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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 73 out of 8,010

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VAERS ID: 1767303 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / OT

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: second dose is pfizer; This spontaneous case was reported by an other health care professional and describes the occurrence of INTERCHANGE OF VACCINE PRODUCTS (second dose is Pfizer) in a 27-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 052E21A) for COVID-19 vaccination. Co-suspect product included non-company product TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Sep-2021, the patient started TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) at an unspecified dose. On 29-Sep-2021, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (second dose is pfizer). On 29-Sep-2021, INTERCHANGE OF VACCINE PRODUCTS (second dose is pfizer) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not provided. Treatment information was not provided. On 29-Sep-2021, the patient received second dose of PFIZER COVID-19 VACCINE in (lot 30155BA) in left deltoid. Most recent FOLLOW-UP information incorporated above includes: On 01-Oct-2021: Follow-up received on 01-OCT-2021 Updated reporters more details and Vaccine route of administration.


VAERS ID: 1767306 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-05
Onset:2021-09-29
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032821A / 1 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Multiple sclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: second dose $g36 days after; This spontaneous case was reported by a consumer and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (second dose $g36 days after) in a 49-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 006C21A and 032821A) for COVID-19 vaccination. The patient''s past medical history included Multiple sclerosis. On 05-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (second dose $g36 days after). On 29-Sep-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (second dose $g36 days after) had resolved. No concomitant medications were reported. No treatment medications were reported. This case was linked to MOD-2021-336457 (Patient Link).


VAERS ID: 1767978 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-16
Onset:2021-09-29
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Hypoxia, Lower respiratory tract congestion, Malaise
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, amlodipine, aspirin, atorvastatin, insulin pen, symbicort, clopidogrel, ferrous sulfate, furosemide, hydralazine, insulin aspart, insulin glargine, latanoprost opthalmic solution, levothyroxine, lisinopril, melatonin, metopro
Current Illness:
Preexisting Conditions: HX bladder cancer, CHF, cholelithiasis, chronic left shoulder pain, CKD stage 3, colonic polyps, COPD, CAD, diabetes, diabetic neuropathy, DJD, GERD, hx of NSTEMI, hyperlipidemia, HTN, hypothyroidism, PVD, Raynauds syndrome, asthma with exacerbation.
Allergies: Raw apple, bactrim.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received both doses of the Moderna COVID-19 vaccine (on 2/16/2021 and 3/16/2021, respectively). Pt became ill with COVID and tested positive on 9/29/2021. She went to urgent care for cough and chest congestion on 9/29/2021. On 10/5/2021, she presented to the ED with worsening symptoms of hypoxia and was admitted. Still admitted today.


VAERS ID: 1768094 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Electrocardiogram ambulatory, Laboratory test
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol sulfate HFA, Vitamin D2, montelukast, Wixela.
Current Illness:
Preexisting Conditions:
Allergies: belviq, doxycycline, sertraline, trintellix, venlafaxine,
Diagnostic Lab Data: lab work, EKG, holter monitor
CDC Split Type:

Write-up: lightheaded


VAERS ID: 1768216 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-20
Onset:2021-09-29
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Atrial fibrillation, Echocardiogram abnormal, Electrocardiogram abnormal
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), 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: I was taking Mycophenolate-1000mg a day/500 twice a day. An eye drop Lumigan, one drop in each eye once a day. OTC-D3 Vit, Omega 3, Turmeric, Calcium Citrate, Align Probiotic.
Current Illness: none
Preexisting Conditions: I have Myasthenia Grovis
Allergies: I am allergic to Penicillin, Cypro, and Levaquin.
Diagnostic Lab Data: EKG-08/29/2021-AVIB was detected Echocardiogram -10/05/2021-still in AVIB
CDC Split Type: vsafe

Write-up: 08/29/2021 I went to my pre-op for upcoming surgery. She did an EKG. Ordered an Echocardiogram. My doctor but me on a blood thinner and a Bata blocker.


VAERS ID: 1768248 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Lethargy, Pain, Pyrexia, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within an hour of vaccine, almost immediately had a fever (100.4). 2 hours post vaccination, I had a fever of 102 even. 2.5 hours post vaccination full body aches and a fever of 103.2. Slept most of the day. Following day, low-grade fever. I''ve had shortness of breath and lethargy ever since the vaccination. I am a very healthy 30 year old female, in shape with an appropriate diet. Who has never had these symptoms prior to the vaccination.


VAERS ID: 1768381 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Decreased appetite, Diarrhoea, Fatigue, Headache, Musculoskeletal stiffness, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd COVID vaccination in late January 2021
Other Medications: Levoxyl Omeprazole Tolterodine Atorvastatin Metroprolol CoQ10 Vitamin D3 Multi-vitamin (iron free) Levocetirizine (as needed for hives)
Current Illness:
Preexisting Conditions: hypothyroidism GERD Urinary incontinence High Cholesterol Angina and Micro Vascular Disease Hives
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: fever, nausea, tiredness, headache, chills, diarrhea, loss of appetite, stiff and sore I felt like this for 2-3 days, but didn''t feel better until day 5.


VAERS ID: 1768424 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-23
Onset:2021-09-29
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count, Metabolic function test, Pelvic pain, Ultrasound pelvis, Vaginal haemorrhage
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cryselle daily
Current Illness: history of anxiety history of dysmenorrhea
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data: CBC, CMP, d-dimer, pelvic ultrasound, EKG
CDC Split Type:

Write-up: Patient reported chest pain, shortness of breath, pelvic pain, and vaginal bleeding


VAERS ID: 1768578 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 RA / IM

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

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

Write-up: Error: Patient Too Young for Vaccine Administered-


VAERS ID: 1768631 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-25
Onset:2021-09-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dysmenorrhoea, Menstruation irregular, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Shot 1, next period cycle, irregular. Menstrual pain coming and going. On day 8 now. Spotting, then flow, repeat. This has never happened during my menstrual cycle, even when stressed.


VAERS ID: 1768690 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Hypoaesthesia, Induration, Mobility decreased, Musculoskeletal stiffness, Nodule, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd dose of COVID vaccine, same reactions, flare up of auto immune symptoms
Other Medications: Prednisone 9mg/day, vitamin D 2000iu/day, indapamide 1.25mg/day, Crestor 10mg/day, metformin 1000mg extended release/day, calcium citrate 650mg/day, Lumigan 0.01% 1 drop per eye/evening, Ventolin inhaler as needed. INFLUENZA
Current Illness: No
Preexisting Conditions: polymyalgia rheumatica, asthma, Meniere''s
Allergies: Possibly penicillin, contrast dye (iodine for CT scan )
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: I had significantly increased shoulder and upper arm pain and stiffness on both sides. On the right side, I got a lot of increased tingling and numbness from the carpal tunnel symptoms. In the crook of my arm, on the right inner side of my arm there feels like a big knot where I bend my arm. It is a hard knot that was also there for the 1st and 2nd dose of the vaccine as well. On 10/4 and 10/5 I took 13mg of prednisone. Today I am on 12mg and will then go down to 9mg. I can tolerate the discomfort. I had a lot of stiffness and pain in my hips where I had trouble getting in and out of a chair. I was not on prednisone for the second shot and had pain, but the prednisone did not get rid of the pain for the 3rd dose. It was not as bad but still there. I was unable to get dressed and move around because I was in so much pain. I contacted the doctor to get advice on taking the prednisone for the pain. I had carpal tunnel which had become tolerable after taking prednisone but flared up completely after the 3rd dose. I am back to my baseline of my auto immune poly myalgia rheumatica which for me, is recovery


VAERS ID: 1768750 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-04
Onset:2021-09-29
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Asthenia, Blood culture, Blood lactic acid, Blood magnesium decreased, COVID-19, Chest X-ray normal, Computerised tomogram head normal, Cystitis, Echocardiogram normal, Electrocardiogram normal, Escherichia infection, Full blood count, Gait inability, Hallucination, Hypotension, Metabolic function test, Pyuria, SARS-CoV-2 test positive, Syncope, Troponin normal, Urinary tract infection, Urine analysis abnormal, Walking aid user
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (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, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet aspirin 81 MG chewable tablet atenolol (TENORMIN) 25 MG tablet benzocaine-menthol (CEPACOL) 15-3.6 MG LOZG benzonatate (TESSALON) 100 MG capsule bisacodyl (DULCOLAX) 10 MG suppository calcium carbonate
Current Illness:
Preexisting Conditions: Benign neoplasm of brain Gastroesophageal reflux disease without esophagitis Depression Hyperlipidemia Hypertension Coronary artery disease Type II or unspecified type diabetes mellitus without mention of complication, not stated as uncontrolled Carotid artery disease CVA (cerebral infarction) Peripheral vascular disease Type 2 diabetes mellitus Seizure disorder Spinal stenosis Poor short-term memory Compression fracture of lumbar vertebra Dementia ACP (advance care planning) Constipation Transient cerebral ischemia Benign essential hypertension Dyslipidemia History of hip replacement Impairment of balance Insomnia CKD stage 3 due to type 2 diabetes mellitus Paroxysmal atrial fibrillation
Allergies: Atorvastatin, Codeine, Darvocet, Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 09/29/2021; COVID-19 positive 09/29/2021; fully vaccinated Assessment/Plan DIAGNOSIS at time of disposition: 1. COVID-19 2. Acute cystitis without hematuria New Prescriptions No new medications prescribed this visit. ED Disposition ED Disposition Hospitalized MEDICAL DECISION MAKING Supervising Physician: Upon arrival to the emergency department patient''s vital signs are notable for hypotension. Possible etiologies of their symptoms include sepsis, urinary tract infection, COVID-19. Our workup in the emergency department includes urinalysis, COVID-19 test, complete blood count, CMP, magnesium, chest x-ray, lactic acid, blood cultures. Workup was notable for urinalysis which demonstrates a urinary tract infection, positive COVID-19 test, increase lactic acid to 2.3, and a low magnesium level. Given these findings most likely etiology of their symptoms is combination of a urinary tract infection as well as COVID-19. The patient was ambulated in the emergency department. She was unable to walk. She normally walks with a walker. I spoke with her son who agrees that she should be admitted to the hospital given that her constellation of symptoms. I spoke with the hospitalist who kindly agreed to accept the patient. Patient will be admitted in guarded condition. We did give her Tylenol, IV fluids, as well as magnesium in the emergency department Note from 10/6/2021: CHIEF COMPLAINT: Asthenia Assessment/Plan ASSESSMENT / PLAN: Principal Problem: Asthenia Active Problems: COVID-19 Asthenia possibly secondary to COVID/UTI COVID-19 positive Pyuria/Urinary tract infection COVID-19 positive but chest x-ray negative No hypoxia. Hold on remdesivir and Decadron E.coli in urine Cont rocephin for 3 days. PTOT consult Episode of syncope - ekg and trops are ok - CT angio thorax done, negative - CT head is negative - echo is normal Care management note on 10/5/2021: Plan/Reassessment: Plan Discharge Coordination/Progress: Initial Assessment done with son by phone; pt reported with Hullucinations; hx of Dementia. Pt will be out of covid isolation (day 11) by 10/11/21. Will plan completion of 77/78 and continue to find accepting SAR.


