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

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



Case Details (Reverse Sorted by Onset Date)

This is page 73 out of 5,069

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VAERS ID: 1446317 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

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

Write-up: Extremely fast heart rate, fatigue


VAERS ID: 1446333 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Migraine
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: Moderna Vaccine Lot 007C21A, 51 (1st Dose)
Other Medications: FLINTSTONES DAILY VITAMIN
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: DIFLUCAN, METRONIDAZOLE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Throbbing, non-stop, migraine headaches with no relief, I pray this is temporary.


VAERS ID: 1446353 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-28
Onset:2021-06-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram abnormal, CSF test, Hypoaesthesia, Ischaemic stroke, Magnetic resonance imaging neck, Movement disorder, Quadriplegia, Spinal cord drainage, Spinal cord infarction, Vaccination site pain
SMQs:, Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol inhaler, Biktarvy, lisinopril, norethindrone
Current Illness: HIV
Preexisting Conditions: HIV
Allergies: None
Diagnostic Lab Data: MRI C spine on 6/30 and 7/1 - indicative of Cervical cord ischemic stroke C spine endovascular diagnostic angiogram 7/2 CSF fluid analysis 7/1
CDC Split Type:

Write-up: Patient complained of left arm soreness initially at the vaccination site. On 6/30 she woke up from a nap and noticed her left arm was numb and she was unable to move. Went to acute care facility where had acute onset quadriplegia. Was transferred to local hospital ED where CT scan or cervical spine and MRI C spine were done with concern for acute spinal cord infarct. Patient was subsequently transferred to hospital for further care. At hospital her BP was raised to increase blood flow to the spinal cord. Also lumbar drain was inserted for increased cord perfusion. Despite attempt to increase cord perfusion patients symptoms did not improve


VAERS ID: 1446363 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Feeling abnormal, Headache, Nausea, Pain in extremity, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: anaphylaxis to hepatitis vaccine in ~1990; allergic rxn to pfizer covid 12/2020
Other Medications: premedication: prednisone motrin singulair zyrtec advair, flonase, singulair taken regularly
Current Illness: none
Preexisting Conditions: seasonal allergies, moderate-severe, controlled with singulair/advair
Allergies: hepatitis vaccine solumedrol PCN cephalosporin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: fever and nausea at roughly hour 16 nausea and diarrhea by ~24 hours vomiting with intermittent fever at hour ~42 headache at hour ~50 fatigue beginning at about hour 36 arm soreness thru hour 72 significant brain fog from about hour 42-72 all but arm soreness resolved by hour 72.


VAERS ID: 1446405 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

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

Write-up: The vaccine storage did not meet standards, vaccine stored in freezer beyond allowable time. Recommend revaccination.


VAERS ID: 1446411 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

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

Write-up: The vaccine storage did not meet standards, vaccine stored in freezer beyond allowable time. Recommend revaccination.


VAERS ID: 1446413 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / UNK LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine & Pantoprazole
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe fever and muscle ache for 24 hours. I have not experienced this in over 10 years! If I had known, I would NEVER had received, what I consider to be a foreign invasion of poison into my body. I regret taking the vaccine!!


VAERS ID: 1446503 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Face injury, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Additional Details: Patient after sitting down , experienced symcope after about 2 minutes post covid 19 vaccination,fell on face from chair, bruised face/rug burn


VAERS ID: 1446606 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-01
Onset:2021-06-30
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Troponin I 7.67 (7/2/2021), 3.40 (7/3/2021), 0.5 (7/4/2021)
CDC Split Type:

Write-up: Chest pain, elevated troponin levels, acute myopericarditis


VAERS ID: 1446704 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 LA / IM

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

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

Write-up: Per patient: got swollen lump on her left neck and under left armpit starting a few hours after the shot until today (4 days). Pt has been been taken Meloxicam 15mg once daily for her arthritis everyday. Pt will see PCP tomorrow 7/5 since the pain still persists & more swellings.


VAERS ID: 1446718 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Heart rate increased, Hypoaesthesia, Palpitations
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: Numbness in right arm, right and left legs. Started about 2 hours after getting the 1st dose of Pfizer vaccine (06/30/21) and no numbness when I woke up the next morning. Fast heartbeat, intermittent pounding heartbeat at 3am 07/03/21 and was normal when I woke up the next morning I never went to the doctor


VAERS ID: 1446755 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Malaise, Myalgia, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Tiredness, muscle pain, itching, feeling unwell.


VAERS ID: 1446801 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / N/A LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: SORE ARM BRUISE TIRED
Other Medications: LOSARTAN POTASSIUM 50 mg, PRAVASTATIN SODIUM 40 mg, PANTOPRAZOLE 40 mg, VICTOZA .18,VITAMIM D3 4000
Current Illness: NONE
Preexisting Conditions: TYPE 2 DIABETES
Allergies: CODINE, CIPRO
Diagnostic Lab Data:
CDC Split Type:

Write-up: I WAS SCHEDULED FOR SHINGLES SHOT AT 11 AM, WAS NOTIFIED AFTER CALLING CVS BACK AFTER A ONE RING CALL I WAS GIVEN THE PFIZER 1ST DOSE SHOT I WAS GIVEN PFIZER SHOTS 1. 6206 3/10/2021 AND 2ND #ER 8733 ON 03/31/2021. WON''T SHARE ANY OTHER INFORMATION WITH ME WAS A MISS COMMUNICATION.


VAERS ID: 1446819 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

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

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

Write-up: No adverse reaction to Moderna vaccine. Patient was under the recommended age to obtain vaccine as Pfizer is the only approved vaccine for that age range. When verifying CDC they still recommend to provide second dosage for child if first dose was administered.


VAERS ID: 1446884 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), 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? 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: Site: Bruising at Injection Site-Severe, Site: Pain at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: Severe bruising was almost 2 inches below the actual injection site. Bruising covered large area of arm just above elbow--again not near actual site.


VAERS ID: 1446973 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site swelling, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Injection site pain, injection site swelling and injection site redness
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site pain, tiredness, headache, muscle pain, chills, injection site swelling, injection site redness and feeling unwell.


VAERS ID: 1447021 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Erythema, Eye pain, Headache, Hypoaesthesia, Neck pain, Pain, Pain in extremity, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: patient reported on 7/5/21 that on Wednesday after her vaccine she experienced rash on stomach, arms, back, legs, headaches, eyes hurting, legs and back hurting, stomach cramping and neck hurting. she also reported right sided pain over whole body and numbness in her face. Patient showed me redness on stomach, recommendedBenadryl. Patient stated she had already been to the doctor (ruled out bells palsy or stroke due to no facial droop).


