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

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



Case Details (Reverse Sorted by Onset Date)

This is page 70 out of 8,010

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VAERS ID: 1750604 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750606 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750607 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Numb/tingly left hand immediately after shot given. Following day hand is achy and weak.


VAERS ID: 1750608 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

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

Write-up: Administration error: Mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750609 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750611 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750614 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750615 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750617 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750620 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750621 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750623 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF 2589 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Lymph node pain, Lymphadenopathy, 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? 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: High fever of 103.2, chills, horrible body aches, swollen and painful lymph node


VAERS ID: 1750624 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750625 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

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

Write-up: Administration error: Mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750626 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750805 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750806 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750807 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750808 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750809 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750810 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750811 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750812 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750813 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750815 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750816 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750817 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Patient came in for an additional dose of Moderna and was administered a dose of Pfizer. Vaccine mismatch.


VAERS ID: 1750818 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750819 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750820 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750822 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750824 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30125BA / 2 LA / IM

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

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

Write-up: The patient got Moderna as her first dose and was given Pfizer as the second dose. The patient did not have an adverse reaction to our knowledge at this time.


VAERS ID: 1750825 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750826 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750827 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750829 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750832 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750833 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750835 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750836 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750837 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750838 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750839 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750840 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750842 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / -

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1750845 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Amnesia, Mental status changes, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever: 38.5 C, responsive to Acetaminophen 1g IVPB, and 1g ceftriaxone IV down to 37.1 C, 90 minutes after administration Patient reported altered mental status, unable to remember how she arrived to ER


VAERS ID: 1751749 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-09-29
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling cold, Skin irritation
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: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: Patient had no known allergies. Patient had no drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210957341

Write-up: IRRITABLE SENSATION IN BACK OF NECK; COLD FEELING IN CHEST AND BACK OF NECK; This spontaneous report received from a patient concerned a 20 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: abstains from alcohol, and non smoker, and other pre-existing medical conditions included: Patient had no known allergies. Patient had no drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1820095 expiry: UNKNOWN) dose was not reported, administered on 29-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 29-SEP-2021, the patient experienced irritable sensation in back of neck. On 29-SEP-2021, the patient experienced cold feeling in chest and back of neck. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from cold feeling in chest and back of neck, and irritable sensation in back of neck. This report was non-serious.


VAERS ID: 1751756 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-29
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210958249

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 29 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, and batch number: 206A21A expiry: 21-SEP-2021) dose was not reported, administered on 29-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 29-SEP-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958423, 20210958321, 20210958993, 20210958502, 20210958716, 20210958892 and 20210958366.


VAERS ID: 1751763 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Oklahoma  
Vaccinated:0000-00-00
Onset:2021-09-29
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210958358

Write-up: ADMINISTRATION OF EXPIRED VACCINE; 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: Unknown ,expiry: unknown) dose was not reported, administered on 29-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 29-SEP-2021, the patient experienced administration of expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of expired vaccine was not reported. This report was non-serious.


VAERS ID: 1751766 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-09-29
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210958387

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a physician 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: 1808982, expiry: 21-SEP-2021) dose was not reported, administered on 29-SEP-2021 09:37 for prophylactic vaccination. No concomitant medications were reported. On 29-SEP-2021, the patient experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious.


VAERS ID: 1751795 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-09-29
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210958993

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a pharmacist concerned a 62 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: 206A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 29-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 29-SEP-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210958321, 20210958423, 20210958716, 20210958502, 20210958405, 20210958366, 20210958249, 20210958892 and 20210959620.


VAERS ID: 1752855 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Dyspnoea, Hyperhidrosis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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 receiving the shot at noon, I began to feel shortness of breath and chest pain by evening, and by night time, I was experiencing fever. I was shivering and sweating at the same time in my bed that night. The following day (today) the shortness of breath and chest pain are still present, although less intense.


VAERS ID: 1752859 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Headache, Nasal congestion, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Nausea, headache, weakness, stuffy nose, body aches


VAERS ID: 1753024 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-22
Onset:2021-09-29
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Inflammation, Rash, Rash pruritic, Rash vesicular, Scab
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: Sentraline - Depression Losartan - High Blood Pressure Metoprolol - High Blood Pressure Hydrocodone - Osteoarthritis Pain Tylenol - Liquid Gels, Pain Bayer Aspirin - (OTC) Aspirin to Prevent Heart Attacks
Current Illness: Same as Chronic, #12 (nothing new)
Preexisting Conditions: Osteoarthritis Pain, Depression, High Blood Pressure
Allergies: Iodine Seafood: Lobster, Crab, Shrimp
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have severe rash, looks likes Shingles. My face, neck, chin, chest, and upper back, along hairline. Very itchy, crusty. Ear and chin are inflamed and red with little round water fill bubbles. It hurts, so I take Tylenol for pain, and Claritin for the itch. Today I have a Telehealth follow up appointment with my doctor. It''s getting worst.