VAERS ID: 1768776 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Malaise, Pyrexia, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No reported.
Current Illness: No reported.
Preexisting Conditions: No reported.
Allergies: No reported.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received 1st dose of vaccine on 9/27/21. Patient reported fever and symptoms of "not feeling well" on 9/29/21. On 9/30/21, patient was evaluated by a healthcare professional. Patient had tachycardia (107), elevated BP (148/88), and was visibly "shaken & confused." Patient stated her 20 minute commute took 40 minutes since she had pull over due to feeling of confusion. At visit, patient was still confused and was escorted to the emergency department for further evaluation.


VAERS ID: 1768796 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-23
Onset:2021-09-29
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Arthralgia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Developed muscle and joint aches along with severe anxiety a week after receiving the second dose. Lasting over a week.


VAERS ID: 1768935 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site inflammation, Injection site pruritus, Injection site urticaria, Injection site warmth, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Initially/same day patient had no adversities. The next day arm was extremely sore and had a small wheal in the area that she had been vaccinated in. According to the patient 9/29 It was about the size of a quarter. The following day it had increased to size 8cmx5cm the 30th. Patient complained it was inflamed and itchy and hot to the touch. The patient took ibuprofen and iced the area. Per the patient it eventually resolved and was much less visible by the 10/5. Patient had no other side effects.


VAERS ID: 1768998 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-02
Onset:2021-09-29
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Exposure during pregnancy, Full blood count normal, Hypoaesthesia, Laboratory test normal, Magnetic resonance imaging head normal, Metabolic function test, Migraine, Protein total normal, Scan with contrast, Urine analysis normal, Visual field defect
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pre-natal vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: lab work; comprehensive metabolic panel, CBC, urine analysis, protein CRT-all these looked good. MRI of the brain performed 09/29/2021 with contrast demonstrated; no acute ischemia, minimal focal of T2 flare intensity especially on the frontal subcortal white matter, likely reflex sequeale of migraine.
CDC Split Type: vsafe

Write-up: I am pregnant and at the time of vsafe check in, I am just 78 weeks 4 days pregnant. On 09-29-2021 I had a complex migraine. I went to the hospital , I had episode where I could not speak, my right arm arm went numb and had a blind spot in the middle of my eyes. They ruled that it was a complex migraine. They did lab work, did an MRI of the brain with contrast. EDD: 10/16/2021.


VAERS ID: 1769870 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

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

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

Write-up: Patient claims this is her first dose, upon checking database, this is her 3rd dose. She claims she never receive any covid vaccine. She is 58 , 6 months apart from second, but with no medical conditon.


VAERS ID: 1770020 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-24
Onset:2021-09-29
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac flutter, Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Famotidine 20 mg
Current Illness:
Preexisting Conditions: Hypothyroid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I started feeling short of breath and heaviness in my chest, extreme heart flutters. Specially with walking or during meals.


VAERS ID: 1770417 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-09-29
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Military       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: USJNJFOC20211012245

Write-up: ADMINISTRATION OF EXPIRED VACCINE; This spontaneous report received from a health care professional 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: 205A21A, 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 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: 1770448 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: This spontaneous case reported by an other healthcare professional, describes the occurrence of administered product to patient of inappropriate age (a patient under the age of 18 received the first dose of the Moderna vaccine) in a 13-year-old male patient who received mRNA-1273 (Moderna COVID-19 vaccine, batch/lot# 005C21A) for COVID-19 immunization. No medical history reported. On Sep 29, 2021, patient received the first dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On Sep 29, 2021, administered product to patient of inappropriate age (a patient under the age of 18 received the first dose of the Moderna vaccine). On Sep 29, 2021, administered product to patient of inappropriate age (a patient under the age of 18 received the first dose of the Moderna vaccine) resolved. The action taken with mRNA-1273 (Moderna COVID-19 vaccine): unknown. The reporter did not provide any causality assessments, concomitant medications or treatment information.


VAERS ID: 1770464 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-01
Onset:2021-09-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient upset because they had given them an expired vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient upset because they had given them an expired vaccine) in a 32-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033B21A) for COVID-19 vaccination. No Medical History information was reported. On 01-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient upset because they had given them an expired vaccine). On 29-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Patient upset because they had given them an expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No Concomitant medication was reported. No treatment medications were reported


VAERS ID: 1770501 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 12 year old patient was administered 1st dose of modern vaccine/12 year old received moderna vaccine/1st dose administered/Mistakenly administered moderna covid vaccine/error; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old patient was administered 1st dose of modern vaccine/12 year old received moderna vaccine/1st dose administered/Mistakenly administered moderna covid vaccine/error) in a 12-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Sep-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old patient was administered 1st dose of modern vaccine/12 year old received moderna vaccine/1st dose administered/Mistakenly administered moderna covid vaccine/error). On 29-Sep-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old patient was administered 1st dose of modern vaccine/12 year old received moderna vaccine/1st dose administered/Mistakenly administered moderna covid vaccine/error) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported. Most recent FOLLOW-UP information incorporated above includes: On 30-Sep-2021: Follow-up received contains additional Non-significant follow-up appended additional reporter details were added.


VAERS ID: 1770505 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient received expired first dose of the Moderna vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient received expired first dose of the Moderna vaccine) in a 32-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient received expired first dose of the Moderna vaccine). On 29-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Patient received expired first dose of the Moderna vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was provided by reporter. No treatment information was provided by reporter. This case was linked to MOD-2021-338604 (Patient Link).


VAERS ID: 1770506 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient received first expired dose of the Moderna vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient received first expired dose of the Moderna vaccine) in a 31-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient received first expired dose of the Moderna vaccine). On 29-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Patient received first expired dose of the Moderna vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported. This case was linked to MOD-2021-338604 (Patient Link).


VAERS ID: 1770508 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Stomach hurts; Arm is sore; Diarrhea; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (Diarrhea), ABDOMINAL PAIN UPPER (Stomach hurts) and MYALGIA (Arm is sore) in a 30-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 29-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Sep-2021, the patient experienced DIARRHOEA (Diarrhea). On an unknown date, the patient experienced ABDOMINAL PAIN UPPER (Stomach hurts) and MYALGIA (Arm is sore). At the time of the report, DIARRHOEA (Diarrhea) had not resolved and ABDOMINAL PAIN UPPER (Stomach hurts) and MYALGIA (Arm is sore) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medication was not reported. Treatment information was not reported.


VAERS ID: 1770509 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient received expired third dose of the Moderna vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient received expired third dose of the Moderna vaccine) in a 76-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient received expired third dose of the Moderna vaccine). At the time of the report, EXPIRED PRODUCT ADMINISTERED (Patient received expired third dose of the Moderna vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications was not reported. Treatment medications was not reported.


VAERS ID: 1770518 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-24
Onset:2021-09-29
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Pain, Pain in extremity
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METHYLPREDNISOLONE
Current Illness:
Preexisting Conditions: Comments: No medical history was reported.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Whole body hurts; Diarrhea; Sore arm,soreness in the arm; Tiredness, exhaustion; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (Whole body hurts), DIARRHOEA (Diarrhea), PAIN IN EXTREMITY (Sore arm,soreness in the arm) and FATIGUE (Tiredness, exhaustion) in a 40-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 051E21A) for COVID-19 vaccination. No medical history was reported. Concomitant products included METHYLPREDNISOLONE for an unknown indication. On 24-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Sep-2021, the patient experienced FATIGUE (Tiredness, exhaustion). On an unknown date, the patient experienced PAIN (Whole body hurts), DIARRHOEA (Diarrhea) and PAIN IN EXTREMITY (Sore arm,soreness in the arm). At the time of the report, PAIN (Whole body hurts), DIARRHOEA (Diarrhea), PAIN IN EXTREMITY (Sore arm,soreness in the arm) and FATIGUE (Tiredness, exhaustion) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No treatment drugs were reported.


VAERS ID: 1770521 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine used; The vials were in the refrigerator for over 30 days; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) and PRODUCT STORAGE ERROR (The vials were in the refrigerator for over 30 days) in a 27-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) and PRODUCT STORAGE ERROR (The vials were in the refrigerator for over 30 days). On 29-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) and PRODUCT STORAGE ERROR (The vials were in the refrigerator for over 30 days) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment information was not provided by the reporter. This case was linked to MOD-2021-338604 (Patient Link).