VAERS ID: 1447029 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

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: Administered vaccine from vial that''s BUD was 6-26-21 at 10:15 A.M. Vial was kept in refrigerator entire time prior to administration.


VAERS ID: 1447035 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

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

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

Write-up: Administered vaccine from vial that''s BUD was 6-26-21 at 10:15 A.M. Vial was kept in refrigerator entire time prior to administration.


VAERS ID: 1447059 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK LA / IM

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


VAERS ID: 1447146 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA LLOT050C21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA LOT050C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-Vitamins, Magnesium 250mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Tireness, Fatigue, Chills & Headaches. Took about 12 hours to run its course$g


VAERS ID: 1447349 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-25
Onset:2021-06-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotension, Rash, Skin discolouration
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bystolic, welchol, meloxicam, minoxidil, lasix, potassium...
Current Illness: Tuesday thought he ate bad food and had diarrhea. Didn?t go into work on time from being up all night. Went to bed at 6:30 pm and kept sleeping till morning only to get up for bathroom so very tired. Took tums no relief, took pepto some relief, still diarrhea on Wednesday.
Preexisting Conditions: Blood pressure very mild asthmas
Allergies: None. Ate watermelon 5 hours prior to reaction. Has eaten watermelon all his life with no problem. Has follow with primary to see if he wants to do allergy test in two days
Diagnostic Lab Data: Wasn?t there. I asked if they checked his heart and he said they checked his heart and all was good. Gave him fluids because they said he was dehydrated from diarrhea
CDC Split Type:

Write-up: Started with rash around belly and spread so went to ER. They gave him steroid shot, Benadryl, and one other thing he could t remember. things got worse. Blood pressure got very low, dizzy, nurse couldn?t get a pulse ox reading, fingers turning blue. They thought he was having allergic reaction to shot. Gave him Epipen. He said things got better then


VAERS ID: 1449422 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-30
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Body temperature, Feeling abnormal, Feeling hot, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (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: TRAMADOL; IBUPROFEN; TYLENOL; VENLAFAXINE
Current Illness: Alcohol use (Not for the last few weeks.); Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies, no drug abuse or illicit drug usage and no past medical history not with COVID or anything like that.
Allergies:
Diagnostic Lab Data: Test Date: 20210630; Test Name: Body temperature; Result Unstructured Data: 101.9-102.1
CDC Split Type: USJNJFOC20210702840

Write-up: LOST MY TASTE BUDS A LITTLE BIT CINNAMON STICKS PUT IN MOUTH BUT COULD NOT TASTE IT AT ALL; BODY ACHES OCCURRING HERE AND THERE THEY COME AND GO; LEFT ARM SORE/ACHES IN LEGS; TEMPERATURE OF 101.9-102.1; FELT HOT; FEELS UNDER THE WEATHER; This spontaneous report received from a patient concerned a 31 year old male. The patient''s weight was 180 pounds, and height was 67 inches. The patient''s concurrent conditions included non-smoker, and alcohol user, and other pre-existing medical conditions included the patient had no known allergies, no drug abuse or illicit drug usage and no past medical history not with covid or anything like that.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A expiry: 07-AUG-2021) dose was not reported, administered on 30-JUN-2021 18:00 for prophylactic vaccination. Concomitant medications included ibuprofen, paracetamol, tramadol, and venlafaxine. On 30-JUN-2021, the subject experienced felt hot. On 30-JUN-2021, the subject experienced feels under the weather. On 30-JUN-2021, the subject experienced temperature of 101.9-102.1. Laboratory data included: Body temperature (NR: not provided) 101.9-102.1. On an unspecified date, the subject experienced lost my taste buds a little bit cinnamon sticks put in mouth but could not taste it at all, body aches occurring here and there they come and go, and left arm sore/aches in legs. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from left arm sore/aches in legs, and body aches occurring here and there they come and go, and the outcome of temperature of 101.9-102.1, feels under the weather, lost my taste buds a little bit cinnamon sticks put in mouth but could not taste it at all and felt hot was not reported. This report was non-serious.


VAERS ID: 1449712 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-06-30
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210702970

Write-up: ADMINISTRATION OF EXPIRED VACCINE; This spontaneous report received from a pharmacist concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A expiry: UNKNOWN) dose was not reported, administered on 30-JUN-2021 to Left Arm for prophylactic vaccination. No concomitant medications were reported. On 30-JUN-2021, the subject 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: 1449747 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-28
Onset:2021-06-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contraception, Nervous system disorder, Tic, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Shakiness-Medium. Additional Details: Patient received the vaccine on 06/28/2021. Two days later, she developed what she described as a nervous tic, which is still manifests even after 7 days. The patient received the vaccination on the same arm she has a Nexplanon implant.


VAERS ID: 1450053 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Electrocardiogram, Full blood count, Headache, Lipase, Tachycardia, Troponin
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: clonidine, prazosin, viibryd, nortriptyline, hydroxyzine, gabapentin
Current Illness: none
Preexisting Conditions: migraine headaches, PTSD, chronic kidney disease stage III
Allergies: Ambien (zolpidem)
Diagnostic Lab Data: complete blood count, EKG, troponin, lipase
CDC Split Type:

Write-up: Patient developed a frontal headache, tachycardia and shortness of breath about 6 hours after receiving the vaccine. She was evaluated in the emergency room where her labs including platelets and complete blood count, EKG and vitals were normal.


VAERS ID: 1450106 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atomoxetine 40mg, Levothyroxine 88mcg
Current Illness: none
Preexisting Conditions: n/a
Allergies: nkda
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT LESS THAN 18 YEARS OLD - CURRENT APPROVED DATE FOR MODERNA COVID 19 VACCINE


VAERS ID: 1450118 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LAMOTRIGINE 100MG,
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT UNDER THE APPROVED AGE OF 18 AT TIME OF VACCINATION


VAERS ID: 1450310 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 AR / IM

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

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

Write-up: Patient came to lab for a COVID-19 J&J vaccination on June 30, 2021. She was sent by employee health at to our vaccination clinic and filled out the paperwork prior to the vaccine. She checked "NO" for the question asking if you have received any covid-19 vaccination before. She did not ask us any questions. The J&J vaccine was given. The vaccines were logged in later that day (June 30 2021) and it showed that patient had actually received the Pfizer Covid-19 vaccine on May 20 2021 and June 17 2021 at clinic. A staff member called the patient and the patient verified that she did receive vaccines in May and June. The patient stated she must have misunderstood about getting the covid-19 vaccine today, but did not ask any questions. I personally called the patient on July 6th 2021 at 930am (verified name and DOB) and the patient reports no side effects that she is experiencing. No doctors visits. No illness. no hospitalizations. She is a little tired (some fatigue) but no other symptoms.