VAERS ID: 1753027 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Allergies: Multi dose solution of injectable medications and vaccines. Covid vaccine is only available in multi dose. I took benedryl and my albuterol inhaler before the injection and allergic symptoms were managed.
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am allergic to multi dose solution of injectable vaccines and medications. Covid vaccine is only available in multi dose. I took benedryl and albuterol inhaler before injection and symptoms were managed.


VAERS ID: 1753043 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immunisation, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Severe arm swelling, erythema, pruritis from injfluenza vaccine, autumn 2020
Other Medications: Levothyroxine 75 mcg/d, calcium carbonate 1600 mg/day, vitamin D3 90 mcg/day, flaxseed oil, 1000 mg/d, Aspirin 81 mg/d.
Current Illness: None
Preexisting Conditions: 1. Mild left body muscular weakness from remote (2002) right brain radiation. 2. Treated Hashimoto''s thyroiditis (in remission) with secondary (treated) hypothyroidism
Allergies: allergic to Septra/Bactrim (sulphamethoxizole/trimethoprim)
Diagnostic Lab Data: None required or performed.
CDC Split Type:

Write-up: 1. Mild injection site soreness lasting about 51 hours. It did not impair my functioning, from 4 hours to 51 hours after dose..2. 2. Small (2-3 cm by 8-10 cm) skin erythema near injection site, onset about 4 hours after, ending about 48 hours after dose. Neither side effect required treatment. Spontaneous resolution od both adverse events.


VAERS ID: 1753047 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer Covid Vaccine doses 1 and 2
Other Medications: Olmesartan
Current Illness: Hypertension
Preexisting Conditions: hypertension
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm, malaise, fever, chills lasting 36 hours. Refractory to tylenol. Mild response to ibuprofen.


VAERS ID: 1753233 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl 25mg, Tylenol 500mg
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: No tests done. However, I would like to report that I have told by Clinic that they have giving me 6 doses of Pfizer Vaccine by accident.
CDC Split Type:

Write-up: Fever 102.1, Headache, Body Ache, Nausea and vomiting, Took Benadryl 25mg, Tylenol 500mg 3 times 6 hrs apart. Fever broke Oct 1st, 08:00


VAERS ID: 1753238 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Covid Pfizer vaccination age 69 March 2021. Chills, headache and achy.
Other Medications: Atenolol Levothyroxine
Current Illness: None
Preexisting Conditions: None
Allergies: Latex sensitive
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache within 8 hours of injection that lasted almost 24 hours.


VAERS ID: 1753245 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-09-29
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Hospitalized after fully vaccinated


VAERS ID: 1753264 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris, Dizziness postural, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Started running high fever and headache at about 9:45pm on the date of vaccine 9/29/21 still running a fever today 10/01/21. On. 9/30/21 couldn''t get out of bed except to use the bathroom due to headache and fever. 10/01/21 I still have slight headache fever has reduced. However I am dizzy anytime I stand for any amount of time I have started to have pain around my heart area as well.


VAERS ID: 1753266 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec 20mg daily-Lipitor 40mg daily-Zetia 10mg daily.-Vit C 500mg daily-Vit D 1000 units 2xday.- Citracal Slow Release 1200mg daily.
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Lymphadenopathy-L neck swelled up and lymph nodes palpable just above the collarbone on the side of neck. Injection was given in the left arm.


VAERS ID: 1753271 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-21
Onset:2021-09-29
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood culture, Blood lactic acid, Blood sodium decreased, Blood test, COVID-19, Chest X-ray abnormal, Haemoglobin decreased, Oxygen saturation decreased, Pneumonia, Pyrexia, SARS-CoV-2 test positive, White blood cell count decreased
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Current Home Medications 1. atorvastatin 10 mg oral tablet : 1 tab(s) orally once a day (at bedtime) 2. candesartan 16 mg oral tablet : 1 tab(s) orally once a day 3. famotidine 20 mg oral tablet : 1 tab(s) orally 2 times a day 4. ferrous su
Current Illness: anemia
Preexisting Conditions: hyptertension, hyperlipidemia, hx of DVT
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is seen upon arrival to emergency department. Vitals are reviewed and noted for a low-grade temp of 99.6 as well as a heart rate of 101. Patient is 95% on room air. Patient is extremely hard of hearing, and left his hearing aids at home. His daughter at bedside. Patient will have an IV established, blood work performed, chest x-ray and a rapid Covid test for further evaluation. Patient''s labs are reviewed, noted for hemoglobin of 7.9, is his baseline. WBCs are low at 3.5. Given this blood cultures and lactate are ordered. His sodium is noted to be low at 126. Chest x-ray shows evidence of right lower lobe pneumonia. Patient will be given Rocephin 1 g IV and azithromycin 500 mg IV. He is also given Decadron 10 mg IV. Rapid Covid test is positive. Patient and daughter at bedside have been updated of this. Patient has been continued to be monitored in the ER, and his oxygen does go down to 87% while he is at rest. Given this, and patient''s chest x-ray findings of pneumonia and Covid, I did offer admission, and they are agreeable to this.