VAERS ID: 1770547 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-14
Onset:2021-09-29
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary mass, Off label use
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: has a lump under his left arm in the arm pit area; he received the 3rd dose (lot # 037C21A) for immunocompromised patients on 29Sep2021 in his left arm despite not being immunocompromised; This spontaneous case was reported by a consumer and describes the occurrence of AXILLARY MASS (has a lump under his left arm in the arm pit area) and OFF LABEL USE (he received the 3rd dose (lot # 037C21A) for immunocompromised patients on 29Sep2021 in his left arm despite not being immunocompromised) in a 66-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037C21A, 011J20A and 030M20A) for COVID-19 vaccination. No Medical History information was reported. On 14-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 11-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced OFF LABEL USE (he received the 3rd dose (lot # 037C21A) for immunocompromised patients on 29Sep2021 in his left arm despite not being immunocompromised). On an unknown date, the patient experienced AXILLARY MASS (has a lump under his left arm in the arm pit area). On 29-Sep-2021, OFF LABEL USE (he received the 3rd dose (lot # 037C21A) for immunocompromised patients on 29Sep2021 in his left arm despite not being immunocompromised) had resolved. At the time of the report, AXILLARY MASS (has a lump under his left arm in the arm pit area) outcome was unknown. Concomitant medication was not reported. Treatment information was not reported.


VAERS ID: 1771070 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Moderna COVID-19 vaccine were administered on 29Sep2021 and they had expired on 28Sep2021; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Moderna COVID-19 vaccine were administered on 29Sep2021 and they had expired on 28Sep2021) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036B21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Moderna COVID-19 vaccine were administered on 29Sep2021 and they had expired on 28Sep2021). On 29-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Moderna COVID-19 vaccine were administered on 29Sep2021 and they had expired on 28Sep2021) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. No treatment information was provided.


VAERS ID: 1771075 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Colorado  
Vaccinated:0000-00-00
Onset:2021-09-29
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 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: USJNJFOC20211012141

Write-up: EXPIRED DOSES OF THE VACCINE WERE ADMINISTERED; This spontaneous report received from a health care professional concerned multiple patients. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A, 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 expired doses of the vaccine were administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired doses of the vaccine were administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20211011801, 20211012209, 20211012114 and 20211012383. This report was associated with product quality complaint : 90000196306.


VAERS ID: 1771092 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-28
Onset:2021-09-29
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site mass, Vaccination site pain, Vaccination site warmth
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: SYNTHROID; HYDROCHLOROTHIAZIDE.
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: a red lump on the injection site and that is warm to the touch; warm to the touch; felling that their arm is killing them; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE MASS (a red lump on the injection site and that is warm to the touch), VACCINATION SITE WARMTH (warm to the touch) and VACCINATION SITE PAIN (felling that their arm is killing them) in a 51-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 048121A and 020f21a) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included LEVOTHYROXINE SODIUM (SYNTHROID) and HYDROCHLOROTHIAZIDE for an unknown indication. On 28-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Sep-2021, the patient experienced VACCINATION SITE MASS (a red lump on the injection site and that is warm to the touch), VACCINATION SITE WARMTH (warm to the touch) and VACCINATION SITE PAIN (felling that their arm is killing them). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. At the time of the report, VACCINATION SITE MASS (a red lump on the injection site and that is warm to the touch), VACCINATION SITE WARMTH (warm to the touch) and VACCINATION SITE PAIN (felling that their arm is killing them) outcome was unknown.


VAERS ID: 1771124 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-09-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine administered to 6 patients; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered to 6 patients) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In September 2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered to 6 patients). On 30-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered to 6 patients) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered to 6 patients) to be possibly related. No concomitant medications were reported. No treatment medications were reported. Pharmacist was calling to report that 6 patients received the Moderna COVID-19 vaccine from 29SEP2021 to 30SEP2021. The Moderna Covid-19 vials administered to these 6 patients expired on 28SEP2021. Reporter did not allow further contact


VAERS ID: 1771149 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: patient was vaccinated on Wednesday 29Sept2021 with a Moderna dose from a vial the pharmacist believes was opened on Monday 27Sep2021/ Patient was administered a dose that was stored for over 30 days t; patient administered a dose from an excursed vial; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (patient was vaccinated on Wednesday 29Sept2021 with a Moderna dose from a vial the pharmacist believes was opened on Monday 27Sep2021/ Patient was administered a dose that was stored for over 30 days t) and PRODUCT STORAGE ERROR (patient administered a dose from an excursed vial) in a 20-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (patient was vaccinated on Wednesday 29Sept2021 with a Moderna dose from a vial the pharmacist believes was opened on Monday 27Sep2021/ Patient was administered a dose that was stored for over 30 days t) and PRODUCT STORAGE ERROR (patient administered a dose from an excursed vial). On 29-Sep-2021, EXPIRED PRODUCT ADMINISTERED (patient was vaccinated on Wednesday 29Sept2021 with a Moderna dose from a vial the pharmacist believes was opened on Monday 27Sep2021/ Patient was administered a dose that was stored for over 30 days t) and PRODUCT STORAGE ERROR (patient administered a dose from an excursed vial) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. The pharmacist believed was opened on Monday 27-Sep-2021 (but he was not sure). Pharmacist was unsure if it was the patient''s first or second dose and unsure which arm vaccine was administered in. It was also reported that administered a dose that was stored for over 30 days to a patient. No other adverse events have been experienced. Concomitant medications were not reported. Treatment medications were not reported. Most recent FOLLOW-UP information incorporated above includes: On 02-Oct-2021: Follow up received on 02 OCT 2021 contains : Reporter information updated, patient demographics added and lot number updated. On 05-Oct-2021: Folow up received on 05 oct 2021 contains No New Information.


VAERS ID: 1771159 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-01
Onset:2021-09-29
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 RA / OT
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Body temperature, Headache, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METHOTREXATE
Current Illness: Arthritis; Immunocompromised
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202109; Test Name: Body temperature; Result Unstructured Data: 100.7 degrees Farenheight,
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Sore left arm; Low grade fever , 100.7 degrees Farenheight; Slight headache; Generalized weakness; This spontaneous case was reported by a consumer and describes the occurrence of ASTHENIA (Generalized weakness), PAIN IN EXTREMITY (Sore left arm), PYREXIA (Low grade fever , 100.7 degrees Farenheight) and HEADACHE (Slight headache) in a 21-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 003B21A and 025A21A) for COVID-19 vaccination. Co-suspect product included non-company product INFLUENZA VACCINE (FLU) for an unknown indication. Concurrent medical conditions included Arthritis and Immunocompromised. Concomitant products included METHOTREXATE for an unknown indication. On 01-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Sep-2021, the patient started INFLUENZA VACCINE (FLU) (unknown route) at an unspecified dose. On 29-Sep-2021, the patient experienced ASTHENIA (Generalized weakness), PYREXIA (Low grade fever , 100.7 degrees Farenheight) and HEADACHE (Slight headache). On an unknown date, the patient experienced PAIN IN EXTREMITY (Sore left arm). At the time of the report, ASTHENIA (Generalized weakness), PAIN IN EXTREMITY (Sore left arm), PYREXIA (Low grade fever , 100.7 degrees Farenheight) and HEADACHE (Slight headache) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In September 2021, Body temperature: 100.7 (High) 100.7 degrees Farenheight. The patient received his flu shot at the same time that he received his third dose of Moderna Covid-19 vaccine. The side effects were generalized weakness, low grade fever of 100.7 degrees Fahrenheit and a slight headache. Patient also reported a sore left arm. Treatment information was not provided. This case was linked to MOD-2021-339370, MOD-2021-339390 (Patient Link).


VAERS ID: 1771186 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site swelling, Lymph node pain, Lymphadenopathy, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Site: Swelling at Injection Site-Severe, Systemic: lymph node/armpit area is tender and swollen-Severe, Systemic: Lymph Node Swelling-Severe, Systemic: Vomiting-Mild, Additional Details: extreme fatigue and extreme lymph node swelling and tenderness on same side of injection site


VAERS ID: 1771406 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, Xarelto, Vitamin D3, Tylenol, FeSO4, Flomax, Pravastatin
Current Illness: Diverticulitis with abscess, Wound abdomen
Preexisting Conditions: Pancreatic adenoma, DVT/PE. HTN, COPD, CKD
Allergies: Cephalexin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, Myalgia, Diarrhea


VAERS ID: 1771433 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Burning sensation, Eye pain, Pain in jaw, Pruritus, Toothache, Trigeminal nerve disorder
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Glaucoma (broad), Hearing impairment (broad), Osteonecrosis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Vitamin D, Pure Multivitamin
Current Illness: none
Preexisting Conditions: No Spleen
Allergies: none
Diagnostic Lab Data: Doctor checked it out and asked me to report it...no known issue was found from examination.
CDC Split Type:

Write-up: After the shot the next morning I had pain in my front jaw area, top and bottom. First thought was tooth ache. Then the next day the pain was in around my eyes and my jaw/cheek area. I looked up the nerves in that area and it seems to be the Trigeminal nerves. The pain would throb, then itch and burn. Now, 10 days later I have some jaw pain but lots of pain around the eyes...burning and itching. You can''t see anything which makes me think it is nerves....maybe a sort of bells palsy? I visited the doctor yesterday and said the Trigeminal nerves usually is just one junction of the nerve not all of them. I would say it is 30% better so at least is getting better. The odd thing about it my husband is experiencing the SAME THING!! That is why we think it is from the Covid booster as we got it the same time. His is more around the top of his eye and front of ear. It is only one side of the face.