VAERS ID: 1450314 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CW0196 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: I received the shot on 6/29/21. Wednesday my stomach started cramping. Thursday night my stomach started to hurt a lot more. I had dirrhea almost constantly Friday morning 1 am - 2 pm Friday afternoon.


VAERS ID: 1450369 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-11
Onset:2021-06-30
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

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

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

Write-up: Developed s/s of COVID 6/30, tested positive for COVID 7/2/2021. Pt is currently pregnant, but was not pregnant at the time of vaccination


VAERS ID: 1450455 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a. patient had a J&J vaccine already given on 3/19/21. He got Pfizer on 6/30/21
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: n/a, patient already had a J&J vaccine in March 19 2021


VAERS ID: 1450519 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroid .375 mcg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm and redness 2" x 4" for 5 days


VAERS ID: 1450629 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Muscular weakness, X-ray limb normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Emergency room visit, xray of left shoulder showed nothing, referral to orthopedics.
CDC Split Type:

Write-up: Severe pain in left shoulder within an hour of recieving vaccine, and weakness in left arm, for 6 days has become progressively worse.


VAERS ID: 1450631 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-17
Onset:2021-06-30
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Heart rate decreased, Insomnia
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Drop in heart rate, light-headed at about noon on June 30 and then drop in heart rate and anxiety and sleeplessness on Jul


VAERS ID: 1450937 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

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

Write-up: PATIENT CALLED ON 07/06/2021 AND REPORTED HAVING FEVER, NAUSEA AND EXTREME FATIGUE STARTING THE NIGHT OF IMMUNIZATION. SHE HAD THESE ADVERSE EVENTS FOR 3 DAYS AND ONCE THESE ADVERSE EVENTS WENT AWAY, SHE STARTED ITCHING ALL OVER HER BODY. SHE HAS BEEN TAKING BENADRYL SINCE THEN BUT STILL THE ITCHING PERSISTS.


VAERS ID: 1450941 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / UNK LA / IM

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

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

Write-up: Patient completed consent stating he received previous vaccine noting it was Moderna Covid 19 vaccine. Here for 2nd dosage but did not have his vaccine card available at time 2nd dose was given. This nurse gave 2nd dose of Moderna Covid19 in LD with no adverse reaction at time of service. Returned with vaccine card to complete 2nd dose entry and noted 1st dose was actually Pfizer Covid 19 mRNA vaccine. Patient states and presents with no adverse reaction at that time. Follow up 6 days later on 7/6/2021 and still no adverse reaction noted. This incident was reported on site and entered into system as well with in the 24 hr time requirement and Completed VAERS. No further follow up needed at this time.


VAERS ID: 1451981 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 4 LA / IM

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

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

Write-up: Patient received Pfizer COVID vaccine in our facility on 6/9/21 and 6/30/21. As dose #2 is documented in the vaccine card, patient inadvertently pulled out 2 vaccine cards. One of them is documented with Pfizer dose #1 given on 6/9/21, still needing 2nd dose to be documented. While the other card showed that patient has received Pfizer COVID vaccine on 2/24/21 and 3/18/21 from another facility. Patient was apprehensive when asked about the other vaccine card. Information System also showed that patient did receive Pfizer COVID vaccine on 2/24/21, 3/18/21, and 6/9/21, making 6/30/21 as a 4th dose. There was no adverse reaction in this case. Event is reported due to administration error.


VAERS ID: 1451998 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0151 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Vaccine positive rechallenge
SMQs:

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: Simvastatin, Tylenol, Ibuprofent
Current Illness: Denied
Preexisting Conditions: Hyperlipidemia, Intermittent Elevated Blood pressure
Allergies: Denied. Had ''migraine'' headaches after first vaccine for daily for 1 month then 2-3 times per week for about one month. Document no reaction to first Pfizer covid vaccine
Diagnostic Lab Data: Referred to Neurology for evaluation since patient had recovered from Covid illness prior to receiving any vaccines. Date of illness uncertain but believed within a few months of first vaccine.
CDC Split Type:

Write-up: Acute onset of Frontal headache, associated with photophobia, reduced cognition and ability to concentrate or focus when headache present since 6/30/2021. 5/10 initially, now 8/10. He reportedly had the same reaction after his initial Covid vaccine on 2/3/2021 and was treated for ''migraine'' with an unknown pill which just made him sleepy. It took several months for the headaches to resolve and he had been advised to delay the second vaccine. Prior symptoms not reported on day of second vaccine.


VAERS ID: 1452183 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Supraclavicular and posterior chain cervical lymphadenopathy and pain; ipsilateral arm


VAERS ID: 1453921 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Flushing, Hyperhidrosis, Injection site erythema, Injection site pruritus, Injection site rash, Pruritus, Rash
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Site: Itching at Injection Site-Medium, Site: Redness at Injection Site-Medium, Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Flushed / Sweating-Medium, Additional Details: Patient had adverse side effect 30 mins after the vaccine administration. Patient had difficulty breathing, rash on the arm where injection was given and it radiating out to the forearm. Patient managed the adverse effects by taking benadryl. Upon doctor''s visit medrol dose pak was prescribed. Advese effects are under control.


VAERS ID: 1454069 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-06-30
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Bite, Contusion, Haematoma, Petechiae, Platelet count decreased, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 7/3 - plts 6 7/6 - plts 136 7/7 - plts 176
CDC Split Type:

Write-up: Patient received dose #1 on 5/14/21 and dose #2 on 6/4/21. On 6/30, began to develop petechiae and easy bruising. Presented to urgent care on 7/3 after biting cheek and a large bruise/hematoma developing on the inside of her cheek. Thrombocytopenia identified on labs, resolved in 4 days without intervention.


VAERS ID: 1454113 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo- Provera IM injection 12/21/2020
Current Illness: No
Preexisting Conditions: Irregular menses, Right ovarian cyst
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Central chest pain with pain between the shoulder blades. Patient received Motrin


VAERS ID: 1454124 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Cough, Dyspnoea, Muscle spasms
SMQs:, Anaphylactic reaction (broad), Dystonia (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: FLOVENT HFA 44 mcg/act inhaler
Current Illness: No
Preexisting Conditions: Asthma
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest tightness in the morning after with shortness of breath. Mild cough and neck spasms. Patient received prednisolone


VAERS ID: 1454177 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Employee vaccinated at clinic. Vaccinated with 0.3 ml of un-diluted Pfizer vaccine serum. Discrepancy was discovered within one minute of administration Health Dept was notified. Instructed to monitor and report to emergency department for any severe symptoms. Close monitoring of employee continued for the day. Employee reported only side effects of vaccine were soreness at the site the next day and slight fatigue, both of which resolved within 24 hours. No other symptoms noted.