VAERS ID: 1753318 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Burning sensation, Chills, Headache, Pain, Panic reaction, Sleep disorder
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I started to feel very weak around 8:30 pm the night of the shot. I went to bed to wake up at 3 am in chills and panic. My body was on fire. My husband got up and took my temperature which was 103.9! He gave me Tylenol which i also took right before going to bed. I woke up again at 7 am with 103.3. With another dose of Tylenol and Advil, the whole day my fever would not break. It remained at 102.8. The following night i woke the same way with 102.9. Today is the third day and still woke up with a fever and severe body aches and headache.


VAERS ID: 1753334 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308435 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anion gap normal, Basophil count normal, Basophil percentage, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Carbon dioxide decreased, Chills, Condition aggravated, Differential white blood cell count, Dyspnoea, Eosinophil count normal, Eosinophil percentage, Extra dose administered, Feeling cold, Full blood count normal, Haematocrit normal, Haemoglobin normal, Immature granulocyte count, Lymphadenopathy, Lymphocyte count normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume increased, Metabolic function test normal, Monocyte count normal, Monocyte percentage, Musculoskeletal stiffness, Neutrophil count normal, Neutrophil percentage increased, No reaction on previous exposure to drug, Pain, Platelet count normal, Red blood cell count normal, Red cell distribution width normal, Seizure, Tremor, Vaccination complication, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Arthritis (broad), Tumour lysis syndrome (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: after the first dose mild symptoms
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: CBC and Metabolic Panel ED Provider Notes MD at 9/29/2021 11:51 PM Chief Complaint Patient presents with ? Other family said pt was "convulsing" in bed and SOB. Had second COVID and flu shot today The patient is a 58-year-old female who presents by squad for evaluation of shaking. She tells me that she got an influenza immunization in her right arm and the COVID-19 booster shot in her left arm. This is her third COVID-19 vaccine. She has not had COVID-19 infection in the past. She got the shots at 11:00 this morning. She states that she was fine all day with exception of some soreness in her arms from the immunizations. She went to take the dog for a walk this evening and felt like her right leg locked up. She describes that she couldn''t flex or extend very well, but nonetheless got back into the house. She states that she started having coarse shaking of both arms and both legs. The paramedics described that she was awake, alert and talking, but having shaking of both her upper and lower extremities. Eventually she stopped shaking. She denies having a fever today, but feels cold. She did not have any previous reactions to her first 2 COVID-19 vaccines. She currently feels much better. She states that she has never had a panic attack before and has not been under a lot of stress today. Patient History No Known Allergies Home Medications: Prior to Admission medications Not on File Past Medical History: Past Medical History: Diagnosis Date ? Renal stones Social History: reports that she has never smoked. She has never used smokeless tobacco. She reports current alcohol use. She reports being sexually active and has had partner(s) who are male. She reports that she does not use drugs. E-Cigarettes (such as Vapes or Juul) Family History: Family History Problem Relation Age of Onset ? Cancer Mother colon ? Cancer Maternal Grandmother lung ? Cancer Maternal Grandfather lung ? Cancer Maternal Aunt breast ? Diabetes Paternal Grandmother Surgical History: Past Surgical History: Procedure Laterality Date ? OTHER SURGICAL HISTORY 6/21/11 No surgeries Review of Systems Review of Systems All other systems reviewed and are negative. Physical Exam There were no vitals taken for this visit. Physical Exam Vitals and nursing note reviewed. Constitutional: General: She is not in acute distress. Appearance: She is well-developed. HENT: Head: Normocephalic and atraumatic. Eyes: Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: No murmur heard. No friction rub. No gallop. Pulmonary: Effort: Pulmonary effort is normal. Breath sounds: Normal breath sounds. Abdominal: General: There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: General: Normal range of motion. Cervical back: Normal range of motion and neck supple. Comments: Normal range of