VAERS ID: 1771520 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-25
Onset:2021-09-29
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LL / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 RL / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Dyspnoea, Dyspnoea exertional, Rheumatoid arthritis, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Arthritis (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

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

Write-up: received Pfizer vaccines on 1/4/21, 1/25/21 Tested positive for COVID by PCR on 9/29/21 Admitted to hospital on 10/8/21 with SOB, DOE, weakness. Received Monoclonal antibodies on 9/30/21. underlying rheumatoid arthritis


VAERS ID: 1771521 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-18
Onset:2021-09-29
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Asthenia, Blood albumin decreased, Blood creatinine increased, Blood sodium decreased, Blood urea increased, COVID-19, Carbon dioxide decreased, Chest X-ray abnormal, Diarrhoea, Fatigue, Haemoglobin decreased, Lung opacity, N-terminal prohormone brain natriuretic peptide increased, Nausea, SARS-CoV-2 test positive, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: simvastatin, Preservision, latanoprost ophthalmic drops, benazepril, amlodipine
Current Illness:
Preexisting Conditions: hypertension, hyperlipidemia, macular degeneration
Allergies: NKA
Diagnostic Lab Data: 10/8/21 Chest X-ray: faint airspace opacities of the mid lungs bilaterally HGB: 13.4 SCr: 1.22; BUN: 31; Sodium: 134; CO2: 18; ALT: 86; AST: 59; albumin: 3.3 Pro-BNP: 586 High sensitivity troponin (1231): 71; (1355): 62 Rapid COVID-19: Positive
CDC Split Type:

Write-up: The patient has had worsening fatigue and weakness for approximately 10 days. He also complains of nausea and diarrhea. Patient found to have COVID-19 in ED. Patient will be admitted to hospital. Patient has received a fluid bolus in ED.


VAERS ID: 1771611 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-24
Onset:2021-09-29
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Induration, Lymphadenopathy
SMQs:, 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:
Other Medications: none
Current Illness: none
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: went to urgent care, had a cbc lab done and was given antibiotic for possible infection starting.
CDC Split Type:

Write-up: lymph node under left arm became enlarged after 5 days of vaccine. 12 days after vaccine, lump became hard.


VAERS ID: 1771695 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back disorder, Condition aggravated, Feeling abnormal, Headache, Hypoaesthesia, Lymph node pain, Mammogram normal, Musculoskeletal discomfort, Pain, Paraesthesia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Rosuvastatin, Vitamin D3, Protonic.
Current Illness: None.
Preexisting Conditions: High cholesterol, acid reflux.
Allergies: Penicillin, Sulfa, Codeine, Zithromax, Rocephin.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine in her left arm that evening, she felt fine. The next morning she got up, felt a little off but she went to work. About 2:00 PM she knew that she had developed a fever. Came home, took her temp it was 101.5, and that lasted almost for the next 24 hours. She had the body aches, joint pain. She took Tylenol and over the 24 hours it relieved her symptoms. She also had a slight headache. After that 24 hour period she felt fine (Thursday). On Friday she went to work and sat down in a chair, and when she got up from there she had numbness and tingling down her left leg into her foot. She has had some lower back issues and some hip issues before, but she had not done anything since she had gotten the vaccine. She does not know whether this is part of the vaccine or unrelated, but felt she should report it. She is still having the numbness and tingling in the left leg and foot today. She also had the pain almost like a lymph node pain under her left arm with this one and with the 2nd dose as well. She did have a mammogram that was OK. She is going to a doctor today to see if it''s related to the vaccine or not.


VAERS ID: 1771945 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chest pain, Dyspnoea, Fatigue, Headache, Inflammation, Injection site erythema, Injection site pruritus, Injection site warmth, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: oral birth control, women''s daily vitamin, Celexa, zyrtec, flonase
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 5 hours after the shot I developed sore arm, headache, fatigue, muscle aches, small red spot at injection site, chest pain. Everything but the chest pain went away within 48 hours. Shortness of breath and chest pain continued, shortness of breath was mostly only noticeable with excess movement. As the days went on it got worse. I saw my doctor on day 8, she said I had inflammation in my chest. I was told to take 800mg of ibuprofen every 8 hours for 2 weeks. After the first dose of ibuprofen I got stomach cramps so I started taking 600mg after that. On Day 8 in the evening I noticed a large red spot at my injection site. It was warm to the touch and slightly itchy but no pain. It has been slowly fading since. I am now at Day 10 after the vaccine and My chest pains and shortness of breath are worse, ibuprofen do not seem to be helping. I now get pains in my back between my shoulder blades.


VAERS ID: 1772088 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-21
Onset:2021-09-29
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abnormal dreams, Extra dose administered, Paraesthesia, Somnolence
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: I started to experience paresthesia in my hands the day after receiving the 3rd dose/booster dose. I also experienced very vivid dreams and was unable to wake easily. The paresthesia lasted about 5 days.


VAERS ID: 1772135 (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: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Fibrin D dimer increased, Gout, Red blood cell sedimentation rate increased
SMQs:, Haemorrhage laboratory terms (broad), Arthritis (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: HSCRP ESR d-dimer
CDC Split Type:

Write-up: flare of gout, elevated HSCRP$g10, ESR 22, d-dimer 0.64


VAERS ID: 1772581 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal distension, Body temperature increased, Chills, Ear discomfort, Injection site pain, Oropharyngeal pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Beginning at 2130 hrs- temp 104.3; chills, sore throat and ears, abdominal discomfort with bloating. Sore left shoulder at the injection site for a week. Alternated take Tylenol and Advil every 4 hours for two days.


VAERS ID: 1773399 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-09-29
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Dizziness, Headache, Heart rate, Heart rate increased, Hypertension, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient had no prior medical history or chronic conditions.
Allergies:
Diagnostic Lab Data: Test Date: 20210930; Test Name: Heart rate; Result Unstructured Data: Rapid; Test Date: 20210930; Test Name: Blood pressure; Result Unstructured Data: Very very high
CDC Split Type: USJNJFOC20211011852

Write-up: NOT FEELING WELL (JUST NOT QUITE RIGHT); VERY VERY HIGH BLOOD PRESSURE; RAPID HEARTBEATS; NAUSEA; DIZZINESS (LIGHTHEADEDNESS); HEADACHES; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: Patient had no prior medical history or chronic conditions. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 28-SEP-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 29-SEP-2021, the patient experienced dizziness (lightheadedness). On 29-SEP-2021, the patient experienced headaches. On 30-SEP-2021, the patient experienced very very high blood pressure. On 30-SEP-2021, the patient experienced rapid heartbeats. On 30-SEP-2021, the patient experienced nausea. Laboratory data included: Blood pressure (NR: not provided) Very very high, and Heart rate (NR: not provided) Rapid. On 05-OCT-2021, the patient experienced not feeling well (just not quite right). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from very very high blood pressure, and rapid heartbeats on 05-OCT-2021, and nausea on 30-SEP-2021, and was recovering from dizziness (lightheadedness), headaches, and not feeling well (just not quite right). This report was non-serious.; Sender''s Comments: V0: Medical Assessment Comment not required as per standard procedure as case assessed as non-serious.


VAERS ID: 1773456 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Bilirubin conjugated increased, Blood lactate dehydrogenase increased, Coombs positive haemolytic anaemia, Coombs test positive, Leukocytosis, Red blood cell count decreased, Reticulocyte count increased, Serum ferritin increased, Warm type haemolytic anaemia, White blood cell count increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Haemolytic disorders (narrow), Haematopoietic erythropenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Biliary system related investigations, signs and symptoms (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No prescribed medications Occasional acetaminophen
Current Illness: None
Preexisting Conditions: Mantle zone MALT lymphoma in 2018 Asthma Panic attacks CoViD in 12/2020 H pylori 2016
Allergies: None
Diagnostic Lab Data: Coombs (+), elevated LDH, elevated direct bilirubin, slightly elevated ferritin, leukocytosis 13, anemia 8.4, reticulocyte elevation 7.4
CDC Split Type:

Write-up: Warm autoimmune hemolytic anemia


VAERS ID: 1773478 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-17
Onset:2021-09-29
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA QS4C2VT / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram head, Ear pain, Herpes zoster, Impaired work ability, Lipoma, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Lipodystrophy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Codeine
Diagnostic Lab Data: CT of the head due to severe ear pain prior to the rash showing up. Will also be seeing a general surgeon in a couple of weeks to have a lipoma removed.
CDC Split Type:

Write-up: I got shingles within 2 weeks after my 2nd shot. No hx health problems. I believe it to be a severe case on my face. I spent time in the ER due to this and despite treatment, still in severe pain 1.5 weeks after the initial onset of sxs. I am unable to work due to the pain. This was 2 weeks after my 2nd Moderna shot. I also had a lipoma grow on my forearm within 2 weeks after my first shot. No hx of lipomas, and no family hx of them either. I now have to have it removed by a general surgeon.


VAERS ID: 1773496 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient received expired second dose of the Moderna vaccine; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient received expired second dose of the Moderna vaccine) in a 43-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient received expired second dose of the Moderna vaccine). On 29-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Patient received expired second dose of the Moderna vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was reported by the reporter. No treatment was reported by the reporter. This case was linked to MOD-2021-338604 (Patient Link).


VAERS ID: 1773507 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-04
Onset:2021-09-29
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Myalgia, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ROSUVASTATIN; PEPCID [FAMOTIDINE]; LORAZEPAM
Current Illness: Spinal stenosis (Degenerative spinal stenosis)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Back pain; Pain got worst to the rest of the arm; (Pain) to the rest of the body/Mild localized pain/at night got horrible pain/got spots of pain during the night that woke the patient up; Fever- 99F; This spontaneous case was reported by a consumer and describes the occurrence of BACK PAIN (Back pain), PAIN IN EXTREMITY (Pain got worst to the rest of the arm), MYALGIA ((Pain) to the rest of the body/Mild localized pain/at night got horrible pain/got spots of pain during the night that woke the patient up) and PYREXIA (Fever- 99F) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037C21A, 016M20A and 011A21A) for COVID-19 vaccination. Concurrent medical conditions included Spinal stenosis (Degenerative spinal stenosis). Concomitant products included LORAZEPAM for Insomnia, ROSUVASTATIN and FAMOTIDINE (PEPCID [FAMOTIDINE]) for an unknown indication. On 04-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Sep-2021, the patient experienced BACK PAIN (Back pain), PAIN IN EXTREMITY (Pain got worst to the rest of the arm), MYALGIA ((Pain) to the rest of the body/Mild localized pain/at night got horrible pain/got spots of pain during the night that woke the patient up) and PYREXIA (Fever- 99F). At the time of the report, BACK PAIN (Back pain), PAIN IN EXTREMITY (Pain got worst to the rest of the arm) and MYALGIA ((Pain) to the rest of the body/Mild localized pain/at night got horrible pain/got spots of pain during the night that woke the patient up) was resolving and PYREXIA (Fever- 99F) outcome was unknown. No Treatment medications were reported. This case was linked to MOD-2021-338672 (Patient Link).