VAERS ID: 1454237 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none that pharmacy is aware of
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: patient reported no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received a vaccine that had been drawn up with expired solution. Patient was then given correct vaccine that wasn''t expired


VAERS ID: 1454252 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 RA / IM

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

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

Write-up: At 4:00PM the same day that the vaccine was administered; patient noticed a rash on his back. Patient took one dose of benadryl and the rash went away by that same evening. The following day at 10:30AM patient noticed his lips swelled. He took another dose of Benadryl and swelling of lips went away. His wife encouraged patient to call and report his side effects. Client is completely recovered from his side effects. He did not sign up for and did not seek medical attention from his physician.


VAERS ID: 1454263 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-14
Onset:2021-06-30
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Antinuclear antibody positive, Blood culture negative, Blood lactic acid increased, CSF culture negative, Culture urine negative, Dizziness, Fibrin D dimer increased, Headache, Laboratory test abnormal, Procalcitonin increased, Pyrexia, White blood cell count increased
SMQs:, Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: no known
Preexisting Conditions: no known - but perhaps undiagnosed CHF
Allergies: NKA to food, drugs, or environment
Diagnostic Lab Data: Antibody was detected - 7/6/2021; D-dimer 386400 - 7/1/2021; Elevated Lactic, procalcitonin, and WBC on 7/1/2021; Negative cultures in blood, urine, and CSF
CDC Split Type:

Write-up: Pt came to hospital with dizziness, headache and fever. Pt had extremely elevated D-dimer, and elevated infection markers including procalcitonin. However, her workup for an infectious process was inconclusive. Vaccine related event is a possibility as no infection source was detected.


VAERS ID: 1454339 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-30
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Rash, 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: Dye in red wine
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: I developed a rash 11 days after vaccination in my private area that then spread to my neck and all over my body. The rash is itchy and in patches. I have to see an allergist.


VAERS ID: 1454412 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-10
Onset:2021-06-30
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood culture positive, Cardiac tamponade, Cough, Drain placement, Echocardiogram, Illness, Inferior vena cava dilatation, Pericardial drainage, Pericardial effusion, Pyrexia, Right ventricular diastolic collapse, Staphylococcal bacteraemia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: PCN, Contrast dye, THC
Diagnostic Lab Data: 6/29/2021-7/3/2021 : Blood cultures x 2 daily: Methicillin sensitive staph aureus in 2/2 blood cultures TTE 7/6/21: Brief result: A large-sized circumferential pericardial effusion is present measuring $g3.0 cm posteriorly. IVC is dilated with minimal respiratory variation. Significantly increased respiratory variations of mitral inflow velocities, and collapse of right ventricle in early diastole are noted, suggestive of tamponade physiology. Correlate clinically. Dr was notified of the critical findings. MD note post pericardiocentesis: Status post pericardiocentesis with removal of 1380 mL of clear/straw-colored pericardial fluid. Pericardial drain left in place and sutured to the skin. Pericardial drain was attached to a bag. Will leave the drain in at this time. Will monitor the amount of pericardial fluid drainage. Drain will be removed once less than 50 cc in 12 hours or less than 100 cc in 24 hours.
CDC Split Type:

Write-up: Patient presented to another hospital 6/16/21 will cough fever illness was discharged from ED to recover at home, no cultures drawn at that time. Subsequently remained ill and came to our facility 6/30/21 was diagnosed with MSSA bacteremia. After persistent bacteremia despite appropriate antibiotics TTE was performed revealing large pericardial effusion requiring intervention. Patient still admitted and treatment ongoing.


VAERS ID: 1454416 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-06-30
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cellulitis, Full blood count, Metabolic function test, Ultrasound Doppler
SMQs:

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

Write-up: cellulitis of leg


VAERS ID: 1454588 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

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

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

Write-up: Patient was given Moderna vaccine and patient is only 17 years old. No signs and symptoms of adverse event to the vaccine.


VAERS ID: 1454641 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Dizziness, Dry mouth, Dysstasia, Fatigue, Feeling cold, Heart rate increased, Malaise, Muscle spasms, Nausea, Palpitations, Paraesthesia, Tremor
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (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: AMOUR THYROID, BUSPAR, VALCYCLOVIR,
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: SULFA, NEOSPORINE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: AFTER RECEIVING MY FIRST DOSE I WENT TO WAIT IN THE WAITING ROOM AND BEGAN HAVING A RACING HEARTBEAT ABOUT 10 MINUTES AFTER THE SHOT. I BEGAN TO FEEL DIZZY, MY HEART WAS RACING, MY PULSE SHOT UP FROM 64 TO 154 PER MY WATCH AND MY MOUTH GOT DRY. I ASKED FOR A NURSE AND THEY ESCORTED ME BACK TO A ROOM. I WAS FEELING LIKE I WAS GOING TO PASS OUT SO THEY LOWERED ME ON THE THE TABLE. THEY CHECKED MY PULSE AND 02. MY MOUTH WAS DRY AND MY LEGS AND HANDS WERE TINGLING. MY HEART WAS POUNDING AND I FELT SICK TO MY STOMACH. THEY CHECKED MY BP WHICH IS USUALLY LOW AND IT WAS REALLY HIGH. I WAS FEELING WEAK AND UNABLE TO STAND SO THEY TOLD ME THEY WERE TRANSPORTING ME TO THE ER. I WAS SHAKING, FREEZING, MY MUSCLES WERE CRAMPING IN MY ARMS AND LEGS. MY HEART CONTINUED TO RACE, I WAS DIZZY AND REALLY WEAK. I HAVE CONTINUED TO HAVE A RACING HEART BEAT AT RANDOM TIMES DURING THE DAY, STILL FEEL DIZZY AND FATIGUED. MY HEART ALSO POUNDS AT RANDOM TIMES DURING THE DAY. I AM NOT FEELING WELL.


VAERS ID: 1454678 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-06-30
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received COVID-19 vaccinations on 1/28/21 and 2/18/21 . The patient tested positive for COVID-19 on 6/30/21 and was hospitalized.


VAERS ID: 1454690 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

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

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

Write-up: pt made appt and received pfizer dose 1 on 6/30/21. However, following review pt had already received j&J on 4/2/21 at facility outside of county . No side effects noted.


VAERS ID: 1454779 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not available
Current Illness: Not available
Preexisting Conditions: Not available.
Allergies: Not available
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: There is no reported adverse event. I am just reporting that this patient had received the Johnson and Johnson Covid vaccine at a different site on a different date prior to this vaccine. The Immunization Registry contacted use at our pharmacy to confirm our vaccine because they somehow new from the previous vaccination facility that he would be seeking the Pfizer at some point after he received the J and J. The previous vaccination facility said he knew it was an approved combination but that he was most like going to get both manufacturers of the vaccine.