motion of the upper and lower extremities. No drift with straight arm raises. Lymphadenopathy: Cervical: No cervical adenopathy. Skin: General: Skin is warm and dry. Findings: No rash. Neurological: General: No focal deficit present. Mental Status: She is alert. Cranial Nerves: No cranial nerve deficit. Comments: The patient is awake and alert. No cranial nerve deficits. No dysarthria or aphasia. No resting or intention tremor of the upper or lower extremities. Psychiatric: Mood and Affect: Mood normal. Procedures Radiology/EKG/Labs: Results for orders placed or performed during the hospital encounter of 09/29/21 CBC WITH DIFF Result Value Ref Range WBC 10.4 (H) 3.7 - 10.3 x10(3)/mcL RBC 4.62 3.90 - 5.20 x10(6)/mcL Hgb 14.2 11.2 - 15.7 g/dL Hct 42.5 34.0 - 45.0 % MCV 92.0 80.0 - 100.0 fL MCH 30.7 26.0 - 34.0 pg MCHC 33.4 30.7 - 35.5 g/dL RDW 14.0 <=14.9 % Platelet 230 155 - 369 x10(3)/mcL MPV 11.0 8.8 - 12.5 fL Neut Percent 75.1 % Imm Gran% 0.3 % Lymph Percent 17.0 % Mono Percent 5.2 % Eos Percent 1.9 % Baso Percent 0.5 % Neut # 7.8 (H) 1.6 - 6.1 x10(3)/mcL IMMGRAN# 0.0 0.0 - 0.1 x10(3)/mcL Lymph # 1.8 1.2 - 3.9 x10(3)/mcL Mono # 0.5 0.3 - 0.9 x10(3)/mcL Eos# 0.2 0.0 - 0.5 x10(3)/mcL Baso # 0.1 0.0 - 0.1 x10(3)/mcL BASIC METABOLIC PANEL Result Value Ref Range Sodium 137 136 - 145 mmol/L Potassium 3.9 3.5 - 5.0 mmol/L Chloride 104 98 - 107 mmol/L Total CO2 19 (L) 22 - 29 mmol/L Anion Gap 14 7 - 16 mmol/L Calcium 8.9 8.6 - 10.4 mg/dL Glucose Lvl 108 (H) 74 - 100 mg/dL BUN 24 (H) 6 - 20 mg/dL Creatinine 0.83 0.51 - 1.30 mg/dL GFR Afr Am 90 $g=60 mL/min/1.73 m2 GFR Non Afr Am 78 $g=60 mL/min/1.73 m2 ED Course: Appropriate laboratory and radiology studies reviewed Patient presents after having her right leg "lock up." She also describes having shaking of her arms and legs. She is not having any symptoms at this time. It''s unclear what caused her symptoms. The patient''s sister came out to find me at the nurse''s station and reported that the patient was shaking again. The patient was lying on her side with twitching of her upper and lower extremities rhythmically. She was awake and would talk with me. When I had her hold out her arms, the movements stopped. Her sister wonders if the patient has a functional movement disorder. It is more likely that she has an adverse reaction to the vaccines today. Her temperature initially was 99.8. She was given Tylenol 1 g by mouth. Repeat temperature was 100.2. She was observed and her temperature improved. She requested discharge and was sent home. She was told to take Motrin and Tylenol regularly for her symptoms. ED Clinical Impression: 1. Adverse reaction to COVID-19 vaccine Critical Care time Condition at Discharge/Transfer from Department: Stable This chart was completed using voice recognition technology and may contain unintended errors MD 09/30/21 0321
CDC Split Type:

Write-up: At approximately 9:30pm I became chilled and experienced overall body ache. Later when taking my dog out my right leg locked up and once I got into bed I began convulsing, could not breath and was unable to communicate with my husband. Initially the paramedics felt it was a panic attack. Vital signs, CBC and Metabolic panel showed no abnormal results. Medical Center ER doc also initially indicated he also suspected a panic attack, however conceded it was possibly an adverse reaction. I spent 9-31-2021 resting and on 10-1 feel back to normal. I do not believe it was a panic attack. After the first dose of the Pfizer vaccine (EL9269) I was aware of underarm gland swelling. Now after the third dose it is more pronounced.


VAERS ID: 1753340 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-01
Onset:2021-09-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BT / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad)

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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, Vitamin D3, Lexapro, Neurontin, metoprolol succinate
Current Illness: None except for chronic disease states
Preexisting Conditions: CKD, hypertension, COPD, chronic pain, depression, GERD
Allergies: Chlorothiaxide, Hydrocholorothiazide, lisinopril, valsartan
Diagnostic Lab Data: 9/29 CTA of chest: Saddle type pulmonary thromboembolism with large burden primary, lobar, and segmental distribution PTE.
CDC Split Type:

Write-up: Saddle PE


VAERS ID: 1753363 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013584 / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins.
Current Illness:
Preexisting Conditions: Heart condition, blood clot in left lung, arthritis (AS)
Allergies: Sulfa.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itching and swelling at injection site, began to itch over entire body.