VAERS ID: 1773509 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Bowel movement irregularity, Chills, Decreased appetite, Diarrhoea, Fatigue, Headache, Inappropriate schedule of product administration, Insomnia, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ATENOLOL; DILTIAZEMUM; DULOXETINE [DULOXETINE HYDROCHLORIDE]; FAMOTIDINE; FOLIC ACID; FUROSEMIDE; METHOTREXATE; MINOXIDIL; MOMETASONE FUROATE; MONTELUKAST; NIACIN ALUMINIUM; OLMESARTAN MEDOXOMIL; POTASSIUM 99; ZOLPIDEM; TORSEMIDE; GLUCOSAMI
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertensive heart disease (controlled via medication); Obesity (losing weight); Osteoarthritis (osteoarthritis, seronegative rheumatoid arthritis, increased dosage of methotrexate); Sleep apnea (controlled by Bi-PAP); Venous stasis ulcer (treating with DuoDERM)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: nappropriate schedule of vaccine administered; trouble sleep/difficulty sleeping; slight upset stomach/gastrointestinal distress/discomfort and fullness in my bowels; feeling not good in bowels/bowel movement was loss; fatigue; nauseas/light nausea; muscle ache; loss of appetite; loose BM (but not diarrhea); chills; slight headache; slight sorenessin arm/Muscle ache especially in ankle/slight aches in the muscles in my arms and legs; This spontaneous case was reported by a consumer and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (nappropriate schedule of vaccine administered), INSOMNIA (trouble sleep/difficulty sleeping), ABDOMINAL DISCOMFORT (slight upset stomach/gastrointestinal distress/discomfort and fullness in my bowels), BOWEL MOVEMENT IRREGULARITY (feeling not good in bowels/bowel movement was loss) and FATIGUE (fatigue) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Hypertensive heart disease (controlled via medication) on 07-Nov-2008, Sleep apnea (controlled by Bi-PAP) on 20-Aug-2009, Obesity (losing weight) on 15-Jul-2004, Osteoarthritis (osteoarthritis, seronegative rheumatoid arthritis, increased dosage of methotrexate) on 02-Jul-2019 and Venous stasis ulcer (treating with DuoDERM) on 16-Sep-2021. Concomitant products included MONTELUKAST for Allergic rhinitis, FOLIC ACID for Anemia, DULOXETINE HYDROCHLORIDE (DULOXETINE [DULOXETINE HYDROCHLORIDE]), GLUCOSAMINE, CHONDROITIN and CURCUMA LONGA, PIPER NIGRUM (TURMERIC & BLACK PEPPAR) for Arthritis and Pain, POTASSIUM (POTASSIUM 99) for Electrolyte imbalance, NIACIN ALUMINIUM for High cholesterol, FAMOTIDINE for Hyperacidity, ATENOLOL, DILTIAZEMUM, MINOXIDIL, OLMESARTAN MEDOXOMIL and TORSEMIDE for Hypertension, ZOLPIDEM for Insomnia, MOMETASONE FUROATE for Nasal congestion, METHOTREXATE for Rheumatoid arthritis, FUROSEMIDE, MULTIVITAMIN [VITAMINS NOS], VITAMIN C [ASCORBIC ACID] and VITAMIN D3 for an unknown indication. On 29-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 29-Sep-2021, the patient experienced MYALGIA (slight sorenessin arm/Muscle ache especially in ankle/slight aches in the muscles in my arms and legs). On 30-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (nappropriate schedule of vaccine administered), INSOMNIA (trouble sleep/difficulty sleeping), ABDOMINAL DISCOMFORT (slight upset stomach/gastrointestinal distress/discomfort and fullness in my bowels), BOWEL MOVEMENT IRREGULARITY (feeling not good in bowels/bowel movement was loss), FATIGUE (fatigue), NAUSEA (nauseas/light nausea), MYALGIA (muscle ache), DECREASED APPETITE (loss of appetite), DIARRHOEA (loose BM (but not diarrhea)), CHILLS (chills) and HEADACHE (slight headache). The patient was treated with ACETAMINOPHEN (oral) for Arthritis and Pain, at a dose of 500 mg/2000 mg pm. On 01-Oct-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (nappropriate schedule of vaccine administered), INSOMNIA (trouble sleep/difficulty sleeping), BOWEL MOVEMENT IRREGULARITY (feeling not good in bowels/bowel movement was loss), FATIGUE (fatigue), MYALGIA (slight sorenessin arm/Muscle ache especially in ankle/slight aches in the muscles in my arms and legs), NAUSEA (nauseas/light nausea), MYALGIA (muscle ache), DECREASED APPETITE (loss of appetite), DIARRHOEA (loose BM (but not diarrhea)) and CHILLS (chills) had resolved. At the time of the report, ABDOMINAL DISCOMFORT (slight upset stomach/gastrointestinal distress/discomfort and fullness in my bowels) and HEADACHE (slight headache) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The patient has allergies to medications, food and other products: some medical tape adhesives. Treatment included flushing with fluids, taking 1000 mg of acetaminophen each day, and rest for two days First Dose: 12Feb2021 LOT:031M20A Second Dose: 12Mar2021LOT: 002A21A This case was linked to MOD-2021-341305 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 04-Oct-2021: Significant Follow-up received on 04-Oct-2021. Patient medical history updated. Concomitant medication added. Event outcome updated.


VAERS ID: 1773556 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Dyspnoea, Headache, Nausea, Pyrexia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Shortness of breath; Headache; Diarrhea; Fever; Nausea; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (Diarrhea), DYSPNOEA (Shortness of breath), PYREXIA (Fever), NAUSEA (Nausea) and HEADACHE (Headache) in a 51-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 28-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Sep-2021, the patient experienced DIARRHOEA (Diarrhea), PYREXIA (Fever) and NAUSEA (Nausea). On 30-Sep-2021, the patient experienced DYSPNOEA (Shortness of breath) and HEADACHE (Headache). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. At the time of the report, DIARRHOEA (Diarrhea), DYSPNOEA (Shortness of breath), PYREXIA (Fever), NAUSEA (Nausea) and HEADACHE (Headache) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: negative (Negative) Negative. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided. Most recent FOLLOW-UP information incorporated above includes: On 01-Oct-2021: The followup contains No new information


VAERS ID: 1774917 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-10
Onset:2021-09-29
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30415BA / 2 LA / IM

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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received J&J vaccine on 3-4-21, then recevied first Pfizer vaccine on 9-10-21 and second on 9-29-21.


VAERS ID: 1775072 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-26
Onset:2021-09-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood electrolytes normal, Deep vein thrombosis, Differential white blood cell count normal, Pain in extremity, Peripheral swelling, Platelet count normal, Red blood cell count normal, Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Propranolol, Excedrine (aspririn),Acetominophin, Tums
Current Illness: None
Preexisting Conditions: Antiphospholipid Syndrome; Celiac disease
Allergies: Radi-opaque dye, Iodine, Macrodantin, Furadantin, Flagyl
Diagnostic Lab Data: Ultrasound (Oct. 1, 2021); DVT involving the superficial femoral vein, posterior tibial vein and peroneal vein, left lower extremity Blood Work; normal WBC and DIFF, normal platelets, normal RBC and indices, normal electrolytes
CDC Split Type:

Write-up: DVT in left leg, diagnosed in ER after three days of leg pain and swelling; was prescribed Xarelto, 15 mg twice daily; still have swelling and pain; elevate leg with heat; intermittent ambulation


VAERS ID: 1775102 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site swelling, Pain in extremity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: montelukast 10 mg once dialy
Current Illness: no
Preexisting Conditions: nno
Allergies: azithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling of injection site very sore arm after administration giant welt appeared on right arm less than 24 hours after administration only went away after taking Benadryl for2-3 days


VAERS ID: 1775232 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-24
Onset:2021-09-29
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155814 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Blood test normal, Chest pain, Computerised tomogram normal, Fibrin D dimer normal, Hypertension, Pain, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st Pfizer vaccine on 8/25/21
Other Medications: None. Just whole food vitamins
Current Illness: No
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: CT SCAN STAT with contrast on 10-06-21, Blood work STAT on 10-06-21
CDC Split Type:

Write-up: 3 days after receiving the pfizer vaccine in my LEFT ARM I started have had pain in my RIGHT arm pit and down my arm and my chest was burning with pain. My blood pressure on Sunday October 3rd was 154/84 and my normal blood pressure is is borderline low of 97/67. I almost went to the ER and waited to go to the doctor. It was very painful and I tried taking advil, aleve, and it would not stop hurting. My arm also had a burning feeling down my forearm. I Went to the doctor on October 5th and she ordered blood work STAT that included a d-dimer test for blood clots. She the sent me to get a CT scan STAT with contrast of my chest. The result came back normal and I will be going back to the doctor next week for a follow up. She prescribed 800 milligrams of advil and it still hasn''t stopped the pain. I am of normal weight and I work out 5 days per week and have always been very healthy until this vaccine. The first pfizer shot left me with ringing in my ears and a VAEERS report was filed as well. I wish I NEVER would have gotten the vaccine.