VAERS ID: 1454808 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM

Administered by: Other       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IDK
Current Illness: IDk
Preexisting Conditions: IDK
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was given a pfizer shot but already had a J& J shot in March the 9th


VAERS ID: 1456786 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-28
Onset:2021-06-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

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

Write-up: Site: Itching at Injection Site-Mild, Site: Swelling at Injection Site-Mild


VAERS ID: 1456961 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient felt as though he was going to pass out. Became diaphoretic, pale, nausea. Patient was given juice, cold pack applied to neck and forehead. Placed on his back. He felt better about 5 mins after treated.


VAERS ID: 1456996 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-06-25
Onset:2021-06-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Diarrhoea, Fatigue
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Fatigue, loose bowels.


VAERS ID: 1457025 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 UN / IM

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

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

Write-up: 17 year old was given a dose of Moderna that, at this time, is only recommended for those 18 years of age and older. Per phone conversation with mother, the child had no adverse reactions to this vaccine.


VAERS ID: 1457061 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu Vaccine: Rotator cup injury
Other Medications: Simvastatin 5mg Fish Oil Supplement Viactiv Fiber Well One A day multivitamin
Current Illness: Allergies to weeds
Preexisting Conditions: Ulcerative Colitis Arthritis Allergies to weeds
Allergies: Sulfa Seasonal allergies: pollen, weeds. bee stings, spider bites and poison ivy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Allergic reaction, tiredness


VAERS ID: 1457067 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-06-30
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: D69.6 - Thrombocytopenia, unspecified


VAERS ID: 1457072 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adrenocortical insufficiency acute, Chills, Confusional state, Diarrhoea, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Adderall, Chantix, B-12, Estradiol, fludrocortisone, Flonase, Mucinex, Claritin, hydrocortisone, ibuprofen, lorazepam, meloxicam, Norditropin Flexpro, omeprazole, triazolam, albuterol,
Current Illness:
Preexisting Conditions: Patient reports a history of pituitary tumor.
Allergies: nkda
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient reports having an adrenal crisis consisting of N/V/V, chills and confusion.


VAERS ID: 1457185 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-06-30
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/6/21- SARS Coronavirus-2, PCR detected
CDC Split Type:

Write-up: Travleled with family out of country, family members contracted COVID, pt developed s/s on 6/30/21, tested positive 7/6/21


VAERS ID: 1457278 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Joint injury, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Arthritis (broad)

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

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


VAERS ID: 1457330 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-28
Onset:2021-06-30
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Bone pain, Chest X-ray normal, Chest discomfort, Chest pain, Cough, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Fibrin D dimer normal, Nasal congestion, Pericarditis, SARS-CoV-2 test negative, Troponin normal, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Osteonecrosis (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

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

Write-up: 25yr old patient with no significant PMH presented to urgent care on 7/4 for left side chest pain x 4-5 days. Just prior, patient had upper back pain (thought to be muscle related) which resolved and then chest tightness/pain started. Patient denied sweats, nausea, lightheadedness, dizziness, palpitations, or shortness of breath. Patient did endorse sharp stabbing pain under left breastbone while taking a deep breath which improved slightly. Patient endorsed pain improved if "laying completely flat and stretching out upper body so heart is not touching his chest wall". Patient had been taking ibuprofen 200mg daily x several days and Tums. Patient developed upper respiratory infection with cough and congestion 2-3 we Patient developed upper respiratory infection with cough and congestion 2-3 weeks ago, symptoms resolved. Self swab Covid test on 6/15 was negative. Patient endorsed receiving Pfizer vaccine (second dose 5/28/21). Unknown LOT number, sight of administration or details and date of first Pfizer vaccine administration. On 7/4, ECG noted ST elevation with multiple leads with concern for acute pericarditis. Provider noted "likely viral, related to recent URI which may have been COVID". VS normal, and chest x-ray normal. D-dimer negative (<100), cardiac panel/troponin normal (Troponin < 0.05). Patient prescribed ibuprofen 600mg TID and colchicine 0.6mg daily x 14 days (# 551151809). Cardiology referral pending EKG formal read. Patient returned to urgent care on 7/7 for follow up with resolution of symptoms. EKG still noted ST elevation in multiple leads but had improved from prior. Repeat labs deferred (as patient self pay). Patient placed on 3 week taper for ibuprofen and instructed to continue colchicine until completed (2 weeks). Provider noted while standard 3 month colchicine course typical for acute pericarditis, normal labs and mild symptoms supported discontinuing med early.


VAERS ID: 1457634 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-03-13
Onset:2021-06-30
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster, Hypoaesthesia, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, diltiazem, vascepa, estradiol, progesterone, fenofibrate
Current Illness: None
Preexisting Conditions: High blood pressure, kidney stone
Allergies: Sulphate, erythromycin, tetracycline, penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Shingles - pain, itching, numbness. Front and back right side of midsection


VAERS ID: 1457884 (history)  
Form: Version 2.0  
Age: 0.58  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 546621A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alcohol use, Blood glucose, Blood magnesium, Chest X-ray, Dizziness postural, Electrocardiogram, Full blood count, Head injury, Hyperhidrosis, Malaise, Metabolic function test, Nausea, Neurological examination, Substance use, Swelling, Thyroid function test, Troponin I
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Drug abuse and dependence (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amitryptiline, progesterone, estrogen, telmisartan, levothyrox
Current Illness: none
Preexisting Conditions: hypothyroid, high blood pressure
Allergies: none
Diagnostic Lab Data: COMPLETE BLOOD CELL COUNT, COMPREHENSIVE METABOLIC PANEL, FINGERSTICK BLOOD SUGAR, MAGNESIUM LEVEL, THYROID FUNCTION (TSH), TROPONIN 1 (CARDIAC ENZYME)
CDC Split Type:

Write-up: Sudden onset on standing of : extreme dizziness, extreme nausea, sweats. Have never felt so ill; I thought I might be having a heart attack or stroke. Discovered large swelling on back of head, so presumably I fainted, although I have no recollection of falling/injuring my head. Neurological exam EKG XR CHEST 1 VIEW ALSO: JOHNSON&JOHNSON COVID19 VACCINE 1805020 MARCH 25 2021 ALSO: consumed very small quantity of cannabis between the Moderna vaccine and fainting (one puff) and 1/4 inch of rum in a water glass (I know this was stupid, had forgotten about the vaccination!)