VAERS ID: 1753420 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-09-29
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/30 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1753424 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Ear pain, Fatigue, Head discomfort, Headache, Nausea, Oropharyngeal pain, Pain, Pyrexia, Sinusitis
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratidine for allergies
Current Illness: sinus infection one week prior
Preexisting Conditions: seasonal allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The initial reaction was severe headache and body aches, nausea, fatigue, sore throat, earaches, fever, chills. The 6-24 hours after the vaccine was the worst, seeing some improvement today at almost 48 hours. It seems my sinus infection from a week ago has returned since I have those reoccurring symptoms of head pressure, ear aches, sore throat. I do still have some body aches and fatigue.


VAERS ID: 1753425 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

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

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

Write-up: Patient complained that she has swelling under her arm at the lymph nodes. She experienced this about 4 to 6 hours after injection.


VAERS ID: 1753431 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Headache, Respiratory tract congestion, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal 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: headache and head/face congestions within 12 hours (and still have three days later), blurred/wobbly vision (started two days after, continuous and still have)


VAERS ID: 1753449 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
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: POTASSIUM 20 MEQ. OMEPRAZOLE 40 MG TOPIRAMATE 100 MG TIZANIDINE 4 MG IBUPROFEN 800 MG LAMOTRIGINE 100 MG HYDROCODONE/APAP 5/325 MG GABAPENTIN 800 MG ARIPIPRAZOLE 10 MG CITALOPRAM 40 MG FOLIC ACID 1 MG DESVENLAFAXINE ER 25 MG CLONAZEPAM 1 M
Current Illness: EPILEPSY (CONTROLLED WITH MEDICATION, NO RECENT EPISODES)
Preexisting Conditions: EPILEPSY (CONTROLLED WITH MEDICATION, NO RECENT EPISODES)
Allergies: SULFA ALLERGY
Diagnostic Lab Data:
CDC Split Type:

Write-up: SEIZURE LASTING APPROXIMATELY 30 MINUTES, MEDICAL PERSONNEL CALLED TO PATIENT LOCATION AND PATIENT WAS TREATED/OBSERVED UNTIL PATIENT WAS CONSIDERED STABLE AND COHERENT.


VAERS ID: 1753486 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 WALGREEN / 3 - / -

Administered by: Work       Purchased by: ?
Symptoms: Axillary pain, Injection site warmth, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (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: Birth Control Vitamin B12 w/ Folate Vitamin D 5,000mg Iron Tumeric Probiotics
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Latex
Diagnostic Lab Data: None done yet
CDC Split Type:

Write-up: - Injection site became warm 10 minutes after shot - Underarm became sore 24 hours after shot - Underarm became swollen 40 hours after shot


VAERS ID: 1753531 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Dizziness, Eye pruritus, Fatigue, Headache, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (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: Injection Site Pain, common with all injected vaccines
Other Medications: Standard one a day multivitamin Generic version of Claritin 10 mg Vit D 1000 IU Vit C 500 mg Zinc 25 mg Melatonin 3 mg
Current Illness: None, other than those caused by the first dose of this vaccine on September 8, 2021 and already captured in VAERS ID 1694318
Preexisting Conditions: None
Allergies: Amoxicillin Neosporin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Injection Site Pain (Wed Sep 29 ~ 1350 to present time of this report ~1000 Fri Oct 1, obviously due to the vaccine), took NSAIDs, did not help. Chills (Thur Sept 30 ~ 1230 to 1330, never happened with any other type of vaccine, nor any other time when I was not obviously sick). Fatigue (Thur Sept 30 ~ 1230 to 1330, never happened with any other type of vaccine, nor any other time when I was not obviously sick). Dizziness (Wed Sep 29 ~ 1150 to Fri Oct 1 ~ 0900, very unusual for me and nearly constant for almost two full days). Headache (various times from Wed Sep 29 evening to Thur Sep 30 night, unusual due to frequency, usually only get one headache every few weeks). Itchy eyes (Thur Sep 30 ~ 0900 to 1400, hard to say if this is due to vaccine, but it was unusually intense and brief compared to seasonal allergies) I take Claritin every day but it did not help with this bout of itchiness.


VAERS ID: 1753557 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

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

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

Write-up: On 09/29/21 at 1330 contacted and arrived to assist patient who complained of chest pain. No signs of severe distress. A&Ox4 and verbal. Patient was transferred to urgent care via wheelchair with 2 members of urgent care staff.