VAERS ID: 1775329 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Impaired work ability, Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: I have had two side effects. My first one is essential/kinetic tremors that have gotten worse. Anytime I hold something or do something my hands shake very bad. That has gotten worse since It started. It has made it very hard to do my job as a nurse starting IVs, etc. The second one is ?pins and needles? feeling like when you?re feet fall asleep from my calves down to my feet constantly. That has slowly gotten better, but my feet fall asleep much faster than usual anytime I?m sitting down. My doctor said they should go away and we will reevaluate. No treatment has been given to me


VAERS ID: 1775482 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-14
Onset:2021-09-29
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Headache, Pneumonia, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, atorvastatin, vit D, insulin detemir, insulin lispro, liraglutide, metformin, metoprolol, omeprazole, topamax, trazodone, vortioxetine
Current Illness: none
Preexisting Conditions: Morbid Obesity, DM2, HTN, migraines, anxiety and depression
Allergies: nka
Diagnostic Lab Data: CXR: + multifocal PNA, PCR + 9.29/2021
CDC Split Type:

Write-up: breakthrough covid + 9.29.2021, requiring hospitalization 10.6.2021, cough, SOB, HA, fevers, congestion, O2 requirements.


VAERS ID: 1775488 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole 20mg 1 daily Tamsulosin HCL 0.4mg 1 daily Eliquis 5mg 2 daily Rosuvastatin 10mg 1 daily Metoprolol 25 mg 1/2 daily
Current Illness: None
Preexisting Conditions: None
Allergies: Codeine Niacin Naproxen Tussionex
Diagnostic Lab Data: Has Dr video call and Dr diagnosed shingles.
CDC Split Type:

Write-up: Shot was given high on arm, top of shoulder. Very painful injection. Next day developed Shingles on left backside


VAERS ID: 1775520 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Brain natriuretic peptide, Cardiac monitoring, Chest X-ray, Chills, Dyspnoea, Dysstasia, Electrocardiogram, Full blood count, Metabolic function test, Pyrexia, Troponin I
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (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? No
Previous Vaccinations:
Other Medications: calcium, multivitamins, lansoprazole, pepcid
Current Illness: balance disorder
Preexisting Conditions: neurological degenerative disease, shortness of breath, taking a blood thinner/warfarin
Allergies: nystatin, afrin
Diagnostic Lab Data: troponin I, ECG 12 lead, Chest X-Ray, CBC and differential, basic metabolic profile, PT/INR, 2019 norcoronavirus PCR, BNP
CDC Split Type:

Write-up: Fever 102.3F, weak and unable to stand, chills, difficulty breathing; went to ER for evaluation, coronary monitoring, chest x-ray, hydration


VAERS ID: 1775637 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Erythema, Headache, Heart rate increased, Nausea, Ocular hyperaemia, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Rapid heartbeat, skin became bright red, itching, naseau, headache, bloodshot eyes, difficulty breathing


VAERS ID: 1775755 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Dizziness, Fatigue, Headache, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Next day woke with tightness in my chest, headache, joint pain, dizziness and extremely tired. Lasted a week with more noticeable joint pain in my right hip and knee. Third day woke up with a lump on my right palm. It''s tender when I grab things. Its been a little over a week and I still have the lump and still hurts.


VAERS ID: 1775953 (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: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administration of expired vaccine dose; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine dose) in a 63-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036B21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine dose). On 29-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Administration of expired vaccine dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication details were not reported by the reporter. Treatment details was not reported by the reporter. Patient reported- administered vaccine one day after past expiry date. Most recent FOLLOW-UP information incorporated above includes: On 05-Oct-2021: Follow-up received contains Pregnancy data, Race, Ethnic Group, Vaccine Route & body site updated.


VAERS ID: 1776035 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Cardiac arrest, Cardiac disorder, Loss of consciousness, Pyrexia, Vaccination site erythema
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Exposure to COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210929; Test Name: body temperature; Result Unstructured Data: 103?F
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Heart is weak; heart stop; collapsed in the kitchen; fever of 103?F; 2 inches redness around the shot site; This spontaneous case was reported by a nurse and describes the occurrence of CARDIAC DISORDER (Heart is weak), CARDIAC ARREST (heart stop) and LOSS OF CONSCIOUSNESS (collapsed in the kitchen) in a 35-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 058E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Exposure to COVID-19. On 28-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Sep-2021, the patient experienced PYREXIA (fever of 103?F) and VACCINATION SITE ERYTHEMA (2 inches redness around the shot site). On 01-Oct-2021, the patient experienced CARDIAC DISORDER (Heart is weak) (seriousness criterion hospitalization), CARDIAC ARREST (heart stop) (seriousness criterion medically significant) and LOSS OF CONSCIOUSNESS (collapsed in the kitchen) (seriousness criterion medically significant). The patient was hospitalized on 01-Oct-2021 due to CARDIAC DISORDER. The patient was treated with Manual therapy (CPR compressions on their chest till the paramedics arrived) for Cardiac arrest. At the time of the report, CARDIAC DISORDER (Heart is weak), CARDIAC ARREST (heart stop), LOSS OF CONSCIOUSNESS (collapsed in the kitchen), PYREXIA (fever of 103?F) and VACCINATION SITE ERYTHEMA (2 inches redness around the shot site) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 29-Sep-2021, Body temperature: 103 (High) 103?F. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. The patient collapsed with stopped heart in kitchen, parent performed CPR compressions on chest till the paramedics arrived. Patient was now hospitalized and intubated doctor diagnosed as weak heart with no inflammation. It was reported that the Patient was not on any medication and had not been diagnosed with any heart conditions before and has not had covid.19. Patient has no history of COVID-19 and heart conditions. Concomitant medications were not provided. Treatment information was not provided. Company Comment: This case concerns a 35 year-old female patient with no reported medical history, who experienced the unexpected serious events of Loss of consciousness, Cardiac arrest, and Cardiac disorder. The events occurred 3 days after the first dose of mRNA-1273 vaccine. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This case concerns a 35 year-old female patient with no reported medical history, who experienced the unexpected serious events of Loss of consciousness, Cardiac arrest, and Cardiac disorder. The events occurred 3 days after the first dose of mRNA-1273 vaccine. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.


VAERS ID: 1776043 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Injection site pain, Pruritus, Skin mass, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MELATONIN
Current Illness: Environmental allergy (Sneezes when dusty)
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Hives right armpit that extends above the ribcage/hives in LEFT side from armpit until above of his chest with clumps; itchiness; redness; hives in LEFT side from armpit until above of his chest with clumps; injection site pain; This spontaneous case was reported by a consumer and describes the occurrence of URTICARIA (Hives right armpit that extends above the ribcage/hives in LEFT side from armpit until above of his chest with clumps), PRURITUS (itchiness), ERYTHEMA (redness), SKIN MASS (hives in LEFT side from armpit until above of his chest with clumps) and INJECTION SITE PAIN (injection site pain) in a 24-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048B21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concurrent medical conditions included Environmental allergy (Sneezes when dusty). Concomitant products included MELATONIN for Sleep disorder. On 29-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Sep-2021, the patient experienced INJECTION SITE PAIN (injection site pain). On 03-Oct-2021, the patient experienced URTICARIA (Hives right armpit that extends above the ribcage/hives in LEFT side from armpit until above of his chest with clumps), PRURITUS (itchiness), ERYTHEMA (redness) and SKIN MASS (hives in LEFT side from armpit until above of his chest with clumps). On 01-Oct-2021, INJECTION SITE PAIN (injection site pain) had resolved. At the time of the report, URTICARIA (Hives right armpit that extends above the ribcage/hives in LEFT side from armpit until above of his chest with clumps), PRURITUS (itchiness), ERYTHEMA (redness) and SKIN MASS (hives in LEFT side from armpit until above of his chest with clumps) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No treatment medications were provided.


VAERS ID: 1776434 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Fatigue, Hyperhidrosis, Injection site pain, Pain, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (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), Hypoglycaemia (broad)

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

Write-up: Patient experienced fatigue and injection site pain. Patient developed a raised red bump (three by two inches in diameter) that was warm to the touch and painful. Patient continued to experience fatigue and was diaphoretic. Patient consulted Primary Care Provider due to symptoms.


VAERS ID: 1776585 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Two days after getting vaccine, patient started to have palpitations, with HR above 100 at rest and difficulty breathing. She continues to have these issues. Unable to tell if rxn is from vaccine or not. Was sent to ER.


VAERS ID: 1776623 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bradykinesia, Dizziness, Dizziness postural, Vertigo
SMQs:, Anticholinergic syndrome (broad), Parkinson-like events (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa, Diltiazem, Omeprazole, Lovastatin, Temazepam PRN, Multivitamin
Current Illness: N/A
Preexisting Conditions: Atrial Fibrillation
Allergies: N/A
Diagnostic Lab Data: Dose1#EL3249 Dose2#EL9266
CDC Split Type: vsafe

Write-up: One hour after getting the 3rd dose of the vaccine, I was at the store and I got very dizzy. I managed to get home during the dizzy period which lasted for the rest of the day. The next day I felt better. On the second day after the shot I got vertigo and everything was spinning. I was diagnosed with Acute Vertigo I was taken to the hospital and the Vertigo lasted for three days. I could not do anything and I was in the hospital for four days. I was prescribed a medication Meclizine. I am still experiencing dizziness and I have to move slowly especially when I stand up.