VAERS ID: 1457887 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, Discomfort, Dizziness, Ear discomfort, Ear infection, Ear pain, Pyrexia, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to nyquil and dayquil unsure of components. Develops hives
Diagnostic Lab Data: Double ear infection
CDC Split Type:

Write-up: Starting on Wednesday morning, couldn''t hear in left ear and over the day both ears starting to lose hearing. Thursday both ears felt like they were clogged and continued to get worse and felt pain and have a fever up until today. Patient also experienced ringing in the ear and discomfort. Pt would not use phone. Also experience dizziness. Patient was seen at urgent care on 7/7/21 and was diagnosed as a double ear infection and was prescribed cefdinir.


VAERS ID: 1458614 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 RA / IM

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

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

Write-up: REDNESS; ITCHINESS; SWOLLEN


VAERS ID: 1459255 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-11
Onset:2021-06-30
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210630; Test Name: PCR test; Test Result: Positive ; Test Date: 20210630; Test Name: Molecular alere testing,; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC2021821662

Write-up: Diagnosed with COVID-19 on 30Jun2021 after receiving the covid vaccine; Diagnosed with COVID-19 on 30Jun2021 after receiving the covid vaccine; This is a spontaneous report from a contactable nurse (patient). A 26-year-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot Number: EL8982), via an unspecified route of administration, administered in arm left on 11Feb2021 (at the age of 26-year-old) as dose 2, single for COVID-19 immunization. The patient medical history and concomitant medications were not reported. Patient had no known allergies. The patient did not receive any other vaccine in four weeks. The patient did not receive other medications in two weeks. Patient was not diagnosed with Covid prior vaccination. Patient was Covid tested post vaccination. The patient previously took bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot Number: EK9231), via an unspecified route of administration, administered in arm left on 21Jan2021 (at the age of 26-year-old) as dose 1, single for COVID-19 immunization. The patient diagnosed with COVID-19 after receiving the Covid vaccine on 30Jun2021. AE resulted in doctor or other healthcare professional office/clinic visit. The patient underwent lab tests and procedures which included PCR test was positive, Molecular alere testing was positive (nasal swab) on 30Jun2021. The patient did not receive treatment for AE. Outcome of the events was recovering.; Sender''s Comments: based on the reported information ,a causal relationship between the events and suspected drug cannot be excluded.


VAERS ID: 1459768 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Afib kidney failure congestive heart failure
Current Illness:
Preexisting Conditions: Kidney failure
Allergies: None
Diagnostic Lab Data: CTSCAN
CDC Split Type:

Write-up: Heart attack


VAERS ID: 1459790 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-25
Onset:2021-06-30
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fall, Multiple fractures, X-ray
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Osteoporosis/osteopenia (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: X-Rays
CDC Split Type:

Write-up: After the shot got extremely light headed and ended up falling down a flight of stairs which ended in a broken bone that will need surgery to fix. Surgery was May, 27th and had to go in for a second surgery on June 28th.


VAERS ID: 1459852 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-12
Onset:2021-06-30
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Parosmia, Taste disorder
SMQs:, Taste and smell disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopryl
Current Illness: no (Covid Positive in March)
Preexisting Conditions: high BP
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer Vaccination ... affect took place aproximately 2 weeks after my final shot. Racid smell and taste ongoing for two weeks now.


VAERS ID: 1459886 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-06-25
Onset:2021-06-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head, Erythema, Facial pain, Laboratory test, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen-codeine 300mg-30mg/12.5ml solution takes 12.5 ml at bedtime. Gabapentin 300mg. 1 cap twice a day; Nystatin 100,000 unit/gram powder applly to skin 3 x day; furosemide 40mg daily; ProAir 90 mcg 2 puffs every 4-6 hrs as neede
Current Illness:
Preexisting Conditions: COPD; Fatty LiverDisease; obstructive sleep apnea, Cardiomyopathy; Tachycardia, Hirsutism
Allergies: Lisinopril; Wellbutrin ; Dilt-XR; morphine;
Diagnostic Lab Data: head CT scan and some laboratory tests.
CDC Split Type:

Write-up: left sided facial swelling, redness, severe pain started 06/30/2021,. Went to ER 06/03/2021 treated with Kflex QID without improvements


VAERS ID: 1459899 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-05
Onset:2021-06-30
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 88 mcg
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Raw peaches
Diagnostic Lab Data: Diagnosis by PCP on 7/9/2021.
CDC Split Type:

Write-up: Shingles symptoms began around 6/30/2021. Shingles officially diagnosed by PCP on 7/9/2021. Oral antivirals started the day of diagnosis.


VAERS ID: 1460014 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Balance disorder, Chills, Fatigue, Gait disturbance, Headache, Nausea, Pyrexia, Vertigo
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: I had no symptoms until 5 hours after recieving the shot, i began to get tired and run a fever then i became off balance and actually almost fell out of my bed, i had trouble walking straight and was having chills along with nausea and headache. the vertigo became less severe after 3 hours but stayed for about a week afterr the first dose.


VAERS ID: 1460048 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Blood test, Chills, Oropharyngeal pain, Oxygen saturation decreased, Pain, Pyrexia, Rhinorrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu Shot - had pneumonia 2013
Other Medications: No
Current Illness: No
Preexisting Conditions: Type II Diabetes Hyperthyroidism
Allergies: I am allergic to the medication Turinabol.
Diagnostic Lab Data: Blood work
CDC Split Type: vsafe

Write-up: I experienced body aches, fever, chills, and went I arrived home the fever increased to 105.1. I called emergency number and in the ambulance on the way to the hospital it was 101.3. My fever was still at 101.3 after the doctor took my temperature after two hours hours of waiting. I was experiencing low oxygen, weak, abdominal pain, and vomiting. I still have a sore throat and a runny nose.


VAERS ID: 1460150 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Rash pruritic
SMQs:, Anaphylactic reaction (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: influenza
Other Medications: vit D , fish oil, cyanobalamin
Current Illness: none
Preexisting Conditions: none
Allergies: influemza vaccine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Itchy rash development days of vaccine followed by non productive cough days later. rash persisted past 8 days


VAERS ID: 1460261 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 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? 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: Moderna vaccine given to a patient who it was not indicated for since patient was only 17 years of age at the time of the vaccine. No adverse events reported.


VAERS ID: 1460394 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-24
Onset:2021-06-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Heavy menstrual bleeding, Menstruation irregular, Urine analysis normal, 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ER visit 7/8/21. Did blood and urine tests, all which came back normal. They couldn''t find a problem other than the fact that I had just gotten a vaccine.
CDC Split Type:

Write-up: abnormal vaginal bleeding. I completed my period on 6/24/21 and less than 2 weeks later I was bleeding heavily again. I have very regular periods. This is not normal for me.


