 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-07-01
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, Computerised tomogram abnormal, Hypoxia, Lung opacity, Respiratory failure, Respiratory viral panel, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: QVAR,Bumex, Plavix, Wellbutrin, Mycelex, Toprol XL, Farxiga, Aldactone, Klor-Con, Cozaar, Zaroxolyn, Bentyl, Asa 81mg, Nitrostat, Colcrys, Norco, Duoneb, Ventolin, Colace, Prvacid, Synthroid, Flomax,Zofran, Zyloprim, Sinus Rinse, Corlanor
Current Illness: unknown
Preexisting Conditions: Asthma COPD Acid Reflux, CAD CA, CHF, Hodgekin Lymphoma at age 22, HTN, Hyperlipidemia, IgG4 deficiency, Left Ventricular, systolic dysfunction, Type 2 DM, testicular CA, Thyroid CA, sleep apnea, nutcracker esophagus
Allergies: Avelox, Imdur, Entresto, moxifloxacin
Diagnostic Lab Data: CTA of chest bilateral opacities noted in lobes, 2 positive PCR tests for covid, negative remainder of respiratory panel
CDC Split Type:

Write-up: Respiratory Failure related to positive covid test. PCR positive on 07/01/2021 and PCR positive 07/07/2021. Patient placed on BIPAP due to hypoxia in ER and admitted. Remdesivir and decadron administed as inpatient. unknown exposure date admitted 07/07/2021


VAERS ID: 1457154 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Seizure like phenomena, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Convulsions (narrow), Parkinson-like events (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: The 15 year old female complained of being anxious. She was shaking almost like she was having a seizure for about 2 minutes. She felt better and went home with her dad.


VAERS ID: 1457173 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Dizziness, Dyspnoea, Fatigue, Headache, Mobility decreased, Pain in extremity, Palpitations, Pyrexia, Tinnitus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CONCOR; hydroxyzine -HCl - (did not take it 3days before and 3 days after)
Current Illness: Fever, Throat pain, sinus infection
Preexisting Conditions: Sjogren''s Syndrome and joint inflammation
Allergies: Severe Urticaria. NSAIDS. Sulfa, Latex, Penicillin
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: The first day: I had symptoms of fatigue, mild headache, dizziness and buzzing in my ears, could not get out of bed, in the afternoon I had fever (99F), my arm was burning and it hurt. I called the Dr. and she told me the symptoms the vaccine causes (headache, burning). She told me to wait a week and if it continued to go see a doctor. I took anti-allergy medicine and it helped me. I am taking azelastine (nasal allergy) and it has helped me. 2nd day: Rapid heart palpitations (heart pounding). 3rd day: Palpitations and shortness of breath when changing positions. I also have a pain above my hip on the right side.


VAERS ID: 1457177 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-12
Onset:2021-07-01
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 03/22/2021 pfizer,Lot# ER8727 2nd dose: 04/12/2021 Pfizer,Lot# EW0150 Diagnosed covid positive: 07/02/2021 Exposure: Symptoms:Fever, fatigue, headache.


VAERS ID: 1457178 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia oral
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of dizziness and numbness of her upper lip after the first dose of Pfizer. Patient verbalized she felt better after the intervention and she went home. BP 162/80; HR 80


VAERS ID: 1457183 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-07-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FW0181 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Fatigue, Nasal congestion, Pain, Pain in extremity
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: gavapin, inhaler, nabulizer, iron and birth control
Current Illness: none
Preexisting Conditions: asthma, fibromyalgia
Allergies: asprin, toderal, citnal,
Diagnostic Lab Data: none
CDC Split Type: vsafe

Write-up: chest pains, fatigue, toes hurting, my nose was stopped and body aches


VAERS ID: 1457187 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-24
Onset:2021-07-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009O21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Breo Spiriva baclofen gabapentin singulair Zoloft tizanidine
Current Illness:
Preexisting Conditions: COPD Multiple Sclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large red rash @ injection site swelling ,feverish to touch,pain & itching


VAERS ID: 1457189 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hyperhidrosis, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient complained of facial numbness and tingling, sweating but no SOB. BP 130/72; O2 Sat 98%; HR 112. She got J&J vaccine. The ambulance was called and they came. Care was transferred to the paramedic but the patient refused to go to the ER.