VAERS ID: 1753584 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Malaise, Migraine, Musculoskeletal stiffness, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Adverse effects noticed: Crippling Migrane headache (9/10), high fever (101-102?F), neck stiffness (7/10), nausea (6/10), joint and muscle pain (8/10), malaise (7/10), and considerable fatigue (8/10) Treatment used: Over the counter medications (acetaminophen, small doses of caffeine, heat applications (submerged in high temperature bath, and used a heating pad set to high every 30 minutes), rest, fluids, and non-solid foods (soup, mashed potatoes) Outcome: symptoms started rapidly 8 hours after vaccine, dampened after 32 hours, and disappeared after 53 hours from the vaccine.


VAERS ID: 1753590 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-18
Onset:2021-09-29
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia
SMQs:, Infective pneumonia (narrow), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Simvastatin, Methocarbamol, Levothyroxine, Paroxetine, Fioricet, Phenobarbital, Clonazepam
Current Illness: unk
Preexisting Conditions: Seizure disorder, Hypertension, Chronic Pain
Allergies: Epinephrine, Fentanyl, Morphine, Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated with Moderna on 02/18/2021 and 03/18/2021, hospitalized on 9/29/2021 for covid 19 pneumonia.


VAERS ID: 1753625 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-19
Onset:2021-09-29
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Atelectasis, Chest X-ray abnormal, Dyspnoea, Hypoxia, Lung opacity, Pneumonia, Productive cough, SARS-CoV-2 test positive, Surgery, Traumatic lung injury
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), 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: Eliquis 5mg, vitamin C 500mg, Calcium, cyanocobalamin, ferrous sultate 325mg, lasix 20mg, melatonin, lialda 1.2g, Multivitamin, prilosec 20mg, KCl 10 meQ, florajen3, Verapamil 240mg, vitamin D3, zinc sulfate, levothyroxine 25mg, mycostatin
Current Illness: Anemia, osteopenia, obesity aortic stenosis, hypercholesterolemia, HTN, GERD, Deep vein thrombosis (2/21/2021), Chrons, C-diff infections
Preexisting Conditions: Bladder cancer status post radical cystectomy with urostomy, bilateral lymph node dissection and ileal conduit urinary diversion last year complicated by recent vaginal cuff dehiscence with small bowel perforation status post exploratory laparotomy with partial small bowel resection, primary anastomosis and vaginal cuff repair, recent left lower extremity group C Streptococcus cellulitis complicated by sepsis, history of recurrent C. difficile colitis including recently, recently diagnosed COVID-19 infection, history of recurrent DVT anticoagulated on apixaban, history of Crohn''s disease, history of limited breast cancer, hypertension, hypercholesterolemia, history of vitamin B12 deficiency and chronic anemia
Allergies: Sultamethoxazole-trimethoprim
Diagnostic Lab Data: COVID-19 PCR swab positive 9/17/21 9/29/21 Chest X-ray Compared to 7/21/2020, lungs are underinflated with left basilar opacity, either atelectasis or localized organizing pneumonia pattern of lung injury resulting from SARS-CoV-2 infection. No pleural effusion or pneumothorax. Heart size and mediastinal contours are unchanged.
CDC Split Type:

Write-up: Patient was fully vaccinated against COVID 19 on 2/19/21. Patient was found to be asymptomatic COVID positive prior to a surgery on 9/17/21. Upon surgical follow-up in clinic, patient was symptomatic with productive cough, dyspnea and hypoxemia requiring 2L nasal cannula 02. Patient was admitted to reporting hospital on 9/29/21 and remains hospitalized at this time.


VAERS ID: 1753647 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / SYR

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

Write-up: Given the booster shot within the 6 months window. 2nd shot - 09/02/2021 3rd shot - 10/01/2021


VAERS ID: 1753661 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-09-29
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 RA / IM

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

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

Write-up: Breakthrough covid case. PCR results positive on 9/29/2021


VAERS ID: 1753666 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same side effects with Moderna shot 2.
Other Medications: Atorvastatin, Betamethasone Cream, Synthroid, Claritin, 81 mg Aspirin.
Current Illness: None
Preexisting Conditions: Sinus
Allergies: Penecilian
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received the Moderna COVID-19 Vaccine. Immediate effect was being tired on the morning after the shot because I did not sleep well. Then slight fever later in the day. Same on day two. Day two and three also had red rash all over my upper body.