VAERS ID: 1461482 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal distension, Cough, Dysuria, Infrequent bowel movements, Pyrexia, Urine odour abnormal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/a
Preexisting Conditions: NHL 2001-2 in r?mission D?g?n?rative bone disease Heart disease Taksubo cardiomyopathy High BP
Allergies: Sulpha, codeine, latex, tree nuts, metals
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extr?me fever and unaware of surroundings for 1 day. Then chemical odd smell of urine and pain /burning upon urination, then urination became very infrequent and so did bowel movements. Extreme abdominal swelling which has continued for over 1 week. Slight dry cough.


VAERS ID: 1461782 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-08
Onset:2021-06-30
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Angioedema, Anxiety, C-reactive protein increased, Electrocardiogram normal, Epstein-Barr virus test negative, Full blood count normal, Inflammatory marker increased, Metabolic function test, Oedema peripheral, Oropharyngeal pain, Pharyngeal erythema, Platelet count increased, Pyrexia, Red blood cell sedimentation rate increased, Streptococcus test negative, Troponin normal, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Minocycline, Cetirizine, Norethindrone/Eth Estradiol triphasic OCP 0.5/0.75/1-35
Current Illness:
Preexisting Conditions: acne, dysmenorrhea, exercise induced asthma
Allergies: NKDA
Diagnostic Lab Data: 7/1 Abbott grp A strep neg 7/2 EBV panel neg, ESR 45(nl 1-19) CRP 123.9(nl<10), plt 473, rest of CBC nl, CMP normal, no troponin or coags done.
CDC Split Type:

Write-up: Pt developed fever, ST and presented to office with hives and edema of hands/feet$g Pharynx red. Strep neg and started on prednisone for presumed angioedema. EBV titers neg when ST persisted, inflammatory markers very high. Clinically did well and by day 3 steroids much improved. Of interest pt did have COVID in Jan 2021 with chest pain after that was evaluated with normal troponin and EKG/ECHO by cardiology and normal, though to be anxiety


VAERS ID: 1463405 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Decreased appetite, Dizziness, Frequent bowel movements, Migraine, Neuralgia, Pain in extremity
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE. In fact, I had been running 6 miles every other day for several weeks before the injection so I was in exceptionally good shape for someone aged 63.
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had headache on June 30(day after 2nd Pfizer vaccine injection). Headache became persistent migraine after day 4 and only started to subside after taking 2 advil tablets per day for about 5 days in a row. In addition to migraine headache, general dizziness(lasted almost two weeks now) loss of appetite(lasted week and a half) intermittent pains in stomach active bowels(going to bathroom 4 or 5 times a day rather than once) SEVERE PAIN in left leg which could best be describe as a general Neuropathy(no pain in muscles or bones) - had to take two advil tables on separate nights to relieve pain. After fourth day of this leg pain and having taken the advil, the pain subsided and seems to be mostly cleared up. NOTE: This leg pain started on July 2(4 days after injection) and lasted 4 days. NOTES: I rarely get even mild headaches and never get any of the other symptoms.


VAERS ID: 1463420 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-06
Onset:2021-06-30
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Fatigue, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Dizziness, nausea, fatigue


VAERS ID: 1464023 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray, Full blood count, Lymphadenopathy, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Naproxen.
Current Illness: None.
Preexisting Conditions: Hypertension.
Allergies: Tomatoes; Tramadol; Azithromycin; Benadryl; Hydrocodone.
Diagnostic Lab Data: July 6, 2021 at 3PM did a CBC and July 10, 2021 chest x-ray.
CDC Split Type: vsafe

Write-up: I started experiencing muscle aches in left arm and swelling started on clavicle area lower neck it was dime size in morning and went to doctor after July 4 continuous to grow a little bit. Lymph node on neck is swollen.


VAERS ID: 1464300 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: Patient received a Moderna for her 1st dose and a Pfizer vaccine for her second dose in the series. Spaced 28 days apart.


VAERS ID: 1464323 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-06
Onset:2021-06-30
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Hypoaesthesia, Laboratory test, Lumbar puncture, Magnetic resonance imaging head normal, Magnetic resonance imaging spinal normal, Movement disorder, Myositis, Neuritis, Radiculopathy
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (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? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: vitamin D3, multivitamin
Current Illness: gave birth 2 weeks prior
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: lumbar puncture, multiple labs for ruling out MS, autoimmunue issues.
CDC Split Type:

Write-up: woke up on 6/30/21, no problems, felt normal. An hour later, got up to go to kitchen, right leg stated to go numb. Within 5 mins, right leg and hip and buttock were numb, could not feel or move it. Ended up going to ER, had L-spine MRI done, negative. Was told it was muscle inflammation causing nerve inflammation and irritation. Given one dose of IV steroids and a prednisone taper pack and sent home. The following day, 7/1/21, numbness had increased to include perineum and buttocks, and worse in the right leg. Went to see a spine specialist, who sent me to the ER to get a bigger workup. In the ER, they ended up doing a complete spine and brain MRI, all of which were negative for any structural abnormality. Diagnosed it as possible transverse myelitis, admitted to the hospital for high dose IV steroids. Had lumbar puncture 7/2/21. Had 4 doses IV steroids, then started on prednisone taper (will be for 2.5 weeks).


VAERS ID: 1464353 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vaccine vials (Lot#002C21A, Expiration date 10/14/21) had been removed from the freezer and sent from a larger healthcare facility within our organization. Pharmacy stored the vials in the medication fridge, with a fridge expiration of 6/24/21. The fridge expiration date was written on the bag that the vial of the vaccine was in, but not on the vial itself. Nursing drew up a vial of vaccines on 6/30/21 without looking at the fridge expiration date on the bag and administered to 8 patients. Pharmacy discovered expired vials on 7/9/21. No adverse reactions noted. Notified Moderna on 7/12/21 and no further actions recommended, instructed not to give another dose.


VAERS ID: 1464373 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vaccine vials (Lot#:002C21A, expiration 10/14/21) were removed from freezer and delivered from larger healthcare facility within enterprise to our facility with a fridge expiration date of 6/24/21. The fridge expiration date was written on the bag that the vials came in, but not directly on the vials. The nurse administering vaccines on 6/30/21, grabbed a vial from the pharmacy fridge without knowing about or looking at the expiration date on the bag. The nurse then administered 8 doses of the expired vaccine that day. Pharmacy caught adverse event on 7/9/21 when reporting doses given. Notified Moderna on 7/12/21 who recommended to report to but not to administer additional dose as no studies done on patients receiving more than 2 doses. No further follow-up recommended. No adverse reactions noted.