VAERS ID: 1457197 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Seizure like phenomena, Syncope, Unresponsive to stimuli, Vaccine positive rechallenge
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient was experiencing symptoms after 10 minutes of receiving J&J vaccine. He passed out for 5 minutes without any verbal response; with signs of seizure. He has a history of the same reaction with another vaccine. He got epinephrine 0.3mg IM Lot OFM625 Exp. Nov. 22. The ambulance was called and the patient''s care was transferred to the paramedic. The patient was transferred to the ER.


VAERS ID: 1457202 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Confusional state
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: pancreatic cancer, breast cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called to report "bouts of confusion" starting ~24 hrs post vaccination. Patient reported already improving at time of call.


VAERS ID: 1457247 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-15
Onset:2021-07-01
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR 7/5/2021 positive for Covid
CDC Split Type:

Write-up: Also received COVID19 Pfizer vaccine #2 on April 5 at same location. On July 1, client had nasal congestion and loss of taste and smell. Tested positive PCR on 7/5 for Covid. VAERS report submitted because client is fully vaccinated and tested positive with symptoms for Covid.


VAERS ID: 1457265 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-08
Onset:2021-07-01
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: XARELTO STARTER PACK 15 & 20 MG TBPK nystatin (NYSTOP) 100000 UNIT/GM POWD powder APPLY TOPICALLY TO THE AFFECTED AREA(S) TWO TIMES A DAY insulin detemir (INSULIN DETEMIR) 100 units/mL pen Inject 15 Units into the skin daily. glipIZIDE (GL
Current Illness:
Preexisting Conditions: Cardiac Essential hypertension First degree AV block Hyperlipidemia Pulmonary embolism Nephrology Overactive bladder Neurologic Type 2 diabetes mellitus with polyneuropathy Fibromyalgia Charcot foot due to diabetes mellitus Orthopedic Lymphedema of leg Endocrine Dyslipidemia Hypothyroidism ENT Benign paroxysmal positional vertigo Digestive Irritable bowel syndrome Vitamin D deficiency Musculoskeletal Glaucoma Other Generalized weakness Morbid obesity History of bowel resection for diverticulitis Diverticulitis
Allergies: Amoxicillin Clavulanic Acid Erythromycin Erythropoietin Beta [Epoetin Beta] Latex LisinoprilCough Sitagliptin Sulfa Antibiotics Tannic Acid Tetracycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB AND DVT RESULTING IN HOSPITALIZATION ON 07/01/21


VAERS ID: 1457282 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast feeding, Breast induration, Breast pain, Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Lipodystrophy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyradin-S (levothyroxine sodium hydrate) 75mcg
Current Illness: None
Preexisting Conditions: Hashimoto''s Disease
Allergies: possibly sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: I''m currently breastfeeding a 14 month old. I think my right breast had a little hard spot the morning before I got the vaccine, but in the past when it happened I just breastfed and massaged the spot and nothing would come of it. The day we got vaccinated I don''t recall noticing any symptoms when breastfeeding. But, the morning after the vaccine, my right breast had a red patch and a little hard patch and let down was painful. I went to the doctor that afternoon and was diagnosed with mastisis. I haven''t had it before, that I am aware of. The doctor prescribed me 10 days worth of antibiotics. My symptoms subsided in a few days. Now it''s been a week and I feel fine. I am still taking the antibiotics as reccommended. The doctor thought it was most likely not related to the vaccine. I am reporting it since the CDC called me since I was signed up for VSafe.


VAERS ID: 1457402 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP, Aspirin, Atorvastatin, Baclofen, Bisacodyl, Docusate, Glycolax, Levetiracetam, lexapro, lisinopril, lovenox, melatonin, multivitamin, norvasc, plavix, zyprexa
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Reesident received 3rd dose of Pfizer covid vaccine series on the same day, a few hours after the 2nd dose was given.


VAERS ID: 1457468 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-08
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 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? 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: n/a
CDC Split Type:

Write-up: none - was given at age 16


VAERS ID: 1457470 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-04
Onset:2021-07-01
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline 25MG Rizatriptan 10MG
Current Illness: Migraines
Preexisting Conditions: Migraines
Allergies: Dramamine Ambien
Diagnostic Lab Data:
CDC Split Type:

Write-up: My first period since the vaccine was very weird. It stopped and started three times and it was very light. This is very unusual for my menstruation.


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