VAERS ID: 1753672 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-09-29
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 RA / IM

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

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

Write-up: Breakthrough case of covid. PCR test positive on 9/29/2021


VAERS ID: 1753682 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Chills, Decreased appetite, Dry mouth, Dyspnoea, Fatigue, Feeling abnormal, Headache, Heart rate increased, Injection site pain, Nausea, Pain, Parosmia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: Penicillin
Other Medications: None
Current Illness: None
Preexisting Conditions: Diabetic Type II Asthmatic GERD Insomnia Sural neuropathy Migraine (All of my conditions are under control and I''ve been seeing a specialist for all of them).
Allergies: Clindamycin hydrochloride Doxycycline sodium Duloxetine Latex Erythromycin Methylprednisolone Metronidazole Penicillin Sulfamethoxazole
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: Upon receiving the 3rd dose and within 5 minutes, my head felt like it was in a fog. I started to shake my head to clear the fog. My pulse started to get more rapid. It was becoming difficult to breathe. Plus I was starting to feel nauseous. I had two nurses standing in front of me discussing what they were going to do after work. They ignored me and weren''t paying attention to me. Someone came out from another room and did notice me. They asked me if I was okay and I said no. They laid me down, gave me an ice pack, and placed it on my neck. I felt like vomiting. They took my blood pressure. The female nurse seem to not want to monitor me for 30 minutes. My stomach was hurting and I was sensitive to smell. My mouth was dry at that time. They did not offer me any oxygen and they did not recheck my O2 levels. They gave me this impression that they wanted to leave and go home. They wanted to discharge me quickly. I was not escorted out to my vehicle. They did not know if I was going drive or not even though I was not in a good condition. I came home. I could barely eat that night. I still feel foggy. I''ve been drinking Pedialyte. I still have pain at the injection site, abdominal pain, chills, fatigue and body aches. I still have a headache and from one out of ten - the pain of the headache is at an 8.


VAERS ID: 1753713 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO183 / 3 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Axillary pain, Induration, Lymph node pain, Lymphadenopathy, Neck pain, Nodule, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Roughly one day after getting vaccinated I started having pain in my right armpit and in the right side of my neck. There is also swelling on the right side of the neck and an inch away from that swollen area one BB sized hard lump. There is NOT discoloration or skin that is hot to the touch. This appears to be pain in my right axillary lymph nodes and pain with swelling in my right supraclavicular lympnodes. My plan is to self monitor this for a week and if the swelling increases or doesn''t go away I will go to the doctor. I still feel safe to get future covid vaccines but felt like this information was worth sharing.


VAERS ID: 1753729 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling hot, Hyperhidrosis, Limb discomfort, Muscular weakness, Pyrexia, Thirst
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer vaccine- had reactions to all doses given
Other Medications: I take my prescribed medication in the morning and the evening but did not disclose them.
Current Illness:
Preexisting Conditions: Rheumatoid arthritis; lupus; celiac disease; hypertension
Allergies: Bacterium; azithromycin; ROCEPHIN; penicillin; Biox, MOTRIN OTC; pork ( I get severe headaches)
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: About 3:45pm that day, I started feeling really tired, weird tiredness never felt before. When I was walking out of the OR, I felt my legs weak and wobbly and very tired. I went home and to came up the stairs my legs still felt very heavy. About 10:40pm, I felt very thirsty and I felt warm and checked my temperature and it was 103.5F. I drank water and called in to work for the next day to tell them how I was feeling. I was sweating and did have some chills. Around 2:00pm on Wednesday, my fever was not going down and was taking naproxen and Tylenol and also taking showers but my fever would not go down. I was told to continue taking my medication. My fever did not break through until yesterday. After that I did not have the fever and I am still continue taking the medication.


VAERS ID: 1753742 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

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

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

Write-up: Vaccine expired 9-28-2021. Administered on 9-29-2021.


VAERS ID: 1753745 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-20
Onset:2021-09-29
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, SARS-CoV-2 test positive, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81mg, Alphagan 0.2% ophthalmic soln, Trusopt 2% ophthalmic solution, Proscar 5mg, mevacor 40 mg, flomax 0.4mg
Current Illness: BPH, dyslipidemia, arthritis
Preexisting Conditions: BPH, dyslipidemia, arthritis
Allergies: None
Diagnostic Lab Data: COVID-19 PCR NP swab positive 9/29/21
CDC Split Type:

Write-up: Patient completed Pfizer COVID-19 vaccine series on 2/20/21. Patient presented to reporting hospital ER on 9/29/21 after complaint of weakness and was admitted for COVID and Troponinemia. He is currently not requiring oxygen. His symptoms were mild cough and weakness. Patient continues to be admitted at this time.