VAERS ID: 1464383 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vaccine vials (Lot#:002C21A, expiration 10/14/21) were removed from freezer and delivered from larger healthcare facility within enterprise to our facility with a fridge expiration date of 6/24/21. The fridge expiration date was written on the bag that the vials came in, but not directly on the vials. The nurse administering vaccines on 6/30/21, grabbed a vial from the pharmacy fridge without knowing about or looking at the expiration date on the bag. The nurse then administered 8 doses of the expired vaccine that day. Pharmacy caught adverse event on 7/9/21 when reporting doses given. Notified Moderna safety team on 7/12/21 who recommended to report to report to VAERS but not to administer additional dose as no studies done on patients receiving more than 2 doses. No further follow-up recommended. No adverse reactions noted.


VAERS ID: 1464388 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Adverse event, Expired product administered, No adverse event, 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: Moderna vaccine vials (Lot#:002C21A, expiration 10/14/21) were removed from freezer and delivered from larger healthcare facility within enterprise to our facility with a fridge expiration date of 6/24/21. The fridge expiration date was written on the bag that the vials came in, but not directly on the vials. The nurse administering vaccines on 6/30/21, grabbed a vial from the pharmacy fridge without knowing about or looking at the expiration date on the bag. The nurse then administered 8 doses of the expired vaccine that day. Pharmacy caught adverse event on 7/9/21 when reporting doses given. Notified Moderna safety team on 7/12/21 who recommended to report to report to VAERS but not to administer additional dose as no studies done on patients receiving more than 2 doses. No further follow-up recommended. No adverse reactions noted.


VAERS ID: 1464395 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 - / -

Administered by: Private       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: Moderna vaccine vials (Lot#:002C21A, expiration 10/14/21) were removed from freezer and delivered from larger healthcare facility within enterprise to our facility with a fridge expiration date of 6/24/21. The fridge expiration date was written on the bag that the vials came in, but not directly on the vials. The nurse administering vaccines on 6/30/21, grabbed a vial from the pharmacy fridge without knowing about or looking at the expiration date on the bag. The nurse then administered 8 doses of the expired vaccine that day. Pharmacy caught adverse event on 7/9/21 when reporting doses given. Notified Moderna safety team on 7/12/21 who recommended to report to report to VAERS but not to administer additional dose as no studies done on patients receiving more than 2 doses. No further follow-up recommended. No adverse reactions noted.


VAERS ID: 1464400 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vaccine vials (Lot#:002C21A, expiration 10/14/21) were removed from freezer and delivered from larger healthcare facility within enterprise to our facility with a fridge expiration date of 6/24/21. The fridge expiration date was written on the bag that the vials came in, but not directly on the vials. The nurse administering vaccines on 6/30/21, grabbed a vial from the pharmacy fridge without knowing about or looking at the expiration date on the bag. The nurse then administered 8 doses of the expired vaccine that day. Pharmacy caught adverse event on 7/9/21 when reporting doses given. Notified Moderna safety team on 7/12/21 who recommended to report to report to VAERS but not to administer additional dose as no studies done on patients receiving more than 2 doses. No further follow-up recommended. No adverse reactions noted.


VAERS ID: 1464405 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vaccine vials (Lot#:002C21A, expiration 10/14/21) were removed from freezer and delivered from larger healthcare facility within enterprise to our facility with a fridge expiration date of 6/24/21. The fridge expiration date was written on the bag that the vials came in, but not directly on the vials. The nurse administering vaccines on 6/30/21, grabbed a vial from the pharmacy fridge without knowing about or looking at the expiration date on the bag. The nurse then administered 8 doses of the expired vaccine that day. Pharmacy caught adverse event on 7/9/21 when reporting doses given. Notified Moderna safety team on 7/12/21 who recommended to report to report to VAERS but not to administer additional dose as no studies done on patients receiving more than 2 doses. No further follow-up recommended. No adverse reactions noted.


VAERS ID: 1464408 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vaccine vials (Lot#:002C21A, expiration 10/14/21) were removed from freezer and delivered from larger healthcare facility within enterprise to our facility with a fridge expiration date of 6/24/21. The fridge expiration date was written on the bag that the vials came in, but not directly on the vials. The nurse administering vaccines on 6/30/21, grabbed a vial from the pharmacy fridge without knowing about or looking at the expiration date on the bag. The nurse then administered 8 doses of the expired vaccine that day. Pharmacy caught adverse event on 7/9/21 when reporting doses given. Notified Moderna safety team on 7/12/21 who recommended to report to report to VAERS but not to administer additional dose as no studies done on patients receiving more than 2 doses. No further follow-up recommended. No adverse reactions noted.


VAERS ID: 1464531 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cough, Feeling hot, Flushing, Sensation of foreign body
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOSARTAN LIPITOR CELEXA
Current Illness: HTN, HLP
Preexisting Conditions: HTN, HLP
Allergies: SHELLFISH IODINE DILAUDID
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: WITHIN 15-20 MINUTES OF RECEIVING THE SECOND VACCINATION, SHE BECAME "HOT", FLUSHED IN THE FACE, AND FELT LIKE SHE HAD A "LUMP" IN HER THROAT. SHE DID HAVE SOME COUGHING WITH REPEATED ATTEMPTS TO CLEAR HER THROAT. A NURSE AND FELT IT BEST TO USE AN INHALER THAT WAS SUPPLIED IN THE ANAPHYLAXIS KIT BROUGHT TO THE CLINIC WITH THE VACCINES. SHE DID 2 PUFFS OF A VENTOLIN INHALER AND TOOK BENADRYL 25MG BY MOUTH. THE SYMPTOMS DID NOT WORSEN AND SHE SAID SHE FELT BETTER WITHIN AN HOUR OF TAKING THE MEDICATIONS. THE ONLY COMPLAINT THAT SHE HAD WAS EXCESSIVE DROWSINESS SECONDARY TO THE BENADRYL.


VAERS ID: 1464574 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia, Nausea, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Do not care to list.
Current Illness: None.
Preexisting Conditions: Non-Alcoholic Psoriasis; Mitral Valve Prolapse.
Allergies: Penicillin; Azithromycin; Codeine; Zocor; Neosporin; Flagyl.
Diagnostic Lab Data: None.
CDC Split Type: vsafe

Write-up: I had a slight headache for a couple of days. I was fatigued for about five days with muscle aches. I had nauseous. I developed a rash in my groin area and I still have it. I talked to the doctor and they advised me to take Zyrtec and Pepcid.


VAERS ID: 1464663 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-02
Onset:2021-06-30
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous
SMQs:, Termination of pregnancy and risk of abortion (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: cetirizine 10mg
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: MISCARRIAGE AT 7 WEEKS 5 DAYS GESTASTIONAL AGE, 1 PREVIOUS HEALTY PREGNACY IN 7/17/2019, NO PREVIOUS HISTORY OF MISCARRIAGE


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