VAERS ID: 1776737 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Imaging procedure abnormal, Intestinal dilatation, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific dysfunction (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: mesalamine, ferrrous sulfate, cholecalciferol, potassium
Current Illness:
Preexisting Conditions: dementia, narcolepsy, ulderative colitis, atrial fibrillation,vit D deficiency
Allergies: nkda
Diagnostic Lab Data: radiographs - no fractures, but did show distended colon
CDC Split Type:

Write-up: bilateral leg weakness, left hip pain


VAERS ID: 1776950 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-26
Onset:2021-09-29
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Cough, Diarrhoea, Fatigue, Myalgia, Pyrexia, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: subjective ever, chills, muscle aches, loss of taste and smell, fatigue, cough, wheezing, diarrhea,


VAERS ID: 1777085 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-18
Onset:2021-09-29
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Hypophagia, Lung opacity, Oxygen saturation decreased, SARS-CoV-2 test positive, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril-hydroCHLOROthiazide (PRINZIDE/ZESTORETIC) 20-25 mg Oral Tab Sig: Take 1 tablet by mouth daily
Current Illness: Upper respiratory infection
Preexisting Conditions: history of tobacco use (stopped smoking 1 m/ago), and HTN
Allergies: nka
Diagnostic Lab Data: XRAY CHEST ** HISTORY **: 68 years old, known COVID-19 ** TECHNIQUE **: 1 view of the chest acquired. COMPARISON: Radiograph 9/11/2021 ** FINDINGS **: Osseous structures and cardiomediastinal silhouette are unchanged in their appearance. Interval development of right perihilar opacities. Mildly vascular congestion has also developed. No effusion or pneumothorax.
CDC Split Type:

Write-up: 68 Y male with a h/o COVID+ on 9/23 (vaccinated in February), history of tobacco use (stopped smoking 1 m/ago), and HTN who presents with syncopal episode at home. The patient experienced a syncopal episode on 9/29 overnight after going to the bathroom. No neurologic symptoms or seizing to suggest a neurologic etiology, and patient has no history of cardiac disease with no events noted on tele for 24 hours to suggest a cardiogenic etiology. Most likely orthostatic and vasovagal in etiology in the setting of poor PO intake for the past week. Patient was noted with improved appetite over the course of his admission eventually eating 100% of his meals with no destaurations or dizziness noted on road test. His initial pre-renal AKI improved to baseline with fluids. Patient notably tested positive for COVID on 9/23 now s/p 5 day course of prednisone 40 mg daily starting 9/22 with symptom onset on 9/22. On arrival to the ED, patient was afebrile, hemodynamically stable, and non-hypoxic satting well on room air. On 9/30, patient''s O2 desaturated to 92 and 90-92 on road test requiring 2L NC; he was then started on decadron/remdesivir. He was quickly weaned back to room air on 10/1 and discharged on 10/2 with 2 more days of decadron for a 5 day decadron regimen total. Primary Procedures: None Secondary Procedures: None Reason for Hospital Admission (Admitting Diagnosis): COVID pneumonia


VAERS ID: 1777566 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-22
Onset:2021-09-29
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Constant itching all over. If I itch it, it turns to welts and hives.


VAERS ID: 1777821 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Electrocardiogram, Fibrin D dimer, Heart rate irregular, Muscle spasms, Neuralgia, Pain in extremity, Paraesthesia, Ultrasound scan, Vision blurred
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypertension (narrow), Lens disorders (broad), Retinal disorders (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: had similar tingling in legs and heart rate and blood pressure problem from first Covid vaccine on 09/01/21
Other Medications: Lisinopril, Metoprolol, Vit D3, Comp Vit B group , Zomig, Percocet, Botox, Hydroxychloroquine , Vit B9, Merina IUD, Climara-Pro patch
Current Illness: Chronic migraine, heart ablation after SVT, Rheumatoid arthritis, HRT
Preexisting Conditions: migraines, Hx of SVTs, hormone replacement therapy.
Allergies: Penicillin, Mometasone, Carbamazepine, Mupirocin.
Diagnostic Lab Data: ECG, blood tests, D-Dimer, Ultrasound on left leg
CDC Split Type:

Write-up: irregular hart rate, hard time to control blood pressure it spiking up to 186/110 , tingling and firing pain in legs( in particular left with sever cramps, I couldn''t walk normally for 5 days), nerve pain and tingling in lower head and shoulders with blur vision that goes away and coming back.


VAERS ID: 1777981 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206 A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Hyperhidrosis, Nausea, Pain, Polydipsia, Pyrexia
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

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

Write-up: Approximately 15 hours after receiving the vaccine, I woke up with a fever of 103, drenched in sweat, body aches, extreme headache, and nausea. I drank 16 oz of water and went back to sleep. The symptoms continued into the morning. At 0700, I took DayQuil and continued drinking water. The symptoms continued throughout the day. The medication eased the symptoms slightly, but they persisted until the following day at around 0700.


VAERS ID: 1778520 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

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

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

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


VAERS ID: 1778803 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Chest X-ray, Chest discomfort, Dyspnoea, Electrocardiogram normal, Headache, Hypersensitivity, Nausea, Palpitations, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Infancy - Adulthood - Anaphylactic reaction multiple Vaccines
Other Medications: Wixela - Daily Asthma Medication Biotin - Daily Unknown Dosage Collagen - Daily Unknown Dosage
Current Illness:
Preexisting Conditions: Asthma
Allergies: Diagnosed - Allergies to Penicillin, Nuts (all but pine). Undiagnosed - Reactions to Wheat, Dairy, and other Inflammatory foods
Diagnostic Lab Data: No Tests on Hives - Smart online Exam and diagnosis of Allergic Reaction. 10.11.21 Chest X Ray and EKG. - EKG Normal Range but High Resting Rate Chest X Ray no Results to date.
CDC Split Type:

Write-up: I In office - Tightness of Chest. Pressure in Left Chest. Same Day Evening - Headache, Nausea, and shortness of breath. Next Day Morning - Headache, Nausea, randomized Tightness in chest breathing normal, normal heart rythum Next Day Evening - Headache, Nausea, randomized Tightness in chest ,Welts on legs itchy. Friday Morning - Burning sensation throughout the legs, HIVES all over the legs, felt like Fire. Tightness in Chest Friday - forward - Random sets of Chest Pressure, concern of Heart palpatations, and lung capacity.


VAERS ID: 1778823 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Dysgeusia, Dyspnoea, Immune system disorder, Impaired work ability, Malaise, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Symbicort, singulair, lexapro
Current Illness: Seasonal allergies
Preexisting Conditions: Allergies
Allergies: Penicillin drugs and sulfa drugs
Diagnostic Lab Data: Chest X-ray, Covid 19 test (negative)
CDC Split Type:

Write-up: I had a metallic taste in my mouth for about two days. My immune system went completely haywire. My oxygen saturations dropped to 95. I had trouble breathing and my allergy asthma doctor had to put me on additional medication''s. This included a steroid shot a round of steroids and anabiotic''s. That didn''t work so I had to be put on a nebulizer treatment of albuterol, that didn''t work so I had to be put on a twice a day nebulizer treatment of Pulmicort. I had to receive a chest x-ray to see if I had pneumonia. I had to Have a COVID-19 test to see if I had Covid. So one urgent care visit to physician visits a visit to get an x-ray and multiple new medication''s all of which on this date I still don''t feel 100% over a week later. I have missed 3 to 4 days of work which I normally do not miss any days due to not feeling well.


VAERS ID: 1778961 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth, Peripheral swelling, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Large, warm, itchy, welt at injection site
Other Medications: Amiodarone, Xarelto, Synthroid, Lisinopril, Gabapentin, Valacyclovir, Fluticasone Propionate Nasal Spray USP, Azelastine HCL Nasal Solution, Cyclobenzaprine, Valium, Sucralfate, Vitamins B12, C, D, Multivitamin, Probiotic, Zyrtec, Omeprazol
Current Illness:
Preexisting Conditions: Afib, Hypothyroid, Sleep Apnea, Osteoporosis, Hypertension
Allergies: Polymyxin, Adhesives
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Tenderness turned to moderate pain at injection site. This lasted about 5 days. Tight chest - resolved in 24 hours. Cardiologist was contacted and spoke to ARNP. No treatment, monitor condition and call office back or go to ER. Neither was needed. Large, round, red, warm, itchy welt about 4 inches. Lasted about 14 days diminishing in size and symptoms after 10 days. Initially used Cortisone 10 cream for itching for several days and then switched to Benadryl Cream on day 5 which was very helpful. Slight tender bump remains under skin at injection site after 14 days.


VAERS ID: 1779182 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-17
Onset:2021-09-29
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NA / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Decreased appetite, Feeling cold, Influenza like illness, Pain, Pyrexia, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: coughing, wheezing, fever, achy, no appetite Mbr is a firefighter, fighting the fires currently in city, tested positive for Covid yesterday and is isolated but temperatures are very cold. Would like to discuss if he should drive home in his condition. States that he is describing symptoms as flu like.


VAERS ID: 1779195 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gout, Joint swelling, Mobility decreased
SMQs:, Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Protonics, amlodipine 5 mg
Current Illness: None
Preexisting Conditions: Mild high blood pressure managed with 5 mg amlodipine.
Allergies: Bell peppers, Aleve, Losartan
Diagnostic Lab Data: None, virtual contact to dr on 10/7. Recommended adding Celebrex as trial to see if it would help.
CDC Split Type:

Write-up: Significant swelling of joints?left hand, fingers and knuckles, knees and ankles. This lasted for 36 hours until gout attacked swollen joints. Gout is still ongoing 12 days later leaving patient immobile due to pain. Taking colchicine (since gout inception) and Celebrex with limited to no results in improvement thus far. Normally colchicine alone provides significant results within 24 hours.


VAERS ID: 1779346 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 2 RA / IM

Administered by: Public       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: unknown
Preexisting Conditions: unknown
Allergies: NA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Johnson & Johnson vile was pulled and given instead of Moderna


VAERS ID: 1779401 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL5378 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cerumen removal, Ear discomfort, Excessive cerumen production, Hypoacusis, Sudden hearing loss, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hearing impairment (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1350mg daily Lithium, Discovy, Allegra, Emergen-C
Current Illness: none
Preexisting Conditions: sleep apnea, high stress work and personal engagements
Allergies: none
Diagnostic Lab Data: 10/12/21 - Hearing Test
CDC Split Type:

Write-up: Two issues. First - day after shot I noticed hives over my entire upper body but followed my clothing line. I did last wash prior to this use a common washer /dryer at an air bnb and may have had contamination with detergent or other alergens. Second - about a week later ears felt full and hearing was hard... used OTC ear wax removal and did remove some heavy black wax in each ear. However hearing never recovered. After a week - neither recovered so went to Urgent care on 10/11/21 for the appooint noted above. Today 10/12/21 I had a hearing test and it was confirmed i have suddon hearing loss.