VAERS ID: 1753765 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Chest X-ray normal, Electrocardiogram normal, Fatigue, Heart rate increased, Nervousness, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Tendinopathies and ligament disorders (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sumatriptan
Current Illness: UTI 2 weeks prior
Preexisting Conditions: No
Allergies: Doxycycline
Diagnostic Lab Data: EKG, Chest X-ray (results normal) and blood work (waiting results)
CDC Split Type: vsafe

Write-up: About hour I started feeling shaky and high heart rate. I stopped at a friends house she is a nurse checked my BP 183/125. She suggested I go to the ER took about 1 hour to get there. I got EKG, Chest X-ray and blood work stayed for observation for 3 hours. As of today I don''t feel but regular symptoms such as sore arm and tired.


VAERS ID: 1753772 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / UNK - / -

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

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

Write-up: Pfizer 2nd dose was given @ 1540 , Dose expired @ 1500.


VAERS ID: 1753787 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: Prior years influenza vaccination.
Other Medications: CALCIUM; IRON; VITAMIN C
Current Illness: None
Preexisting Conditions: Osteopenia
Allergies: Sulfa drugs
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Soreness at injection site onset 9/29/21, persists through the time of this report (11:00M 10/1/21). Fever up to 100.8* F on 9/30/21 (the day after the injection), resolved by 5:00AM on 10/1/21. Chills starting 9/29/21 7:30PM, resolved by 1:00PM on 09/30/21. Body aches, resolved by 10:00AM on 10/1/21.


VAERS ID: 1753792 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 RA / IM

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

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

Write-up: Vaccine expired on September 28, 2021. Administered September 29, 2021.


VAERS ID: 1753815 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-09-29
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/29/21 Covid Positive collected by Dept of Health
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1753822 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Heart rate decreased, Loss of consciousness, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: no illness listed
Preexisting Conditions: no chronic health conditions listed
Allergies: no known allergies
Diagnostic Lab Data: blood pressure taken with automated cuff
CDC Split Type:

Write-up: patient suffered syncope. fainted multiple times within a 15 minute period after regaining consciousness. blood pressure and heart rate also dropped to 79/44 pulse 49. Blood pressure slowly increased over 30 minute period. An unconscious episode resembled a seizure. called Emergency patient was taken to ER for follow up. Returned next day to report BP had stabilized.


VAERS ID: 1753851 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: He did not report any adverse event related to the given vaccine.
CDC Split Type:

Write-up: Patient came to get his booster covid vaccine on 9/29/21. Patient stated and signed that he got Pfizer 2 doses morethan 6 months ago and requested Pfizer Covid vaccine booster dose. He signed the consent. I gave him Pfizer booster dose and he waited 15 minutes after the vaccine and did not have any vaccine adverse reaction. Later he brought his covid vaccine card, and verified his card which was showing he got Moderna x2 doses, 6 months ago. Patient stated that he thought he got Pfizer 6 months ago as his wife also got Pfizer. He did not report any adverse effects related to the given vaccine.


VAERS ID: 1753856 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-10
Onset:2021-09-29
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM

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

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

Write-up: pt fully vaccinated against COVID but then developed + covid test and required hospital admission on 9/29


VAERS ID: 1753860 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness
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: Omeprazole Magnesium
Current Illness: None
Preexisting Conditions: IBS
Allergies: None
Diagnostic Lab Data: Waiting on ENT appointment.
CDC Split Type:

Write-up: Loss of hearing 2 days after Moderna vaccine. Hearing "motor type" sounds also off and on.


VAERS ID: 1753864 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Injury, Limb injury, Pain in extremity, Paraesthesia, Product administration error
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), 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: Site: Pain at Injection Site-Severe, Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-, Additional Details: Pt reports severe arm pain; patient thinks vaccine may have been administered too high and injured her shoulder


VAERS ID: 1753866 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Site Bruising at Injection Site, Severe.


VAERS ID: 1753867 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-08
Onset:2021-09-29
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C12A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

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

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

Write-up: Tested positive for COVID 19 09/29/2021


VAERS ID: 1753875 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Delirium, Disturbance in attention, Headache, Myalgia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: Rx: Losartan, HCTZ, metoprolol, rosuvastatin, metformin, glipizide, allopurinol OTC: 81mg aspirin, potassium chloride
Current Illness: None Covid-19 survivor April 24 - May 8, 2021.
Preexisting Conditions: Diabetic Type II Hypertension Mild obesity (not terribly fat, just overweight)
Allergies: Allergy to morphine (anaphlyactic shock) Irritation from prolonged exposure to latex such as orthodontia.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe body shaking and delirium for about 8 hours, Intense general muscle and joint pain, with splitting headache continuing after 36 hours. Inability to mentally focus


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