VAERS ID: 1779453 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chest X-ray normal, Chest discomfort, Chest pain, Electrocardiogram normal
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: Levaquim, bioxin, augmentin, bactrim, penicillin
Diagnostic Lab Data: Urgent care visit on Friday, October 8, 2021 for EKG and Chest X-ray. Appeared normal, and doctor has referred me to a cardiologist for possible pericarditis.
CDC Split Type:

Write-up: Chest felt heavy about a half hour after injection. Having chest pains on and off ever since first dose from middle of my chest to my shoulder.


VAERS ID: 1779910 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Megace 40 mg, Losartan 25 mg
Current Illness: high blood pressure, post menopausal bleeding
Preexisting Conditions: high blood pressure
Allergies: no known allergies on file
Diagnostic Lab Data: Not applicable
CDC Split Type:

Write-up: Patient experienced headaches, seizure in head such as head shaking and involuntary movement. She also experienced leg jerking or shooting movement (involuntary movement). Still has ongoing headache.


VAERS ID: 1780466 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Diplopia, Dry eye, Eye pain, Eye swelling, Photopsia, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (narrow), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Ocular motility disorders (broad), Hypersensitivity (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Covid vaccine moderne on 9/28/2021
CDC Split Type:

Write-up: Eyes swollen shut the next morning. Could not open eyes fully for several days. Currently (2 weeks later) still having pain behind the eyes, double vision, dry eyes, blurry vision, seeing flashes. Cannot keep eyes open without pain for long.


VAERS ID: 1782225 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-09-29
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8787 / 2 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Arthralgia, Blood pressure decreased, Condition aggravated, Feeling cold, Pruritus
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Nitro Patch 0.1 NG_HR; Atenolol( doctor has taken me off for a week); Levothyroxine 150 mg; Pantoprazole; Eliquis 2.5 mg 2 a day; Triamcinolone; Acetonide 0.1% cream; Ketoconazole cream;Vit C; Vit D; Omega Vit; Zinc; Lotion for dry skin
Current Illness: No
Preexisting Conditions: Afib; High Lymphedema Legs; Overweight; Arthritis; Corponal Hands; Hypothyroidism; Coronary Artery Disease
Allergies: Sulfa; Diltiazem; Cipro; Oxybutynin Chloride; Acyclovir; Tramadol; Dairy; Salt; Canola Oil; Whole Grains; Dried Fruits; Grapes; Cantaloupe; Papaya; Banana; Beef; Very little Pork; Preservatives
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: I had a increase in the itchy spots on both sides joints (toes connect, ankles, knees, fingers where my bases touch, shoulder). This has happen before not so severe, painful and frequent. On Oct 1,2021 the doctor recommended for me to stop Atenolol and chart my blood pressure for being cold causing my blood pressure to drop.The lowest BP 83/67 with a pulse rate of 73 and the highest BP 150/84 with a pulse of 78. I have a appt this week with a Nephrologist for my kidneys.


VAERS ID: 1782603 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-04-09
Onset:2021-09-29
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Condition aggravated, Cough, Decreased appetite, Dizziness, Dyspnoea, Epistaxis, Fatigue, Feeling abnormal, Headache, Hypersomnia, Immediate post-injection reaction, Muscular weakness, Pain, Pain in extremity, Rash, Rash erythematous, Rash papular, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID 19 Pfizer dose 1 - 3/19/2021 - on the 21st, I had a severe headache, extreme fatigue, and kind of like a cough for two day
Other Medications: Citrulline - 150 mg once a day; Hydroxyzine - 50 mg up to 3 times a day as needed. I also take 5 mg of Melatonin at night as needed; Vit C - 1000 mg every day; The Merena IUD for birth control; I take Tylenol - 500 to 1000 mg as needed for
Current Illness: no
Preexisting Conditions: no
Allergies: No
Diagnostic Lab Data: no -except COVID test - COVID test site - they have an out center for people to drive up and be tested and then they call you (like a rapid test)
CDC Split Type: vsafe

Write-up: Wednesday, the 29th, I noticed a rash from my waist up and so on my abdomen, chest, neck, arms down to wrist. Similar to heat rash. It was red and the bumps were raised. That just finally resolved about three days ago. On the 9th or 10th of October it finally resolved. But if those areas of my body get too hot, they kind of come back out. No treatment. September 30, I woke up with bad cough, body aches, chills and extreme fatigue and a massive headache. I had that all day Thursday on the 30th. Friday morning, Oct 1st - the same symptoms were worse. I tested positive October 1st - for COVID. I went into Quarantine. I slept the first, second, third and fourth (of October) all day and all night with still having all of those symptoms including the cough and the rash. When I coughed, I would cough so hard, I would get short of breath. It continued on with the coughing - I still have the cough. The headaches are off and on at this time. The body aches are off and on still. The body chills have gone away for the last four or five days. I lost my sense of smell and taste about the 5th of October - I still don''t have those back. My last day of Quarantine was Sunday, the 10th, I tried to be doing normal things again since Sunday but not feeling back to myself. I am completely exhausted still; I can only be up and moving for a little bit because of the body aches and my legs don''t feel like they have enough energy in them. I still cough and get the headaches. I have also experienced lack of appetite. I have to force myself to drink any fluids. No treatment other than attempting to take any over the counter cough or flu medication to help ease the symptoms - those have been unsuccessful. I have also experienced severe bloody noses. I have one or two a day probably. This is since having the symptoms - I haven''t been stuffed up. I have been able to breathe the whole time, so it''s weird to have the bloody noses. I get light-headed, dizzy feeling and then a small headache and then I get a bloody nose after this. I will see my doctor on Monday for this. Immediately after receiving the vaccine, I only had sore arm. That lasted two or three days.


VAERS ID: 1782640 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Crying, Headache
SMQs:, Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I am not on any prescription medications and take zinc, vitamin C and magnesium but did not take this 3 days prior to the vaccine or more than a week afterwards
Current Illness: none
Preexisting Conditions: Seasonal asthma when allergies are acting up.
Allergies: none
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: Severe anxiety and uncontrollable crying. I also had a severe headache for a few days. These symptoms lasted for one week.


VAERS ID: 1782800 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Huperzine A 200 mg, Alpha lipoic Acid 600 mg. lutein20 mg, bilberry 120mg, CoQ10, Vit D3 5000, Vit B12 1000mcg, flaxseed meal,
Current Illness:
Preexisting Conditions: Multiple Sclerosis
Allergies: ciprofloxacin, flagyl, sulfamethoxazole, cat scratches
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site still throwing off heat and raised lesion around site approximately 3 inchX2 inch (covid arm). It has been more than 2 weeks since the injection. Information online gives time between 24hrs and a week for this "new" symptom to dissipate. I know the thread of advice states that this should not prevent getting the second shot. I am already immune compromised due to MS. I have lost muscular strength and use in the past due to antibiotic allergic reaction. Quite frankly I do not trust the current available info nor my body to this situation.


VAERS ID: 1783026 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Injection site erythema, Injection site swelling, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: I woke that evening with shortness of breathe, fatigue, and muscle aches. I spot at the injection site that is swollen and red the size of a baseball.


VAERS ID: 1783045 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Pain in extremity, X-ray normal
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspirone 30 mg 2x daily Buproprion 150 mg Lisinopril 40 mg Rosuvastatin 5 mg Hydrochlorothiazide 25 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: x-ray, no visible damage.
CDC Split Type:

Write-up: Prolonged pain in left arm - unable to raise arm straight out from body without significant pain.


VAERS ID: 1783143 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Extra dose administered, Lymphadenopathy, Pain
SMQs:, Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I received my booster shot (3rd in total) of the Pfizer COVID-19 vaccine and the next morning I noticed that my left armpit was in pain. I received my shot on my left arm and believe my lymph node in the area of my left armpit was swollen. It was a dull pain that hurt more with any activity and lasted for a total of 8 days. I had no residual effects after 8 days.


VAERS ID: 1784640 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Fatigue, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, Chills, Body Aches, Shortness of Breath, Fatigue


VAERS ID: 1784854 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Very itchy red skin rash all over back, abdomen, arms, upper legs, for two weeks.


VAERS ID: 1785081 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-09-29
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid PNA admitted to hospital


VAERS ID: 1785199 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-23
Onset:2021-09-29
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Blood creatinine increased, Cough, Dehydration, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetic Colon cancer Hypertension CAD, elevated cholesterol
Allergies: Lisinopril
Diagnostic Lab Data: Creatnine 4.1
CDC Split Type:

Write-up: Had multiple syncope episodes, cough. Admitted for dehydration, acute kidney injusry. Pt was discharged 10/09/2021


VAERS ID: 1785538 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-16
Onset:2021-09-29
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19 pneumonia, Cardiac failure congestive, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Lung infiltration, Pleural effusion, Pneumonia
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Hyperlipidemia
Allergies: Gluten
Diagnostic Lab Data: CT 9/29 bilateral pneumonia and trace effusion, chest x ray 10/9 bilateral central infiltrates, minimal pleural effusions.
CDC Split Type:

Write-up: Hospitalized 13 days. Discharged to skilled nurse facility on 2-3 L via nasal cannula. Admitted with acute respiratory failure with hypoxia, pneumonia due to COVID-19 virus, 10 day course of dexamethasone, baricitinib, new onset a-Fib, new onset CHF, IV Lasix, oxygen required up to 10L


VAERS ID: 1785658 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036 / UNK - / -

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

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

Write-up: Expired Moderna vaccine administered to patient. Vaccine expiration date was 9/28/21 per manufacturer.


VAERS ID: 1785660 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK - / -

Administered by: Unknown       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: Expired Moderna vaccine administered to patient. Vaccine expiration date was 9/28/21 per manufacturer.


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